Difference between revisions of "Sea wasp sting"
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==Background== | ==Background== | ||
+ | [[File:Avispa marina cropped.png|thumb|Box jellyfish (Chironex fleckeri)]] | ||
+ | [[File:Nematocyst discharge.png|thumb|Nematocyst stages of discharge]] | ||
*''Chironex fleckeri'', commonly known as sea wasp | *''Chironex fleckeri'', commonly known as sea wasp | ||
− | *Large form of box jellyfish, found mostly off the coast of northern Australia to the Philippines | + | *Large form of [[box jellyfish]], found mostly off the coast of northern Australia to the Philippines |
*Extremely deadly, often considered one of the most poisonous jellyfish | *Extremely deadly, often considered one of the most poisonous jellyfish | ||
*Identification: Often difficult to distinguish in environment, as animal is transparent. Pale blue bell, often the size of a basketball, with 15 tentacles emerging from lower corners up to 3 meters in length. Has been described as having an eerie similarity to a human skull | *Identification: Often difficult to distinguish in environment, as animal is transparent. Pale blue bell, often the size of a basketball, with 15 tentacles emerging from lower corners up to 3 meters in length. Has been described as having an eerie similarity to a human skull | ||
Line 8: | Line 10: | ||
==Clinical Features== | ==Clinical Features== | ||
*Sting is extremely painful, described as burning, and can cause death as quickly as 3-5 minutes | *Sting is extremely painful, described as burning, and can cause death as quickly as 3-5 minutes | ||
+ | *Can cause significant [[hypotension]], [[hypertension]], cardiac [[arrhythmia]], and [[cardiac arrest]] | ||
*Most stings are mild and are self-limiting | *Most stings are mild and are self-limiting | ||
*Deaths most commonly occur in children | *Deaths most commonly occur in children | ||
− | *Venom causes cells to become leaky, causing hyperkalemia | + | *Venom causes cells to become porous and leaky, causing [[hyperkalemia]] |
==Differential Diagnosis== | ==Differential Diagnosis== | ||
− | + | {{Marine envenomation DDX}} | |
==Evaluation== | ==Evaluation== | ||
− | + | *Assess/manage ABCs | |
+ | *[[ECG]] (look for arrhythmia, blocks, ischemia) | ||
+ | *CXR | ||
+ | *CBC, BMP, troponin/CK | ||
+ | *Consider: | ||
+ | **ABG, echo, nematocyst sampling | ||
==Management== | ==Management== | ||
− | + | *Address ABCs (e.g. [[CPR]], [[fluid resuscitation]], [[vasopressors]], [[intubation]] as needed) | |
+ | *Remove tentacles!!! | ||
+ | **Nematocysts can continuing firing and delivering more venom if tentacles still attached | ||
+ | **If available, pour lots of vinegar over tentacles first to inactivate | ||
+ | *Do NOT apply pressure dressing/immobilization (triggers nematocysts to fire) | ||
+ | *Box Jellyfish antivenom, if available | ||
+ | **Cardiac arrest: 6 ampules IV push | ||
+ | **Systemic envenomation with hypotension, collapse, or significant arrhythmia: 3 ampules in 100mL NS over 20m | ||
+ | **Pain refractory to opioids: 1 ampule in 100mL NS over 20m | ||
+ | *[[Magnesium sulfate]]: 10 mmol (~2-3g) IV if hemodynamically unstable | ||
==Disposition== | ==Disposition== | ||
Line 25: | Line 42: | ||
==See Also== | ==See Also== | ||
− | + | *[[Marine toxins and envenomations]] | |
+ | *[[Box jellyfish]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
+ | https://lifeinthefastlane.com/toxicology-conundrum-010/ | ||
[[Category:Environmental]] | [[Category:Environmental]] | ||
[[Category:Toxicology]] | [[Category:Toxicology]] |
Latest revision as of 21:47, 28 September 2019
Contents
Background
- Chironex fleckeri, commonly known as sea wasp
- Large form of box jellyfish, found mostly off the coast of northern Australia to the Philippines
- Extremely deadly, often considered one of the most poisonous jellyfish
- Identification: Often difficult to distinguish in environment, as animal is transparent. Pale blue bell, often the size of a basketball, with 15 tentacles emerging from lower corners up to 3 meters in length. Has been described as having an eerie similarity to a human skull
- Tentacles contain millions of stinging cells known as cnidocytes
Clinical Features
- Sting is extremely painful, described as burning, and can cause death as quickly as 3-5 minutes
- Can cause significant hypotension, hypertension, cardiac arrhythmia, and cardiac arrest
- Most stings are mild and are self-limiting
- Deaths most commonly occur in children
- Venom causes cells to become porous and leaky, causing hyperkalemia
Differential Diagnosis
Marine toxins, envenomations, and bites
- Toxins
- Ciguatera
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
- Shellfish poisoning
- Amnesic shellfish poisoning
- Diarrheal shellfish poisoning
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Stingers
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
Evaluation
- Assess/manage ABCs
- ECG (look for arrhythmia, blocks, ischemia)
- CXR
- CBC, BMP, troponin/CK
- Consider:
- ABG, echo, nematocyst sampling
Management
- Address ABCs (e.g. CPR, fluid resuscitation, vasopressors, intubation as needed)
- Remove tentacles!!!
- Nematocysts can continuing firing and delivering more venom if tentacles still attached
- If available, pour lots of vinegar over tentacles first to inactivate
- Do NOT apply pressure dressing/immobilization (triggers nematocysts to fire)
- Box Jellyfish antivenom, if available
- Cardiac arrest: 6 ampules IV push
- Systemic envenomation with hypotension, collapse, or significant arrhythmia: 3 ampules in 100mL NS over 20m
- Pain refractory to opioids: 1 ampule in 100mL NS over 20m
- Magnesium sulfate: 10 mmol (~2-3g) IV if hemodynamically unstable