Difference between revisions of "Sea wasp sting"
(→‎Management)
 
(10 intermediate revisions by 2 users not shown)
Line 1: Line 1:
 
==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

Background

Box jellyfish (Chironex fleckeri)
Nematocyst stages of discharge
  • 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

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

Disposition

See Also

References

https://lifeinthefastlane.com/toxicology-conundrum-010/

Retrieved from "https://www.wikem.org/w/index.php?title=Sea_wasp_sting&oldid=230705"