Sea wasp sting: Difference between revisions
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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 | ||
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==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== | ||
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==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== | ||
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==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
- 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