Marine Envenoming  Chris Nickson http://lifeinthefastlane.com  September 2010
Overview <ul><li>Box jellyfish </li></ul><ul><li>Irukandji syndrome </li></ul><ul><li>Blue bottles </li></ul><ul><li>Blue-...
When Doug met Struan …
When Doug met Struan … <ul><li>Doug: ‘So what do we do if we get bitten by something deadly, then?’ </li></ul><ul><li>Stru...
Box Jellyfish Chironex fleckeri
Box jellyfish worldwide
 
 
 
Clinical features <ul><li>Stinger season (Nov-April) </li></ul><ul><li>Linear cross-hatched welts </li></ul><ul><li>Adhere...
Management <ul><li>Prehospital  </li></ul><ul><ul><li>Analgesia </li></ul></ul><ul><ul><li>Vinegar </li></ul></ul><ul><ul>...
Irukandji Syndrome Carukia barnesi  & others
<ul><li>“ The first Carybdeid was applied to an adult (J.B.), and to a boy, aged nine years (N.B.). A robust young life-sa...
 
Clinical features <ul><li>Exmouth to Moreton Bay </li></ul><ul><li>Mild sting… </li></ul><ul><li>Progressive severe pain a...
Management <ul><li>Prehospital  </li></ul><ul><ul><li>Vinegar, no PIB </li></ul></ul><ul><li>Resuscitation </li></ul><ul><...
Bluebottle Physalia  spp.
 
Bluebottle Physalia  spp. <ul><li>Immediate burning (2h) </li></ul><ul><li>Linear/ elliptical welts </li></ul><ul><li>Non-...
OCTOPUSSY
BRO <ul><li>Hapalochlaena  spp . </li></ul>
Clinical  features <ul><li>Coastal waters </li></ul><ul><li>‘ Innocuous’ bite </li></ul><ul><li>Rapidly progressive descen...
Management <ul><li>Prehospital  </li></ul><ul><ul><li>PIB </li></ul></ul><ul><li>Resuscitation </li></ul><ul><ul><li>respi...
Maculotoxin = Tetrodotoxin
Pufferfish
Sea Slug
Cone snail Conus  spp. Conotoxin
Stonefish Synanceia  spp .
Master of camouflage
Clinical features <ul><li>Immediate severe pain,  puncture wound, local swelling </li></ul><ul><li>Non-specific symptoms, ...
Management <ul><li>Prehospital </li></ul><ul><ul><li>Analgesia, hot water, no PIB </li></ul></ul><ul><li>Regional anaesthe...
Lionfish Pterois  spp.
 
Sea snake Hydrophiidae <ul><li>Paralysis & rhabdomyolysis </li></ul><ul><li>Management </li></ul><ul><ul><li>PIB, Bloods, ...
Seafood poisoning <ul><li>Shellfish poisoning </li></ul><ul><ul><li>Neurotoxic </li></ul></ul><ul><ul><li>Paralytic </li><...
QUESTIONS? http://lifeinthefastlane.com/education/toxicology/
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Marine Envenoming

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A clinical overview of marine envenoming from an Australian perspective. Slides used for teaching session for the Fellowship of the Australian College of tropical Medicine.

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Marine Envenoming

  1. 1. Marine Envenoming Chris Nickson http://lifeinthefastlane.com September 2010
  2. 2. Overview <ul><li>Box jellyfish </li></ul><ul><li>Irukandji syndrome </li></ul><ul><li>Blue bottles </li></ul><ul><li>Blue-ringed octopus </li></ul><ul><li>Stonefish </li></ul><ul><li>Many others!... </li></ul>
  3. 3. When Doug met Struan …
  4. 4. When Doug met Struan … <ul><li>Doug: ‘So what do we do if we get bitten by something deadly, then?’ </li></ul><ul><li>Struan: ‘Well what do you think you do?’ ‘You die of course. That’s what deadly means.’ </li></ul>
  5. 5. Box Jellyfish Chironex fleckeri
  6. 6. Box jellyfish worldwide
  7. 10. Clinical features <ul><li>Stinger season (Nov-April) </li></ul><ul><li>Linear cross-hatched welts </li></ul><ul><li>Adherent tentacles </li></ul><ul><li>Severe pain (8h) </li></ul><ul><li>Collapse and cardiovascular effects </li></ul><ul><li>Scarring </li></ul><ul><li>Delayed hypersensitivity </li></ul>
  8. 11. Management <ul><li>Prehospital </li></ul><ul><ul><li>Analgesia </li></ul></ul><ul><ul><li>Vinegar </li></ul></ul><ul><ul><li>No PIB </li></ul></ul><ul><li>Resuscitation </li></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Dysrhythmias </li></ul></ul><ul><ul><li>Cardiac arrest </li></ul></ul><ul><li>Analgesia </li></ul><ul><ul><li>Ice (hot water?) </li></ul></ul><ul><li>Wound care </li></ul><ul><li>Antivenom </li></ul><ul><ul><li>Arrest: 6 amps </li></ul></ul><ul><ul><li>Unstable: 3 amps </li></ul></ul><ul><ul><li>Refractory pain: 1 amp </li></ul></ul><ul><li>Delayed type hypersensitivity </li></ul><ul><ul><li>Steroid cream </li></ul></ul>
  9. 12. Irukandji Syndrome Carukia barnesi & others
  10. 13. <ul><li>“ The first Carybdeid was applied to an adult (J.B.), and to a boy, aged nine years (N.B.). A robust young life-saver (C.R.) volunteered to test the second specimen, of similar size to the first. ” </li></ul>Barnes, J. H. (1964). “Cause and Effect in Irukandji Stingings.” Med J Aust 1: 897-.
  11. 15. Clinical features <ul><li>Exmouth to Moreton Bay </li></ul><ul><li>Mild sting… </li></ul><ul><li>Progressive severe pain and “catecholamine excess syndrome” </li></ul><ul><li>Cardiovascular complications </li></ul><ul><ul><li>Shock, acute pulmonary oedema, cardiomyopathy, intracranial hemorrhage </li></ul></ul>
  12. 16. Management <ul><li>Prehospital </li></ul><ul><ul><li>Vinegar, no PIB </li></ul></ul><ul><li>Resuscitation </li></ul><ul><li>Medications </li></ul><ul><ul><li>Fentanyl </li></ul></ul><ul><ul><li>Promethazine </li></ul></ul><ul><ul><li>GTN </li></ul></ul><ul><ul><li>magnesium </li></ul></ul>
  13. 17. Bluebottle Physalia spp.
  14. 19. Bluebottle Physalia spp. <ul><li>Immediate burning (2h) </li></ul><ul><li>Linear/ elliptical welts </li></ul><ul><li>Non-specific symptoms, self-limiting </li></ul><ul><li>Management - hot water </li></ul>
  15. 20. OCTOPUSSY
  16. 21. BRO <ul><li>Hapalochlaena spp . </li></ul>
  17. 22. Clinical features <ul><li>Coastal waters </li></ul><ul><li>‘ Innocuous’ bite </li></ul><ul><li>Rapidly progressive descending symmetrical paralysis </li></ul>
  18. 23. Management <ul><li>Prehospital </li></ul><ul><ul><li>PIB </li></ul></ul><ul><li>Resuscitation </li></ul><ul><ul><li>respiratory support </li></ul></ul><ul><ul><li>Hypotension </li></ul></ul><ul><li>Supportive care </li></ul>
  19. 24. Maculotoxin = Tetrodotoxin
  20. 25. Pufferfish
  21. 26. Sea Slug
  22. 27. Cone snail Conus spp. Conotoxin
  23. 28. Stonefish Synanceia spp .
  24. 29. Master of camouflage
  25. 30. Clinical features <ul><li>Immediate severe pain, puncture wound, local swelling </li></ul><ul><li>Non-specific symptoms, rarely cardiovascular effects </li></ul><ul><li>? Retained foreign bodies </li></ul>
  26. 31. Management <ul><li>Prehospital </li></ul><ul><ul><li>Analgesia, hot water, no PIB </li></ul></ul><ul><li>Regional anaesthesia </li></ul><ul><li>Antivenom </li></ul><ul><ul><li>1 ampoule per 2 spines </li></ul></ul><ul><li>Wound care </li></ul>
  27. 32. Lionfish Pterois spp.
  28. 34. Sea snake Hydrophiidae <ul><li>Paralysis & rhabdomyolysis </li></ul><ul><li>Management </li></ul><ul><ul><li>PIB, Bloods, VDK </li></ul></ul><ul><ul><li>Antivenom: 1 amp or 3 amps of Tiger snake AV </li></ul></ul>
  29. 35. Seafood poisoning <ul><li>Shellfish poisoning </li></ul><ul><ul><li>Neurotoxic </li></ul></ul><ul><ul><li>Paralytic </li></ul></ul><ul><ul><li>Diarrhetic, Azaspiracid </li></ul></ul><ul><ul><li>Amnestic </li></ul></ul><ul><ul><li>Palytoxin </li></ul></ul><ul><ul><li>Tetrodotoxin </li></ul></ul><ul><ul><li>Others… </li></ul></ul><ul><li>Fish poisoning </li></ul><ul><ul><li>Ciguatera </li></ul></ul><ul><ul><li>Scombroid </li></ul></ul><ul><ul><li>Tetrodotoxic fish </li></ul></ul><ul><ul><li>Clupetoxic fish </li></ul></ul><ul><ul><li>Palytoxin </li></ul></ul><ul><ul><li>Hypervitaminosis A </li></ul></ul><ul><ul><li>Others… </li></ul></ul>
  30. 36. QUESTIONS? http://lifeinthefastlane.com/education/toxicology/

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