Marine Envenoming

Marine Envenoming Chris Nickson http://lifeinthefastlane.com September 2010

Overview
Box jellyfish
Irukandji syndrome
Blue bottles
Blue-ringed octopus
Stonefish
Many others!...

When Doug met Struan …

When Doug met Struan …
Doug: ‘So what do we do if we get bitten by something deadly, then?’
Struan: ‘Well what do you think you do?’ ‘You die of course. That’s what deadly means.’

Box Jellyfish Chironex fleckeri

Box jellyfish worldwide

Clinical features
Stinger season (Nov-April)
Linear cross-hatched welts
Adherent tentacles
Severe pain (8h)
Collapse and cardiovascular effects
Scarring
Delayed hypersensitivity

Management
Prehospital
Analgesia
Vinegar
No PIB
Resuscitation
Hypotension
Dysrhythmias
Cardiac arrest
Analgesia
Ice (hot water?)
Wound care
Antivenom
Arrest: 6 amps
Unstable: 3 amps
Refractory pain: 1 amp
Delayed type hypersensitivity
Steroid cream

Irukandji Syndrome Carukia barnesi & others

“ 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. ”
Barnes, J. H. (1964). “Cause and Effect in Irukandji Stingings.” Med J Aust 1: 897-.

Clinical features
Exmouth to Moreton Bay
Mild sting…
Progressive severe pain and “catecholamine excess syndrome”
Cardiovascular complications
Shock, acute pulmonary oedema, cardiomyopathy, intracranial hemorrhage

Management
Prehospital
Vinegar, no PIB
Resuscitation
Medications
Fentanyl
Promethazine
GTN
magnesium

Bluebottle Physalia spp.

Bluebottle Physalia spp.
Immediate burning (2h)
Linear/ elliptical welts
Non-specific symptoms, self-limiting
Management - hot water

OCTOPUSSY

BRO
Hapalochlaena spp .

Clinical features
Coastal waters
‘ Innocuous’ bite
Rapidly progressive descending symmetrical paralysis

Management
Prehospital
PIB
Resuscitation
respiratory support
Hypotension
Supportive care

Maculotoxin = Tetrodotoxin

Pufferfish

Sea Slug

Cone snail Conus spp. Conotoxin

Stonefish Synanceia spp .

Master of camouflage

Clinical features
Immediate severe pain, puncture wound, local swelling
Non-specific symptoms, rarely cardiovascular effects
? Retained foreign bodies

Management
Prehospital
Analgesia, hot water, no PIB
Regional anaesthesia
Antivenom
1 ampoule per 2 spines
Wound care

Lionfish Pterois spp.

Sea snake Hydrophiidae
Paralysis & rhabdomyolysis
Management
PIB, Bloods, VDK
Antivenom: 1 amp or 3 amps of Tiger snake AV

Seafood poisoning
Shellfish poisoning
Neurotoxic
Paralytic
Diarrhetic, Azaspiracid
Amnestic
Palytoxin
Tetrodotoxin
Others…
Fish poisoning
Ciguatera
Scombroid
Tetrodotoxic fish
Clupetoxic fish
Palytoxin
Hypervitaminosis A
Others…

QUESTIONS? http://lifeinthefastlane.com/education/toxicology/

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Marine Envenoming

by precordialthump on Sep 21, 2010

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Marine Envenoming — Presentation Transcript