small blue creatures with an air sac which allows them to float with the wind on the sea surface (although often they end up stranded on beaches in their thousands as a result), and up to 1m long tentacles which can cause a painful sting lasting around 2hrs and welts lasting 1-2 days, and rarely anaphylaxis
Australian blue bottles do not cause major systemic envenoming unlike other Physalia sp.
treatment:
do NOT use vinegar or apply pressure immobilisation bandage as this makes the pain worse
Chironex fleckeri is found in tropical waters of Australia mainly from December to April
most stings only cause severe pain which lasts 8hrs and cause welts is a cross-hatch pattern, and half of victims develop delayed HS causing pruritic erythema at the original site 1-2 weeks later
severe envenomation causes death within 5 minutes presumably due to direct cardiotoxicity
treatment:
apply vinegar to sting sites as this helps de-activate undischarged nematocysts
do NOT apply pressure immobilisation bandage
transport to hospital if systemic symptoms or persistent pain
if cardiac arrest:
give up to 6 ampoules antivenom as a rapid iv push undiluted
if no response, give iv Mg 10mmol
if systemic envenomation symptoms:
give 3 x 20,000 unit ampoules antivenom diluted in 100mL 0.9% saline over 20 minutes
if persistent severe pain:
give titrated iv morphine
if still in pain, give 1 x 20,000 unit ampoule antivenom diluted in 100mL 0.9% saline over 20 minutes
Irukandji syndrome is due to envenomation by Carukia barnesi) or other similar jellyfish in tropical Australian coastal waters as well as other equatorial waters
the sting is painless but systemic envenomation features suggestive of massive catecholamine release develop within 30-120 minutes, and rarely the uncontrolled hypertension may cause intracerebral haemorrhage within 3-4 hrs
symptoms settle with 12 hrs but those with severe envenomation are at risk of cardiomyopathy, cardiogenic shock, pulmonary oedema and rarely, death
there is no antivenom
treatment:
apply vinegar to sting sites
do NOT apply pressure immobilisation bandage
transport all to a hospital ASAP
iv fentanyl
iv 50mcg clonidine (Catapres) has given immediate and dramatic resolution to symptoms, especially hypertension, tachycardia, agitation, restlessness and pain, in one case 2)
iv promethazine for nausea
iv GTN infusion if refractory severe hypertension
iv Mg up to 10mmol in adults if pain not resolving - anecdotal evidence of benefit only
bites contain a sodium channel blocking tetrodotoxin which result in a descending flaccid paralysis with respiratory failure within minutes and potential death
NB. puffer fish also have tetrodotoxin but these require ingestion of the fish to cause paralysis
bite is not painful
early signs of paralysis include ptosis, blurred vision, diplopia and dysphagia (similar to Australian venomous snake bites but much more rapid onset)
treatment:
apply pressure bandage
respiratory support
mouth-to-mouth resuscitation may be life saving
intubation and ventilation may be required until paralysis resolves in about 24 hours