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marine stings in Australia


blue bottle or Portugese man'o'war (Physalia sp.)

  • 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
    • use hot water 45degC 1)

box jellyfish

  • 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

  • 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

blue ringed octopus

  • 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
marine_stings.txt · Last modified: 2017/03/28 16:48 (external edit)