Marine envenomation M Anto ED prov fellow MVH

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Marine envenomation M Anto ED prov fellow MVH 12 Jan 2017

Marine envenomation M Anto ED prov fellow MVH 12 Jan 2017

Blue bottle jellyfish • • Common Swarms in shallow water Immediate local effect Systemic

Blue bottle jellyfish • • Common Swarms in shallow water Immediate local effect Systemic sx uncommon Linear raised rash Wash off with saltwater Hot water immersion No PIB/vinegar

Box jellyfish • Can cause CVS collapse • Requires contact with several metres of

Box jellyfish • Can cause CVS collapse • Requires contact with several metres of tentacles, less in children • Vinegar then sticky tape to remove tentacles • Ice packs • Fluid resus, AV, inotropes or Mg

Irukandji • Northern Australia • Minor local effects, severe generalised pain + sympatheticomimetic effects

Irukandji • Northern Australia • Minor local effects, severe generalised pain + sympatheticomimetic effects • May cause pulm oedema • Analgesia, ? Mg

Venomous fish Catfish, stonefish, scorpionfish Hot water immersion Analgesia LA or regional block (do

Venomous fish Catfish, stonefish, scorpionfish Hot water immersion Analgesia LA or regional block (do not use hot water if anaesthetised) • AV stonefish IM • Treat infection • ? Prophylactic abx • •

Abx Saltwater: Vibrio - doxy Freshwater, brackish water, mud: Aeromonas - cipro Vibrio -

Abx Saltwater: Vibrio - doxy Freshwater, brackish water, mud: Aeromonas - cipro Vibrio - doxy Fish tanks: Mycobacterium marinum – clarithyo, doxy, bactrim • Coral cuts: - Strep pyogenes - treat as per cellulitis • • • -

Stingrays • More related to trauma rather than venom • Venom causes pain and

Stingrays • More related to trauma rather than venom • Venom causes pain and slowly progressive necrosis • Systemic sx uncommon • Hot water immersion • Debridement, primary delayed closure • ? Prophylactic abx

Sea urchin • • Most non venomous Sig pain if venom, rx with hot

Sea urchin • • Most non venomous Sig pain if venom, rx with hot water immersion XR/USS for retained spines Can be observed for ongoing pain +/- surgical removal

Blue ringed octopus Tetradotoxin – Na channel blocker Painless bite Develop paresthesia nausea dizziness

Blue ringed octopus Tetradotoxin – Na channel blocker Painless bite Develop paresthesia nausea dizziness Severe cases may progress to paralysis + resp failure • PIB recommended • •

Cone snail • Inject venom via teeth • Causes local pain/swelling, weakness, incoordination, visual/speech

Cone snail • Inject venom via teeth • Causes local pain/swelling, weakness, incoordination, visual/speech disturbance, rarely progressing to paralysis + resp failure • PIB recommended • Manage airway + hypotension

Summary • • Symptomatic treatment Hot water immersion AV + vinegar for box jellyfish

Summary • • Symptomatic treatment Hot water immersion AV + vinegar for box jellyfish Trauma/FB PIB for blue ringed octopus + cone snail Check and update ADT status Abx – saltwater vs freshwater

References/resources • Managing injuries by venomous sea creatures in Australia (Australian Prescriber) • Therapeutic

References/resources • Managing injuries by venomous sea creatures in Australia (Australian Prescriber) • Therapeutic guidelines (ETG)

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