Envemomation

Question 1

Box jellyfish Sting clinical features and Mx

Answer 1

• Severe localised pain
• Adherent tentacles and lesions causing welts
• Cardiovascular collapse within 20-30 mins (life threatening)
• K+ leakage from cells
• Mx: Copious amounts of vinegar

Question 2

Irukandji clinical features and Mx

Answer 2

• Delayed onset of pain
• Sting associated with catecholamine release leading to sympathomimetic toxicity: impending doom, n/v, diaphoresis, generalised pain, hypertension, tachycardia, APO
• Onset of symptoms appear after 30 mins with pain, agitation, vomiting, diaphoresis
• ECG changes reflecting myocardial injury

Mx: Vinegar to remove tentacles

Question 3

Blue-ringed octopus clinical features and Mx

Answer 3

• Bites which release toxins, progressively inhibiting the CNS resulting in paralysis leading to apnea and respiratory depression.
• Hypoxia leads to cardiac arrest and death

Mx: Pressure immobilisation bandage

Question 4

Generalised management for marine envenomation

Answer 4

• Pt assessment and Hx
• Primary survey
• Specific treatment: Box and irukunji - vinegar; blue-bottle - PIB
• supine and rest
• analgesia
• ABC monitoring
• IV access

Question 5

Snake envenomation clinical features

Answer 5

• Local: pain, swelling, bruising, lymphodema
• Systemic: N/v, headache, ado pain, diarrhoea, diaphoresis
• Sudden collapse
• Neurotoxicity: ptosis, blurred vision, dysarthria, flaccid paralysis
• Coagulopathy
• Myotoxcicity: muscle pain/tenderness
• Thrombotic microangiopathy: renal impairment, haemolytic anaemia, low PLTs

Question 6

Mechanism of venom induced consumptive coagulopathy (VICC)

Answer 6

• Type 1: prothrombin activator, rapidly consuming clotting factors to exhaustion, leading to inability to clot (15-20mins)
• Type 2: anticoagulant coagulopathy increase aPTT

Question 7

Snake bite management

Answer 7

• Immobilise the patient; lay supine
• Cover the bite with a dressing
• Apply pressure bandage over the bite and then from the distal limb, covering the whole limb, marking the bite site; immobilise the limb
• IV access, analgesia, antiemetic

Question 8

Funnel-web spider clinical features and Mx

Answer 8

• Localised pain
• Puncture/fang marks visible
• General: n/v, abdo pain, headache
• Neuro: muscle spasm, numbness/tingling
• Autonomic: diaphoresis, salivation, lacrimation, hypertension, tachycardia or bradycardia
• CVS: APO
• Agitation, drowsiness, coma

Mx: Pressure immobilisation baandage

Question 9

Redback spider clinical features and Mx

Answer 9

• Pain at bite site increases over house, radiating
• N/v, generalised pain
• Headache
• Diaphoresis

Mx: Cold compress