Marine Flashcards
BOX JELLYFISH (chironex fleckeri)
Moderate size, many metres of tentacles
Mostly are okay, but can be rapidly fatal
WHERE
Tropical
Northern coast of Aus
CLINICAL
Severe, immediate pain
Collapse and arrest within minutes
—> cardiotoxicity, mainly. Dermolysis.
If don’t die prehospital, usually okay
Long, ladder-like sting marks
MANAGEMENT
Tropical jellyfish first aid:
- Vinegar
- Don’t remove tentacles at scene
- NO PBI
- Analgesia
- Manage sting as a burn
Specific
If cardioresp compromise:
Box jellyfish antivenom- up to 6 vials
MgSO4 if no response
IRUKANDJI JELLYFISH (Caruso’s Barnesi)
Tiny
Tentacles up to 70cm
Delayed ‘syndrome’ of catecholamine effect- usually more unpleasant than fatal
WHERE
Northern coast of Aus
Tropical
CLINICAL
Sting may not be noticed
Delayed onset after an hour
Irukandji Syndrome = catecholamine excess
- anxiety, sweat, vomit, tachycardia etc
- Risks are cardiac failure, APO, ICH
- Severe trunkal pain
Better in 6 hours
MANAGEMENT
Tropical jellyfish first aid:
- Remove tentacles
- Vinegar
- Don’t remove tentacles at scene
- NO PBI
- Analgesia
- Manage sting as a burn
Specific
- No antivenom
- Seek and treat early life threats:
—> severe HTN
—> APO
- MgSO4 for pain, cardioprotect
Which animals cause Irukandji Syndrome?
Irukandji jellyfish
And, multiple other not-yet-identified.
Ie. any tropical jellyfish sting
BLUEBOTTLE
Painful, not dangerous
Ubiquitous
Hot water
NO VINEGAR- makes envenomatioworse
—> Unless tropical sting and not sure
No antivenom
Why shouldn’t you removed jellyfish tentacles?
Will cause more nematocysts to fire
/ more envenomation
If vinegar not available:
- SALT water rinse
- Gently remove tentacles with fingers
BLUE RINGED OCTOPUS
Doesn’t attack, usually interfered with
Potentially fatal
Sodium channel blocking neurotoxin
WHERE
Ubiquitous
Shallow, coastal waters, rockpools
CLINICAL
May not notice bite
Rapid descending paralysis within minutes
Hypotension
MANAGEMENT
Pressure bandage and immobilisation
Resus area
SEDATION- will be paralysed but aware
Supportive- intubate, ventilate, manage hypotension
Usually better in 24 hours
No antivenom
Can discharge is ASX at 6 hours

STONEFISH
Well camouflaged reef fish
Poisonous dorsal spines
Very painful, rarely fatal
WHERE
Northern coast Aus
Reefs
CLINICAL
Toxin:
- Vasodilator, permeability —> CV instability
- Tissue necrosis
Immediate, severe local pain
Nonspecific: vomit, dizziness, dyspnoea
CV collapse is rare
MANAGEMENT
First Aid
Remove spine
Hot water
Analgesia
Specific
Stonefish antivenom, 1-3 ampoules
—> if CV effect, refractory pain
Ensure no retained spine- XR
Consider antibiotics
SEA SNAKE
flat, oar-like tail
Warm, coastal- ie. most of Aus except Southern states- SA, VIC, Tas.
CLINICAL
Neurotoxic incl. descending paralysis
Myotoxic
No coagulopathy
MANAGEMENT
Usual snake first aid: PBI, immobilisation
Usual snake bit algorithm
Sea snake antivenom- 1 vial
—> at pinch, Tiger or Poly
Note:
* Venom detection kits (VDK) don’t test for Sea snake
* Polyvalent antivenom doesn’t cover Sea snake
The following apply to which marine stings:
Vinegar
Hot water
Antivenom
PBI
VINEGAR
Tropical jellyfish
(Box, Irukandji)
AVOID for temperate jellyfish
HOT WATER
Temperate jellyfish (bluebottle)
Stonefish
ANTIVENOM
Box jelly
Stonefish
PBI
Blue ringed octopus
What are the syndromes of marine ingestions?
SCOMBROID
- Shortly after eating saltwater fish- eg. Tuna, mackerel, sardine
- Not prevented by cooking
- Histamine syndrome, mimics severe allergic reaction/ anaphylactoid
- Managed the same: antihistamine or adrenaline, bronchodilators
CIGUATERA
- 1-6 hours of eating tropical fish (eg. QLD)
- Neurological and GI symptoms:
—> perioral tingling, cold burning, myalgia, ataxia…
—> N&V, abdo pain, diarrhoea
Cardioresp symptoms are rare
- Resolves in a week
- Avoid tropical fish for 6months
