Marine Stings
Blue Bottle
Most common jellyfish sting
Immediate intense pain - minutes to hours
Linear redness for 1 to 2 days
Systemic effects rare - nausea, vomiting , abdominal pain, muscle aches
Treatment
Remove tentacle
Hot water immersion for 20 minutes at 45 degree celsius
If not possible then hot shower or constant flow of hot water
Do not apply vinegar
Major Box Jellyfish
Most stings minor - can kill
Local intense pain
Linear redness
Delayed papular urticaria in 50%
Rare life threatening effects - cardiovascular collapse within 30 minutes
Treatment
Hospital and basic resuscitation
Remove tentacles
Apply vinegar - stop further nematocyst discharge - not to reduce pain
Ice pack
Hot water immersion was not superior to ice
Opiate analgesia if needed
Skin reactions may be severe and can be treated like burns
Limited evidence antivenom
Irukandji Syndrome
Mainly Northern Australia
Different jellyfish
Delayed onset 30 minutes - severe widespread pain
Treatment
Hospital due to severity
Opiates
Antiemetics
ECG monitoring
Fish Stings
Stonefish, bullrout, catfish and scorpion fish
Effect depends on size of spine and amount and potency of venom
Infection is the most important
Treatment
Hot water immersion 45 degrees for pain relief for up to 90 min only
Clean the wound
Analgesia
Local anaesthetic if cleaning
Prophylactic antibiotics not indicated most of the time but regular review is important
Stonefish IV antivenom available but limited evidence
Stingray
Most are ankles
More severe trauma due to size of spine and force of tail
Localised pain, trauma, bleeding and inflammation
Systemic effects rare
Higher risk infection due to extent of trauma
Treatment
Clean wound
Local pressure
Hot water 45 degrees for up to 90 min for pain if needed
Analgesia and local anaesthetic
Chest and back wounds need to be managed as trauma
Prophylactic antibiotics indicated for large wounds and high risk
Follow up essential
Sea Urchin
Similar to fish
Most are non venomous
Treatment
Wash wound and hot water immersion
Locate and remove broken spines
Imaging often required
Sea Snakes
Bites cause minor pain and systemic effects over minutes to hours
Systemic symptoms are usually myotoxicity
Muscle aches, rigidity, trismus and weakness
Treatment
Similar to land snakes
Compression bandage and immobilisation
Antivenom
Blue Ringed Octopus
Tidal and rock pools
Saliva contains tetradotoxin
Bites are often painless but bleed
Most cases cause minor effects with local numbness
Systemic effet are flaccid paralysis
Treatment
Early resuscitation and transport to hospital
Pressure immobilisation
Treatment is supportive
Sponges
Uncommon
Minor numbness, itch and pain for hours, rarely 3 days
Treatment is washing the area, analgesia and antihistamine
Ciguatera
Commonest marine poisoning
Northern Australia
Ingestion of ciguatoxin caused by small marine creatures
Effects are gut symptoms then neurological symptoms
Gut symptoms may resolve over 12 hours
Neurological symptoms are delay by 24 hours including a sensory polyneuropathy
Cold allodynia
Muschle aches, joint aches, and itch
Treatment
Supportive
Tetrodotoxin
Numerous fish
Sodium channel blocker
Neurological symptoms within minutes to hours
Numbness and ataxis
Treatment
No antidote
Supportive
Ventolin for 2 to 5 days
Shellfish poisoning
Rare in Australia
Neurotoxic
Scombroid
Allergic type reaction
Due to large ingestion of histamine
Reference:
Marine Stings - Australian Doctor