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