AVOCA STREET MEDICAL CENTRE
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Venomous Sea Creatures



First aid and treatment of jellyfish stings and venomous fish injuries
TypeFirst aidMedical treatment

Bluebottles (Physalia species)
  • Wash the sting site with seawater and remove any tentacles
  • Immerse in hot water at 45ºC for 20 minutes or hot shower
  • Do not use vinegar

  • The patient rarely requires transport to hospital or medical intervention
  • Severe local stings or bullous wounds may need dressing

Major box jellyfish (Chironex fleckeri)
  • Immediately remove any tentacles
  • Apply vinegar immediately and liberally
  • Apply ice packs
  • Resuscitate (airway, breathing and circulation) patients who are unconscious or have cardiovascular collapse
  • All but very minor stings require transport to hospital
  • Give oral and parenteral analgesia for sting site pain
  • For severe life-threatening envenoming:
    - give first aid
    - resuscitate
    - administer intravenous antivenom
    - consider magnesium therapy

Irukandji syndrome
  • Apply vinegar immediately and liberally
  • Remove any tentacles if present
  • If vinegar is not available wash the area with seawater
  • Transport to hospital for:
- parenteral analgesia with titrated intravenous fentanyl or morphine- cardiac monitoring, ECG and cardiac enzymes
  • Cardiac involvement and pulmonary oedema will require supportive care and management of breathing and circulation

Other jellyfish:
- mauve stinger (Pelagia species)
- hair jellyfish (Cyanea species)
- jimble (Carybdea rastoni)
- other box jellyfish (Chiropsalmus bronzeii)
  • Wash the sting site with seawater and remove any tentacles
  • Consider hot water immersion or ice packs
  • Do not use vinegar
  • Patients rarely require transport to hospital or medical intervention
  • Severe local stings or bullous wounds may need dressing

Venomous fish stings:- stonefish
- catfish
- other venomous
stinging fish
  • Wash the wound site and immerse in hot water about 45ºC for a maximum duration of 90 minutes
  • Irrigate the wound and remove foreign debris
  • Radiograph to exclude retained spiny material
  • Give oral or parenteral analgesia and occasionally local or regional anaesthesia for severe pain
  • Stonefish antivenom is available for stonefish stings with severe pain or systemic effects
  • Surgical consultation for involvement of joints or bones

Stingray injuries
  • Wash the wound site and immerse in hot water about 45ºC for a maximum duration of 90 minutes
  • Apply local pressure for bleeding and resuscitate if there are thoracic or abdominal injuries
  • Irrigate and debride the wound
  • Titrate intravenous analgesia and/or local or regional anaesthesia
  • Surgical consultation for deep injuries, injuries to the chest or abdomen, or with retained material
  • Resuscitation and surgical intervention for major trauma from thoracic or abdominal injuries

Sea urchin injuries
  • Wash the wound site and immerse in hot water about 45ºC for a maximum duration of 90 minutes
  • Radiograph or ultrasound to identify any retained spines
  • Remove spines close to the surface
  • Review regularly until resolved
  • Wound may require further spine removal and further radiographic imaging or ultrasound


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