Marine bites and stings

Transcription

1 Marine bites and stings not use pressure bandage on marine bites or stings except sea snake bite. Box jellyfish (Chironex fleckeri) stings Number of species of box jellyfish. Chironex fleckeri (major box jellyfish) sting most likely to be fatal. Symptoms usually obvious straight away. Will have Strong pain from time of sting Marks on skin Been in contact with sea water includes tidal rivers and creeks Fast pulse (p452), high BP (p452) Sting lines on skin whip weals, may be frosted ladder pattern Trouble swallowing, breathing, talking Stopped breathing, have no pulse Remember Life support DRS ABC D (p2). not not use pressure bandage Pour vinegar over sting area for at least 30 seconds Remove tentacles (even if no vinegar), especially from child Use gloves and/or forceps if available. If not use fingers may cause minor stings if vinegar not used first, but not dangerous Always stay with person send someone for help Serious box jellyfish sting Unconscious, serious breathing or circulation problems (check heart rhythm) If pulseless or cardiac arrest start CPR Give oxygen by mask 6L/min child, 8L/min adult Give box jellyfish antivenom straight away 1 ampoule IV/IO mixed in 10ml normal saline If IV/IO not possible, give 3 ampoules IM at different sites If no immediate response give more ampoules of antivenom 97

2 If doesn't get better OR breathing or circulation get worse Continue CPR Medical consult straight away may suggest More box jellyfish antivenom (up to 6 ampoules if available) Adrenaline, deep IM (doses p452) These must be tried before stopping CPR Anaphylaxis (p33) due to antivenom very rare, but can happen. Mild to moderate box jellyfish sting Conscious, normal breathing and circulation. Temp, pulse, BP, RR, O2 sats every 15 minutes Tetanus status, give if needed (p438) Keep person still Medical consult Use ice packs for pain. If pain not relieved give morphine (p402) If pain not relieved by ice and repeated morphine medical consult about antivenom. May be useful but uncertain how effective Needs antivenom Stings to face, private parts (genitals), hand or multiple stings Child, unless minor sting not needing morphine Adult with pain not relieved by ice and 1 injection of morphine Try to collect piece of tentacle material and send with person put sticky tape on skin over tentacle, take off, attach to glass slide Strong pain from time of sting Swelling of sting site and limb Weakness, can't move stung limb Stonefish sting Remember Life support DRS ABC D (p2). 98

3 Temp, pulse, BP, RR Tetanus status, give if needed (p438) not not use pressure bandage or tourniquet increases pain, tissue damage Put stung area into hot water C (not burning) Test water first If pain continues Inject plain lignocaine 1% (up to 2mg/kg/dose) along sting track Opioid may be needed (p402) Regional nerve block (CPM p324) may be useful Medical consult will decide if stonefish antivenom needed Note: Stonefish antivenom may be best pain relief for significant stings. Needs antivenom More than mild pain and/or local effects Mild pain that doesn't go away may have foreign body in wound Catfish sting Manage as for stonefish sting (p98). No antivenom available. Have sting site x-rayed piece of barb often breaks off in wound No antivenom available. Stingray barb injury Pain at sting site may get worse minutes after injury Wound that bleeds, then becomes pale and bluish-white Significant local trauma, damage to underlying structures, eg nerves, tendons and heart, lungs if chest wall puncture (rare) Swelling of limb Rarely more serious symptoms like nausea, vomiting, increased spit (saliva), diarrhoea, sweating, fainting, muscle cramps, irregular heart beat (arrhythmia), fits 99

4 Tetanus status, give if needed (p438) not not use pressure bandage not let person eat or drink anything until sure they don't need to go to hospital Control any obvious bleeding Wash wound with soap, clean fresh water Put stung area into hot water C (not burning). Test water first If heat doesn't help pain or hot water not available try ice packs for 30 minutes If strong pain continues Inject plain lignocaine 1% (up to 2mg/kg/dose) in and around wound Opioid may be needed (p402) Regional nerve block may be useful (CPM p324) Medical consult may suggest antibiotics if wound more than 6 hours old Stabbing or penetrating stingray barb injuries for x-ray May need surgery to look for pieces of barb, remove dead tissue Barb has injured chest (p72) or abdomen (p68) Irukandji syndrome Caused by various small 4-tentacled tropical jellyfish. No antivenom available. Serious symptoms can be delayed 2 12 hours after sting occasionally come on over several hours. Early symptoms At first person may have Pain or tingling at sting site. May be very mild, usually settles after 30 minutes Oval (1 3cm) sting site, looks like orange peel and sweats Late symptoms 5 60 minutes after sting person may Appear very unwell Have strong pain, often in waves. Often starts in lower back and spreads to limbs, abdomen, chest muscles 100

5 Be sweating a lot in local areas or whole body, pale Feel anxious, restless, like they are going to die Have headache, nausea, vomiting Have fast pulse (p452), high BP (p452) After 2 12 hours Rarely develop acute cardiac related pulmonary oedema Shortness of breath, BP drops, O2 sats low Symptoms can last 1 2 days Remember Assessing trauma primary and secondary survey (p8). Temp, pulse, BP, RR, O2 sats, every 15 minutes not not use pressure bandage Pour vinegar over sting area (if seen) for at least 30 seconds Put in IV cannula and bung (CPM p85) Flush with 5ml normal saline every 4 hours Give pain relief (p399) pain may be severe If settles quickly with treatment observe in clinic for 4 hours, advise to stay in community for 24 hours, return to clinic or get help straight away if symptoms get worse or they feel sick Pain not relieved by 1 injection of morphine High BP (p452) not relieved by morphine Low BP (p452) Shortness of breath, low O2 sats (from pulmonary oedema ) Blue ringed octopus bite Small venomous octopus found in Australian coastal waters. Saliva has potent fast-acting paralytic neurotoxin, tetrodotoxin. No antivenom available. Small and/or painless bite, usually when octopus put on bare skin out of water Tingling around lips or elsewhere Rapid onset progressive flaccid paralysis 5 30 minutes In severe cases respiratory paralysis, respiratory arrest, cardiac arrest if untreated 101

6 Temp, pulse, BP, RR, O2 sats for up to 6 hours Remove person from water Support respiration if needed Put in IV cannula (CPM p85) Definite blue ringed octopus bite Developing paralysis Fish poisoning ciguatera Diarrhoea, abdominal pain, nausea, vomiting usually within 2 12 hours, but up to 36 hours after eating larger reef fish Temperature sensation reversal (cold feels hot, hot feels cold) Muscle aches (myalgia), joint aches (arthralgia), itching (pruritus), headache Pins and needles (paraesthesia) around mouth, hands and feet Depression, irritability, anxiety, unsteadiness (ataxia), tiredness Rarely trouble breathing, slow pulse (p452), low BP (p452), unconscious (p115) If fish eaten in last 4 hours, make them vomit by putting fingers down back of throat Put in IV cannula (CPM p85) Give fluids if severe diarrhoea More than mild symptoms, increasing symptoms 102 Fish poisoning fugu Number of marine and freshwater fish can have tetrodotoxin in flesh, eg puffer fish. Eating them can cause tetrodotoxin paralysis (like blue ringed octopus bite). Can cause fatal respiratory paralysis. No antivenom available. History of eating puffer or similar fish Nausea, occasional vomiting, tingling lips, progressive weakness, unsteadiness (ataxia) after 30 minutes to several hours

7 Respiratory failure in severe cases Support respiration if needed Put in IV cannula (CPM p85) Temp, pulse, BP, RR, O2 sats for up to 24 hours If developing paralysis send to hospital Sea snake bite Manage the same as land snake bite (p43). Note: Only effective antivenom is CSL sea snake antivenom. 103