Box jellyfish envenomation - Revision history

Rossdonaldson1: Rossdonaldson1 moved page Box jellyfish to Box jellyfish envenomation

2021-11-27T06:52:27Z

Rossdonaldson1 moved page Box jellyfish to Box jellyfish envenomation

← Revisión anterior	Revisión del 06:52 27 nov 2021
(Sin diferencias)

Rossdonaldson1: /* Clinical Features */

2021-11-03T19:44:33Z

Clinical Features

← Revisión anterior		Revisión del 19:44 3 nov 2021
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	[[File:PMC4756446 13104 2016 1931 Fig1 HTML.png\|thumb\|Patient stung by multiple box jellyfish tentacles.]]		[[File:PMC4756446 13104 2016 1931 Fig1 HTML.png\|thumb\|Patient stung by multiple box jellyfish tentacles.]]
	[[File:PMC4756446 13104 2016 1931 Fig3 HTML.png\|thumb\|Box jellyfish sting.]]		[[File:PMC4756446 13104 2016 1931 Fig3 HTML.png\|thumb\|Box jellyfish sting.]]
			[[File:PMC4756446 13104 2016 1931 Fig2 HTML.png\|thumb\|Pediatric box jellyfish sting.]]
	*Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched "ladder-rung" pattern		*Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched "ladder-rung" pattern
	**Erythematous maculopapular rash		**Erythematous maculopapular rash

Rossdonaldson1: /* Clinical Features */

2021-11-03T19:43:03Z

Clinical Features

← Revisión anterior		Revisión del 19:43 3 nov 2021
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	[[File:PMC4756446 13104 2016 1931 Fig4 HTML.png\|thumb\|Patient stung by multiple box jellyfish tentacles.]]		[[File:PMC4756446 13104 2016 1931 Fig4 HTML.png\|thumb\|Patient stung by multiple box jellyfish tentacles.]]
	[[File:PMC4756446 13104 2016 1931 Fig1 HTML.png\|thumb\|Patient stung by multiple box jellyfish tentacles.]]		[[File:PMC4756446 13104 2016 1931 Fig1 HTML.png\|thumb\|Patient stung by multiple box jellyfish tentacles.]]
			[[File:PMC4756446 13104 2016 1931 Fig3 HTML.png\|thumb\|Box jellyfish sting.]]
	*Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched "ladder-rung" pattern		*Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched "ladder-rung" pattern
	**Erythematous maculopapular rash		**Erythematous maculopapular rash

Rossdonaldson1: /* Clinical Features */

2021-11-03T19:41:46Z

Clinical Features

← Revisión anterior		Revisión del 19:41 3 nov 2021
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	==Clinical Features==		==Clinical Features==
	[[File:PMC4756446 13104 2016 1931 Fig4 HTML.png\|thumb\|Patient stung by multiple box jellyfish tentacles.]]		[[File:PMC4756446 13104 2016 1931 Fig4 HTML.png\|thumb\|Patient stung by multiple box jellyfish tentacles.]]
			[[File:PMC4756446 13104 2016 1931 Fig1 HTML.png\|thumb\|Patient stung by multiple box jellyfish tentacles.]]
	*Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched "ladder-rung" pattern		*Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched "ladder-rung" pattern
	**Erythematous maculopapular rash		**Erythematous maculopapular rash

Rossdonaldson1: /* Clinical Features */

2021-11-03T19:40:06Z

Clinical Features

← Revisión anterior		Revisión del 19:40 3 nov 2021
Línea 18:		Línea 18:

	==Clinical Features==		==Clinical Features==
			[[File:PMC4756446 13104 2016 1931 Fig4 HTML.png\|thumb\|Patient stung by multiple box jellyfish tentacles.]]
	*Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched "ladder-rung" pattern		*Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched "ladder-rung" pattern
	**Erythematous maculopapular rash		**Erythematous maculopapular rash
Línea 23:		Línea 24:
	*25-30% may still have tentacles attached		*25-30% may still have tentacles attached
	*Systemic envenomation (usually >10% [[BSA]]) can manifest as cardiac [[arrhythmias]], [[respiratory distress\|respiratory dysfunction]], death		*Systemic envenomation (usually >10% [[BSA]]) can manifest as cardiac [[arrhythmias]], [[respiratory distress\|respiratory dysfunction]], death
	**~~usually~~ manifests within 5 minutes of sting		**Usually manifests within 5 minutes of sting
	*~~delayed~~ [[hypersensitivity reaction]]s occur in >50%		*Delayed [[hypersensitivity reaction]]s occur in >50%
	**[[Pruritus\|Itching]], redness at sting sites 7-14d after initial incidence		**[[Pruritus\|Itching]], redness at sting sites 7-14d after initial incidence

Jonrako: /* Management */

2021-08-15T20:00:28Z

Management

← Revisión anterior		Revisión del 20:00 15 ago 2021
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	*Antivenom for life-threatening envenomations		*Antivenom for life-threatening envenomations
	**Bovine IgG Fab with 20,000 units/ampule		**Bovine IgG Fab with 20,000 units/ampule
	*'''Avoid treating with fresh water, alcohol, methylated spirits, ~~and~~ urine as these have shown to increase nematocyst firing.''' <ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>		*'''Avoid treating with fresh water, alcohol, methylated spirits, or urine as these have shown to increase nematocyst firing.''' <ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>

	===Antivenom Indications^===		===Antivenom Indications^===

Jonrako at 19:59, 15 August 2021

2021-08-15T19:59:40Z

← Revisión anterior		Revisión del 19:59 15 ago 2021
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	*''Chironex fleckeri'' or [[sea wasp]] is cause of most deaths		*''Chironex fleckeri'' or [[sea wasp]] is cause of most deaths
	*Largely restricted to the Indo-Pacific Ocean/Australian waters but various species can be found widely		*Largely restricted to the Indo-Pacific Ocean/Australian waters but various species can be found widely
	*Most stings are benign (requiring local treatment only), ~~only a few species~~ have been ~~implicated in human deaths~~		*83% occur in < 1m of water.
			*Most stings are benign (requiring local treatment only), recent data suggests fatality rate is much lower than the 20% previously reported.
			**Morbidity and Mortality are dose- and time-dependent, which explains why majority of deaths have been children.

	===Mechanism===		===Mechanism<ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>===
	*~~Specific venom components unclear~~		*Has about 15 tentacles (measure up to 3m in length) that contain millions of "stinging cells" called nematocysts.
			*Contact with the tentacles cause rapid onset of pruritic/burning
	*Thought to affect sodium/potassium/calcium channels		*Thought to affect sodium/potassium/calcium channels
			*Rhabodmyolysis can occur from sustained muscle contractions caused by myotoxins in venom.
			*Cardiovascular collapse can occur d/t dysrhythmia (from hyperkalemia) and osmotic dysregulation of endothelial and cardiac tissues from pore-forming toxins within the venom.
	*''[[Sea wasp\|Chironex fleckeri]]'' venom causes cell membranes to become porous allowing K+ influx/hyperkalemia		*''[[Sea wasp\|Chironex fleckeri]]'' venom causes cell membranes to become porous allowing K+ influx/hyperkalemia

	==Clinical Features==		==Clinical Features==
	*Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched pattern		*Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched "ladder-rung" pattern
			**Erythematous maculopapular rash
	**May progress to blisters/necrosis		**May progress to blisters/necrosis
	*25-30% may still have tentacles attached		*25-30% may still have tentacles attached
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	*Antivenom for life-threatening envenomations		*Antivenom for life-threatening envenomations
	**Bovine IgG Fab with 20,000 units/ampule		**Bovine IgG Fab with 20,000 units/ampule
			*'''Avoid treating with fresh water, alcohol, methylated spirits, and urine as these have shown to increase nematocyst firing.''' <ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>

	===Antivenom Indications^===		===Antivenom Indications^===
	*[[Cardiac arrest]]		*[[Cardiac arrest]]
	**undiluted antivenom administered as an IV Push: up to 6 vials		**undiluted antivenom administered as an IV Push: up to 6 vials
	**if no response then give [[magnesium]] IV		**if no response then give [[magnesium]] IV (0.2mmol/kg, max 10mmol in adults)
	*[[Hypotension]], [[tachycardia]], [[shock]], [[arrhythmia]]		*[[Hypotension]], [[tachycardia]], [[shock]], [[arrhythmia]]
	**dilute 3 amps antivenom in 100mL [[NS]] and run over 20 minutes		**dilute 3 amps antivenom in 100mL [[NS]] and run over 20 minutes

Jonrako: /* Management */

2021-07-19T21:46:45Z

Management

← Revisión anterior		Revisión del 21:46 19 jul 2021
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	*First remove any tentacles		*First remove any tentacles
	**tentacles separated from medusae can still emit venom		**tentacles separated from medusae can still emit venom
	*4-5% acetic acid/vinegar solution should be applied to the injured area for at least 30 seconds.<ref>4-~~5% acetic acid~~/~~vinegar solution should be applied to the injured area for at least 30 seconds~~.</ref>		*4-5% acetic acid/vinegar solution should be applied to the injured area for at least 30 seconds.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. </ref>
	*[[analgesia\|Pain control]]		*[[analgesia\|Pain control]]
	*Supportive measures for minor envenomations		*Supportive measures for minor envenomations

Jonrako: /* Management */

2021-07-19T21:45:41Z

Management

← Revisión anterior		Revisión del 21:45 19 jul 2021
Línea 30:		Línea 30:
	*First remove any tentacles		*First remove any tentacles
	**tentacles separated from medusae can still emit venom		**tentacles separated from medusae can still emit venom
	*4-5% acetic acid/vinegar solution should be applied to the injured area for at least 30 seconds. <ref>~~Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations~~ - ~~Page 4 of~~ 5~~. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4~~/. </ref>		*4-5% acetic acid/vinegar solution should be applied to the injured area for at least 30 seconds.<ref>4-5% acetic acid/vinegar solution should be applied to the injured area for at least 30 seconds.</ref>
	*[[analgesia\|Pain control]]		*[[analgesia\|Pain control]]
	*Supportive measures for minor envenomations		*Supportive measures for minor envenomations

Jonrako: /* Management */

2021-07-19T21:43:28Z

Management

← Revisión anterior		Revisión del 21:43 19 jul 2021
Línea 28:		Línea 28:

	==Management==		==Management==
	*~~Remove~~ any tentacles		*First remove any tentacles
	**tentacles separated from medusae can still emit venom		**tentacles separated from medusae can still emit venom
	*4-5% acetic acid/vinegar solution should be applied to the injured area for at least 30 seconds. <ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. </ref>		*4-5% acetic acid/vinegar solution should be applied to the injured area for at least 30 seconds. <ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. </ref>