Emergency Medicine

Toxinology Emergencies 197

Marine Envenomation

(c) i.v. administration diluted in 100 mL normal saline over

30 min may be used as an alternative, particularly if the initial

response to i.m. antivenom by 90 min was poor

(d) discuss additional management with a clinical toxicologist if

symptoms continue

(e) observe all patients given antivenom until symptoms have

resolved

(f) discharge all the other patients with mild or absent

symptoms. Advise them to return if symptoms worsen, as

antivenom may work even days after envenoming.

(ii) Funnel-web spider antivenom

(a) administer funnel-web spider antivenom to patients

with clinical manifestations of systemic toxicity or severe

uncontrolled local symptoms

(b) give two vials (250 units) i.v. slowly (four if severe) and repeat

every 15 min until symptoms have resolved

(c) refer all patients with persistent local symptoms or significant

systemic envenomation to the intensive care unit (ICU)

(d) discharge other patients who remain systemically well, with

absence of signs of envenoming by 4 h after removal of any

first-aid bandage applied.

MARINE ENVENOMATION

Several hazardous marine animals are found in coastal waters around the world.
Warm water immersion is useful symptomatic treatment for injuries from many
species of spiny fish, with antivenom therapy available for only a few specific
instances.

DIAGNOSIS

1 Jellyfish
(i) Irukandji syndrome (Australia). This causes mild local pain
followed 30–40 min later by severe generalized muscle cramps,
back and abdominal pain, hypertension, and pulmonary oedema.
It is potentially fatal.
(ii) Box jellyfish (Australia). This causes severe local pain and
cross-hatched erythematous dermal lesions, associated with
cardiovascular and respiratory collapse. It is also potentially fatal.
(iii) Bluebottle or Portuguese man-of-war (worldwide). These cause
severe local stinging pain, erythema, and elliptical blanched
wheals, rarely associated with a muscle pain syndrome and
hypotension.