Blue-Ring Octopus & Cone Shell Bites/Stings

UNCONTROLLED WHEN PRINTED

Quick Chart

Introduction

Some marine creatures are capable of injecting venom causing paralysis and respiratory failure within 30 minutes. Most venom reaches the blood stream via the lymphatic system. Research by the ARC indicates little venom reaches the circulation, even after several hours, if a Pressure Immobilization Technique is applied IMMEDIATELY and MAINTAINED.
Blue-ringed octopuses are present in all Australian coastal waters, often found in tidal pools and can inflict a potentially fatal bite when handled.
Cone shells are found in tropical waters, and deliver venom through a dart like barb.

Clinical Presentation

Painless bite, spot of blood at the site
Numbness to lips and tongue
Progressive weakness of respiratory muscles, hypoventilation and respiratory arrest
Headache, nausea/vomiting, abdominal pain
Swollen or tender lymphatic glands at groin/axilla of bitten limb
Symptoms can resemble dysfunction of the CNS:
- Confusion
- Collapse
- Visual disturbances
- Drooping eyelids
- Difficulty speaking, swallowing or breathing
- Weakness/paralysis
- Respiratory weakness/arrest
- Seizure

Exclusion Criteria

Risk Assessment

The amount of toxin administered at the time of envenomation AND the weight of the patient dictates the speed with which life-threatening signs and symptoms may develop.
It is advised that such patients be transported to a medical facility for assessment and observation.
Venom from both Cone Shell and Blue-ringed Octopus can cause paralysis and respiratory failure within 30 minutes, without direct effects on the heart, the treatment for which is basic life support to assist respiration.
Paralysis may be long lasting and where possible treatment for respiratory or cardiac arrest should continue until arrival at an appropriate medical facility.
It is uncommon for a patient with an effectively applied PIT to be time critical in the absence of signs and symptoms of envenomation

Management

Primary Care

Primary Survey
- Assist ventilations as required
- Manage cardiac arrest as per guidelines
Keep patient at rest and limit movement where possible
- Continually reassure
- Do not:
  - Walk the patient
  - Utilise an artery tourniquet.
  - Apply a Pressure Immobilization Technique if the bite does not occur on a limb.
Apply Pressure Immobilization Technique to bitten limb as per clinical skill.
- If applied correctly, and in a timely fashion, the PIT should slow the progression of venom
Apply splint to further minimize movement
Conduct Vital Sign Survey, monitoring closely for respiratory depression (assist ventilations as required)
DO NOT remove bandages or splint prior to arrival at a suitable hospital for treatment

Intermediate Care (EMT / Level 2)

Apply cardiac monitor if trained and authorised
Consider pain relief
Consider anti-emetic
Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
Transport Priority 1 if signs and symptoms of envenomation is evident; pre-notify receiving facility

Advanced Care (AP)

Apply cardiac monitoring
Establish vascular access; obtain pre-hospital blood sample
Consider pain relief
Consider anti-emetic
Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
Transport Priority 1 if signs and symptoms of envenomation is evident; pre-notify receiving facility

Critical & Extended Care (CCP, PSO)

Additional Information

References

Key Terms & Links

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