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Quick Chart
Introduction
  • Jellyfish inject venom on contact with skin, through microscopic nematocyst tubules located on the tentacles or bulb of the animal.
  • Nematocysts from different species of jellyfish are inhibited by different substances used for first-aid, those being hot water and vinegar.

Tropical Jellyfish

Tropical waters range approximately from Geraldton and extends north around the coast line of Western Australia.

  • Box jellyfish
    • Inhabit estuarine and on shore coastal tropical waters.
    • Can cause respiratory and cardiac arrest within minutes in large stings.
  • Jellyfish producing Irukandji syndrome
    • Sting can be minor, followed in 5-40 minutes time by severe generalised pain and cramping, nausea and vomiting, difficulty breathing, sweating, anxiety and feeling of impending doom.
    • Heart failure, severe hypertension, pulmonary oedema and hypertensive stroke.

Non-tropical Jellyfish

  • In other regions of Australia, the objective of treatment is pain relief.

Venomous Fish

  • Venom is deposited through spines causing excruciating pain. Cardiovascular toxic effects can occur, but are rare.
Clinical Presentation
  • Pain, from mild irritation to intense, sharp or burning.
  • Muscle aches and cramps, moderate to severe.
  • Nausea, vomiting, headache.
  • Whips and wheel marks, may be visible or absent varying by species.
  • Raised welts.
  • Sweating at the site.
  • Restlessness, anxiety and irrational behavior.
  • In Irukandji: severe hypertension, sense of impending doom, development of pulmonary oedema.
  • Difficulty breathing.
  • Collapse, followed by respiratory or cardiac arrest.
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • Children are at increased risk of envenomation due to small body size.
  • Vinegar will deactivate non-discharged nematocysts, but not reduce the pain of venom already injected.
  • Antivenom is available for some Box Jellyfish species.
  • Patients initially stable but suffering severe symptoms within 30 minutes may have an Irukandji sting and require immediate medical attention.
  • Contact the CSP in SOC if further information or advice is needed.
Management
Tropical Jellyfish
  • Liberally douse/spray area with vinegar for 30 seconds to neutralize visible stinging cells
  • If no vinegar is available: remove tentacles with gloved hands and wash well with sea water, NOT fresh water
  • Antivenom is available for some box jellyfish
  • Transport URGENTLY
Non-tropical Jellyfish
  • Remove any visible tentacles and rinse well with sea water, NOT fresh water
  • Where possible, place the stung area in water as hot as the patient can comfortably tolerate for 20 minutes
  • If pain not relieved by heat or hot water unavailable, apply cold pack
Venomous Fish
  • Treat for haemorrhage or impaled object if required
  • If stung on a limb, immerse stung area in water as hot as the patient can comfortably tolerate
Primary Care
  • Primary Survey
  • Keep patient at rest and limit movement where possible
  • Observe patient closely for signs of anaphylaxis; if identified, treat accordingly.
  • Refer to treatment for TROPICAL/NON-TROPICAL Jellyfish sting OR VENOMOUS FISH here
  • Use cold compress to reduce pain and swelling at the site if specific treatment cannot be carried out
  • Conduct Vital Sign Survey
Intermediate Care (EMT / Level 2)
  • Consider pain relief
  • Consider anti-emetic
  • Consider applying cardiac monitor if trained and authorised
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • N/A

References
References
Key Terms & Links
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