Marine Creatures Nurse Management Guidelines

Red Flag Exclusion Criteria

Child at risk of significant harm
Suspected non-accidental injury
Unplanned repeat ED presentation
Sting from venomous spiny fish, sea urchin or sting ray
Wound from an oyster shell
One of more of the following (signs and symptoms of envenomation / allergy / anaphylaxis
- Non-localised rash
- Blurred vision
- Muscle weakness
- Any facial paralysis
- Fever
- Headache
- Confusion / agitation
- Abdominal pain
- Nausea or vomitting
Presence of a foreign body
Penetrating wound involving joints or soft tissue
Involvement of face / eyes
History of workplace injury
Yellow or Red Zones observations or additional criteria outlined in the NSW Health Standard Observation Charts

Additional Observations

If limb affected, conduct a full set of neurovascular observations

Additional History

Full history of bite or sting
Date and time
Location / size of injury
Possible perpetrator
First aid treatment prior to ED including NSW Ambulance
Tetanus immunisation status
Consider contacting Poisons Information (13 11 26) for further guidance

Management Principles

Provide analgesia as required according to pain scale. Refer to Pain (any cause) NMG
Refer to table below for specific creature management principles

Marine Creature	Management	NOTES
Jellyfish (non-tropical region(1)	Remove any remaining tentacles Immerse affected area in tolerably hot (45°C) water for up to 20 minutes. Remove for a short time. If symptoms persist, re-immerse for 20 minutes as above in cycles for up to 2 hours	Jellyfish includes 'Blue Bottles' Tentacle removal does not pose a risk to staff Hot shower is appropriate
Other	Provide analgesia Clean and apply simple dressing to wound if required

Marine Creature

Management

NOTES

Jellyfish (non-tropical region(1)

Remove any remaining tentacles
Immerse affected area in tolerably hot (45°C) water for up to 20 minutes. Remove for a short time. If symptoms persist, re-immerse for 20 minutes as above in cycles for up to 2 hours

Jellyfish includes 'Blue Bottles'

Tentacle removal does not pose a risk to staff

Hot shower is appropriate

Other

Provide analgesia
Clean and apply simple dressing to wound if required

[1] Tropical jellyfish are generally found north of Bundaberg, Queensland. This Nursing Management Guidelines does not cover tropical jellyfish envenomation.

Consider administration of Tetanus Toxoid as per immunisation history and Tetanus Toxoid Standing Order
Document assessment findings, interventions and outcomes

References / Further Resources

Australian Resuscitation Council (2010) Guideline 9.4.5 Envenomation – Jellyfish Stings Australian Resuscitation Council, Melbourne
NSW Department of Health (2013) Snakebite and Spiderbite Clinical Management Guidelines NSW Department of Health, North Sydney
Berling, I. and Isbister, G. (2015) Marine Envenomations. Australian Family Physician Volume 44, No. 1. East Melbourne