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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

  1. Provide analgesia as required according to pain scale. Refer to Pain (any cause) NMG

  2. Refer to table below for specific creature management principles

Marine Creature ManagementNOTES
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

  • 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. 

  1. Consider administration of Tetanus Toxoid as per immunisation history and Tetanus Toxoid Standing Order

  2. Document assessment findings, interventions and outcomes

References / Further Resources

  1. Australian Resuscitation Council (2010) Guideline 9.4.5 Envenomation – Jellyfish Stings Australian Resuscitation Council, Melbourne

  2. NSW Department of Health (2013) Snakebite and Spiderbite Clinical Management Guidelines NSW Department of Health, North Sydney

  3. Berling, I. and Isbister, G. (2015) Marine Envenomations. Australian Family Physician Volume 44, No. 1. East Melbourne

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