Bluebottles, jellyfish, sea urchins and stingrays.
If clinically concerned, or for severe or persistent symptoms consult the Poisons Information Centre on 13 11 26 or a local clinical toxicologist.
Assessment
If there is a delay in first aid treatment or a known anaphylaxis to bite or sting, prioritise escalation of care and or act with heightened suspicion for deterioration.
Examination
A-G clinical assessment.
Presentation:
- type of bite or sting if known
- time of bite or sting
- number of bites or stings
- location and size.
Management
Jellyfish and bluebottles
First aid
Wash off any remaining tentacles (with sea water).
Immerse the affected area in tolerably hot water, 45°C, for up to 20 minutes. Remove for a short time. If symptoms persist, repeat until the pain subsides.
Treatment
Bluebottle jellyfish stings usually result in local pain where the tentacles contact skin. There is a raised erythematous or urticarial lesion that is distinctive and can last hours to days. Typically, the pain resolves within 1-2 hours.
Sea urchins
First aid
Immerse the affected area in tolerably hot water, 45°C, for up to 20 minutes. Remove for a short time. If symptoms persist, repeat until the pain subsides.
Treatment
Remove visible spines, which may be segmented and fall apart.
- Do not attempt to remove deeply penetrated spines.
- Consider imaging to exclude retained spine.
- Local or regional anaesthesia may be required.
Follow up 24-48 hours for symptoms of infection.
Stingray
First aid
Immerse the affected area in tolerably hot water, 45°C, for up to 90 minutes. Remove for a short time. If symptoms persist, repeat until the pain subsides.
Treatment
Remove superficial barb, if safe to do so.
- For any barbs penetrating the chest or abdomen, or deeply penetrating, escalate as per local clinical escalation response system (CERS) protocol.
- Consider imaging to exclude retained spine.
Large and unclean wounds may have delayed healing and secondary infection if not adequately irrigated, debrided and observed.
- Treat infection. See Therapeutic Guidelines: Water immersed wound infections (NSW Health log required)
- Consider surgical referral for deep or truncal wounds or wounds involving joints or bones.
Review the tetanus immunisation status of patients. Consider tetanus prophylaxis.
Background
Marine bites and stings have the potential to cause an anaphylactic reaction. Treatment of anaphylaxis is a clinical priority.
Sting severity is related to:
- the number of stinging cells that fire, which depends on the amount of tentacle contact with skin
- the potency of injected venom, which depends on the species.
Bluebottles
Bluebottles (Physalia species) are the most common cause of jellyfish stings in Australia, although few people present to hospital.
Sea urchins
Sea urchins occur throughout Australian coastal waters. Penetrating injuries occur from their spines, usually when people step on them or handle them.
Stingray
Stingrays are found in all Australian coastal waters and some fresh water sites.
The barb in a stingray’s tail can cause significant penetrating trauma. Injuries are compounded by venom in the barb that can cause local tissue necrosis and pain. Most stingray injuries occur to the ankles, but divers can suffer severe thoraco-abdominal penetrating trauma.
Accessed from the Emergency Care Institute website at https://aci.health.nsw.gov.au/networks/eci/clinical/tools/non-venomous-marine-stings