Blue-ringed octopus, box jellyfish, cone snail, sea snake and stone fish
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.
History
- Symptoms of envenomation may not be immediately present and may develop over 60 minutes to several hours.
- Severe envenomation may cause stomach pain, nausea, vomiting, headache, muscle pain, weakness, drowsiness, difficulty breathing, cardiac arrhythmias and cardiac arrest.
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: First aid and treatment
Blue ringed octopus and cone snail
Apply pressure bandage with immobilisation.
- Use a broad 15cm elasticised bandage. The bandage is applied over the bite site and then distally to proximally, covering the whole limb.
- Leave the bandage in situ if already placed or reinforce it if the current bandage is inadequate.
Tetrodotoxin toxicity (envenomation)
Clinical effects of tetrodotoxin poisoning occur within one to two hours.
- Intubate and ventilate patients with tetrodotoxin poisoning if they have respiratory paralysis, or airway compromise due to altered conscious state. Patients with severe tetrodotoxin poisoning usually require assisted ventilation for two to five days.
- No antidote is available for tetrodotoxin poisoning. Supportive care is usually adequate until the respiratory paralysis resolves.
- Atropine is indicated for symptomatic bradycardia.
Admit symptomatic patients with tetrodotoxin poisoning. Discharge them once neurological effects are resolving.
Discharge asymptomatic patients if they remain well after at least six hours of observation.
Stone fish
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.
- For persistent pain use systemic analgesia.
- Observe for signs of shock and envenomation.
Suspected envenomation
Consider using stonefish antivenom if the patient has protracted severe pain or systemic symptoms. Consult Poisons Information Centre 13 11 26 or a local clinical toxicologist.
Admit patients with a penetrating injury from stonefish if they require treatment with antivenom.
Discharge patients after penetrating injuries from venomous fish once their pain and systemic symptoms are controlled.
CAUTION: Penetrating marine injuries
- Can cause significant trauma depending on location of the injury.
- Large and unclean wounds may have delayed healing and secondary infection if not adequately irrigated, debrided and observed.
- Consider imaging to exclude retained spine.
- Consider surgical referral for deep or truncal wounds, wounds involving joints or bones.
Review patients within 48 hours to enable early detection of infection after a penetrating marine injury, then review the wound regularly until symptoms have resolved.
Box jellyfish
If a box jellyfish sting is suspected the area should be rinsed with vinegar and the tentacles removed. Use sea water if vinegar is unavailable.
Monitor for signs of envenomation. Immediate resuscitation is crucial for survival.
Manage pain with systemic analgesia.
Sea snake
First aid for sea snake bites is the same as for terrestrial snake bites, including application of a pressure bandage and complete immobilisation of the affected limb and the patient.
Due to rarity of sea snake bites, early consultation with Poisons Information Centre 13 11 26 or a local clinical toxicologist is recommended.
Background
Marine bites and stings have the potential to cause an anaphylactic reaction. Treatment of anaphylaxis is a clinical priority.
Blue ringed octopus
Several species of blue-ringed octopuses occur in tidal areas around Australia. Blue-ringed octopus bites are rare and only occur when the octopus is disturbed or handled. The bite is often painless, but envenoming causes numbness and paraesthesia, followed by an ascending flaccid paralysis. This is due to tetrodotoxin toxicity from the octopus’s saliva.
Stone fish
Venomous fish are found in all Australian coastal waters and some fresh water sites. Venomous fish can cause penetrating injuries and envenomings if their spines are stepped on or handled during fishing.
Box jellyfish (major)
The box jellyfish, including the Irukandji, can be found in NSW waters.
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.
Major box jellyfish are the most dangerous jellyfish in Australia. Most stings are minor, but rarely severe envenoming can occur. In an adult, severe envenoming occurs with several metres of tentacle-to-skin contact. In a child, severe envenoming has occurred with just over one metre of tentacle-to-skin contact. Severe envenoming results in life-threatening systemic effects, characterised by cardiovascular collapse and death within 20 to 30 minutes.
Sea snake
Sea snake bites are extremely rare in Australia (approximately one or two cases per year). The bite may be painless. The main clinical effect of sea snake venom is myotoxicity (rhabdomyolysis), causing muscle pain and non-specific weakness, which develops within hours of the bite. Muscle pain may become severe with muscle spasms developing. Symptoms suggestive of systemic envenoming include nausea, vomiting and malaise. Neurotoxicity has been reported in two cases of sea snake bites.
Patient information
Sea creature bites and stings
Source: Healthdirect
Accessed from the Emergency Care Institute website at https://aci.health.nsw.gov.au/networks/eci/clinical/tools/venomous-marine-stings