Nematocysts - Revision history

Rossdonaldson1: /* Irukandji syndrome Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. */

2021-11-27T06:51:51Z

Irukandji syndrome Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.

← Older revision		Revision as of 06:51, 27 November 2021
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	**[[cardiac arrest\|Death]]		**[[cardiac arrest\|Death]]

	==[[Irukandji syndrome]]<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>==		===[[Irukandji syndrome]]<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>===
	*Usually develops within 2 hours of envenomation & can last up to 2 days		*Usually develops within 2 hours of envenomation & can last up to 2 days
	*Rare but potentially fatal complication. It often involves intense pain, diffuse muscle cramps, vasconstriction and marked hypertension due to a catacholamine surge.		*Rare but potentially fatal complication. It often involves intense pain, diffuse muscle cramps, vasconstriction and marked hypertension due to a catacholamine surge.

Rossdonaldson1 at 06:46, 27 November 2021

2021-11-27T06:46:58Z

← Older revision		Revision as of 06:46, 27 November 2021
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	</gallery>		</gallery>

			{{Nematocyst mechanism}}
	~~===Mechanism===~~
	~~[[File:~~Nematocyst ~~discharge.png\|thumb\|Nematocyst stages of discharge]]~~
	*Physical contact or osmotic gradient causes discharge of nematocysts
	*A spring loaded venom delivery system
	*Once opened, a nematocyst releases all of its contained venom

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Background */

2021-11-27T06:23:07Z

Background

← Older revision		Revision as of 06:23, 27 November 2021
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	<gallery mode="packed">		<gallery mode="packed">
	File:Avispa marina cropped.png\|[[Box jellyfish]]		File:Avispa marina cropped.png\|[[Box jellyfish]]
	File:Lithothamnion sp..jpg\|Coral reef		File:Lithothamnion sp..jpg\|[[Coral reef]]
	File:Portuguese Man-O-War (Physalia physalis).jpg\|Portuguese Man-O-War {Physalia physalis)		File:Portuguese Man-O-War (Physalia physalis).jpg\|[[Portuguese Man-O-War]] {Physalia physalis)
	File:Actiniaria.jpg\|A selection of various sea anemones		File:Actiniaria.jpg\|A selection of various [[sea anemones]]
	</gallery>		</gallery>

Athorne: /* Irukandji syndrome Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. */

2021-07-31T02:40:59Z

← Older revision		Revision as of 02:40, 31 July 2021
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	*Rare but potentially fatal complication. It often involves intense pain, diffuse muscle cramps, vasconstriction and marked hypertension due to a catacholamine surge.		*Rare but potentially fatal complication. It often involves intense pain, diffuse muscle cramps, vasconstriction and marked hypertension due to a catacholamine surge.
	**Beware of [[hypertensive emergency]]: Look for signs of end organ damage (ie ACS, CHF, intracranial hemorrhage, renal injury)		**Beware of [[hypertensive emergency]]: Look for signs of end organ damage (ie ACS, CHF, intracranial hemorrhage, renal injury)
	**This condition can be fatal

	==Differential Diagnosis==		==Differential Diagnosis==

Athorne: /* Management */

2021-07-31T02:38:31Z

Management

← Older revision		Revision as of 02:38, 31 July 2021
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	***Box Jellyfish: 4-5% acetic acid solution should be applied to the injured area for at least 30 seconds.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. </ref>		***Box Jellyfish: 4-5% acetic acid solution should be applied to the injured area for at least 30 seconds.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. </ref>
	*Symptomatic treatment for [[Irukandji syndrome]]		*Symptomatic treatment for [[Irukandji syndrome]]
	**Consider [[fentanyl]] for pain and antihypertensives such as magnesium sulfate and ~~nitroglycerine~~		**Consider [[fentanyl]] for pain and antihypertensives such as magnesium sulfate and nitroglycerin
	*Antivenom is only readily available in Australia for severe [[box jellyfish]] sting		*Antivenom is only readily available in Australia for severe [[box jellyfish]] sting

Athorne: /* Management */

2021-07-31T02:32:27Z

Management

← Older revision		Revision as of 02:32, 31 July 2021
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	***Box Jellyfish: 4-5% acetic acid solution should be applied to the injured area for at least 30 seconds.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. </ref>		***Box Jellyfish: 4-5% acetic acid solution should be applied to the injured area for at least 30 seconds.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. </ref>
	*Symptomatic treatment for [[Irukandji syndrome]]		*Symptomatic treatment for [[Irukandji syndrome]]
			**Consider [[fentanyl]] for pain and antihypertensives such as magnesium sulfate and nitroglycerine
	*Antivenom is only readily available in Australia for severe [[box jellyfish]] sting		*Antivenom is only readily available in Australia for severe [[box jellyfish]] sting

Athorne: /* Irukandji syndrome Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. */

2021-07-31T02:30:22Z

← Older revision		Revision as of 02:30, 31 July 2021
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	==[[Irukandji syndrome]]<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>==		==[[Irukandji syndrome]]<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>==
	*Usually develops within 2 hours of envenomation & can last up to 2 days		*Usually develops within 2 hours of envenomation & can last up to 2 days
	*Rare but potentially fatal complication ~~can manifest in diverse ways:~~		*Rare but potentially fatal complication. It often involves intense pain, diffuse muscle cramps, vasconstriction and marked hypertension due to a catacholamine surge.
	**Myalgias		**Beware of [[hypertensive emergency]]: Look for signs of end organ damage (ie ACS, CHF, intracranial hemorrhage, renal injury)
	**Back pain		**This condition can be fatal
	**Chest pain
	**Abdominal pain
	**Nausea and ~~vomiting~~
	**~~Diaphoresis~~
	**Hypertensive crisis
	**Cardiogenic pulmonary edema
	**Intracranial hemorrhage
	**~~Death~~

	==Differential Diagnosis==		==Differential Diagnosis==

Athorne: /* Clinical Features */

2021-07-31T02:25:10Z

Clinical Features

← Older revision		Revision as of 02:25, 31 July 2021
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	**[[cardiac arrest\|Death]]		**[[cardiac arrest\|Death]]

	==[[Irukandji syndrome]]==<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>		==[[Irukandji syndrome]]<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>==
	*Usually develops within 2 hours of envenomation & can last up to 2 days		*Usually develops within 2 hours of envenomation & can last up to 2 days
	*Rare but potentially fatal complication can manifest in diverse ways:		*Rare but potentially fatal complication can manifest in diverse ways:

Rossdonaldson1: /* Management */

2021-07-24T12:34:46Z

Management

← Older revision		Revision as of 12:34, 24 July 2021
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	*Symptomatic treatment for [[Irukandji syndrome]]		*Symptomatic treatment for [[Irukandji syndrome]]
	*Antivenom is only readily available in Australia for severe [[box jellyfish]] sting		*Antivenom is only readily available in Australia for severe [[box jellyfish]] sting



	===Avoid===		===Avoid===

Jonrako: /* Management */

2021-07-23T21:41:58Z

Management

← Older revision		Revision as of 21:41, 23 July 2021
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	*Remove tentacles and nematocysts		*Remove tentacles and nematocysts
	*Hot salt water immersion (inactivates heat labile toxins), submerging the area in 45 ℃ water for 20 minutes has been shown to provide significant pain relief<ref>#Isbister GK, Currie BJ. Hot water immersion v icepacks for treating pain of Chironex fleckeri stings: a randomised controlled trial. Med J Aust. 2017 Oct 16;207(8):362. PubMed PMID: 29020913.</ref>		*Hot salt water immersion (inactivates heat labile toxins), submerging the area in 45 ℃ water for 20 minutes has been shown to provide significant pain relief<ref>#Isbister GK, Currie BJ. Hot water immersion v icepacks for treating pain of Chironex fleckeri stings: a randomised controlled trial. Med J Aust. 2017 Oct 16;207(8):362. PubMed PMID: 29020913.</ref>
			*Stingose is a topical solution composed of 20% aluminum sulfate and 1.1% surfactant.
			**Used for pain control, venom removal via osmosis, & venom neutralization via denaturation of proteins and polysaccharides through interactions with the aluminum ion.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>
	*Consider topical [[lidocaine]]		*Consider topical [[lidocaine]]
	*Consider oral or parenteral [[analgesia]] for severe pain		*Consider oral or parenteral [[analgesia]] for severe pain
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	**Some evidence that it does inhibit nematocyst discharge in the Australian Box Jellyfish species <ref>Yanagihara AA, Wilcox CL. Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations. Toxins (Basel). 2017;9(3):105. Published 2017 Mar 15. doi:10.3390/toxins9030105</ref>		**Some evidence that it does inhibit nematocyst discharge in the Australian Box Jellyfish species <ref>Yanagihara AA, Wilcox CL. Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations. Toxins (Basel). 2017;9(3):105. Published 2017 Mar 15. doi:10.3390/toxins9030105</ref>
	***Box Jellyfish: 4-5% acetic acid solution should be applied to the injured area for at least 30 seconds.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. </ref>		***Box Jellyfish: 4-5% acetic acid solution should be applied to the injured area for at least 30 seconds.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/. </ref>
	*~~'''~~Symptomatic treatment for Irukandji syndrome~~'''~~		*Symptomatic treatment for [[Irukandji syndrome]]
	*~~'''~~Antivenom is available for severe [[box jellyfish]] sting~~'''~~		*Antivenom is only readily available in Australia for severe [[box jellyfish]] sting



	===Avoid===		===Avoid===