Box jellyfish sting

Q: 26 years old ocean-surfer, while vacationing at an Australian beach, was brought to ED after an "Australian box jellyfish" sting and is now in severe cardiogenic shock. What's the next step? (select one) 

A) specific sheep serum antivenom 

B) removal of tentacles 

C) cold packs & irrigation with vinegar 

D) Rx for acute decompensated heart failure 

E) All of the above 

 

Answer: E 

 The objective of the above question is to emphasize the urgency of treatment in jellyfish stings, particularly C. fleckeri, popularly known as Australian box jellyfish, which shows the most venomous tendency and is known to cause potential cardiogenic shock or cardiac arrest. All treatments (conservative to antidote) should be applied simultaneously and early in the course or else patient can deteriorate quickly. Even though evidence to use specific sheep serum antivenom is very weak, there is nothing to lose in such a life-threatening situation. The antidote is most effective early in the course. The vial can be repeated three times if symptoms last. 

 #toxicity 

 References: 

 1. Isbister GK. Jellyfish stings. Aust Prescrib 2007; 30:117. 

 2. Australian Resuscitation Council. Guideline 9.4.5. Envenomation: Jellyfish stings. Available at: http://www.resus.org.au/guidelines/ (Accessed on June 27, 2023). 

 3. Currie BJ. Marine antivenoms. J Toxicol Clin Toxicol 2003; 41:301.