Basic HTML Version
Chapter 29 — 5
The venom has its most serious effects on the heart and the respiratory system. It paralyses
the respiratory muscles leading to death. Weakening of cardiac contraction, as well as cardiac
rhythm disturbances, compounds the problem. The venom exerts a local effect producing
agonising pain with skin and muscle destruction.
Clinical Features
The victim experiences
immediate agonising pain
on contact with the tentacles. With a large
sting, sudden
collapse
,
cessation of breathing, cyanosis
,
unconsciousness
and
death
may
follow rapidly
.
These effects are particularly dangerous in small children or old frail
swimmers.
If the victim recovers, severe pain still persists for many hours, and
scarring
is common in
the stung areas due to local tissue destruction.
Treatment
Rescue
the victim from the water and prevent drowning. This takes immediate precedence.
If the patient is unconscious the basic life support
(
BSL
) priciples take precedence and should be
followed (see Chapter 42) while enlisting medical
assistance.
Apply copious amounts of ordinary
household
vinegar
to the tentacles and gently remove the
tentacles from the victim’s skin. The tentacles
cannot sting effectively through the thick skin of
the palm of the hand and fingers so this may be
safer than it sounds. It is important not to rub or
damage the tentacles as this will encourage the
injection of further venom into the victim.
Alcohol application is no longer advised, as there is
some evidence that this may cause the discharge of
further venom into the victim, as may pressure-
bandage/immobilisation (see later). If the alcohol is
of good quality, it may be more beneficial to the
rescuer, once the victim has been taken safely to
hospital.
The cause of death in box jellyfish sting is usually
respiratory arrest. However, this may be transient if
the victim is kept alive by expired air resuscitation
or other
artificial ventilation
during this period.
The victim should be transported to hospital
urgently. Most survive, especially if still alive after
the first few minutes.
Fig 29.3
Chironex – Box Jellyfish