9.3 D) - F) Environmental Marine Envenomations

Front 1

(Isbister 2007)
Which of the following is the most common source of marine bites/stings/envenomations in Australia?
A. Sea snakes
B. Blue bottle jellyfish
C. Sea urchin spines
D. Blue ringed octopi bites

Back 1

B.

A,C,D are less common.

Front 2

(Isbister 2007)
The 3 most important groups of Jellyfish in

Australia are ?

Back 2

1. Physalia - Blue bottles /

Portugese Man-of-War
2. Major Box Jellyfish ( Chironex fleckeri)
3. Other Box Jellyfish

( Causing Irukandji Syndrome)

Front 3

(Isbister 2007)
which of the following is incorrect regarding Bluebottle stings ?
A. Vinegar is recommended.
B. Hot water immersion for 20 minutes is

recommended
C. The venom is heat labile.
D. The stings are very common, and only a few patients develop systemic symptoms.

Back 3

A. Vinegar is not recommended.

Front 4

(Isbister 2007)
Which of the following is incorrect regarding Bluebottle stings?
A. The pain of a sting is immediate and intense
B. There is characteristic linear erythematous raised eruptions.
C. Stings usually occur in shallow waters.
D. The sting pain usually lasts about 24 hours.

Back 4

D. The sting pain usually lasts about 1 hour .

More severe cases :
- can last longer
- have a delayed local vesicular reaction
- can have systemic symptoms of Nausea,

Vomiting,Abdominal pain and myalgia.

Front 5

(Isbister 2007)
Which of the following is correct regarding

Chironex fleckeri stings and envenomation?
A. The initial dose for cardiac arrest is 4

ampoules
B. Vinegar is not effective in First Aid.
C. Pressure immobilisation bandages (PIB) are recommended.
D. There is an "all-or-none" phenomenon with systemic envenomation- with severe envenomings rarely arriving to Hospital alive.

Back 5

D.

A = 6 ampoules
B = Vinegar is recommended :

"generous application"
C. PIB not done.

Front 6

(Isbister 2007)
Which of the following is incorrect regarding

Chironex fleckeri ?
A. It is Australia's most dangerous jellyfish
B. Death from cardiovascular collapse occurs within 10 minutes
C. Ice packs, rather than hot water , is

recommended for local analgesia.
D. Cardiovascular collapse is managed with 3 ampoules for hypotension/ arrhythmias, and 6 ampoules for cardiac arrest.

Back 6

B. 20-30 minutes.

Front 7

(Isbister 2007)
List the treatment for Chironex

fleckeri stings / envenomation.

Back 7

1. Remove tentacles
2. Vinegar +++ (deactivates remaining nematocysts)
3. Local ice packs
4. Oral and parenteral analgesia
5. IV fluids
6. IV antivenom
7. Magnesium
8. Vasopressors.

Front 8

(Isbister 2007)
Which is correct regarding

irukandji Syndrome?
A. Vinegar is ineffective
B. The tentacles can be allowed to remain.
C. Antivenom can be life-saving
D. It is characterised by significant generalised autonomic effects.

Back 8

D.

A = First aid
B = Remove tentacles
C = There is no anti venom

Front 9

(Isbister 2007)
Which is incorrect regarding

Irukandji Syndrome.
A. It is characterised by MINOR LOCAL EFFECTS and severe generalised effects.
B. The sting may be painless.
C. Severe pain develops over 10 minutes, in the back, abdomen and chest.
D. The autonomic effects include agitation, sweating, vomiting,

tachycardia and hypertension.

Back 9

C. Severe pain develops over 20-30 minutes.

Front 10

(Isbister 2007)
Which is incorrect regarding

Irukandji Syndrome?
A. Significant cardiac symptoms can occur, including ECG changes,

troponin rise, pulmonary oedema and cardiogenic shock.
B. The pain takes > 24 hours to resolve
C. The mainstay of treatment is SUPPORTIVE
D. The sting is usually painless.

Back 10

B. Pain takes 6-12 hours to resolve

Front 11

(Isbister 2007)
Which jellyfish stings do not utilise

vinegar as first aid?
A. Chironex fleckeri
B. Bluebottles
C. Major box jellyfish
D. Irukandji syndrome

Back 11

B.

A is C

Front 12

(Isbister 2007)
Which Jellyfish requires vinegar as first aid?

A. Bluebottles
B. Hair jellyfish
C. Chironex fleckeri (Major Box jellyfish)
D. Mauve stinger.

Back 12

C.

Front 13

(Isbister 2007)
Which Jellyfish does not require hot water

immersion for relief of pain?
A. Mauve stinger
B. Bluebottles
C. Chironex fleckeri
D. Hair jellyfish

Back 13

C. Chironex fleckeri = ICE and vinegar

Front 14

(Isbister 2007)
In regards to Venomous Fish, which of the

following has an anti venom?
A. Scorpion fish
B. Catfish
C. Stonefish
D. Soldier fish

Back 14

C.

Front 15

(Isbister 2007)
Which of the following is incorrect regarding

Venomous fish stings?
A. They tend to cause puncture wounds with

localised pain, after being trodden on.
B. The most important complication is secondary infection with marine / aquatic organisms .
C. Catfish commonly cause spiny injuries.
D. The First aid is ice packs

Back 15

D. 45 degree hot water immersion

for 90 minutes

Front 16

(Isbister 2007)
Which of the following is incorrect regarding the treatment of Stonefish stings?
A. Stonefish antivenom is indicted in any Stonefish sting that does not

respond to hot water immersion AND adequate analgesia.
B. Stonefish antivenom is given IMI
C. Both oral and IV analgesia may be required.
D. All wounds are first thoroughly cleaned and irrigated.

Back 16

B. Stonefish antivenom is given IV -

Intravenously.

Front 17

(Isbister 2007)
Which of the following is incorrect regarding Stingray stings?
A. Injury is usually from being trodden on-and can cause intense local pain.
B. Systemic effects are uncommon
C. Treatment is with hot water immersion
D. The most important complication is bleeding.

Back 17

D. Secondary infection.

Front 18

(isbister 2007)
Which is correct regarding Sea Urchins?
A. The spines are usually venomous.
B. Ice packs are the main first aid.
C. The spines can be difficult to remove, requiring surgical removal after ultrasound localisation.
D. There exists antivenom.

Back 18

C.

A = non-venomous
B = Hot water immersion for Sea Urchins
D = non exists.

Front 19

(Isbister 2007)
Which of the following is incorrect regarding Blue-ringed octopus bites?
A. Their saliva contains tetrodotoxin, a potent sodium channel blocker.
B. Pressure immobilisation bandage(PIB) is recommended.
C. The bite is often painful , with small puncture marks.
D. There can be rapid progression to flaccid paralysis and respiratory failure.

Back 19

C. Blue-Ringed Octopus has a Painless bite site.