Wilderness Medical Society snowmass 2005 Page 246
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Chapter 18
MARINE ENVENOMATIONS AND POISONINGS
Recommendations are considered Category 1B by the WMS Panel of Expert Reviewers
I. GENERAL INFORMATION
Marine creatures may cause illness both by injection (envenomation) and ingestion
(poisoning) of the multitude of toxins they elaborate. There is a broad range of species
involved and these are widely distributed. In general, tropical and sub-tropical
environments are the highest risk areas. Many of the venoms and toxins involved are still
poorly characterized yet there are recognizable themes across species in patterns of
envenomation and management.
II. GUIDELINES FOR PREVENTION
Prevention of marine envenomations and poisonings requires local knowledge. In
general, common sense is required. Few marine creatures are aggressive unless
disturbed. Stout footwear is an obvious precaution when walking through shallows,
especially coral or rocks. Do not handle marine creatures--observe them from a distance.
During high risk periods wear `stinger suits' to minimize the risk of jellyfish
envenomation and where possible swim at safe beaches or in protected enclosures. Know
which species of fish and seafood can be safely eaten at any given time. Perhaps most
importantly, know the risks of your local environment. Know the appropriate first aid
and be aware of the definitive care of each condition.
III. GUIDELINES FOR ASSESSMENT AND TREATMENT
Other than attention to the ABC's, care of the victim of a marine envenomation or
poisoning may include: prevention of further envenomation, venom neutralization, pain
relief, specific anti-venoms, specific adjunctive drug therapy and surgical wound care.
A. Jellyfish: This group covers an enormous range of genus and species. They share a
common means of envenomation through thousands of tiny stinging capsules
(nematocysts), which come into contact with exposed flesh that passes through their
trailing tentacles. Some of the medically more important include the box jellyfish
(Chironex), man-o-war and the irukandji. Immediate and often severe local pain is the
rule with jellyfish stings. Most jellyfish will also cause a prominent skin rash. The most
severe envenomations (especially those of the box jellyfish) may lead to respiratory
failure and cardiovascular collapse.
For all types of box jellyfish stings, vinegar (4-6% acetic acid) splashed liberally
over the areas where stingers are adherent has been shown to reliably inhibit nematocyst
discharge and inactivate remaining undischarged nematocysts. This therapy is not proven
