Animal Bites
Box Jellyfish (e.g. Chironex fleckeri / other “box” jellyfish in Australia)
Pathophysiology & Clinical features
- These jellyfish inject venom via nematocysts; large exposures or trunk/face stings may induce cardiovascular collapse, arrhythmia, sudden death. ANZCOR notes that the greatest threat to life is early cardiovascular collapse. ARC
- Symptoms may include: immediate severe burning pain, linear/tram-track skin marks, haemodynamic instability, arrhythmias, collapse, respiratory failure. The “sting load” (tentacle contact area) correlates with severity. Your Site Name+1
First-aid / pre-hospital
- Remove the person from the water to prevent drowning and further contact.ARC
- Remove visible tentacles (by hand with gloves or using a flat instrument) avoiding further discharge. Then apply vinegar (≈4 % acetic acid) for at least 30 s to soak the area (if a lethal box jellyfish is plausible). ANZCOR emphasises this for stings that may be due to potentially fatal species. ANZCOR
- Do not apply fresh water rinse (can trigger nematocyst discharge) and avoid scraping uncontrolled. ANSCOR
- For analgesia: after removal and vinegar, apply ice-packs/cold in a dry bag (or hot-water immersion if local protocol) to relieve pain. ANZCOR states cold packs may be considered if available.ANZCOR
- If the patient is unresponsive or not breathing normally: commence CPR (refer to ANZCOR Guideline 8) and call emergency services. ARC
In-Hospital/Monitoring & Treatment
- Arrange immediate fully monitored care: telemetry, continuous BP/HR, respiratory support, high-acuity bed if required (e.g., ICU).
- Investigations: baseline ECG, troponin, CK, lactate, full blood count, coagulation, renal function, electrolytes. Monitor for arrhythmias, cardiogenic shock, secondary organ injury.
- Analgesia: severe pain is frequent; consider strong opioids, adjuncts (e.g., ketamine infusion if refractory) per local analgesic protocols.
- Antivenom: There is a specific antivenom for box jellyfish envenomation (Chironex) in Australia; however, the evidence base is limited, and timely resuscitation takes precedence. Larger centres in tropical areas stock it. ANZCOR states antivenom is available but emphasizes prompt life-support. ARC
- Supportive care: Inotropes/vasopressors may be required for cardiovascular collapse, mechanical ventilation for respiratory failure, aggressive fluid management/resuscitation.
- Observation: Because profound collapse may occur rapidly, continuous monitoring is essential, and transfer to tertiary facility if not already there.
Key decision-points & tips
- When encountering a suspect box jellyfish sting (especially tropical Queensland/NT waters), treat as potentially fatal until proven otherwise.
- Early vinegar + tentacle removal + supportive care is critical.
- If cardiovascular compromise occurs immediately, don’t delay resuscitation waiting for antivenom.
- Document time of sting, first-aid applied, size/area of tentacle contact (if known).
- Consider ICU admission even if initially stable, given delayed effects have been reported (though less common with box jellyfish compared to Irukandji).
Reference links
- ANZCOR Guideline 9.4.5 (marine envenomation) – full PDF. Your Site Name+1
- HealthDirect: Jellyfish stings for general reference. Healthdirect
2. Irukandji Syndrome (tiny box-jellyfish species, e.g. some Carukia, Malo species)
Pathophysiology & Clinical features
- These are small jellyfish (often not felt initially or may deliver a mild sting) but subsequent systemic syndrome: severe muscle/back/abdominal pain, headache, nausea/vomiting, sweating, anxiety/“impending doom”, hypertension, chest pain, tachycardia, dysrhythmia. Your Site Name+1
- Onset may be delayed (typically 20–40 minutes after sting). Your Site Name+1
- While mortality is rare, complications such as pulmonary oedema, cardiomyopathy, intracranial haemorrhage have been reported.
First-aid / pre-hospital
- Remove from water; call ambulance if systemic features appear. Your Site Name
- As with box jellyfish: remove tentacles, consider vinegar if tropical species suspected (though some controversy remains). ANZCOR states vinegar “should only be considered for species that may be box jellyfish/Irukandji”. Your Site Name+1
- For pain management: hot-water immersion (~45 °C) for ~20 minutes or as per local protocol is recommended for pain relief. Some evidence supports this for jellyfish stings. Healthdirect
- If patient develops systemic signs (chest pain, collapse, nausea/vomiting, sweating) assume Irukandji until proven otherwise.
In-Hospital/Monitoring & Treatment
- Admission for monitoring: continuous BP/HR, ECG (for dysrhythmia), telemetry, frequent assessment of pain, fluid balance, renal function, CK/myoglobin (for rhabdo), troponin if cardiac involvement suspected.
- Pain: often severe, may require multimodal analgesia (IV opioids, ketamine, regional analgesia if available) and hot-water immersion adjuncts.
- Consider antihypertensives/analgesics for hypertension and sympathetic surge (e.g., intravenous magnesium has been used in some centres).
- Antivenom: there is currently no commercially available antivenom for most Irukandji species in use in Australia. Management is supportive and symptomatic. (Note: Some research protocols exist but routine antivenom is not standard.)
Key decision-points & tips
- Because onset may be delayed, maintain high index of suspicion in any tropical jellyfish sting with delayed onset pain plus systemic signs.
- Early hospital transfer is prudent even if initially mild sting, because worsening may occur.
- Document time of sting, first‐aid given, onset of symptoms.
- Pain control is not just comfort: severe pain and sympathetic activation contribute to complications.
Reference links
- ANZCOR Guideline 9.4.5 (marine envenomation) – includes Irukandji discussion. Your Site Name+1
- HealthDirect: Jellyfish stings – general information. Healthdirect
3. Bluebottle (Physalia utriculus / “Portuguese man-o’-war” type)
Pathophysiology & Clinical features
- Typically causes intense local pain and linear/tram-track red eruption. Systemic effects are rare (<1%). Healthdirect+1
- Typically mild but the pain is often disproportionate to surface appearance.
First-aid / pre-hospital
- Remove tentacles and rinse the area with sea water only (not fresh water). Fresh may trigger nematocyst discharge. Healthdirect+1
- Then proceed with hot-water immersion (~45 °C) for about 20 minutes, or continuous heat flow (e.g., hot shower) until pain resolves. This is superior to ice for many cases. Healthdirect+1
- Vinegar is not recommended for bluebottle stings; can worsen pain/discharge. Healthdirect
In-Hospital/Monitoring & Treatment
- Most cases require only analgesia (NSAIDs/paracetamol, opioids if required).
- If systemic signs appear (rare): nausea, vomiting, abdominal pain, muscle aches → treat accordingly and hospitalise for monitoring. Healthdirect
Key decision-points & tips
- In areas outside the tropics and for obvious bluebottle type stings, treatment is straightforward: sea-water rinse + hot-water immersion + analgesia. Serious outcomes exceptionally rare.
- Educate patients about risk of recurrence/sensitisation: avoid further tentacle contact, watch for secondary infections if blistering occurs.
Reference link
- HealthDirect: Jellyfish stings – bluebottle specific guidance. Healthdirect
4. Snakebite (Australia – elapids, sea-snakes)
Pathophysiology & Clinical features
- Snake venoms in Australia can cause:
- Cardiovascular collapse (early) – the major cause of death. New Zealand Resuscitation Council+1
- Venom-induced coagulopathy (VICC) – consumption of clotting factors, fibrinogen, platelets; bleeding risk. The Medical Journal of Australia
- Neurotoxicity – cranial nerve involvement, respiratory muscle paralysis. New Zealand Resuscitation Council+1
- Myotoxicity/rhabdomyolysis – muscle necrosis, elevated CK, risk of AKI. Royal Children’s Hospital
- Recognition may be delayed; local signs (pain, swelling) may be minimal. Your Site Name+1
First-aid / pre-hospital
- Apply pressure-immobilisation bandage (PIB) + immobilise the whole limb; the bandage should cover the bite site and extend to the end of the limb. Do not wash the site, do not incise/suck, do not apply arterial tourniquet. Your Site Name
- The bandage is most effective if applied within ~4 h of bite (some local guidelines say within 4 h; children guideline says “should not be applied more than 4 h after bite”). Children’s Health Queensland+1
- Transport to hospital with antivenom availability, lab capability, critical care capacity. Royal Children’s Hospital+1
In-Hospital/Monitoring & Treatment
Investigations
- Serial labs: FBC, coagulation profile (PT/INR, APTT, fibrinogen, D-dimer), CK, myoglobin, renal panel, electrolytes, troponin/ECG if cardiac involvement suspected.
- Baseline and repeated every 2-4 h initially, then every 6–12 h depending on findings.
Antivenom
- Early consultation with poison centre/clinical toxicologist (e.g. 13 11 26) is mandatory. Agency for Clinical Innovation
- Indications for antivenom: evidence of systemic envenoming (neurotoxicity, VICC, myotoxicity, collapse) or progressive signs. Royal Children’s Hospital+1
- Dose: For many Australian guidelines one vial of the specific antivenom is sufficient (because venom dose is independent of patient size). E.g., RCH guideline: “One vial … is enough to neutralise the venom that can be delivered by one snake.” Royal Children’s Hospital
- Route: Intravenous infusion in critical care setting; be prepared for anaphylaxis. Australian Prescriber
- After antivenom, the pressure bandage may be removed in supervision once stable and labs trending. Royal Children’s Hospital+1
Monitoring & supportive care
- Admit to a facility with ICU capability, continuous monitoring, antidote stock, lab access. www1.health.nsw.gov.au
- Monitor for coagulopathy reversal: VICC can take 10-20 hours to begin improvement and up to 24-30 h for full resolution. Royal Children’s Hospital
- Supportive care: ventilation if neuromuscular paralysis, fluids/renal support for rhabdo/AKI, monitor for secondary brain hemorrhage if VICC.
Key decision-points & tips
- Treat all suspected venomous bites as envenomed until proven otherwise. pch.health.wa.gov.au
- Apply PIB immediately (if safe to do so) and do not delay transport.
- Early antivenom is associated with improved outcomes; delay may allow irreversible organ damage.
- Document time of bite, first-aid applied, arrival time, labs, antivenom time/lot.
- Be ready for antivenom anaphylaxis: pre-hospitalised alert, ICU setting, epinephrine/APLS protocols in place.
- Note that snake species identification is helpful but should not delay treatment. A photograph can assist. Your Site Name
Reference links
- ANZCOR Guideline 9.4.1 (Australian snake bite) – full PDF. Your Site Name+1
- NSW Health “Snake and Spider Bites Clinical Management” GL2024_007. www1.health.nsw.gov.au
- Med J Aust article “Snakebite in Australia: a practical approach” (Isbister et al 2013). The Medical Journal of Australia
5. Funnel-web Spider (e.g. Atrax robustus / genus Hadronyche)
Pathophysiology & Clinical features
- Funnel-web spider venom causes potent neurotoxic and autonomic activation effects: local pain/bleeding, then sweating, salivation, ptosis, muscle fasciculations, respiratory failure, cardiovascular collapse. Historically high mortality before antivenom.
First-aid / pre-hospital
- Apply pressure-immobilisation bandage + immobilise limb and patient (same technique as for snake bite) until antivenom available. Early institution of the PBI is critical. Many first‐aid sources emphasise this for funnel-web bites.
- Call ambulance urgently; treat as medical emergency.
In-Hospital/Monitoring & Treatment
- Admit to ICU, continuous monitoring (respiratory, cardiovascular) and ready for ventilation.
- Antivenom available, and should be given as soon as possible in symptomatic patients. Some earlier statements of “not required after 2 h” are outdated—current practice emphasises prompt antivenom for progressive symptoms.
- Dose and administration: as per local hospital/institutional protocol—generally in a setting with ability to manage anaphylaxis.
Key decision-points & tips
- Any suspected funnel-web bite with systemic signs (sweating, salivation, fasciculations, altered consciousness, chest/back pain) should trigger antivenom consideration.
- Monitor for at least 12-24 hours (or longer if severe) given risk of delayed complications.
- Ensure tetanus immunisation status, analgesia, wound care.
Reference links
- While not as recent in guideline form as snake bites, the NSW Health and Poison centres have protocols for funnel web envenomation (see NSW “Snake and Spider Bites Clinical Management” GL2024_007). www1.health.nsw.gov.au
6. Redback Spider (Latrodectus hasselti)
Pathophysiology & Clinical features
- Venom causes α-latrotoxin mediated release of neurotransmitters → pain, sweating, paraesthesia, abdominal/chest/back pain; fatalities extremely rare in modern era.
First-aid / pre-hospital
- There is no role for pressure-immobilisation bandaging for redback bites (unlike funnel-web/spider/ snake).
- Ice or heat packs (variously recommended) plus analgesia.
In-Hospital/Monitoring & Treatment
- Analgesia (NSAIDs, opioids if required), supportive care. Some hospitals may still have antivenom but nowadays symptom management is usually sufficient.
- Tetanus immunisation status should be reviewed.
Key decision-points & tips
- Pain may persist up to 5 days; patient reassurance is important.
- Monitor for uncommon complications (rare autonomic dysfunction).
Reference links
- NSW Health “Snake and Spider Bites Clinical Management” GL2024_007. www1.health.nsw.gov.au
Summary Comparison Table (for quick reference)
| Envenomation | Key risk / severe outcome | First-aid | Antivenom available? | Observation/monitoring |
|---|---|---|---|---|
| Box Jellyfish | Sudden cardiopulmonary collapse | Tentacles off → vinegar (30 s) → ice/hot-water, CPR if needed | Yes (for Chironex) in some centres | ICU monitoring; ECG/telemetry |
| Irukandji | Severe systemic pain, hypertension, cardiomyopathy | Tentacles off → vinegar if doubtful species → hot-water immersion for pain | No routine antivenom | Admit, monitor for delayed onset |
| Bluebottle | Intense local pain; systemic rare | Rinse with sea water → hot-water immersion ~20 min | None | Usually outpatient; observe if systemic signs |
| Snakebite | Cardiovascular collapse, VICC, neuro/myotoxicity | PIB + immobilise limb → urgent transfer | Yes (multiple snake antivenoms) | ICU/tertiary; serial labs |
| Funnel-web spider | Neurotoxic + autonomic collapse | PIB + immobilise → urgent transport | Yes (funnel-web antivenom) | ICU monitoring 12–24h+ |
| Redback spider | Severe regional pain; fatalities very rare | Ice/heat + analgesia | Less frequently used now | Generally ward/outpatient; monitor pain |
Additional Practical Notes
- In coastal/tropical Queensland/NT settings, always consider risk of box jellyfish/Irukandji with any marine sting. If uncertain species, err on side of caution and treat as potentially lethal.
- Always call the local poison information centre (13 11 26) for envenomation cases to get expert toxicology input and local antivenom availability.
- For snakebites and spider bites: ensure the hospital is equipped with ICU, lab, antivenom stock, ready to manage anaphylaxis. Smaller centres should consider early transfer.
- Maintain clear documentation: species (if identified), first-aid time, bandage applied, antivenom administration (time, lot number), response to therapy.
- For analgesia: given the severity of pain in many of these envenomations (Irukandji, box jellyfish, bluebottle), early use of multimodal analgesia (opioids + adjuncts + hot/cold therapy) is often necessary.
- Patient education: risk prevention (avoid swimming when stinger nets not present, avoid touching jellyfish washed ashore, snake avoidance, spider habitat). Ensure tetanus immunisation up to date.
- Reminder: first aid bandaging/immobilisation for snake/funnel web spiders is different to the approach for bluebottle/most jellyfish (where hot water + sea water rinse is key).
- Because of species-specific variability (especially with jellyfish), many guidelines emphasise that “no one nationwide recommendation for first-aid can be made” for all jellyfish. ARC