EM Vivas · Spider and marine envenomation
Spider and marine envenomation — five syndromes viva
Clinical viva on ANZ spider/marine syndromes, first-aid mapping, antivenom doses, and RAVE context.
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Reveal interpretationShowHide
Five patterns. Latrodectism (regional pain + regional sweat); funnel-web (minutes, autonomic storm, pulmonary oedema — only lethal ANZ spider); Chironex (immediate pain, ladder tracks, cardiac arrest); Irukandji (delayed catecholamine surge, troponin); blue-ringed octopus (awake flaccid paralysis from TTX).[1]
First aid map. PIB = funnel-web only. Vinegar first for box jellyfish (never freshwater). Hot water 45 °C for Irukandji/bluebottle pain. Red-back = ice + analgesia, no PIB.[1]
Antivenom / definitive. Funnel-web 2 vials IV repeat to effect. Red-back 2 vials IV for refractory pain only — RAVE questions efficacy.[2] Chironex antivenom 3 vials + magnesium in arrest.[3] Blue-ringed octopus: ventilate 4–15 h, no antivenom, neostigmine useless.
Discriminator from snake. Coagulation remains normal.[1]
References4ShowHide
- [1]Isbister GK, Gray MR, Balit CR, et al. Funnel-web spider bite: a systematic review of recorded clinical cases. Med J Aust, 2005.PMID 15850438
- [2]Isbister GK, Brown SG, Miller M, et al. A randomised controlled trial of intramuscular vs. intravenous antivenom for latrodectism--the RAVE study. QJM, 2008.PMID 18400776
- [3]Currie BJ, Jacups SP. Prospective study of Chironex fleckeri and other box jellyfish stings in the "Top End" of Australia's Northern Territory. Med J Aust, 2005.PMID 16336157
- [4]Cavazzoni E, Lister B, Sargent P, Schibler A. Blue-ringed octopus (Hapalochlaena sp.) envenomation of a 4-year-old boy: a case report. Clin Toxicol (Phila), 2008.PMID 19238736