7/26/2023 0 Comments Chrinex flickeryIt can be given intramuscularly in the absence of intravenous access, but this route is pharmacokinetically unfavourable and probably ineffective (given the rapid distribution and action of the venom).Chironex fleckeri stings causing pain refractory to IV opioids – one ampoule (1 × 20,000 units) IV diluted in 100 mL normal saline over 20 minutesĬSL box jellyfish antivenom is an ovine IgG Fab available as 20,000 unit (~1.5-4 mL) ampoules.evidence of systemic envenoming by Chironex fleckeri: collapse, hypotension or significant cardiac arrhythmia – three ampoules (3 × 20,000 units) IV diluted in 100 mL normal saline over 20 minutes.cardiac arrest due to Chironex fleckeri envenoming – all immediately available Box Jellyfish antivenom (at least 6 ampoules) should be given as a rapid IV push.The indications for Chionex fleckeri antivenom are: Immediate transport to a medical facility.pressure actually triggers nematocyst firing and the venom acts so rapidly that PIB is unlikely to significantly reduce the systemic distribution of venom.Do NOT attempt pressure-immobilisation bandaging (PIB).Magnesium sulfate (10mmol IV) should be given if there is no response to antivenom.If antivenom is available on arrival of the ambulance, all immediately available Box Jellyfish antivenom (at least 6 ampoules) should be given.In cardiac arrest, undiluted antivenom, administered as a rapid IV push, may be life‑saving.Ideally pour a couple of liters of vinegar over the tentacles continuously for about 30 seconds.Smother the tentacles in vinegar and remove them.Assess “ABCs” and start cardiopulmonary resuscitation. Potential early life‑threats from Chironex fleckeri envenoming that require immediate intervention include cardiac arrest, hypotension or hypertension and cardiac arrhythmia.Recognise that this is a life-threatening situation and get help immediately – call an ambulance!
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