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Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature

journal contribution
submitted on 2023-12-05, 06:42 and posted on 2023-12-05, 12:29 authored by Saif Badran, Yazeed Eldos, Robert J. Hoffman, Sabeena Obaray, Bran Sivakumar, Graeme E. Glass

Background

Extremity ischemia and necrosis after jellyfish envenomation can be mutilating and cause long-term functional deficits. The best way to manage these presentations is unknown.

Objective

The aim of this review was to establish an evidence-based consensus for the management of extremity ischemia after jellyfish envenomation.

Methods

A systematic review of cases of extremity ischemia and necrosis after envenomation by marine cnidarians was performed to clarify what is and what is not known about management and outcomes, to draw conclusions about how best to manage these rare presentations, and to establish an evidence-based algorithm.

Results

The ischemic sequelae of envenomation typically evolves over a few days. Close medical supervision is necessary to react promptly to the evolving clinical scenario. In the literature, 15 different pharmacologic classes have been used to manage these presentations. Only IV infusions of prostaglandin derivatives and intra-arterial thrombolytics have been found to improve the clinical picture and avoid the need for surgical fasciotomy and debridement in some cases. Anticoagulants, antiplatelet agents, steroids, antibiotics, and nitrates, which are among the most commonly prescribed pharmacologic agents, have not been observed to alter the clinical picture.

Conclusions

Surgery for compartment syndrome and necrosis are common sequelae of extremity envenomation by marine cnidarians. Only prompt use of IV prostaglandins or intra-arterial thrombolytics can halt ischemic progression and avoid the need for surgery. An algorithm is proposed to guide management of these rare and mutilative presentations.

Other Information

Published in: The Journal of Emergency Medicine
License: http://creativecommons.org/licenses/by/4.0/
See article on publisher's website: https://dx.doi.org/10.1016/j.jemermed.2022.06.014

Additional institutions affiliated with: Qatar Poison Center - Sidra Medicine

Funding

Open Access funding provided by the Qatar National Library.

History

Language

  • English

Publisher

Elsevier

Publication Year

  • 2022

License statement

This Item is licensed under the Creative Commons Attribution 4.0 International License.

Institution affiliated with

  • Sidra Medicine
  • Hamad Medical Corporation
  • Hamad General Hospital - HMC
  • Qatar University
  • Qatar University Health - QU
  • College of Medicine - QU HEALTH
  • Weill Cornell Medicine - Qatar

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