Identification and Management of Marine Envenomations in Pediatric Patients -

Identification and Management of Marine Envenomations in Pediatric Patients
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Publication Date: April 2020 (Volume 17, Number 04)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 04/01/2023.


Meghan B. Spyres, MD
Assistant Professor of Clinical Emergency Medicine, Division of Medical Toxicology, University of Southern California, Keck School of Medicine, Los Angeles, CA
Jeff Lapoint, DO
Director, Division of Medical Toxicology, Department of Emergency Medicine, Southern Permanente Medical Group, San Diego, CA

Peer Reviewers

Chris Pitotti, MD, FACEP
Associate Program Director, University of Nevada, Las Vegas Department of Emergency Medicine, Las Vegas, NV
Mark Waltzman, MD
Chief of Pediatrics, South Shore Hospital; Senior Associate in Medicine, Division of Emergency Medicine, Boston Children’s Hospital; Assistant Professor in Pediatrics, Harvard Medical School, Boston, MA


Marine envenomations can cause a diverse array of clinical syndromes. Systemic and life-threatening reactions, as well as delayed presentations, can occur. The pediatric population is at higher risk for serious reactions to envenomations because their greater body surface area and smaller body mass can lead to a higher relative venom load. Although the majority of the literature on marine envenomations is of low quality, the available literature does suggest that management varies depending on the geographic location. This issue reviews both common and life-threatening presentations of marine envenomations, highlights key aspects of the history and physical examination that will help narrow the differential, and offers recommendations for management based on the envenomating creature and geographic location.

Excerpt From This Issue

A 4-year-old girl with the chief complaint of rash is brought to the ED. Her family is on a beach vacation to the Florida coast for the summer. After exiting the ocean today, she complained of a “stinging” feeling on her chest and abdomen. Later in the afternoon, while changing her clothes, her father noticed a rash and brought her to the ED. The girl complains that the rash is “very itchy.” On examination, you note an erythematous papular rash on her abdomen, chest, and buttocks, sparing the extremities, upper back, and face. Her vital signs are all within normal range, and she is well appearing, scratching occasionally at her rash. What is the best way to work up this patient? What treatment is needed? What is the expected clinical course of this condition?

An 11-year-old boy is brought into the ED by EMS. He is in severe pain after encountering a large, floating jellyfish while swimming off the Atlantic coast of the United States. The boy experienced immediate pain after contact, and EMS personnel say he became confused en route to the hospital. The boy's physical examination reveals linear, whip-like erythematous lesions on his neck and left upper extremity. Spasm and fasciculations of the bilateral upper extremities are observed. What type of jellyfish could cause these signs? What critical actions should be performed to manage this patient?

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