![]() Immediate pain after a jellyfish sting, occurring in shallow tropical waters between November and April, associated with linear welts with a cross‑hatched pattern, is pathognomonic of Chironex fleckeri sting.A steroid or antihistamine cream may provide symptomatic relief if a delayed hypersensitivity rash occurs.Despite its reputation, the vast majority of box jellyfish stings require only first‑aid Decompression illness may lead to severe pain and collapse shortly after a diver has surfaced.Significant linear dermal markings or welts are not seen Pain associated with Irukandji syndrome is usually delayed, severe and generalised.Pain usually resolves within 1 hour and systemic symptoms are extremely rare Bluebottle stings (Physalia species) are also associated with immediate pain and dermal markings.Give one ampoule (1 × 20,000 units) for pain refractory to IV opioid analgesia.The patient is observed closely for response to treatment and ongoing features of envenoming prompt a further dose of antivenom (up to three ampoules) Give three ampoules (3 × 20,000 units) IV diluted in 100 mL normal saline over 20 minutes to all patients with systemic envenoming as evidenced by collapse, hypotension or significant cardiac arrhythmia.Give titrated morphine (0.1 mg/kg IV up to 5 mg every 10 minutes) to patients with pain refractory to first‑aid.Intravenous magnesium (10 mmol) should be given if there is no response to antivenom All immediately available Box Jellyfish antivenom (up to 6 ampoules) should be given. In cardiac arrest, undiluted antivenom, administered as a rapid IV push, may be life‑saving.Potential early life‑threats that require immediate intervention include cardiac arrest, hypotension or hypertension and cardiac arrhythmia. ![]() Patients should be managed in an area equipped for cardiorespiratory monitoring and resuscitation.Rarely, box jellyfish envenoming is a life‑threatening emergency.
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