Evaluation of a Guest Lecture on Medical Emergency of Box Jellyfish Envenomation Pathophysiology and First Aid for Medical Students.

Introduction: Lethal box jellyfish envenomation has been reported in Indonesia and other countries; therefore, medical students should be equipped with related knowledge. The aim of this study was to evaluate the results of summative exams by student cohort and gender and determine the factors that contribute to success in the summative exams after novel intensive instruction in box jellyfish envenomation pathophysiology and first aid in undergraduate medical students in Surabaya, Indonesia. Methods: This study used explanatory sequential mixed methods, consisting of a cross-sectional study and interviews. A total population sampling of 203 sixth-semester students was employed. Student cohort, gender, previous semester grade point average (GPA), and English proficiency test (EPT) were considered. All statistical tests were carried out using IBM® SPSS® Statistics version 24.0 for Macintosh. The study was complemented by interviews conducted with 20 students. Results: The one-way ANOVA test showed that students from the 2016 cohort had significantly higher mean scores in the exam than the 2015 and 2014 cohorts (p=0.002). Independent samples t-test showed that such differences were not gender-specific (p=0.249). In the binary logistic regression, the GPA in the previous semester was the only factor that contributed to success in the summative exam (OR 3.031, 95% CI: 1.520-6.044). All students commented that the lecture and practicum were interesting and beneficial. However, some considered that the language barrier might have prevented them from understanding the topic well. Conclusion: Results of the summative exam differed by the student cohorts, and previous semester GPA was a predictor of success in the summative exam.

Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations.

Cnidarian envenomations are the leading cause of severe and lethal human sting injuries from marine life. The total amount of venom discharged into sting-site tissues, sometimes referred to as "venom load", has been previously shown to correlate with tentacle contact length and sequelae severity. Since <1% of cnidae discharge upon initial tentacle contact, effective and safe removal of adherent tentacles is of paramount importance in the management of life-threatening cubozoan stings. We evaluated whether common rinse solutions or scraping increased venom load as measured in a direct functional assay of venom activity (hemolysis). Scraping significantly increased hemolysis by increasing cnidae discharge. For Alatina alata, increases did not occur if the tentacles were first doused with vinegar or if heat was applied. However, in Chironex fleckeri, vinegar dousing and heat treatment were less effective, and the best outcomes occurred with the use of venom-inhibiting technologies (Sting No More® products). Seawater rinsing, considered a "no-harm" alternative, significantly increased venom load. The application of ice severely exacerbated A. alata stings, but had a less pronounced effect on C. fleckeri stings, while heat application markedly reduced hemolysis for both species. Our results do not support scraping or seawater rinsing to remove adherent tentacles.

Cnidarian (coelenterate) envenomations in Hawai'i improve following heat application.

A retrospective review of medical records from 113 patients with cnidarian stings in western O'ahu, Hawai'i, was conducted for the 5-year period 1994-98. The most common clinical feature was acute local pain, but cases of anaphylaxis or anaphylactoid syndrome and a persistent or delayed local cutaneous syndrome were also documented. Six cases resembled the Irukandji syndrome described from northern Australia, characterized by severe pain and signs of catecholamine excess, including muscle cramping, elevated blood pressure, diaphoresis, and tremor. Treatment with heat application, usually by means of a whole-body hot shower, appeared to provide better clinical improvement than parenteral analgesics or tranquillizers, particularly in patients with the Irukandji-like syndrome. The heat sensitivity of one or more of the Carybdea alata venom components might account for the effect of heat treatment. Prospective, randomized, controlled clinical trials should be performed to assess heat treatment for cnidarian envenomation.