Address ABCs (e.g. CPR, fluid resuscitation, vasopressors, intubation as needed)
Remove tentacles!!!
Nematocysts can continuing firing and delivering more venom if tentacles still attached
If available, pour lots of vinegar over tentacles first to inactivate
Do NOT apply pressure dressing/immobilization (triggers nematocysts to fire)
Box Jellyfish antivenom, if available
Cardiac arrest: 6 ampules IV push
Systemic envenomation with hypotension, collapse, or significant arrhythmia: 3 ampules in 100mL NS over 20m
Pain refractory to opioids: 1 ampule in 100mL NS over 20m
Magnesium sulfate: 10 mmol (~2-3g) IV if hemodynamically unstable
Nematocysts can continuing firing and delivering more venom if tentacles still attached
If available, pour lots of vinegar over tentacles first to inactivate
Cardiac arrest: 6 ampules IV push
Systemic envenomation with hypotension, collapse, or significant arrhythmia: 3 ampules in 100mL NS over 20m
Pain refractory to opioids: 1 ampule in 100mL NS over 20m
Sea wasp sting
Toxins
Lizard bites
Ciguatera
Octopus bite
Scombroid
Snake bites
Tetrodotoxin 