Octopus Envenomation Treatment & Management
- Author: Jon Mark Hirshon, MD, MPH; Chief Editor: Scott H Plantz, MD, FAAEM more...
Prehospital Care
Cardiopulmonary support, including endotracheal intubation and cardiopulmonary resuscitation (CPR), as clinically indicated.
What constitutes proper wound care for octopus envenomation is controversial. Options include the following:
- Immediately irrigate and care for the wound, as one would for any puncture wound.
- Perform local suction without incision or local sequestration of the venom by applying a constricting band proximal to the injury.
- Perform pressure immobilization technique, which is done by compressing a cloth pad with a bandage directly over the wound and surrounding tissues at 9.3 kPa (70 mm Hg) or greater of pressure.
Emergency Department Care
Treatment of octopus envenomation is supportive.
Provide endotracheal intubation and ventilatory support until the venom has worn off, usually within 4-10 hours.
Confirm that the patient's tetanus status is current.
No antivenin is available.
Neostigmine and edrophonium have shown benefit in restoring muscular strength in some cases of tetrodotoxin intoxication (eg, puffer fish), but have not undergone clinical trials in blue-ringed octopus envenomations.
4-Aminopyridine (Neurelan - US, Pymadine), a drug utilized as an antagonist to nondepolarizing neuromuscular blocking agents (available in the US as an orphan drug for multiple sclerosis), has been shown to reverse tetrodotoxin toxicity in animal experiments.[10]
Consultations
A general surgery consult may be indicated for wide excision of the wound. However, this has not proven to improve outcome.
A medical toxicologist (certified by the American Board of Medical Toxicology or the American Board of Emergency Medicine), or a poison control center certified by the American Association of Poison Control Centers, should be contacted regarding this uncommon intoxication.
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