Prehospital Care
Cardiopulmonary support, including endotracheal intubation and cardiopulmonary resuscitation (CPR), as clinically indicated.
What constitutes proper wound care for octopus envenomation is controversial.
Immediately irrigate and care for the wound, as one would for any puncture wound.
Local suction without incision was suggested by Halstead, but this practice has not been shown to be effective in other envenomations and no evidence supports its use in blue-ringed octopus bites.
Consider performing a 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.
The patient with octopus envenomation should be admitted to an intensive care unit until the venom has worn off, usually in 4-10 hours. Provide endotracheal intubation and ventilatory support until the venom has worn off.
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 used as an antagonist to nondepolarizing neuromuscular blocking agents (available in the United States as an orphan drug for multiple sclerosis), has been shown to reverse tetrodotoxin toxicity in animal experiments. [17]
If significant hypoxia has not occurred, recovery is usually rapid.
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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Blue-ringed octopus. Image courtesy of Simon Dubbin.
