Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature

<h3>Background</h3><p dir="ltr">Extremity ischemia and necrosis after jellyfish envenomation can be mutilating and cause long-term functional deficits. The best way to manage these presentations is unknown.</p><h3>Objective</h3><p dir="ltr"&...

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Main Author: Saif Badran (16888785) (author)
Other Authors: Yazeed Eldos (17545749) (author), Robert J. Hoffman (17545752) (author), Sabeena Obaray (17545755) (author), Bran Sivakumar (6819863) (author), Graeme E. Glass (17545758) (author)
Published: 2022
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author Saif Badran (16888785)
author2 Yazeed Eldos (17545749)
Robert J. Hoffman (17545752)
Sabeena Obaray (17545755)
Bran Sivakumar (6819863)
Graeme E. Glass (17545758)
author2_role author
author
author
author
author
author_facet Saif Badran (16888785)
Yazeed Eldos (17545749)
Robert J. Hoffman (17545752)
Sabeena Obaray (17545755)
Bran Sivakumar (6819863)
Graeme E. Glass (17545758)
author_role author
dc.creator.none.fl_str_mv Saif Badran (16888785)
Yazeed Eldos (17545749)
Robert J. Hoffman (17545752)
Sabeena Obaray (17545755)
Bran Sivakumar (6819863)
Graeme E. Glass (17545758)
dc.date.none.fl_str_mv 2022-10-01T00:00:00Z
dc.identifier.none.fl_str_mv 10.1016/j.jemermed.2022.06.014
dc.relation.none.fl_str_mv https://figshare.com/articles/journal_contribution/Extremity_Ischemia_After_Jellyfish_Envenomation_A_Case_Report_and_Systematic_Review_of_the_Literature/24720444
dc.rights.none.fl_str_mv CC BY 4.0
info:eu-repo/semantics/openAccess
dc.subject.none.fl_str_mv Biomedical and clinical sciences
Clinical sciences
Ischemia
Envenomation
Prostaglandin
Thrombolytic
dc.title.none.fl_str_mv Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature
dc.type.none.fl_str_mv Text
Journal contribution
info:eu-repo/semantics/publishedVersion
text
contribution to journal
description <h3>Background</h3><p dir="ltr">Extremity ischemia and necrosis after jellyfish envenomation can be mutilating and cause long-term functional deficits. The best way to manage these presentations is unknown.</p><h3>Objective</h3><p dir="ltr">The aim of this review was to establish an evidence-based consensus for the management of extremity ischemia after jellyfish envenomation.</p><h3>Methods</h3><p dir="ltr">A systematic review of cases of extremity ischemia and necrosis after envenomation by marine cnidarians was performed to clarify what is and what is not known about management and outcomes, to draw conclusions about how best to manage these rare presentations, and to establish an evidence-based algorithm.</p><h3>Results</h3><p dir="ltr">The ischemic sequelae of envenomation typically evolves over a few days. Close medical supervision is necessary to react promptly to the evolving clinical scenario. In the literature, 15 different pharmacologic classes have been used to manage these presentations. Only IV infusions of prostaglandin derivatives and intra-arterial thrombolytics have been found to improve the clinical picture and avoid the need for surgical fasciotomy and debridement in some cases. Anticoagulants, antiplatelet agents, steroids, antibiotics, and nitrates, which are among the most commonly prescribed pharmacologic agents, have not been observed to alter the clinical picture.</p><h3>Conclusions</h3><p dir="ltr">Surgery for compartment syndrome and necrosis are common sequelae of extremity envenomation by marine cnidarians. Only prompt use of IV prostaglandins or intra-arterial thrombolytics can halt ischemic progression and avoid the need for surgery. An algorithm is proposed to guide management of these rare and mutilative presentations.</p><h2>Other Information</h2><p dir="ltr">Published in: The Journal of Emergency Medicine<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1016/j.jemermed.2022.06.014" target="_blank">https://dx.doi.org/10.1016/j.jemermed.2022.06.014</a></p><p dir="ltr">Additional institutions affiliated with: Qatar Poison Center - Sidra Medicine</p>
eu_rights_str_mv openAccess
id Manara2_4a530b66893e7e1bcf16eb7df112b675
identifier_str_mv 10.1016/j.jemermed.2022.06.014
network_acronym_str Manara2
network_name_str Manara2
oai_identifier_str oai:figshare.com:article/24720444
publishDate 2022
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spelling Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the LiteratureSaif Badran (16888785)Yazeed Eldos (17545749)Robert J. Hoffman (17545752)Sabeena Obaray (17545755)Bran Sivakumar (6819863)Graeme E. Glass (17545758)Biomedical and clinical sciencesClinical sciencesIschemiaEnvenomationProstaglandinThrombolytic<h3>Background</h3><p dir="ltr">Extremity ischemia and necrosis after jellyfish envenomation can be mutilating and cause long-term functional deficits. The best way to manage these presentations is unknown.</p><h3>Objective</h3><p dir="ltr">The aim of this review was to establish an evidence-based consensus for the management of extremity ischemia after jellyfish envenomation.</p><h3>Methods</h3><p dir="ltr">A systematic review of cases of extremity ischemia and necrosis after envenomation by marine cnidarians was performed to clarify what is and what is not known about management and outcomes, to draw conclusions about how best to manage these rare presentations, and to establish an evidence-based algorithm.</p><h3>Results</h3><p dir="ltr">The ischemic sequelae of envenomation typically evolves over a few days. Close medical supervision is necessary to react promptly to the evolving clinical scenario. In the literature, 15 different pharmacologic classes have been used to manage these presentations. Only IV infusions of prostaglandin derivatives and intra-arterial thrombolytics have been found to improve the clinical picture and avoid the need for surgical fasciotomy and debridement in some cases. Anticoagulants, antiplatelet agents, steroids, antibiotics, and nitrates, which are among the most commonly prescribed pharmacologic agents, have not been observed to alter the clinical picture.</p><h3>Conclusions</h3><p dir="ltr">Surgery for compartment syndrome and necrosis are common sequelae of extremity envenomation by marine cnidarians. Only prompt use of IV prostaglandins or intra-arterial thrombolytics can halt ischemic progression and avoid the need for surgery. An algorithm is proposed to guide management of these rare and mutilative presentations.</p><h2>Other Information</h2><p dir="ltr">Published in: The Journal of Emergency Medicine<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1016/j.jemermed.2022.06.014" target="_blank">https://dx.doi.org/10.1016/j.jemermed.2022.06.014</a></p><p dir="ltr">Additional institutions affiliated with: Qatar Poison Center - Sidra Medicine</p>2022-10-01T00:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1016/j.jemermed.2022.06.014https://figshare.com/articles/journal_contribution/Extremity_Ischemia_After_Jellyfish_Envenomation_A_Case_Report_and_Systematic_Review_of_the_Literature/24720444CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/247204442022-10-01T00:00:00Z
spellingShingle Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature
Saif Badran (16888785)
Biomedical and clinical sciences
Clinical sciences
Ischemia
Envenomation
Prostaglandin
Thrombolytic
status_str publishedVersion
title Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature
title_full Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature
title_fullStr Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature
title_full_unstemmed Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature
title_short Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature
title_sort Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature
topic Biomedical and clinical sciences
Clinical sciences
Ischemia
Envenomation
Prostaglandin
Thrombolytic