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

BackgroundExtremity ischemia and necrosis after jellyfish envenomation can be mutilating and cause long-term functional deficits. The best way to manage these presentations is unknown. ObjectiveThe aim of this review was to establish an evidence-based consensus for the management of extremity ischem...

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Main Author: Saif, Badran (author)
Other Authors: Eldos, Yazeed (author), Hoffman, Robert J. (author), Obaray, Sabeena (author), Sivakumar, Bran (author), Glass, Graeme E. (author)
Format: article
Published: 2022
Subjects:
Online Access:http://dx.doi.org/10.1016/j.jemermed.2022.06.014
https://www.sciencedirect.com/science/article/pii/S0736467922003535
http://hdl.handle.net/10576/45370
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author Saif, Badran
author2 Eldos, Yazeed
Hoffman, Robert J.
Obaray, Sabeena
Sivakumar, Bran
Glass, Graeme E.
author2_role author
author
author
author
author
author_facet Saif, Badran
Eldos, Yazeed
Hoffman, Robert J.
Obaray, Sabeena
Sivakumar, Bran
Glass, Graeme E.
author_role author
dc.creator.none.fl_str_mv Saif, Badran
Eldos, Yazeed
Hoffman, Robert J.
Obaray, Sabeena
Sivakumar, Bran
Glass, Graeme E.
dc.date.none.fl_str_mv 2022-10
2023-07-11T11:11:01Z
dc.format.none.fl_str_mv application/pdf
dc.identifier.none.fl_str_mv http://dx.doi.org/10.1016/j.jemermed.2022.06.014
Badran, S., Eldos, Y., Hoffman, R. J., Obaray, S., Sivakumar, B., & Glass, G. E. (2022). Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature. Journal of Emergency Medicine, 63(4), 507-519.
0736-4679
https://www.sciencedirect.com/science/article/pii/S0736467922003535
http://hdl.handle.net/10576/45370
507-519
4
63
1090-1280
dc.language.none.fl_str_mv en
dc.publisher.none.fl_str_mv Elsevier
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
dc.subject.none.fl_str_mv 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 Article
info:eu-repo/semantics/publishedVersion
info:eu-repo/semantics/article
description BackgroundExtremity ischemia and necrosis after jellyfish envenomation can be mutilating and cause long-term functional deficits. The best way to manage these presentations is unknown. ObjectiveThe aim of this review was to establish an evidence-based consensus for the management of extremity ischemia after jellyfish envenomation. MethodsA 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. ResultsThe 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. ConclusionsSurgery 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.
eu_rights_str_mv openAccess
format article
id qu_fe59df918fdb7e8962f5943481f1a019
identifier_str_mv Badran, S., Eldos, Y., Hoffman, R. J., Obaray, S., Sivakumar, B., & Glass, G. E. (2022). Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature. Journal of Emergency Medicine, 63(4), 507-519.
0736-4679
507-519
4
63
1090-1280
language_invalid_str_mv en
network_acronym_str qu
network_name_str Qatar University repository
oai_identifier_str oai:qspace.qu.edu.qa:10576/45370
publishDate 2022
publisher.none.fl_str_mv Elsevier
repository.mail.fl_str_mv
repository.name.fl_str_mv
repository_id_str
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
spelling Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the LiteratureSaif, BadranEldos, YazeedHoffman, Robert J.Obaray, SabeenaSivakumar, BranGlass, Graeme E.IschemiaEnvenomationProstaglandinThrombolyticBackgroundExtremity ischemia and necrosis after jellyfish envenomation can be mutilating and cause long-term functional deficits. The best way to manage these presentations is unknown. ObjectiveThe aim of this review was to establish an evidence-based consensus for the management of extremity ischemia after jellyfish envenomation. MethodsA 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. ResultsThe 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. ConclusionsSurgery 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.Elsevier2023-07-11T11:11:01Z2022-10Articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://dx.doi.org/10.1016/j.jemermed.2022.06.014Badran, S., Eldos, Y., Hoffman, R. J., Obaray, S., Sivakumar, B., & Glass, G. E. (2022). Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature. Journal of Emergency Medicine, 63(4), 507-519.0736-4679https://www.sciencedirect.com/science/article/pii/S0736467922003535http://hdl.handle.net/10576/45370507-5194631090-1280enhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:qspace.qu.edu.qa:10576/453702024-07-23T13:53:53Z
spellingShingle Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature
Saif, Badran
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 Ischemia
Envenomation
Prostaglandin
Thrombolytic
url http://dx.doi.org/10.1016/j.jemermed.2022.06.014
https://www.sciencedirect.com/science/article/pii/S0736467922003535
http://hdl.handle.net/10576/45370