VizD Vol 1.4

Case 1.4

A 35-year-old woman presents to your ED with pain to her right leg.  The patient states that she was swimming in the ocean approximately one hour ago and felt a sharp pain around her knee.  She thought her pain was due to the paddle ball game she was playing earlier in the day.  What do you think?


1. What is the diagnosis?

2. What is the most effective treatment?

3. Name one complication of this patient’s presentation?

Please post your answer in the “reply box” or click on the “comments” link  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

6 Responses

  1. 1) Jellyfish sting
    2) Inactivate nematocysts with vinegar, remove nematocysts with shaving cream and razor, ice pack, topical hydrocortisone and diphenhydramine for minor or oral prednisone for more serious reactions, update tetanus.
    3) Thrombophlebitis and DVT

  2. 1. Cnidarian (formerly Coelenterate) Envenomation
    2. Nematocyst Removal/Inactivation – rinse with saline (not fresh water), scrape affected area, vinegar rinse/anti-venom (around Australia), heat packs, immobilization of affected area, pain management, monitor VS, treat complications.
    3. Severity-, & Geographically-/Species-Dependent – Cardiopulmonary Arrest, Hemolysis, Dermonecrosis, Hypertension, CHF, Severe Pain.
    B. McMichael

  3. 1. Dx: jellyfish sting
    2. Tx: varies depending on howmany times you’ve been around jellyfish –> best is vinegar, next is baking soda or meat tenderizer. Urine is an “old wives trick”. just dont dump water on it, makes it worse.
    3. One Complication: Superficial cellulitis.

  4. 1) Jellyfish sting
    2) Try to remove tentacles or rinse them off. Use vinegar to try and neutralize the toxins.
    3) Those stung can develop severe allergic or anaphylactic reactions.

  5. 1) Jellyfish sting.

    2) Soak the wound in 5% acetic acid for 15-30 minutes to further inhibit nematocyte discharge. Although acetic acid inhibits nematocytes, it does not provide pain relief.

    – Local soft tissue edema and angioedema
    – Ischemic changes distal from localized arterial vasospasm underlying the sting site
    – Thrombophlebitis of the vessel underlying the sting site
    – Local neurapraxia occurring adjacent to sting site from immunologic reaction to toxin or to toxin-induced alteration of the nerve’s ionic permeability

  6. Diagnosis: jelly fish sting
    Most effective treatment: removal of any residual nematocysts and pouring vinegar over wound area
    Complications: In this patient’s case delayed cutaneous reaction as well as possible retained foreign body and infection, although in more severe reactions patients may develop anaphylaxis, more severe stings may result in respiratory paralysis/cardiovascular collapse/death

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