Answer VizD 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?


1. Jellyfish sting – envenomation occurs through nematocysts, which are sharp stinging cells.  Nematocysts are enclosed in venom sacs and present in tentacles.

2. On scene, vinegar is ideal.  Sea water is acceptable.  Tap water should be avoided as it may lead to a worsening of the envenomation.  Patients should receive tetanus toxoid if mandated.

3. Anaphylactoid reaction, leading to hypotension, dysrhythmias. bronchospasm, and cardiovascular collapse.

Here is an article from the Australian experts on Marine Envenomations

Thank you to everyone who submitted their answer.  Stay tuned for next week’s VizD

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.

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