It is widely known that box jellyfish are one of the most venomous marine animals in the world . Envenomation involves the physical discharge of venom into tissues. The venom is a complex mixture of polypeptides and proteins, including hemolytic, cardiotoxic and dermatonecrotic toxins
The islands of Samui and Pha-ngan have the highest incidence of fatal and near fatal box jellyfish cases in Thailand. There is an urgent need for informed pre-clinical emergent care. Optimal pre-clinical care is an area of active research.
All cases developed symptoms and signs immediately after being stung. More than half of the cases were unconscious. There were six fatal cases (46.7 %). The wound characteristics had an appearance similar to caterpillar tracks or step ladder-like burn marks. Almost all cases involved Chirodropidae. One fatal case received fresh water and ice packs applied to the wounds (16.7 %). Among the cases with known first aid, only one out of six fatal cases had vinegar applied to the wounds (16.7 %), while haft of six surviving cases received the vinegar treatment.
Nine lethal jellyfish stings were reported as confirmed cubozoan stings. Of these, 5 or 55 % were reported as confirmed Chirodropid stings, three were reported as suspected Chirodropid stings and one case was due to a either a chirodropid or a carybdeid sting.
Twelve cases were included in analysis where the first aid history was known. Of the six fatal cases, only one had vinegar poured on the injury (16.7 %) as first aid and one had fresh water poured on the wound followed by application of an ice pack (16.7 %). Among the six surviving cases, three received the vinegar treatment (50.0 %). One of them who was stung by Chirodropidae. He lost consciousness and was admitted to Intensive Care Unit, requiring use of a respirator. He received vinegar as first aid at the hospital after 10–15 min being stung (Fig. 4).
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