There’s something in the water: an overview of jellyfish, their stings, and treatment

An increasing presence on many beaches worldwide, jellyfish are a diverse group of Cnidarians equippedwith stinging cells termed cnidocytes. Though few of the over 10,000 species are dangerous to humans,and most that are produce no more than a painful sting, some jellyfish can produce systemic symptomsand even death. Chironex fleckeri, the Australian box jellyfish, has a venom potent enough to kill in lessthan 10 minutes, and for which there is an antivenom of debatable efficacy. Stings from Carukia barnesican cause Irukandji syndrome, characterised by severe pain and hypertension. Jellyfish stings have alsobeen associated with Guillain-Barre syndrome and anaphylaxis. Though optimal treatment of stings remainscontroversial, after removal from the water and addressing any immediate life threats, the tentacles shouldbe removed and the area washed, with seawater being the best choice due to its low likelihood of inducingfurther cnidocyte discharge. Hot water immersion may be beneficial for pain control for non-tropical jellyfishstings, and cold packs for tropical stings. In general, there is no consensus for the optimal treatmentof jellyfish stings, and so further research is needed into species-specific guidelines and whether thereare any overarching rules

Characteristics of fatal marine accidents

Background: Venturing onto the water for business or pleasure is not a risk-free activity. Despite the dangersfacing crew and passengers there is little data on the characteristics of fatal accidents involving vesselsin the water. The goal of this study was to review accident reports from the National Transportation SafetyBoard (NTSB) to determine characteristics of fatal marine accidents.Materials and methods: Data was obtained from the Marine Accident Reports issued by the NTSB. Informationregarding the number of people involved, fatalities and the accident itself was collected.Results: Fifty-two accidents involving 5045 people from 1972 to 2019 were included in the study, with468 fatalities reported. Of the fatalities, 155 (33.1%) were definitely on the vessel when they died,49 (10.5%) were probably on the vessel, 65 (13.9%) were definitely or likely in the water, and the locationof 199 (42.5%) was unknown. The most common cause of death was drowning (88, 18.8%), the mostcommon accident cause was sinking (63.5%), and accidents most often started during nighttime hours(7pm–7am, 30, 57.7%).Conclusions: This study found that sinking was the most common accident cause for fatal marine accidents,drowning the most common cause of death, and where fatality location was known most were on the vesselwhen they died. This suggests that, particularly when a ship is in the process of sinking, it is of paramountimportance to ensure passengers and crew are familiar with exit routes, are able to exit the vessel, andare instructed to do so in a timely manner

Local Pro- and Anti-Coagulation Therapy in the Plastic Surgical Patient: A Literature Review of the Evidence and Clinical Applications

The risks of systemic anti-coagulation or its reversal are well known but accepted as necessary under certain circumstances. However, particularly in the plastic surgical patient, systemic alteration to hemostasis is often unnecessary when local therapy could provide the needed adjustments. The aim of this review was to provide a summarized overview of the clinical applications of topical anti- and pro-coagulant therapy in plastic and reconstructive surgery. While not a robust field as of yet, local tranexamic acid (TXA) has shown promise in achieving hemostasis under various circumstances, hemostats are widely used to halt bleeding, and local anticoagulants such as heparin can improve flap survival. The main challenge to the advancement of local therapy is drug delivery. However, with increasingly promising innovations underway, the field will hopefully expand to the betterment of patient care