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海洋生物刺傷のアルゴリズム Marine envenomation

出典
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1: Auerbach: Wilderness Medicine, 6th ed.FIGURE 80-104, Mosby, 2011

tentacle prints

tentacle printsと呼ばれる触手の痕があればクラゲ刺傷が疑わしい。
出典
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1: Thomas P. Habif. Clinical Dermatology: A Color Guide to Diagnosis and Therapy , FIFTH EDITION. Figure 15-59 2010

カツオノエボシ

出典
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1: Auerbach: Wilderness Medicine, 6th ed.FIGURE 80-31, Mosby, 2011 (From Norbert Wu, with permission.http://www.norbertwu.com.)

オーストラリアウンバチクラゲ抗毒素血清

出典
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1: Auerbach: Wilderness Medicine, 6th ed.FIGURE 80-52, Mosby, 2011

酢

クラゲ刺傷に酢をかけている。
出典
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1: Auerbach: Wilderness Medicine, 6th ed.FIGURE 80-47, Mosby, 2011

クラゲ刺傷のメカニズム

皮膚に触れることで刺胞が刺激され毒が注入される。
a:皮膚からの刺激が刺胞放出プロセスを開始させる。
b:刺傷被膜内に150 atmの高い内圧が生じる。
c:重力の40,000倍の加速により、柄が皮膚内部に穴を開ける。
d:小管が柄に従って体内に毒物を注入する。

水泡を生じたクラゲ刺傷

ハコクラゲ(box-jellyfish)の典型であるオーストラリアウンバチクラゲ(Chironex fleckeri)の毒による草創壊死(24時間以内)
クラゲ刺傷部位に水疱を生じている。
出典
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1: Auerbach: Wilderness Medicine, 6th ed.FIGURE 80-48, Mosby, 2011.

ハコクラゲ(box-jellyfish)の典型であるオーストラリアウンバチクラゲ(Chironex fleckeri)刺傷による壊死

a: インテンス壊死(ここでは48時間)で手足全体に広がる
b:皮膚壊死を起こし、紫~黒色に変化した皮膚
出典
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1: Auerbach: Wilderness Medicine, 6th ed.FIGURE 80-47, Mosby, 2011

反応の重症度(疼痛と反応の臨床徴候の双方を含む)および触角接触後の反応に至るまでの時間をインヒビター投与群とプラセボ投与群で比較したC. fuscescens群の結果

C. fuscescensというクラゲ刺傷におけるSafe sea群とプラセボ塗布群の比較。Safe sea塗布群が痛み・皮疹の出現ともに少なかった。
出典
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1: Efficacy of a jellyfish sting inhibitor in preventing jellyfish stings in normal volunteers.
著者: Alexa Boer Kimball, Karina Zuelma Arambula, Arlen Ray Stauffer, Valeh Levy, Valerie Weaver Davis, Michael Liu, Wingfield Ellis Rehmus, Amit Lotan, Paul S Auerbach
雑誌名: Wilderness Environ Med. 2004 Summer;15(2):102-8.
Abstract/Text: OBJECTIVE: To evaluate the protective effects of a jellyfish sting inhibitor formulated in sunscreen lotion vs conventional sunscreen against Chrysaora fuscescens and Chiropsalmus quadrumanus jellyfish.
METHODS: Twenty-four healthy subjects at 2 research sites were randomly assigned to receive the jellyfish sting inhibitor (Nidaria Technology Ltd, Jordan Valley, Israel) to one forearm and conventional sunscreen to the other arm in a blinded fashion. Subjects were stung with jellyfish tentacles on each forearm for up to 60 seconds. Erythema and pain were assessed at 15-minute intervals over a 2-hour period.
RESULTS: In the C. fuscescens group, all 12 arms pretreated with conventional sunscreen demonstrated erythema, and all subjects noted subjective discomfort. In contrast, no arm pretreated with the jellyfish sting inhibitor had objective skin changes (P < .01). Two subjects noted minimal discomfort in the arm treated with the sting inhibitor (P < .01). In the C. quadrumanus group, discomfort was reported in 3 of the 12 inhibitor-treated arms compared with 10 of the 12 placebo-treated arms (P < .05). Erythema was noted on 1 arm treated with the inhibitor and 9 arms treated with the placebo (P < .01).
CONCLUSIONS: The jellyfish sting inhibitor prevented sting symptoms of C. fuscescens jellyfish in 10 of 12 subjects and diminished the pain of the jellyfish sting in the remaining 2 subjects. The jellyfish sting inhibitor also inhibited the more severe sting of the C. quadrumanus jellyfish in the majority of subjects. The jellyfish sting inhibitor does not eliminate the sting from C. fuscescens or C. quadrumanus jellyfish but significantly reduces the frequency and severity of stings.
Wilderness Environ Med. 2004 Summer;15(2):102-8.

反応の重症度(疼痛と反応の臨床徴候の双方を含む)および触角接触後の反応に至るまでの時間をインヒビター投与群とプラセボ投与群で比較したC. quadrumanus群の結果

C. quadrumanus刺傷においても、Safe sea塗布群において、痛み・皮疹の出現ともに少なかった。
出典
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1: A randomized, controlled field trial for the prevention of jellyfish stings with a topical sting inhibitor.
著者: David R Boulware
雑誌名: J Travel Med. 2006 May-Jun;13(3):166-71. doi: 10.1111/j.1708-8305.2006.00036.x.
Abstract/Text: BACKGROUND: Jellyfish stings are a common occurrence among ocean goers worldwide with an estimated 150 million envenomations annually. Fatalities and hospitalizations occur annually, particularly in the Indo-Pacific regions. A new topical jellyfish sting inhibitor based on the mucous coating of the clown fish prevents 85% of jellyfish stings in laboratory settings. The field effectiveness is unknown. The objective is to evaluate the field efficacy of the jellyfish sting inhibitor, Safe Sea.
METHODS: A double-blind, randomized, placebo-controlled trial occurred at the Dry Tortugas National Park, FL, USA and Sapodilla Cayes, Belize. Participants were healthy volunteers planning to snorkel for 30 to 45 minutes. Ten minutes prior to swimming, each participant was directly observed applying a blinded sample of Safe Sea (Nidaria Technology Ltd, Jordan Valley, Israel) to one side of their body and a blinded sample of Coppertone (Schering-Plough, Kenilworth, NJ, USA) to the contralateral side as placebo control. Masked 26 g samples of both Safe Sea SPF15 and Coppertone SPF15 were provided in identical containers to achieve 2 mg/cm(2) coverage. Sides were randomly chosen by participants. The incidence of jellyfish stings was the main outcome measure. This was assessed by participant interview and examination as subjects exited the water.
RESULTS: A total of 82 observed water exposures occurred. Thirteen jellyfish stings occurred during the study period for a 16% incidence. Eleven jellyfish stings occurred with placebo, two with the sting inhibitor, resulting in a relative risk reduction of 82% (95% confidence interval: 21%-96%; p= 0.02). No seabather's eruption or side effects occurred.
CONCLUSIONS: Safe Sea is a topical barrier cream effective at preventing >80% jellyfish stings under real-world conditions.
J Travel Med. 2006 May-Jun;13(3):166-71. doi: 10.1111/j.1708-8305.2006...

クラゲ刺傷の初診時のアルゴリズム

出典
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1: 著者提供

海洋生物刺傷のアルゴリズム Marine envenomation

出典
img
1: Auerbach: Wilderness Medicine, 6th ed.FIGURE 80-104, Mosby, 2011

tentacle prints

tentacle printsと呼ばれる触手の痕があればクラゲ刺傷が疑わしい。
出典
img
1: Thomas P. Habif. Clinical Dermatology: A Color Guide to Diagnosis and Therapy , FIFTH EDITION. Figure 15-59 2010