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Jellyfish Stings
by DAN Medical Team on March 4th, 2016

​What is the best way to care for a jellyfish sting?
​The term ‘jellyfish’ describes an enormous number of marine animals capable of inflicting a painful, and occasionally life-threatening, sting. These include fire coral, hydroids, jellyfishes (including "sea wasps") and anemones. The stings occur when the victim comes into contact with the creature's tentacles or other appendages, which may carry millions of small stinging cells, each equipped with venom and a microscopic stinger.

Depending on the species, size, geographic location, time of year and other natural factors, stings can range in severity from mild burning and skin redness to excruciating pain and severe blistering with generalized illness (nausea, vomiting, shortness of breath, muscle spasm and low blood pressure). Broken-off tentacles that are fragmented in the surf or washed up on the beach can retain their toxicity for months and should not be handled, even if they appear to be dried out and withered.

The dreaded box jellyfish (Chironex fleckeri) of northern Australia contains one of the most potent animal venoms known to man. A sting from one of these creatures can induce death in minutes from cessation of breathing, abnormal heart rhythms and profound low blood pressure (shock).

The Treatment

BE PREPARED TO TREAT AN ALLERGIC REACTION FOLLOWING A JELLYFISH STING. If possible, carry an allergy kit, including injectable epinephrine (adrenaline) and an oral antihistamine.

The following therapy is recommended for all unidentified jellyfish and other creatures with stinging cells:
  1. Immediately flood the wound with vinegar (5% acetic acid). Keep the victim as still as possible. Continuously apply the vinegar until the victim can be brought to medical attention. If you are out at sea or on an isolated beach, allow the vinegar to soak the tentacles or stung skin for 10 minutes before attempting to remove adherent tentacles or to further treat the wound. In Australia, surf lifesavers (lifeguards) may carry antivenin, which is given as an intramuscular injection – a first aid measure.
  2. Flush the area with large amounts of sea water to remove any remaining tentacles.
  3. Immerse the affected area in hot water for 30 to 90 minutes to reduce and / or manage pain.
  4. Remove any remaining tentacle pieces with forceps/tweezers.
  5. Shave the area using shaving cream and a safety razor.
  6. Apply hydrocortisone cream or lotion.
  7. Monitor for allergic reaction or infection.
  8. Apply warm(113F/45 degrees C max) packs to control the pain. This may be repeated as necessary.
  9. If the victim has a large area involved (entire arm or leg, face, or genitals), is very young or very old, or shows signs of generalized illness (nausea, vomiting, weakness, shortness of breath or chest pain), seek help from a doctor. If a person has placed tentacle fragments in his mouth, have him swish and spit whatever potable liquid is available. If there is already swelling in the mouth (muffled voice, difficulty swallowing, enlarged tongue and lips), do not give anything by mouth, protect the airway and rapidly transport the victim to a hospital.


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4 Comments

Sheryl Shea - June 25th, 2016 at 10:21 AM
Hello, I have a question. I am confused about the hot water vs. hot packs. Do they have the same effect? Can they be used interchangeably, if you only have one or the other?

Thank you!
Dr Frans J. Cronje - July 7th, 2016 at 10:37 AM
Great question. It is a matter of convenience and effectiveness. Having hot water available, and a container that permits submersion or immersion of the affected area, within in a typical diving environment -- is a lot to hope for. Hot packs (lite reusable HotShotz packs) are relatively inexpensive, versatile, and last up to 1h30. So, for First Aid equipment planning - I would recommend packing two medium sized hotpacks. In an actual emergency, you may have to use what you can get.
Gillian Vorster - January 26th, 2017 at 5:35 AM
Good day. It is also suggested that stone fish / scorpion fish injuries should also be immersed in very hot water, would heat packs help for this as well?
Thanks
DAN Team - January 26th, 2017 at 6:49 AM
We are pleased that you took the time to comment on the blog post. Below is an answer to your question. However if you need further advice we feel that your comments will be best addressed in person via our hotline. You can contact the DAN hotline toll-free in South Africa on 0800 020 111 or internationally on 27 828 10 60. Alternatively you can email your contact phone number to the DAN medic on call to danmedic@dansa.org.

Lionfish, scorpionfish and stonefish possess dorsal, anal and pelvic spines that transport venom from venom glands into puncture wounds. Common reactions include redness or blanching, swelling and blistering (lionfish). The injuries can be extraordinarily painful and occasionally life-threatening (in the case of a stonefish).

The Treatment

Soaking the wound in non-scalding hot water to tolerance (110 to 113 F / 43.3 to 45 C) may provide dramatic relief of pain from a lionfish sting, is less likely to be effective for a scorpionfish sting, and may have little or no effect on the pain from a stonefish sting, but it should be done nonetheless, because the heat may inactivate some of the harmful components of the venom. If the injured person appears intoxicated or is weak, vomiting, short of breath or unconscious, seek immediate advanced medical care.

Wound care is standard, so, for the blistering wound, appropriate therapy would be a topical antiseptic cream or bacitracin ointment and daily dressing changes. A scorpionfish sting frequently requires weeks to months to heal, and therefore requires the attention of a physician. There is an antivenin available to physicians to help manage the sting of the dreaded stonefish.
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