Jellyfish in Florida
Wednesday, January 10, 2007
Paul Auerbach, M.D.
This time of year, Portuguese man-of-war jellyfish wash up on the beaches in South Florida. When they are in the area, strong breezes directed toward shore drive them into the surf. As the lifeguards and residents in the area know, they can pack quite a punch, even after they are dead and dried up, as the stinging cells may remain active.
In addition to the skin rash, pain, and general symptoms of muscle pain, weakness, nausea, abdominal pain, and vomiting that may accompany a sting, it is extremely important to remember that a sting from a jellyfish can cause an allergic reaction, which can become life threatening. Anyone known to be allergic to jellyfish should carry medications (e.g., antihistamines and epinephrine) with them when they might be exposed to jellyfish.
Here is more information about what to do if stung by a Portuguese man-of-war jellyfish along the U.S. coastline:
1. Immediately rinse the wound with seawater, not with freshwater. Do not rub the wound with a towel or clothing to remove adherent tentacles. Nonforceful freshwater rinsing or a rubbing variety of abrasion (the latter in the absence of simultaneous application of a decontaminant such as vinegar) is felt to stimulate any microscopic stinging cells. that have not already fired. Surf life savers (lifeguards) in the United States and Hawaii have reported that a freshwater hot shower applied with a forceful stream may decrease the pain of an envenomation. Commercial (chemical) cold or ice packs applied over a thin dry cloth or plastic membrane have been shown to be effective when applied to mild or moderate stings. A warm-hot pack at temperature of approximately 40 to 41 degrees Centigrade [104 to 105.8 degrees Fahrenheit] (taking care to not burn the skin) may be even more effective.
2. Acetic acid 5% (household vinegar) is the treatment of choice to diminish pain from the sting. The vinegar should be applied continuously for at least 30 minutes or until the pain is relieved. Other substances that may be effective include isopropyl ("rubbing') alcohol (40% to 70%), dilute ammonium hydroxide (household ammonia), sodium bicarbonate (baking soda), olive oil, sugar, urine, lemon or lime juice, and papain (papaya latex [juice] or unseasoned meat tenderizer powdered or in solution). Perfume, aftershave lotion, and high proof liquor are not particularly effective. Other substances mentioned to be effective at one time or another, but which are not to be used, are organic solvents such as formalin, ether, and gasoline.
3. As mentioned above, antihistamines may be useful if there is an allergic component. The administration of epinephrine is appropriate in the setting of a severe or rapidly evolving allergic reaction.
4. Once the wound has been soaked with a decontaminant (e.g., vinegar), remaining (and often “invisible”) stinging cells must be removed. The easiest way to do this is to apply shaving cream or a paste of baking soda, flour, or talc and to shave the area with a razor or similar tool. If sophisticated equipment is not available, the nematocysts should be removed by making a sand or mud paste with seawater and using this to help scrape the victim’s skin with a sharp edged shell or piece of wood. The rescuer must take care not to become envenomed; bare hands must be rinsed frequently. If a scrub brush or pad has been used to treat the envenomation, this step may not result in as much, if any, clinical improvement.
Tags: jellyfish, Portuguese man-of-war, Florida, wilderness medicine, outdoor medicine, healthline
photo by Larry Madin
6 Comments:
At Mon Jan 15, 06:38:00 PM 2007,
Jeremy Joslin, MD said…
A recent edition of WEM details a great case report on a jellyfish sting. This got me to reading more on them in general. One such article I read was from WikiPedia (1) which suggests the Man-of-War (psuedo-jellyfish) should be treated differently than other true jellyfish. Is there are credence to this? There is a single study cited (2), but I wonder what your comments are.
1.) http://en.wikipedia.org/wiki/Jellyfish
2.) Fenner P, Williamson J, Burnett J, Rifkin J (1993). "First aid treatment of jellyfish stings in Australia. Response to a newly differentiated species". Med J Aust 158 (7): 498-501
At Tue Jan 16, 08:21:00 PM 2007,
Paul Auerbach, M.D. said…
Thanks for your questions. The first aid ("field") treatment of jellyfish and creatures such as the colonial siphonophore Physalia physalis (Atlantic Portuguese man of war) has been controversial off-and-on for as long as I can remember. The arguments are generally about which, if any, topical methods can be used to diminish the severity of the sting. One important consideration is that to the best of our knowledge, whether or not a creature is a true jellyfish is most important insofar as it relates to the stinging (envenomation) mechanism. So far, all of these creatures seem to employ variations of stinging cells, each of which ejects a venom-laden dart from a "cyst" into the victim. Therefore, it is reasonable to assume that while there may be phylogenetic differences between the creatures, methods that work for one might be expected to work for others. That having been said, since the creatures are not identical, the precise decontaminants (e.g., vinegar, rubbing alcohol, ammonia, etc.) may differ from species to species. Similarly, some may respond better or not at all variations of applied temperature (hot or cold), changes in pH (e.g., vinegar versus ammonia), and so forth. Local knowledge is key, again with the understanding that the empirical observations are often in conflict between observers. Finally, what occurs under the microscope may not translate directly to the in vivo human condition. For now, until I am made aware of data that would lead me to change recommendations, I favor what I have written. However, I stand to be corrected if there is good reason for me to change my mind. For instance, I have recently deferred to my Australian colleagues in their admonition to no longer use the pressure-immobilization technique for a box jellyfish (Chironex fleckeri) sting. They initially recommended it on the supposition that it would sequester venom in the superficial veins and lymphatics and therefore diminish the systemic effects of a sting, but they have now reversed course, citing stimulation of the stinging cells from the pressure as the major effect. As far as vinegar goes for stings, most folks swear by it, while others believe that there are more effective methods, such as application of hot (non-scalding) water.
Finally, while I enjoy reading Wikipedia, without knowing the source of the information, I am not yet ready to accept it as gospel. In the write up on Portuguese man of war, there is an admonition to never apply vinegar to an adherent tentacle, with the implication that this would worsen the envenomation, because it would cause the stinging cells to discharge their contents. I do not know where that information was obtained, but it does not correlate with many clinical observations. It seems that this particular issue would be amenable to a preclinical study.
At Sat Jan 20, 06:21:00 PM 2007,
Littlelight said…
In the past week, while walking the beaches of Mayport south to Jacksonville, Fl, I came across more than one hundred dead jellyfish. None of them had their tentacles. Can you tell me why?
At Fri Aug 17, 02:08:00 AM 2007,
sirjames8 said…
For jellyfish stings, including Portugese-Man-O'-War stings I have found Adolphs meat tenderizer to be very effective. the active ingredient which breaks down thw venom is Papaine (papaya enzyme). It breaks the poison's proteins down into harmless amino acids.
Please let me know how useful you find this advice at Gypsysouls8@yahoo.com use Jim M. as the subject line as this is my wife's e-mail
At Fri Aug 17, 11:02:00 AM 2007,
Paul Auerbach, M.D. said…
As I mentioned in the blog post, papain (commonly found as meat tenderizer) has been recommended as a decontaminant for jellyfish stings, on the theory that it breaks down protein venom components. I personally have not tried it, but others report its effectiveness against a variety of jellyfish, and in particular, "seabather's eruption," sometimes called "sea lice," which represents envenomation by small thimble-shaped jellyfishes and their larval forms. The most important precaution with meat tenderizer is to remember that it can be irritating to sensitive skin, such as that on the inside of one's arm, or the skin of a young child. Therefore, it should not be left on the skin for more than 10 minutes before it is rinsed off, and should not be used on infants and toddlers. I have heard of papain being used effectively to counteract the pain of a bee sting, but am not aware of any science supporting that recommendation.
At Wed Apr 02, 08:37:00 AM 2008,
loose duece said…
here in corpus christi, today, while surfing,i practically picked up a large manowar while surfing,the burn is intense as i write,imediatly i felt severe pain i paniced in the water, the tenticals clung on, anyways with some pressure on my heart the long trip to any place for remedy my feet began to itch with burning pain,finally i rinsed the burn in vinegar but with the tentacles still on, i think this made the pain worse as i began to have more pain in my joints and chest, i have been hit by the mow b4 but never like this,i have been taking tylenol to help with pain
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