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Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Jellyfish in Florida

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.

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photo by Larry Madin

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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