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 Question

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A reader writes (paraphrased by me): “Here in Corpus Christi, today, while surfing, I practically picked up a large man-o-war while surfing. The burn is intense as I write. I felt severe pain immediately. I panicked in the water. The tentacles clung on to me. I felt pressure on my heart and my feet began to itch. It was a long trip for a remedy, but I finally rinsed the burning skin with vinegar, but I think this made the pain worse as I began to have more pain in my joints and chest. I have been hit by a man-o-war before but never like this. I have been taking Tylenol to help with the pain.”

The victim’s experience invokes many of the nuances of jellyfish sting syndromes. First, the pain is typically described as burning, and begins immediately after the tentacles with their microscopic stinging cells make contact with the skin. When the tentacles wrap around the wrist and/or hand, the pain can be sufficient to cause muscle spasm, so that the ability to grip an object is lost. The “pressure in the heart” described by the victim might have been chest discomfort from the toxin, the cause of which is poorly understood. If the victim was in the age category for coronary artery disease, angina may have been invoked, which would be quite worrisome. It is possible to have a heart attack precipitated by a jellyfish sting, but this is quite rare. Itching in the feet makes one think about an allergic reaction, which is certainly possible after a jellyfish sting.

The victim reports that when he rinsed his skin with vinegar, he continued to suffer pains in his chest and joints. The vinegar would only be expected to diminish the skin pain, if it is effective at all, but not to have an effect on any systemic manifestation of the envenomation. So, if any venom that had entered the victim’s circulation was causing chest pain, joint pain, or any other symptom, topical vinegar would not be expected to have an beneficial impact on those particular problems.

From the description, this sounds like a significant, severe envenomation. Jellyfish stings are not to be taken lightly. I wouldn’t be surprised if this victim develops a prominent inflammatory response, which would have an entirely different set of manifestations, and subsequent treatment.

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

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About the Author

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

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