Treating Jellyfish Stings

jelly fish stingYou’ve probably seen the cartoons of the person who is urinating on someone who is suffering from a Jellyfish sting.

Jellyfish stings, especially from some – are painful experiences for those who want to enjoy the water in the ocean. As a result there have been many folk remedies such as vinegar, meat tenderizer, to a slurry made with baking soda and water. But recently in the Journal of Emergency medicine, a review of 19 articles showed the best way to treat those stings in North America.  The first way is to avoid them- but if you are swimming in the ocean, you won’t always see those little creatures. So if you get stung, and you will feel it if you do, here is what you can do:

But in North America the most effective remedies are hot water and creams that contain the pain-numbing medicine, lidocaine spray. Worth keeping in your beach bag if you plan on swimming in the ocean.

Keep this spray in your beach bag. Good for treating scrapes, sunburn, and jellyfish stings

Jelly fish leave stingers in a person similar to bees. These contain a sac that contains venom – the first treatment is to try to get these venom sacs off the skin as they keep releasing the toxin. Hot water helps to “denature” the venom. As with bees who leave their stinger, the venom sacs should be scrapped off and not pulled off. Pulling them can result in crushing the sac and releasing more venom.

Sometimes the jellyfish will leave behind an entire tentacle – and that also needs to be removed- but not with your hands.

If you plan on swimming in the golf of Mexico or in Florida where there are Portugese man-of-ars, or bluebottles then vinegar helps ease the sting. They seem to be the only species. Again, not commonly found in the beach bag, but we would recommend it.

For your beach bag first aid kit we recommend:
Lidocaine containing spray – like Solarcaine
Vinegar if in Florida or along the Gulf coast
A thermos bottle with some hot water in it
A pocket knife to scrape the stingers off
Better than the knife is to get a magnifying tweezer
Tongs to remove a tentacle

Be lucky we don’t live in Australia where some small jelly fish have venom so powerful it can kill people.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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  1. BL says:

    I am even more confused now after reading and responding to this very same article published on June 22 where a undisclosed physician noted, recommended and had a photo of a tube of Lidocaine/prilocaine eutectic mixture marketed as a 5% oil-in-water emulsion incorporated in a cream base (EMLA cream) or a cellulose disk (EMLA patch). I commented how the FDA had issued health advisory warnings related to the application of lidocaine on a jellyfish sting. Here’s that link again just in case there was any confusion..

    http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm109068.htm

    I received a kind rebuttal but yet, now I see the recommendation has switched to Solarcaine, a sunburn relief spray with .5% (that’s 1/2 of 1%) lidocaine designed to provide pain relief on very minor wounds like bee stings and, more importantly, far less than the recent published abstract by Dr Ward at UCSD recommended 4%…Someone even went so far as to edit out the June 22 L-P tube and recommendation. If you have ever been stung, I have many times, I would not characterize a jellyfish sting in any form as minor as some species can be fatal. I find the thought completely irresponsible.

    For the record, I remain, wholeheartedly, in disagreement with Dr Ward as his report flies in the face of U.S. and International medical and scientific organizations, well respected authorities on marine sting envenomations and virtually every published fact based science document dating back to 2007 including the NIH, Mayo, Stanford, U.C. Davis, Georgetown and Am Red Cross, Am Heart Association and countless, highly respected, medical organizations. Vinegar, and 5% acetic acid in particular, is universally recommended across the board.

    Given the outdated references used by Dr Ward and his esteemed colleagues, one can only wonder what the motive could be or should be in the face of overwhelming fact based evidence to refute the lidocaine claim. Lidocaine does NOT neutralize the stinging nematocysts.

  2. thedoc says:

    Solarcaine is a spray form of lidocaine. There were two articles that were cited – one a review of articles where they were tested, and one where it was tested. Several experiments were conducted to determine which products would stop the discharging of nematocysts released from Portuguese man-of-war. Nematocysts are hollow pointed or corkscrew-shaped barbs, which are released when tentacles come into contact with human flesh, causing a painful stinging sensation. After much testing under a microscope, the scientific data proved that applying Jellyfish Squish(TM) on a Portuguese man-of-war paralyzes the unfired nematocysts, preventing them from continuing to fire their toxins. Vinegar, ammonia and other products tested did not paralyze the nematocysts and actually caused the remaining nematocysts to fire.
    When you say overwhelming evidence, you choose to believe one source that you read –
    With regards to “minor as some species can be fatal…”-note the difference between North America and Australia – I am referring to North America.
    We all feel pain differently- and a jellyfish can ruin your day in North America, or kill you in Australia, but this was confined to North America.
    Sorry for your confusion

  3. thedoc says:

    You can disagree – but science moves forward. What we use to think changes- especially as we experiment. Here is the original Ward again along with some other citations. You again say it doesn not neutralize the stinging nematocysts – it does two things: inhibits the sac from releasing the toxin, and depolarizes the nerves in scientific studies.

    As for your final paragraph which was rather snarky and uncalled for- I have edited it out. There is no room here for such comments. Happy to give you references, and you may disagree, or think the world is still flat, but such comments are out of bounds here. References below

    Evidence-Based Treatment of Jellyfish Stings in North America and Hawaii
    Nicholas T. Ward, MD, , Michael A. Darracq, MD, Christian Tomaszewski, MD, Richard F. Clark, MD
    Department of Emergency Medicine, Division of Medical Toxicology, UCSD Medical Center, University of California, San Diego, San Diego, CA
    Received 19 December 2011. Revised 16 February 2012. Revised 28 March 2012and Accepted 9 April 2012. Available online 6 June 2012.
    We performed a systematic review of the evidence supporting various treatments for envenomation by jellyfish (cnidarian) and related organisms in North America and Hawaii. Our review produced 19 pertinent primary articles. Current research demonstrates variable response to treatment, often with conflicting results according to species studied, which contributes to considerable confusion about what treatment is warranted and efficacious. Our review suggests that vinegar causes pain exacerbation or nematocyst discharge in the majority of species. Hot water and topical lidocaine appear more widely beneficial in improving pain symptoms and are preferentially recommended. Unfortunately, they may be difficult to obtain at the site of envenomation, such as the beach or diving sites. In these instances, removing the nematocysts and washing the area with saltwater may be considered. If the envenomation is thought to be due to the bluebottle (Physalia), vinegar may be beneficial.

    and here

    Evaluation of the effects of various chemicals on discharge of and pain caused by jellyfish nematocysts
    Laura M. Birsa, Peter G. Verity, Richard F. Lee,
    Skidaway Institute of Oceanography, 10 Ocean Science Circle, Savannah, GA 31411, USA
    Comparative Biochemistry and Physiology Part C: Toxicology & Pharmacology
    Volume 151, Issue 4, May 2010, Pages 426–430
    Abstract
    Jellyfish tentacles in contact with human skin can produce pain swelling and redness. The pain is due to discharge of jellyfish nematocysts and associated toxins and discharge can be caused by a variety of mechanical and chemical stimuli. A series of tests were carried out with chemicals traditionally used to treat jellyfish stings e.g. acetic acid ammonia meat tenderizer baking soda and urea to determine if these chemicals stimulated or inhibited nematocyst discharge and if they brought relief to testers who were exposed to jellyfish tentacles. Chrysaora quinquecirrha (sea nettle) Chiropsalmus quadrumanus (sea wasp) and Physalia physalis (Portuguese man-of-war) were used in the study. It was found that many of the chemicals traditionally used to treat jellyfish stings stimulated nematocyst discharge and did not relieve the pain. However there was immediate relief when a common anesthetic lidocaine was sprayed on the skin of testers in contact with jellyfish tentacles. Initial exposure of tentacle suspensions to lidocaine prevented the nematocyst discharge by subsequent exposure to acetic acid ethanol ammonia or bromelain. Thus lidocaine in addition to acting as an anesthetic on skin in contact with jellyfish tentacles inhibited nematocyst discharge possibly by blocking sodium and/or calcium channels of the nematocytes.

    and here:
    Journal of Applied Toxicology
    Volume 31, Issue 8, pages 720–729, November 2011
    The extract of the jellyfish Phyllorhiza punctata promotes neurotoxic effects

    Raquel Felipe Vasconcelos Carneiro1, Nilberto Robson Falcão do Nascimento1,*, Paula Priscila Correia Costa1, Victor Martins Gomes1, Alex Jardelino Felizardo de Souza2, Simone Cristina Buzzo de Oliveira2,3, Eduardo Britto dos Santos Diz Filho2,3, Fernando José Zara2, Manassés Claudino Fonteles1,4, Daniela de Oliveira Toyama4, Marcos Hikari Toyama2, Cláudia Ferreira Santos1

    ABSTRACT
    Phyllorhiza punctata (P. punctata) is a jellyfish native to the southwestern Pacific. Herewith we present the biochemical and pharmacological characterization of an extract of the tentacles of P. punctata. The tentacles were subjected to three freeze–thaw cycles, homogenized, ultrafiltered, precipitated, centrifuged and lyophilized to obtain a crude extract (PHY-N). Paralytic shellfish poisoning compounds such as saxitoxin, gonyautoxin-4, tetrodotoxin and brevetoxin-2, as well as several secretory phospholipase A2 were identified. PHY-N was tested on autonomic and somatic neuromuscular preparations. In mouse vas deferens, PHY-N induced phasic contractions that reached a peak of 234 ± 34.7% of control twitch height, which were blocked with either 100 μ m of phentolamine or 1 m m of lidocaine. In mouse corpora cavernosa, PHY-N evoked a relaxation response, which was blocked with either L-NG-Nitroarginine methyl ester (0.5 m m) or 1 m m of lidocaine. PHY-N (1, 3 and 10 μg ml−1) induced an increase in tonus of the biventer–cervicis neuromuscular preparation that was blocked with pre-treatment of galamine (10 μ m). Administration of 6 mg kg−1 PHY-N intramuscularly produced death in broilers by spastic paralysis. In conclusion, PHY-N induces nerve depolarization and nonspecifically increases neurotransmitter release. Copyright © 2011 John Wiley & Sons, Ltd.

  4. thedoc says:

    For the record- I do not endorse Jellyfish Squish- but do follow evidence based medicine and its science as to how lidocaine works. My recommendation for beach goers was outlined in the article.

    There are side effects to all medications/ all drugs/ all formulas. One only need to look at a package insert to see how comprehensive lists of drugs and their side effects are. The sad thing is supplements do not contain, nor are they regulated to have a reporting system of side effects — “natural is better” is a silly notion.

    The first fatality for portuguese man-o’-war was reported in 1989 – and was thought to be an allergic reaction. The patient still had cysts on their skin – but died suddenly.

    For pure biologists a Portuguese man-o-war is not a true jellyfish but a colony –

    There is a reason I like swimming pools – always good to be at the top of a food chain

  5. BL says:

    My apologies for any snarkiness you may have taken from my comments..I stand corrected but will respectfully agree to disagree over the science content…I too prefer a pool at the end of the day and enjoy the view from the top of the chain…

    I am aware of the biology distinguishing the differences between to the Man o War versus the jellyfish..I am also aware, as you are, of the sciences associated with your cited publications…While I would admit a more jaundiced view of the conclusions drawn from the methodology in spite of not living on a flat earth and agree that “natural” is a silly notion, there remains significant evidence in support of vinegar/acetic acid..my point is first aid on the side of safety in the face of a potential for negative medical reactions…so, we are at an impasse as granted by our freedoms to adjudicate this matter from our own perspectives as I believe it was you that said science is not without theory and experimentation…..Be that as it may, I appreciate your time in responding and will leave the matter to rest as it is….regards, BL.

  6. thedoc says:

    I like vinegar- and recommended it, and it fits. But not something most put in their beach bag – but if they are in the Gulf of Mexico swimming they should (too many sharks there for me).
    Until then- wear sun block- consider solarcaine in your bag in addition- and if you see a large dorsal fin do not enter the water

  7. BL says:

    Forgive me two issues if you please

    First: As is my typical day, I was perusing details while reading science with my left eye, tapping my foot to a John P Sousa tune while whistling a top forty tune during a work out, so I fear I may have cut and pasted two of my diatribes and sent them both…for that…my apologies..

    Secondly, I am told there is a vinegar based product, made commercially, currently being used by beach rescue in Galveston…I have no information but if the first aid results turn out then maybe I can put Solarcaine and said vinegar product in my beach bag to satisfy any discerning opinion.. 😉 Regards, BL

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