A regular and progressively problematic issue or menace in the Mediterranean is the increased jellyfish population. Yachts and crew increasingly report issues with stings.
Most often, by the time the person is aware they have been stung, there will be little sign of the offending organism, so no positive identification is possible. Treatment is therefore guided by symptom relief. Any sting can cause a very severe reaction, or even anaphylaxis, so watch for unusual symptoms or symptoms of anaphylaxis.
General symptoms of venomous stings and bites
Typical symptoms
Pain, Rash, Stinging, Redness, Itching, Swelling
Unusual symptoms
Symptoms of Anaphylaxis
Symptom and Signs
General skin flushing
Swelling of lips and eyes
Fast pulse
Faintness
Wheezy chest
Shock / collapse
Treatment call for help and advice EARLY
ABC if collapsed
Adrenaline 0.5mg im (0.5ml of 1:1000 solution)
Anti-histamine: Chlorphenamine 10-20mg im
Steroid: Hydrocortisone 100mg im or iv
iv access and iv fluids (500ml immediately)
Further treatment – seek professional medical assistance
Headache, Weakness, Nausea & vomiting, Muscle pain, Sweating, Chest pain
Types of Jellyfish in the Med
- Cotylorhiza Tuberculata or the fried egg jellyfish – Not a painful sting, causes some itching similar to a mosquito bite.
- Aurelia Aurita – Not a painful sting, causes some itching and irritation.
- Chrysaora Hysoscella – A painful sting, causes itching & a burning sensation. Can cause scarring for up to a month.
- Rhizostoma Pulmo – A painful sting, causes some pain.
- Pelagia Noctiluca – A painful and dangerous sting, causes pain, burning, nausea & possible muscle cramps.
- Physalia Physalis or Portuguese man of war (a purple blue airbag that floats on the surface) – Very painful and dangerous sting usually require a strong anti-histamine to treat
Treatment of stings
- Avoid getting stings or tentacles on yourself – use caution and gloves when treating
- Remove the victim from the water to avoid further stings
- Soak the area in hot seawater (about 40-45°C – hot to the elbow (104-112°)) for 30-90 mins. This will ease pain and cause breakdown of the venom (thermolysis).
- DO NOT USE freshwater – this will cause further envenomation and worsen the symptoms
- Vinegar, urine or bicarbonate could be used, but may cause further envenomation and worsen the symptoms
- Pick off obvious tentacles with tweezers
- Cover the area with a flour past or shaving foam, and gently scrape off the paste/tentacle mixture with plastified scraper cards
- For relief of pain – use lignocaine 5% ointment. Spread very thinly over the affected area – read the patient instructions in the packet. Call for advice before using on children
- For relief of inflammation – use hydrocortisone 1% cream. Spread thinly over the affected area – read the patient instructions in the packet. Call for advice before using on children
- Cover the area with a sterile dressing. Inspect every six hours or so. If there is any sign of infection (increasing pain or redness), use mupirocin 2% ointment. Spread thinly over the affected area – read the patient instructions in the packet. Call for advice before using on children
- Use oral analgesics (paracetamol/ibuprofen) and antihistamines (loratidine) as required.
- If there is on-going infection, call for advice. Oral antibiotics may be required.
At Medical Support Offshore, we have designed, by popular request, a dedicated specialised Sting Treatment kit that includes laminated instructions for treatment guidelines and all the necessary items for first aid response. Housed in a waterproof bag to be located in the Laz or Tenders.
By Nick Stael von Holstein, – MSOS
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