injuries poisoning
Cnidaria (Coelenterates, such as Jellyfish and Sea Anemones) Stings
Treatment of Cnidaria Stings
Removal of tentacles Symptomatic treatment Various rinses to treat pain and deactivate nematocysts, depending on the specific animal Cnidaria sting treatment includes removal of adherent tentacles with a forceps (preferably) or fingers (double-gloved if possible) and liberal rinsing to remove invisible stinging cells. The type of rinse varies by the stinging organism: For jellyfish stings sustained in nontropical waters and for coral stings, seawater rinse can be used. For jellyfish stings sustained in tropical waters, vinegar rinse followed by seawater rinse can be used. Fresh water should not be used because it can activate undischarged nematocysts. For box jellyfish stings, vinegar inhibits nematocyst firing and is used as the initial rinse if available, followed by seawater rinse. Fresh water should not be used because it can activate undischarged nematocysts. For Portuguese man-of-war stings, saltwater rinse can be used. Vinegar should not be used because it can activate undischarged nematocysts. Any difficulty breathing or alteration in level of consciousness, no matter how mild, is a medical emergency, requiring transport to a medical center and possibly injection ofepinephrine. Symptoms are treated supportively. Pain caused by most cnidaria stings is usually short-lived and can be relieved with baking soda in a 50:50 slurry applied to the skin. Soaking the affected area in a warm water bath (105-110° F) has been shown to be effective for pain relief, as have nonsteroidal anti-inflammatory drug (NSAID) analgesics. For severe pain, opioids are preferred. Painful muscle spasms may be treated with benzodiazepines. IV fluids andepinephrinecan be given if shock develops. Antivenom is available for the stings of the box jellyfishC. fleckeribut not for the stings of North American species. Tetanus prophylaxis should be given (see table). Seabather’s eruption is a stinging, pruritic, maculopapular rash that affects swimmers in some Atlantic locales (eg, Florida, Caribbean, Long Island). It is caused by hypersensitivity to stings from the larvae of the sea anemone (eg,Edwardsiella lineate) or the thimble jellyfish (Linuche unguiculata). The rash appears where the bathing suit contacts the skin. People exposed to these larvae should shower after taking off their bathing suit. Cutaneous manifestations can be treated withhydrocortisonelotion and, if needed, an oral antihistamine. More severe reactions may require the addition of oral or IVprednisone. 