From the Guidelines
The management and treatment of marine bites and stings should prioritize immediate observation for systemic reactions, removal of remaining tentacles, and pain relief using nonscalding hot water immersion or topical lidocaine cream. For jellyfish stings, the 2024 American Heart Association and American Red Cross guidelines for first aid recommend observing the person for systemic reactions and calling emergency services if necessary 1. The guidelines suggest removing any remaining tentacles by lifting or pulling while avoiding manual contact, and rinsing the affected area with seawater if mechanical removal is not available 1. Key interventions include:
- Observing for systemic reactions and calling emergency services if necessary
- Removing remaining tentacles and rinsing the affected area with seawater
- Using nonscalding hot water immersion or a heat source to relieve pain
- Considering topical lidocaine cream or gel for pain control if hot water is not available It is essential to note that the management of marine bites and stings may vary depending on the causative organism, and it is crucial to assess for anaphylaxis and provide epinephrine if needed, as well as administer tetanus prophylaxis for puncture wounds and appropriate antibiotics for infected wounds 1. In terms of specific treatments, the guidelines recommend:
- Nonscalding hot water immersion or a heat source to relieve pain
- Topical lidocaine cream or gel for pain control if hot water is not available
- Seawater to rinse the affected area if mechanical removal of tentacles is not available
- Observation for systemic reactions and calling emergency services if necessary, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
From the Research
Management and Treatment of Marine Bites and Stings
- The management and treatment of marine bites and stings involve several steps, including removal from the water, addressing immediate life threats, and removing tentacles or spines 2, 3.
- For jellyfish stings, the area should be washed with seawater, as it has a low likelihood of inducing further cnidocyte discharge 2.
- Hot water immersion may be beneficial for pain control for non-tropical jellyfish stings, while cold packs may be used for tropical stings 2.
- The application of vinegar can inactivate the venom from jellyfish stings 3.
- For sea urchin and stingray injuries, the imbedded spines should be removed after soaking the wound in hot water 3.
- Coral, sea bathers eruption, and swimmer's itch require thorough scrubbing and irrigation 3.
Anaphylaxis Management
- Anaphylaxis is a life-threatening systemic reaction that can occur after a marine bite or sting, and its management involves removal of the trigger, early administration of intramuscular epinephrine, and supportive care for the patient's airway, breathing, and circulation 4, 5.
- Adjunct medications such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon may be considered after epinephrine administration 4.
- Patients should be monitored for a biphasic reaction, which can occur several hours after the initial reaction 4, 5.
- The use of adrenaline autoinjectors is recommended for patients at risk of anaphylaxis, and structured training is suggested to improve the management of anaphylaxis 5, 6.