From the Guidelines
For a jellyfish sting, immediately remove any remaining tentacles by lifting or pulling while avoiding manual contact, and then use nonscalding hot water immersion or a heat source to relieve pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The treatment of jellyfish stings involves several steps to minimize the effects of the venom and relieve pain.
- Remove any remaining tentacles: This can be done by lifting or pulling them off while avoiding manual contact, as manual contact can trigger further venom release 1.
- Rinse the affected area: Rinsing the affected area with seawater to remove the tentacle is a reasonable alternative if mechanical removal is not available 1.
- Apply heat: After removal of tentacles, it is reasonable to use nonscalding hot water immersion or to apply a heat source to relieve pain, as data from human studies generally show benefit from hot water immersion or irrigation compared with alternative treatments 1.
- Pain relief: Topical lidocaine cream or gel may be reasonable for pain control if hot water is not available, as topical application of lidocaine appears to inhibit nematocyst discharge or decrease pain from stings by the tentacles of multiple jellyfish species 1. It is essential to observe the person for systemic reactions and call emergency services for difficulty breathing, signs of shock, or severe pain, as most severe reactions occur soon after envenomation 1.
From the FDA Drug Label
1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.
The treatment for a jellyfish sting is not directly mentioned in the provided drug label. However, anaphylaxis caused by an allergic reaction to a jellyfish sting may be treated with epinephrine (IM). The key points to consider are:
- Emergency treatment of allergic reactions, including anaphylaxis
- Intramuscular and subcutaneous use of epinephrine
- Anaphylaxis symptoms such as flushing, apprehension, syncope, and airway swelling may be alleviated with epinephrine treatment 2
From the Research
Treatment Overview
- The optimal treatment of jellyfish stings remains controversial, but general steps can be taken to alleviate symptoms 3, 4.
- After removal from the water, immediate life threats should be addressed, followed by the removal of tentacles and washing of the area with seawater 3.
Pain Management
- Hot water immersion may be beneficial for pain control in non-tropical jellyfish stings, while cold packs may be more effective for tropical stings 3.
- Oral or topical analgesics, as well as hot water and ice packs, have been shown to be effective painkillers in some cases 4.
- Topical lidocaine may also be beneficial in improving pain symptoms 5.
Prevention of Further Stinging
- Vinegar (4%-6% acetic acid) can be applied to prevent further discharge of unfired nematocysts, but its effectiveness may vary depending on the species 4, 5.
- Alcohol, methylated spirits, and fresh water should be avoided, as they can cause massive discharge of nematocysts 4.
- Pressure immobilization bandaging should also be avoided, as it can stimulate additional venom discharge from nematocysts 4.
Systemic Reactions
- In severe cases, the most important step is stabilizing and maintaining vital functions 4.
- Systemic reactions, including shock, should be controlled, and medical attention should be sought if necessary 4, 6.