What is the treatment for a jellyfish sting?

Treatment for Jellyfish Stings

For jellyfish stings, first remove any remaining tentacles by lifting or pulling them while avoiding direct skin contact, then immerse the affected area in non-scalding hot water (approximately 40°C/104°F) for pain relief. 1, 2

Step-by-Step Treatment Algorithm

1. Initial Assessment and Emergency Response

• Monitor for systemic reactions requiring emergency services:
  • Difficulty breathing
  • Signs of shock
  • Severe pain 1
  • Most severe reactions occur soon after envenomation

2. Tentacle Removal

• Carefully lift or pull remaining tentacles while avoiding direct skin contact
• Alternative: Rinse with seawater to remove tentacles if mechanical removal isn't possible
• AVOID scraping tentacles as this causes more venom release and hemolysis 1, 2

3. Pain Management (in order of preference)

• First choice: Immerse in non-scalding hot water (40°C/104°F) or apply heat source for 20-30 minutes 1, 2
• Second choice: Apply topical lidocaine cream or gel (4-5% or 10-15% formulations) if hot water is unavailable 1, 2

4. What to AVOID

• Do NOT use:
  • Fresh water (causes additional nematocyst discharge)
  • Alcohol or methylated spirits
  • Pressure immobilization bandages
  • Meat tenderizer
  • Scraping methods 1, 2, 3

Special Considerations

Geographic Variations

• Treatment efficacy may vary by jellyfish species
• The guidelines above are most applicable to North American jellyfish species 1
• Box jellyfish (Chironex fleckeri) in Australia can be lethal within minutes and may require specific antivenom 4

Common Pitfalls to Avoid

1. Using fresh water for rinsing (triggers more venom release)
2. Scraping tentacles (increases venom discharge)
3. Applying pressure immobilization bandages (stimulates additional venom discharge)
4. Delaying observation for systemic reactions
5. Using unproven folk remedies like urine 2, 3

Clinical Course

• Most jellyfish stings in North America cause only local symptoms 1
• Some patients may develop delayed skin reactions (painless, itchy erythematous papular rashes) days after the sting 5
• Severe systemic reactions are rare but can include anaphylaxis and, in rare cases, association with Guillain-Barré syndrome 4

The American Heart Association and American Red Cross guidelines provide the strongest evidence for this treatment approach, with human studies confirming the benefit of hot water immersion compared to alternative treatments 1, 2.