What is the treatment for jellyfish stings?

Treatment of Jellyfish Stings

The first-line treatment for jellyfish stings is to rinse with seawater, apply vinegar (4-6% acetic acid) for at least 30 seconds to inactivate nematocysts, then immerse the affected area in hot water (40°C/104°F) for 20-30 minutes for pain relief. 1

Initial Management

1. Safety and Tentacle Removal

   • Remove the victim from the water to prevent further stings
   • Remove any remaining tentacles by carefully lifting or pulling them while avoiding direct skin contact 1
   • Do NOT use bare hands - use tweezers, gloves, or another object
   • Do NOT scrape the area as this can cause additional venom release 1

2. Nematocyst Inactivation

   • Apply vinegar (4-6% acetic acid solution) liberally for at least 30 seconds 2, 1
   • If vinegar is unavailable, use a baking soda slurry as an alternative 2
   • AVOID using fresh water, alcohol, methylated spirits, or scraping the area, as these can trigger additional nematocyst discharge 1, 3
   • AVOID pressure immobilization bandages as they may cause further venom release 2, 3

Pain Management

1. First Choice: Hot Water Immersion

   • Immerse the affected area in hot water (as hot as tolerated or approximately 40°C/104°F) for 20-30 minutes or until pain subsides 2, 1
   • This method has the strongest evidence for pain relief 1

2. Alternative Options (if hot water is unavailable)

   • Apply topical lidocaine cream or gel (4-5% or 10-15% formulations) 1
   • Use dry hot packs 2, 1
   • As a last resort, apply dry cold packs (less effective) 2, 1

3. Ineffective or Harmful Treatments to AVOID

   • Meat tenderizer 1
   • Aluminum sulfate 2
   • Urine (folk remedy with no scientific support) 1
   • Alcohol or methylated spirits 1, 3

Monitoring for Complications

• Monitor for systemic reactions requiring emergency medical services 1:
  • Difficulty breathing
  • Signs of shock
  • Severe or persistent pain
  • Widespread rash or swelling

Important Considerations and Caveats

• Treatment efficacy varies by jellyfish species 1, 4

  • The guidelines above are most applicable to North American jellyfish species 1
  • For Physalia species (bluebottles/Portuguese man-of-war), vinegar may actually increase envenomation and should be avoided 5

• The quality of evidence for jellyfish sting treatments is generally low, with significant heterogeneity across studies 6

• In severe cases involving dangerous species (like box jellyfish), stabilizing vital functions takes priority 3

• For prevention of scarring, monitor for infection and manage hypertrophic scarring according to general wound care principles 1

The treatment approach outlined above follows the most recent guidelines from the American Heart Association and American Red Cross, which provide the strongest evidence for jellyfish sting management 1.