What is the treatment protocol for a patient with suspected jellyfish envenoming, specifically regarding the administration of Jellybox (antivenom)?

Treatment Protocol for Jellyfish Envenomation

There is no specific "Jellybox antivenom" product recommended in current North American first aid guidelines; treatment focuses on tentacle removal, hot water immersion for pain relief, and observation for systemic reactions, with emergency services activation for severe symptoms. 1

Immediate First Aid Management

Tentacle Removal

• Remove any remaining tentacles by lifting or pulling while avoiding direct manual contact 1, 2
• Use tweezers or a similar tool to grasp and pull tentacles off gently 2
• Never scrape tentacles off the skin, as scraping causes significantly more hemolysis and venom release compared to gentle pulling 1, 2
• If mechanical removal is not available, rinse the affected area with seawater to remove tentacles 1
• Avoid fresh water, alcohol, methylated spirits, or ethanol, as these trigger massive additional nematocyst discharge and worsen envenomation 1, 3

Pain Management Protocol

• After tentacle removal, immediately apply hot water immersion or irrigation at 40°C (104°F) for pain relief 1, 2
• Hot water immersion is the most effective first aid intervention based on human studies and systematic reviews, superior to cold application, vinegar, meat tenderizer, or no treatment 1
• If hot water is unavailable, apply topical lidocaine cream or gel (4%-5% or 10%-15% formulations) as a reasonable alternative 1, 2
• Lidocaine inhibits nematocyst discharge and decreases pain from multiple jellyfish species 1, 2

Emergency Activation Criteria

Call emergency services immediately for any of the following 1, 2:

• Difficulty breathing
• Signs of shock (hypotension, altered mental status, pallor)
• Severe pain not controlled by first aid measures

Most severe systemic reactions occur soon after envenomation, though the ideal observation period is unknown 1

Species-Specific Considerations

Box Jellyfish (Chironex fleckeri) - Severe Envenomation

While the 2024 American Heart Association guidelines do not specifically recommend antivenom for North American jellyfish stings 1, older literature from Australia describes box jellyfish-specific antivenom for Chironex fleckeri envenomation 4, 5:

• Early antivenom administration appears effective for severe pain relief and may reduce subsequent skin scarring 4
• Massive Chironex fleckeri stings can cause cardiac arrest within 15-20 minutes and require aggressive resuscitation with potential intravenous verapamil and antivenom 5
• This is relevant only for tropical Australian waters, not North American jellyfish species 1

Critical Pitfalls to Avoid

• Do not apply ice or aggressive cryotherapy - not studied for jellyfish stings and may cause tissue injury 1
• Do not use pressure immobilization bandaging - laboratory studies show this stimulates additional venom discharge 3
• Do not use suction devices - ineffective for venom removal 1
• Do not apply vinegar for pain relief - while vinegar (4%-6% acetic acid) may prevent further nematocyst discharge in some species, hot water is superior for pain control 1, 3, 6

Evidence Quality Note

The 2024 American Heart Association guidelines acknowledge that data on jellyfish sting treatment are limited with a paucity of clinical trials 1. Different Cnidaria species may not respond identically to available treatments 1. A 2025 systematic review confirmed very low-quality evidence due to risk of bias and heterogeneity across studies 6.