Emergency Medicine

Answer 4 Jellyfish—immersion in 5% acetic acid and shaving the affected area to remove nematocysts. Although reactions to marine envenomations may be life threatening, often the venom from marine bites and stings can be neutralized early in the treatment.3 For jellyfish stings, removal of loose nematocysts should be attempted. Fresh water irrigation should be avoided because this can cause nematocysts to discharge. Irrigation with acetic acid or isopropyl alcohol is followed by gentle shaving to remove any remaining nematocysts. The stings of Portuguese man-of-war tentacles can cause severe systemic symptoms, and the tentacles should be removed with forceps and not a gloved hand. A weak vinegar solution may be used to inactivate the nematocysts. When treating wounds from sea urchins, try to remove the barbed fragments and then immerse the affected extremity in hot water (> 45°C) because these toxins tend to be heat labile. Stonefish produce extremely toxic venom and antivenom may be necessary. Like many marine envenomations, applications of basic solutions or fresh water can provoke sea sponge nematocysts to discharge. The best treatment for sea sponge exposures is to remove spicules with adhesive tape, apply isopropyl alcohol, update tetanus status, and prescribe an antihistamine for itching and topical steroids for dermatitis. REFERENCE 3. McGoldrick J, Marx JA. Marine envenomations. Part 2: invertebrates. J Emerg Med 1992;10:71–7. Click here to return to the questions

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