Venomous Sea Creatures First aid and treatment of jellyfish stings and venomous fish injuries Type First aid Medical treatment Bluebottles (Physalia species) Wash the sting site with seawater and remove any tentacles Immerse in hot water at 45ºC for 20 minutes or hot shower Do not use vinegar The patient rarely requires transport to hospital or medical intervention Severe local stings or bullous wounds may need dressing Major box jellyfish (Chironex fleckeri) Immediately remove any tentacles Apply vinegar immediately and liberally Apply ice packs Resuscitate (airway, breathing and circulation) patients who are unconscious or have cardiovascular collapse All but very minor stings require transport to hospital Give oral and parenteral analgesia for sting site pain For severe life-threatening envenoming: - give first aid - resuscitate - administer intravenous antivenom - consider magnesium therapy Irukandji syndrome Apply vinegar immediately and liberally Remove any tentacles if present If vinegar is not available wash the area with seawater Transport to hospital for: - parenteral analgesia with titrated intravenous fentanyl or morphine- cardiac monitoring, ECG and cardiac enzymes Cardiac involvement and pulmonary oedema will require supportive care and management of breathing and circulation Other jellyfish: - mauve stinger (Pelagia species) - hair jellyfish (Cyanea species) - jimble (Carybdea rastoni) - other box jellyfish (Chiropsalmus bronzeii) Wash the sting site with seawater and remove any tentacles Consider hot water immersion or ice packs Do not use vinegar Patients rarely require transport to hospital or medical intervention Severe local stings or bullous wounds may need dressing Venomous fish stings:- stonefish - catfish - other venomous stinging fish Wash the wound site and immerse in hot water about 45ºC for a maximum duration of 90 minutes Irrigate the wound and remove foreign debris Radiograph to exclude retained spiny material Give oral or parenteral analgesia and occasionally local or regional anaesthesia for severe pain Stonefish antivenom is available for stonefish stings with severe pain or systemic effects Surgical consultation for involvement of joints or bones Stingray injuries Wash the wound site and immerse in hot water about 45ºC for a maximum duration of 90 minutes Apply local pressure for bleeding and resuscitate if there are thoracic or abdominal injuries Irrigate and debride the wound Titrate intravenous analgesia and/or local or regional anaesthesia Surgical consultation for deep injuries, injuries to the chest or abdomen, or with retained material Resuscitation and surgical intervention for major trauma from thoracic or abdominal injuries Sea urchin injuries Wash the wound site and immerse in hot water about 45ºC for a maximum duration of 90 minutes Radiograph or ultrasound to identify any retained spines Remove spines close to the surface Review regularly until resolved Wound may require further spine removal and further radiographic imaging or ultrasound Index of general public information