| 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
|
