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When stung by a jellyfish, first aid may be in order. Though most stings are not deadly, some stings, such as those of the box jellyfish (Chironex fleckeri), may be fatal. Serious stings may cause anaphylaxis and may result in death. Hence, people stung by jellyfish must get out of the water to avoid drowning. In serious cases, advanced professional care must be sought. This care may include administration of an antivenin and other supportive care such as required to treat the symptoms of anaphylactic shock. The most serious threat that humans face from jellyfish is the sting of the Irukandji, which has the most potent and deadly venom of any known species.
There are three goals of first aid for uncomplicated jellyfish stings: prevent injury to rescuers, inactivate the nematocysts, and remove any tentacles stuck on the patient. To prevent injury to rescuers, barrier clothing should be worn. This protection may include anything from panty hose to wet suits to full-body sting-proof suits. Inactivating the nematocysts, or stinging cells, prevents further injection of venom into the patient.
Vinegar (3 to 10% aqueous acetic acid) should be applied for box jellyfish stings. Vinegar, however, is not recommended for Portuguese Man o' War stings. In the case of stings on or around the eyes, vinegar may be placed on a towel and dabbed around the eyes, but not in them. Salt water may also be used in case vinegar is not readily available. Fresh water should not be used if the sting occurred in salt water, as a change in pH can cause the release of additional venom. Rubbing the wound, or using alcohol, spirits, ammonia, or urine will encourage the release of venom and should be avoided.
Once deactivated, the stinging cells must be removed. This can be accomplished by picking off tentacles left on the body. First aid providers should be careful to use gloves or another readily available barrier device to prevent personal injury, and to follow standard universal precautions. After large pieces of the jellyfish are removed, shaving cream may be applied to the area and a knife edge, safety razor, or credit card may be used to take away any remaining nematocysts.
Beyond initial first aid, antihistamines such as diphenhydramine (Benadryl) may be used to control skin irritation (pruritus). To remove the venom in the skin, apply a paste of baking soda and water and apply a cloth covering on the sting. If possible, reapply paste every 15-20 minutes. Ice can be applied to stop the spread of venom until either of these is available.
