Columnists :: Kids Health With Dr Jack
Better than pee by Jack Maypole, MD
MySouthEnd.com ContributorWednesday Jul 11, 2012 New recommendations for treating jellyfish stings.
For those beach-goers among you who don’t already know, jellyfish stings are bummers.
From the days of my suns-plashed summers on the Georgia coast, I can remember how they go. One moment I’d be trottng down the beach barefoot, or wading in the waters just off shore. Suddenly, there’d be a tingling, electric sizzle under my toes or across my leg as the stinging cells on the tentacles, called nematocysts, released their venom. My skin would feel as if I’d brushed nettles with teeth. Within moments, clusters or lines of welts would appear upon my skin, depending on whether I’d stepped upon the jelly, or brushed past a strand of tentacles. Sometimes I’d yell, or I’d practice one of the bad words I was starting to discover.
Like the stings of most North American jellyfish species, these wounds would not be life threatening, but they could sing in their madly itchy, terrible way for minutes to hours. But... surely the pain of jellyfish envenomation was better than some of the proposed remedies I’d heard then (and since) to deactivate the stingers and their venom: vinegar?(smelly)...meat tenderizer? (weird)...urine? (if anyone ever saw that Friends episode where this was tried... well, enough said). Do these folksy, kitchen cabinet treatments work? Can jellyfish stings be prevented? Let’s see, shall we?
A recent article in the Annals of Emergency Medicine nicely upends our sense of how to treat - and how not to treat - a child or family member if they ever get stung by a jellyfish. Until now, conventional medical wisdom recommended North American beach-goers use vinegar or a baking soda slurry to deactivate the stingers or neutralize jellyfish venom. Not so! Rather, these treatments were derived from research and treatments better suited for the stings of Pacific and Indian Ocean species of jellyfish. In looking at studies for jellyfish sting treatments in North American and Hawaiian waters, the researchers produced recommendations that are quite different, and in some cases, liberating.
All agree that someone stung by a jellyfish should be removed from the water, if possible, and put on a clean, comfortable spot to check out the exposed area. Anyone offering first aid should take measures to prevent themselves from being stung, remaining watchful that strands of tentacle or active stinging cells may remain on the victim’s skin. Bits of jellyfish tissue or nematocysts may be removed using the edge of a credit card, and/or by a person wearing protective gloves. Be careful.
The offending jellyfish need not be caught to optimize treatment (in many cases, the perpetrator is never seen, the sting is just felt!). However, it can be helpful if the type of jellyfish can be identified when possible.
The most effective treatments for North American jellyfish stings? Irrigating or soaking the stung area for several minutes with tolerably hot water, followed by lidocaine cream; a potent (and prescription only) topical anesthetic works best. Unfortunately, these materials are usually in short supply at most beaches. Fortunately, seawater rinses make for a satisfactory next-best option. Room temperature or cool fresh water soaks or rinses may make the situation worse. Vinegar should also be avoided for most jellyfish encountered in U.S. waters as it too may trigger stingers already on the skin. An exception exists to this rule: If Portuguese man o’ war was known to be the source of sting, then vinegar is just the thing.
And, for those of you who’ve been wondering up to now, the recent review found no indication that meat tenderizer or urine have any positive effect on mitigating jellyfish stinging cells or venom. Sorry, Monica.
Once an area has been cleared of stinging cells and properly rinsed, care and comfort measures such as Motrin for pain, Benadryl and periodic applications of ice to the affected skin are a great idea. Hugs and kisses don’t hurt either.
If it ever appears that the stung individual is having more severe discomfort, such as abdominal upset, muscle cramping, or any indication of breathing difficulty, that may mean a more serious reaction is afoot. In such cases, medical attention, including a trip to the ER or calling 911 may be necessary. If in doubt, get seen!
Can jellyfish stings be prevented? Sorta. Any visitor to the seaside would do well to look online or ask around if there are known jellyfish hazards, or if swim areas offer protective, jellyfishproof netting (really, some places do!). Bathers, snorkelers and scuba divers should get the lowdown before jumping in about what may be in the water. If there is word of a jellyfish bloom, it might be time for a landlocked pursuit and to come back on another day. For those who love those long walks on the beach, a pair of sandals may lower the risk of stepping on a washed up jellyfish whose tentacles may still hold their fire. Lastly, for those who are more concerned or determined to swim in jellyfish-infested waters, one may invest in so called stinger suits. Hey, they may not be trendy, but they work.
And so, do go forth and enjoy your time at the beach. Be safe, wear your sunblock, and mind your kids as they frolic and splash about. Have a ball. And, be mindful of those ever more present jellyfish adrift in the sunny depths. They are a picture of silent beauty, but they deserve our caution and respect.
Jack Maypole, MD is director of Pediatrics at the South End Community Health Center, and Director of the Comprehensive Care Program at Boston Medical Center, a clinic for children with complex and chronic illness. Portions of his articles are drawn from his blog found at thefastertimes.com/pediatrics.
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