Part 1 of 3 -- Excerpts From The Book ---

	All Stings Considered First Aid and Medical Treatment of Hawai`i's Marine Injuries Craig Thomas, M.D., and Susan Scott

Rinse the sting thoroughly with salt or fresh water to remove any adhering tentacles. Apply ice to skin for pain. For persistent itching or skin rash, try 1 percent hydrocortisone ointment four times a day, and one or two 25 milligram diphenhydramine (Benadryl) tablets every 6 hours. These drugs are sold without prescription.

Diphenhydramine may cause drowsiness. Don't drive, swim or surf after taking this medication.

Nearly every substance imaginable has been applied to anemone stings throughout the world, including manure, mustard, and figs. No studies indicate that any of these neutralize the venom. Some may be harmful.

Irrigate exposed eyes with copious amounts of room temperature tap water for at least 15 minutes. If vision blurs, or the eyes continue to tear, hurt, swell, or are light sensitive after irrigating, see a doctor. If a red streak develops between swollen lymph nodes and the sting, or if either area becomes red, warm and tender, see a doctor immediately. (See Staph, Strep and General Wound Care for signs of infection.) Rarely, stings cause seizures and death. Eating anemones can also cause fatalities. If pain persists, the skin rash worsens, allergic symptoms occur or a feeling of generalized illness develops, get medical help quickly.

For minor bites, gently pull the edges of the skin open and remove any embedded teeth either by rinsing or using tweezers. Scrub directly inside the wound with clean gauze or a cloth soaked in clean, fresh water. Press on the wound to stop bleeding. If bleeding persists, or the edges of a wound are jagged or gaping, the victim likely needs stitches. Taping a bite shut is often an effective alternative, but may leave a more visible scar than suturing. For more details on wound care, see Staph, Strep and General Wound Care.

Victims who appear pale, sweaty, and nauseated are in danger of fainting. Lower the victim to the ground.

Barracudas can sever arteries or veins. In such cases, victims can die rapidly from blood loss. Often, a rescuer can stop bleeding from severed blood vessels by firmly pressing anything handy (swimsuit, towel, hand) directly on the wound. Such pressure usually causes the vessel to clamp down in spasm, and clots begin to form. In the water, however, this procedure can be nearly impossible, especially while helping a victim to shore, or to a boat. In these cases, when bleeding may be fatal, a tourniquet is appropriate. Tying a surfboard leash or dive mask strap around a massively bleeding limb could save a life.

Help a bleeding victim get out of the water as quickly as possible. At the beach, or in the boat, control bleeding by pressing directly on the wound, then remove any tourniquets. (Leaving tourniquets on can cause permanent damage.) Maintaining pressure on the wound, take the victim to an emergency facility as quickly as possible.

Two concepts are key to treating box jellyfish stings. One is to prevent firing of any undischarged nematocysts remaining on the skin, thus preventing the injury from getting worse. The second is to treat the symptoms and pain caused by already-fired nematocysts. The following first aid treatment, based on current Australian research, is recommended for the stings of all species of box jellyfish:

1. Immediately flood the area with household vinegar to keep undischarged nematocysts from firing. This does not relieve pain, but prevents additional stings.
2. Never rub the area with sand or anything else.
3. Irrigate exposed eyes with copious amounts of room temperature tap water for at least 15 minutes. If vision blurs, or the eyes continue to tear, hurt, swell, or are light sensitive after irrigating, see a doctor.
4. Pluck off any vinegar-soaked tentacles with a stick or other tool.
5. If the victim has shortness of breath, weakness, muscle cramps, palpitations or any other generalized symptoms, take them to an emergency room.
6. For pain relief, apply ice packs. If pain becomes unbearable, go to an emergency room. No studies support applying heat to box jellyfish stings.

Contradictory studies exist on the effectiveness of meat tenderizer, baking soda, papaya, or commercial sprays (containing aluminum sulfate and detergents) on nematocyst stings. These substances may cause further damage. Some kinds of meat tenderizer, for instance, can cause skin peeling. In one U.S. fatality from the box jellyfish, Chiropsalmus quadrumanus, rescuers placed meat tenderizer almost immediately on the affected arm. The child was soon comatose and later died.

Alcohol and human urine are common nematocyst remedies, but both can be harmful. An Australian study reports that both alcohol and urine caused massive discharge of box jellyfish nematocysts.

Most Hawaii box jellyfish stings disappear by themselves. Because of this, even harmful therapies can appear to work. A key concept in the first aid of any injury is: Do no harm. Therefore, avoid applying unproven, possibly harmful substances to stings.

Occasionally, nematocyst toxins cause lymph nodes near a sting site to swell. If a red streak develops between the two areas, or if either area becomes red, warm and tender, see a doctor immediately. (See Staph, Strep and General Wound Care for more about infection.)

Few box jellyfish stings in Hawaii cause life-threatening reactions, but this is always a possibility. Some people are extremely sensitive to the venom; a few have allergic reactions. Consider even the slightest breathing difficulty, or altered level of consciousness, a medical emergency. Call for help and use an automatic epinephrine injector if available.

Most cone snail punctures in Hawaii are not dangerous, and require no specific treatment other than thorough scrubbing of the wound. Rarely, however, a person stung by a cone snail experiences nausea, headache, or difficulty breathing. If any of these symptoms develop after a sting, go directly to an emergency room. In route, hold the bite site below the rest of the body, while keeping the victim as still as possible. Apply a broad pressure bandage over the bite about as tight as an elastic wrap to a sprained ankle. This slows the venom's spread through the lymph system. Make sure arterial circulation is not cut off by making sure fingers or toes stay pink and warm.

If possible, bring the stinging snail to the emergency room, being careful not to get stung again.

For minor cuts, gently pull the edges of the skin open and remove embedded coral either by rinsing or using tweezers. Scrub directly inside the cut with clean gauze or a cloth soaked in clean, fresh water. Press on the wound to stop bleeding.

If bleeding persists, or the edges of a wound are jagged or gaping, the victim likely needs stitches. Taping a cut shut is often an effective alternative, but may leave a more visible scar than suturing. For more details on wound care, see Staph, Strep and General Wound Care. It is not true that using povidone-iodine or other iodine solutions to wash coral cuts will cause coral to grow in the wound. Coral is a marine animal; it can never grow inside the human body.

A popular local treatment for coral cuts is to urinate on the wound. This may sometimes wash broken pieces of coral from the cut, but urine discharges nematocysts in Australians box jellyfish. Thus, urine may make the injury worse.

For large cuts, fever, or any other signs of infection or illness after coral contact, see a doctor.

Remove any obvious broken spines protruding from the wound. Unless a victim is allergic, these wounds are not a medical emergency and can be treated at home. Soaking the wound in hot water for pain control is unproven. Some authors believe soaking the sting in hot, nonscalding water for 30 to 90 minutes may reduce pain caused by this venom. Others feel heat application has no benefit in crown-of-thorns injuries, and should not be used. Follow First Aid in Staph, Strep and General Wound Care. Infections from these wounds are rare. If you cannot remove broken spines, or develop hives, breathing difficulty, numbness or weakness, go to an emergency room. These symptoms usually disappear after spines are removed.

Remove visible bristles with tweezers. To remove tiny (often invisible) bristles, apply sticky tape to the area, then pull off gently. Regardless of technique, it's nearly impossible to remove all bristles. For persistent itching or skin rash, try 1 percent hydrocortisone ointment four times a day, and one or two 25 milligram diphenhydramine (Benadryl) tablets every 6 hours. These drugs are sold without prescription. Diphenhydramine may cause drowsiness. Don't drive, swim or surf after taking this medication.

No substance always relieves the pain and itching caused by these worms. Although unproven, home remedies of vinegar, rubbing alcohol, dilute ammonia, or a paste of meat tenderizer may help. If the sting is severe, or the area around any fireworm sting looks infected, see a doctor. An allergic reaction to fireworm venom is always a possibility. Go to an emergency room at the first sign of hives, a feeling of overall illness, or breathing difficulty.

Moray eel bites are notorious for tendon and nerve damage in hands and feet. For minor bites, gently pull the edges of the skin open and remove embedded teeth either by rinsing or using tweezers. Scrub directly inside the bite with clean gauze or a cloth soaked in clean, fresh water. Press on the wound to stop bleeding. If bleeding persists, or the edges of a wound are jagged or gaping, the victim likely needs stitches. Taping a bite shut is often effective, but may leave a more visible scar than suturing. For more details on wound care, see Staph, Strep and General Wound Care. If a finger or toe is numb or won't move normally after a bite, see a doctor immediately.

Victims who appear pale, sweaty, and nauseated are in danger of fainting. Lower the victim to the ground.

Don't try to remove a needlefish beak from the flesh. If the fish is still attached to its embedded beak, cut it off. Take the victim to an emergency facility for removal and evaluation of possible deep tissue damage.

If a needlefish pulls its beak from the flesh, or the beak breaks off under the skin, and the wound bleeds, press gently but firmly over the wound to control bleeding. Needlefish wounds are at high risk for retained beak, serious internal injury, and infection. Get medical consultation on all such wounds.

PLEASE NOTE WELL - A DISCLAIMER: The first aid information provided above is up-to-date and accurate, as far as we know, as of October, 2000. The information provided above is for general purpose use and furnished as guidance that is suggestive, not prescriptive, invasive, or medical in nature. You should always consult with or see a medical practitioner for definitive health care information or to receive medical treatment.

HERE ARE SOME
BASIC OCEAN SAFETY TIPS:

• Swim in Lifeguarded Areas
• Never Swim Alone
• Don't Dive Into Unknown Water or Into Shallow Breaking Waves
• Ask a Lifeguard About Beach and Surf Conditions Before Swimming
• If You Are Unable to Swim Out of a Strong Current, Signal for Help
• Rely on Your Swimming Ability Rather Than a Flotation Device
• Look For, Read and Obey All Beach Safety Signs and Symbols
• If In Doubt, Just Stay Out!

And, just when you thought it was safe to read on . . .

Click here for telephone numbers you can call to report a sighting of large (i.e., more than eight feet long), aggressive sharks in Hawai`i.

See several shark species safely, live, at Honolulu's Waikiki Aquarium!

The aquarium is also just a great place to visit to see and learn about Hawai`i and the Pacific Basin's ocean environment, indigenous marine organisms, reefs and coral, seals, and efforts to save and protect them.

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Last modified: 07-Mar-2005 02:21 PM

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