Part 2 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

Unless a person is allergic to it, venom produced by Hawaii's octopuses is not life-threatening. To clean an octopus bite, gently pull the edges of the wound open. 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.

For the average Hawaii Portuguese man-of-war sting:

1. Pick off any visible tentacles with a gloved hand, stick, or anything handy, being careful to avoid further injury.
2. Rinse the sting thoroughly with salt or fresh water to remove any adhering tentacles.
3. Apply ice for pain control.
4. 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.
5. 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.

Although formerly considered effective, vinegar is no longer recommended for Portuguese man-of-war stings. In a laboratory experiment, vinegar dousing caused discharge of nematocysts from the larger (P. physalis) man-of-war species. The effect of vinegar on the nematocysts of the smaller species (which has less severe stings) is mixed: vinegar inhibited some, discharged others.

No studies support applying heat to Portuguese man-of-war stings. Studies on the effectiveness of meat tenderizer, baking soda, papain, or commercial sprays (containing aluminum sulfate and detergents) on nematocyst stings have been contradictory. It's possible these substances cause further damage. In one U.S. Portuguese man-of-war fatality, lifeguards sprayed papain solution immediately on the victim's sting. Within minutes, the woman was comatose, and later died.

Alcohol and human urine may be harmful on Portuguese man-of-war stings. An Australian study reports that both alcohol and urine caused massive nematocyst discharge in the box jellyfish, Chironex fleckeri.

Most Hawaii Portuguese man-of-war stings disappear by themselves, sometimes within 15 or 20 minutes. Because of this, even harmful therapies often appear to work. A key concept in the first aid of any injury is: Do no harm. Therefore, avoid applying unproven, possibly harmful substances on stings.

See a doctor if pain persists, the rash worsens, a feeling of overall illness develops, a red streak develops between swollen lymph nodes and the sting, or if either area becomes red, warm and tender. (See Staph, Strep and General Wound Care for signs of infection.)

Few Portuguese man-of-war 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 automatic epinephrine injector if available.

For ray wounds without envenomation, clean by gently pulling the edges of the skin open and scrub directly inside the cut with clean gauze or a cloth soaked in clean, fresh water.

For ray wounds with venom release (evident by severe pain), rinse the area immediately with whatever water is handy (ocean water if fresh water isn't available) to remove poison gland tissue and venom. Remove any parts of an embedded spine with tweezers and thorough scrubbing and rinsing. Press on the wound to stop bleeding. If bleeding persists, or the edges of a wound are jagged or gaping, the victim likely needs surgery to trim, clean and repair the wound. For more details on wound care, see Staph, Strep and General Wound Care. For pain control after envenomation, soak the area in hot, nonscalding water for 30 to 90 minutes. (Helpers should test the water temperature on their own hand or foot first to make sure it isn't scalding. Victims in pain may not be able to judge if water is too hot.) Often, when the water cools, the pain returns. Repeat hot water soaks for up to two hours. After this, heat is of little value.

Ray wounds often become infected, and some people have reactions to the venom. See a doctor for redness, swelling, or delayed healing. Victims with a numb or abnormally moving finger or toe, or anyone with a feeling of general illness after a ray sting should go directly to an emergency department.

Pain relief is a high priority in scorpionfish stings. To ease pain, soak the wound in nonscalding hot water for 30 to 90 minutes. (Victims in pain may not be able to tell if water is too hot. Someone else should test the water temperature on his or her own hand first.) Heat inactivates at least one of the toxins in the venom, and thus relieves some of the pain. If pain returns an hour or more later, try the heat soaks again.

While soaking, remove any protruding pieces of the spine or skin from the puncture. Do not apply a tourniquet, ice, or pressure bandage. To clean the wound, gently pull the edges of the skin and scrub with clean gauze or a cloth soaked in clean, fresh water. For more details on wound care, see Staph, Strep and General Wound Care. Victims of infected scorpionfish stings should see a doctor. If a victim shows any signs of a serious reaction (listed in Signs and Symptoms above) to a scorpionfish puncture, consider it a medical emergency.

A sea snake bite is always a medical emergency, even if the victim does not appear ill. The primary goal in sea snake first aid is to get the victim to an emergency room as fast as possible. 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 may slow 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.

Never cut open a sea snake bite and try to suck venom from the victim. Little is accomplished, and harm can be done, from this old-fashioned method of snakebite treatment.

Sea snake toxin is not inactivated by changes in temperature or pH. Application of ice, hot packs, or vinegar only wastes time.

For simple punctures, gently pull out any protruding spines.

These are so brittle they almost always break off in the wound. Neither urine nor vinegar dissolves such embedded spines. Never try to crush them by hitting the area with a heavy object. This only adds to the injury. In most cases, the body either absorbs spine fragments in 24 hours to 3 weeks, or they work themselves out through the skin. Most wounds heal in about one month.

Applying heat for pain control is unproven. Some authors recommend it. Others believe it is of no benefit and should not be done.

The thick spines of the `ina do not dissolve as wana spines do.

If `ina spines are embedded in the flesh (a rare occurrence), or any sea urchin spines have penetrated a joint or nerve, see a doctor. Also see a doctor if a sea urchin wound shows any sign of infection, such as redness, warmth, or pus formation.

Victims with generalized weakness, shortness of breath, and/or nausea and vomiting after a puncture should go directly to an emergency facility.

For skin scrapes and minor bites, scrub directly in the wound with clean gauze or a cloth soaked in clean, fresh water. Press on the area to stop bleeding. If bleeding persists, or the edges of a wound are jagged or gaping, the victim likely needs stitches. Taping a small 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. For numbness or inability to move a finger or toe normally, see a doctor immediately. Victims who appear pale, sweaty, and nauseated are in danger of fainting. Lower the victim to the ground.

In wounds where a major artery or vein is severed, a victim can die rapidly from blood loss. Often, a rescuer can stop bleeding from large, 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. Trying 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 a tourniquet on can cause permanent injury. Maintaining pressure on the wound, take the victim to an emergency room as quickly as possible.

For uncomplicated sponge stings, rinse and dry the area, then lift skeletal spikes from the skin with adhesive tape. You may not be able to see these tiny cactus-like spikes. Other treatments for sponge stings are unproven. In some cases, soaking the area in vinegar or rubbing alcohol seems to relieve pain. After soaking, 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. Tetanus (lockjaw)-causing bacteria lives in some sponges. Make sure tetanus immunization is up to date. (See Staph, Strep and General Wound Care for information on tetanus immunization.)

Infections can develop after sponge stings. If blisters fill with pus, or the red area spreads and feels warm, see a doctor.

Any difficulty breathing or a generalized body rash after a sponge sting is always a medical emergency.

For mild to moderate cases of skin rash, remove the swimming suit immediately, and wash skin vigorously with soap and water. Wash the suit too. Although unproven, cool compresses or rubbing alcohol may help relieve the pain. For persistent itching or skin rash, try 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. Irrigate exposed eyes with tap water for at least 15 minutes.

For severe discomfort, blistering not responding to first aid treatment, eye stings, or any signs of infection (redness, swelling, pus), see a doctor.

Victims who have accidentally eaten this limu should suck on ice to relieve pain while going to an emergency room.

Any difficulty breathing signals an allergic reaction, always a medical emergency.

For minor cuts, gently pull the edges of the skin open and remove any embedded material either by rinsing or using tweezers. Then 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 the wound are jagged or gaping, the victim likely needs stitches. Taping a cut shut is often an appropriate alternative, but may leave a more visible scar than suturing. For more details on wound care, see Staph, Strep and General Wound Care. No studies exist on treating surgeonfish cuts, but hot water soaks relieve pain in ray and scorpionfish stings. For pain control, try soaking the wound in nonscalding hot water for 30 to 90 minutes. (Victims in pain may not be able to tell if water is too hot. Someone else should test the water temperature on their own hand first.) If pain worsens, redness and swelling increase, or a digit won't move normally after a surgeonfish cut, see a doctor.

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 aggressive sharks (i.e., more than eight feet long) 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.

Return to the Hale (Home) Aloha Page. You can also use the following links to continue your beach and ocean tour of Oahu's North Shore, South Shore, East Shore, or West Shore.

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Web Developer: This page is maintained by J. B. Lee. You can reach me by email by clicking here.
Last modified: 07-Mar-2005 02:23 PM

Aloha . . . malama i ke kai!