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Use hot water, not pee, for jellyfish stings

Forget the vinegar, meat tenderizer, baking soda or pee for treating a jellyfish sting this summer. Hot water and a topical cream are the best treatment, according to a study by UC San Diego’s Department of Emergency Medicine.

The 16-page review, “Evidence-Based Treatment of Jellyfish Stings in North America and Hawaii,” was published this week in the online edition of the Annals of Emergency Medicine.

The bottom line may be: pack a thermos of hot water, a deck of cards and a bottle of over-the-counter lidocaine with your sunscreen when you head to the beach.

Lidocaine, a generic local anesthetic available in drug stores, and hot water work best for treating the pain of jellyfish stings, said the review's lead author Dr. Richard Clark.

“But probably the most important thing to do first is to get the tentacles and nematocysts off the skin. That’s what I would do,” Clark said.

That’s where the cards come in.

The jellyfish leaves behind nematocysts, or venom sacs, that should be scraped off as soon as possible, Clark said. Flick off the nematocysts with the edge of a playing card, credit card, a kid’s sand shovel or something similar, he recommended. The idea is to avoid crushing the sac and spreading venom, which wiping with a towel could do.

After scraping, wash the area with hot water and apply the lidocaine, which is sold generically or under brand names including Solarcaine and Xylocaine. Salt water can also be effective if hot water isn’t available, he said.

And using a 4 percent or 5 percent solution of lidocaine was found to get rid of pain within a minute, while weaker solutions could take much longer, Clark's report noted.

His team reviewed 19 studies of various treatments for jellyfish stings in North America and Hawaii to reach their conclusions.

The review noted that the American Heart Association and American Red Cross International Consensus on First Aid Science recommends applying a vinegar or baking soda slurry, followed by heat. But Clark’s review recommended against that treatment, saying vinegar can increase pain and was helpful only for Portuguese man-o-war stings.

Clark said hot water is believed to break down the proteins in the venom, but that’s only a theory.

“The definitive study on hot water hasn’t been done yet,” he said. “It’s hard to get volunteers, as you can imagine, willing to put jellyfish tentacles on their arms. But we’re going to try.”

View the full article here.

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Comment by eCoronado on June 8, 2012 at 11:59am: Sent to us from Barry:

I'm writing about the blog by TR related to the use of lidocaine on jellyfish stings. I know TR was citing the article but I am amazed how irresponsible the physicians involved are in preparing this bilge in the face of years on, overwhelming medical research and biologic science that clearly states vinegar (5% acetic acid) to be the universally accepted 1st aid protocol for jellyfish envenomations.

According to the FDA: The U.S. Food and Drug Administration warned consumers and health-care providers about serious and life-threatening risks associated with improper use of topical anesthetics available in over-the-counter (OTC) and prescription forms.

These skin-numbing products in cremes, ointments or gels contain anesthetic drugs such as lidocaine, tetracaine, benzocaine, and prilocaine that are used to desensitize nerve endings near the skin's surface. If used improperly, the FDA said in an agency news release, the drugs can be absorbed into the bloodstream and cause reactions such as irregular heartbeat, seizures, breathing difficulties, coma or even death.

Women considering using a topical anesthetic before a mammogram should talk to their physician first, the FDA said. The agency also recommended against using these products over large areas of skin, especially irritated or broken skin, and not to wrap the treated skin with dressings or apply heat to the treated area. Raising the skin's temperature, the agency said, increases the amount of anesthetic reaching the blood stream, and its effects can be unpredictable.

The FDA said it had received several "adverse events accounts" and reports of two deaths in women who had used topical anesthetics .....

I couldn't help but laugh at Dr Ward's suggestion, "if a product like this could be made, it would solve sting issues...".Miraculously there just happens to be one product that is exactly as described by Dr Ward's "fact based" research. Applying a topical anesthetic doesn't take a rocket scientist to know the product will numb the skin but what first aid does it provide and what are the consequences?

Here's the link posted on ehealth indicating 1800+ negative effect reports using the lidocaine spray product available for jellyfish stings...scroll down to see heart attacks..anaphylactic shock, respiratory issues and so on... http://www.ehealthme.com/report/si2aop

I question whether the physicians have some vested interest in making the irresponsible claims particularly in the face of world health organizations stating the complete opposite...Every major medical organization on the planet suggests just the opposite...Never use lidocaine unless or before seeing your doctor and always use vinegar for jelly sting first aid..."Real",unbiased medical fact based science clearly states the use of 5% acetic acid for jellyfish envenomations...

On another note...visit Coronado often...good friend grew up there...his sister still lives there..LOVE Coronado...fly down as often as possible..walk along Orange Ave just to see the sites...cruise the beach...eat at the Del Coronado...Old Town SD for Mexican food and Mags........never miss a chance to make that trip...

Keep your sunny side up and please warn your readers about using lidocaine..take care

Barry

Comment by TR on June 11, 2012 at 8:37am: Barry,

I appreciate your response and the bigger problem is the lack of any publicity on the subject.

I had the unfortunate experience of being in Italy and having one of my twin daughters stung while swimming. The lack of knowledge was the worst part.

If you visit Coronado Beaches you'll see a yellow placard on the towers and other spots which reference shuffling your feet due to stingrays. I had the unfortunate experience of getting hit twice last summer within a 60 day period(after never knowing about them since I started coming to Coronado in the 60's). The first time the guard gave me no insight as to what to do. I ended up driving 2 hours back to the Pasadena area and about an hour into the drive the most excruciating pain I've ever endured took place. If I could have cut my leg off, I would have. After going to the emergency ward and they too being unprepared I did the research.

The good news is the Fire Dept and Chief Life Guard saw a blog I posted about the experience and made up cheat sheets to hand out and had the placards made up. Scalding hot water made all the difference the 2nd time down at the main tower. Walked away after about an hour with minimal pain..

Anyway the stingray's and jellyfish happen regularly...your point is well taken.