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.”
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