In the tropics, because of the risk (even if small) that the victim has been stung by a potentially lethal jellyfish, the priority must be to preserve life. If the species causing the sting cannot clearly be identified as harmless, or due to a “Bluebottle”, it is safer to treat the victim with vinegar. Outside the tropics, where huge numbers of non-life-threatening stings occur, the primary objective is pain relief with heat or cold.¹
This is in contrast to first aid treatment for Bluebottle stings where, having carefully removed any remaining tentacles by gently washing the area in sea water and carefully scraping (not wiping) or picking tentacles off with a gloved hand (otherwise, a credit card works well), immerse the area of the sting in hot water (no hotter than the rescuer can comfortably tolerate), or take a hot shower, for at least 20 minutes.
Failing that, ice packs may be used. Bluebottle stings cause immediate and severe pain, often with a visible red wavy line or beaded appearance, which generally fades over about an hour. Apply a topical corticosteroid cream to the sting and give oral anti-inflammatories and antihistamines. Allergic reactions are possible.
Blue bottle sting – first aid
- Clear away the tentacles.
- Immerse or wash the sting area in hot water for 20 minutes, for pain relief. A hot shower up to 45°C may be used. First check that the water temperature is not too hot – BEWARE of burns.
- If hot water is not available or does not relieve pain, then apply ice or cool running water
- Seek advice from the Poisons Information Centre 13 11 26 or your local doctor if pain continues
Considered the most venomous creature on earth (carrying enough venom to kill more than 60 people), the pale-blue box jellyfish is readily contrasted to the more intense blue and distinctive shape of the Bluebottle.
Potentially life-threatening, entailing a neurotoxin occasioning severe respiratory distress as well as cardiotoxins and dermatonecrotic toxins, box jellyfish stings leave a characteristically linear welt with crosshatched pattern.² Immediate, severe burning pain is followed by multiple wheals on the skin, not long after which the person suffering a major sting (systemic envenomation) develops arrhythmias, cessation of breathing, and cardiac arrest.
Having removed the person from the water, rinse the sting with sea water before dousing with vinegar and hot water (toxin proteins are fragile and easily degraded by unfavourable temperatures and pH) while scraping off any tentacles. Be prepared to commence CPR. Manage pain with NSAIDs or morphine. Administer supportive therapy as per ABCs and as soon as possible give antivenin. Treat stings as burns, to lessen scarring.
Although most box jellyfish stings in Australia have proved a nuisance rather than a medical threat, the seriousness of the sting relates to the size of the box jellyfish: those with a bell over 150 mm are considered highly dangerous.
If the total estimated length of welts is over 700 mm, unconsciousness follows rapidly, culminating in a painful death after 5–20 minutes. With their lower body-mass, children are most vulnerable.³
Of similar length to Chironex fleckeri, yet the much smaller and more transparent bell of Carolina barnesi, predominant causative jellyfish of Irukandji syndrome, makes them much harder to spot.
Within minutes of a sting begin waves of severe lower back, chest, and abdominal pain from disabling muscle cramps lasting a few minutes each. This is associated with vomiting, restlessness, anxiety, sweating with piloerection and soon followed by a hypertensive crisis: tachycardia, hypertension, heart failure, and pulmonary oedema. Treatment is supportive as there is no antivenin, with narcotic analgesics and management of the hypertensive crisis.
List of fatal jellyfish stings occurring in Australian territorial waters in the 21st century³
| SEX | Age | Year | Month | Species | State or Territory | Location; Comments |
|---|---|---|---|---|---|---|
| 74 | 2016 | November | Irukandji (suspected, not confirmed) | Queensland | Michelmas Cay. Two French tourists died within 10 minutes of each other. Hypothesis formed by cardiologist. Dismissed as speculation by tour operator.[9] | |
| 76 | 2016 | November | Irukandji (suspected, not confirmed) | Queensland | Michelmas Cay. Two French tourists died within 10 minutes of each other. Hypothesis formed by cardiologist. Dismissed as speculation by tour operator.[9] | |
| Boy | 6 | 2007 | November | Chironex fleckeri | Northern Territory | [8] |
| Girl | 7 | 2006 | January | Queensland | Umagico Beach near Bamaga,[10] | |
| Boy | 7 | 2003 | March | Chironex fleckeri | Queensland | Wongaling Beach near Cairns,[2] stung on chest and neck. Allegedly the 68th person in Australia known to have died from a chironex fleckeri sting since records began in 1883.[11] |
| Male | 44 | 2002 | April | Queensland | Port Douglas [12][11][13] | |
| Male | 58 | 2002 | January | Irukandji | Queensland | Hamilton Island, Whitsunday Islands [12][13] |
| Male | 5 | 2000 | January | Chironex fleckeri | Queensland | Yarrabah, near Cairns[11] |
References
- “Envenomation – Jellyfish Stings.” Guideline 9.4.5, Australian Resuscitation Council (ARC). July 2010.
- Cadogan, Mike. Box Jellyfish (Chironex fleckeri) • LITFL • Toxicology Library. Nov 3, 2020.
- “Jellyfish stings in Australia.” Wikipedia. As at Nov 10, 2020.
- Berling, Ingrid and Isbister, Geoffrey. “Marine envenomations.” AFP 44(1–2); Jan–Feb, 2015: 28-32.
- Tibballs, James et al. “Immunological and toxinological responses to jellyfish stings.” Inflammation & allergy drug targets vol. 10,5 (2011): 438-46. doi:10.2174/187152811797200650.
- Due, Kirsten; Oakley, Amanda; and McGivern, Maria. Australian box jellyfish stings. DermNetNZ. May 2017. Available at Australian box jellyfish stings | DermNet NZ. Accessed Jan 9, 2021.
Further
- Stinging Jellyfish in tropical Australia: Current State of Knowledge (Nov 2004). CTC Reef Research Centre.
- Cegolon, Luca et al. “Jellyfish stings and their management: a review.” Marine drugs vol. 11,2 523-50. 22 Feb. 2013, doi:10.3390/md11020523.
