Heated Debates: Hot-Water Immersion or Ice Packs as First Aid for Cnidarian Envenomations?

Christie Wilcox,Angel Yanagihara

doi:10.3390/toxins8040097

Christie Wilcox, Angel Yanagihara

Open Access

https://doi.org/10.3390/toxins8040097

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Abstract

Cnidarian envenomations are an important public health problem, responsible for more deaths than shark attacks annually. For this reason, optimization of first-aid care is essential. According to the published literature, cnidarian venoms and toxins are heat labile at temperatures safe for human application, which supports the use of hot-water immersion of the sting area(s). However, ice packs are often recommended and used by emergency personnel. After conducting a systematic review of the evidence for the use of heat or ice in the treatment of cnidarian envenomations, we conclude that the majority of studies to date support the use of hot-water immersion for pain relief and improved health outcomes.

Highlights

According to some estimates, more than 150 million cnidarian envenomations occur worldwide every year [1]
We examined reference lists from studies and guidelines discovered in our searches for potentially relevant papers missed in our database searches
The preponderance of evidence demonstrates that hot-water immersion is a safe and effective method of reducing pain from cnidarian envenomations, and is associated with improved clinical outcomes

Summary

Introduction

More than 150 million cnidarian envenomations occur worldwide every year [1]. Despite the frequency of cnidarian envenomations and the medical urgency, there is much debate and disagreement between national and international guidelines as to the most effective first-aid measures to reduce pain or pathology from cnidarian stings. Immersion in hot water (~45 ̋ C) is a well documented and commonly recommended therapy for many kinds of marine envenomations, including the painful stings from echinoderms and venomous fish [2]. The mechanism of action is not entirely clear, but there is evidence that marine venoms are heat labile, and immersion of the sting area in hot water is thought to inactivate key venom components. Others have postulated that the temperatures needed for such inactivation are much higher (~60 ̋ C), and suggest that the pain relief which occurs during hot-water immersion instead results from physiological reactions to heat application (such as increased subcutaneous blood flow)

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