Abstract
Jellyfish (cnidarians) have a worldwide distribution. Despite most being harmless, some species may cause local and also systemic reactions. Treatment of jellyfish envenomation is directed at: alleviating the local effects of venom, preventing further nematocyst discharges and controlling systemic reactions, including shock. In severe cases, the most important step is stabilizing and maintaining vital functions. With some differences between species, there seems to be evidence and consensus on oral/topical analgesics, hot water and ice packs as effective painkillers and on 30 s application of domestic vinegar (4%–6% acetic acid) to prevent further discharge of unfired nematocysts remaining on the skin. Conversely, alcohol, methylated spirits and fresh water should be carefully avoided, since they could massively discharge nematocysts; pressure immobilization bandaging should also be avoided, as laboratory studies show that it stimulates additional venom discharge from nematocysts. Most treatment approaches are presently founded on relatively weak evidence; therefore, further research (especially randomized clinical trials) is strongly recommended. Dissemination of appropriate treatment modalities should be deployed to better inform and educate those at risk. Adequate signage should be placed at beaches to notify tourists of the jellyfish risk. Swimmers in risky areas should wear protective equipment.
Highlights
20% Al2(SO4)3; † NaHCO3; ♣ sublingual; * tested on C. quadrigatus; pressure immobilization bandage (PIB): Pressure Immobilization Bandage; Level of scientific evidence according to the Agency for Healthcare Research and Quality [113]: 1 = Randomized controlled trials; 2 = Experimental paired/crossover study; 3 = Observational studies with controls; case series; 4 = Studies without controls, studies based on physiology and basic science, case reports and expert opinion
The most important step after envenomation is basic life support (ABCs), with the aim of maintaining respiration and blood circulation [2,98], and tentacle removal, since as long as tentacles adhere to the skin, nematocysts continue to discharge venom [2,100]
protective equipment (PPE) is, almost totally effective against all jellyfish stings and is routinely recommended in Australia for all people [24]
Summary
The phylum is subdivided into five classes (see Figure 1: Staurozoa (Stauromedusae); Scyphozoa (true jellyfish); Hydrozoa (Portuguese Man O’ War, fire corals and hydroids); Cubozoa (box jellyfish); and Anthozoa (sea anemones and true corals) [1]) and is composed of about 10,000 species, with 100 of them known to be dangerous to humans [2,3]. Jellyfish have a bell-shaped body (umbrella) of different sizes, with a varying number of tentacles, depending on the species. The tentacles present specialized epidermic cells, called cnidocytes, that contain three categories of organelles, called cnidae (and cnidocysts). Nematocysts, one of the three categories of cnidae, are hollowed capsules containing a tightly coiled and folder thread immersed in the cnidarians’
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