adhere), and then scrape off with a dull knife. Apply
cool packs and hydrocortisone cream.
Some jellyfish (notably, the Portuguese
man-of-war, the box jellyfish, and certain jellyfish
from northeastern Australia) may cause serious
injuries and even have the potential to be lethal. In
cases where the kind of jellyfish that caused the sting is
either unknown or is known to have been from a box
jellyfish or Portuguese man-of-war, the injury should
be treated as a serious one, regardless of initial
symptoms. The following steps should be taken in the
case of serious jellyfish stings.
1. Retrieve the victim from the water if necessary.
2. Send others for an ambulance and antivenom.
(Antivenom is available for box jellyfish stings.
It is from sheep, and should be given in all
3. Pour vinegar liberally (2 liters) over the sting
area for at least 30 seconds to inactivate stinging
cells that may remain.
4. Remove any remaining tentacles carefully.
(Excessive manipulation may cause rupture of
nematocysts and further poison release.)
Carefully (and gently) use a towel if necessary,
or use a dull knife edge (as described above to
remove arthropod stingers).
5. Apply a compression bandage to stings
covering more than half of one limb or causing
6. Start an IV.
7. Remain with the victim, and monitor vital signs
(the ABCs and consciousness, responding
appropriately (possibly including CPR) and as
8. Transport the patient to a hospital as quickly as
9. Opiate analgesics (morphine or meperidine)
may be necessary for pain relief.
SPINE INJURIES.Spiny fish, stingrays,
urchins, and cone shells inject their venom by
puncturing with spines (fig. 5-6). General signs and
symptoms include swelling, nausea, vomiting,
generalized cramps, diarrhea, muscular paralysis, and
shock. General emergency care consists of prompt
flushing with cold sea water to remove the venom and
to constrict hemorrhaging blood vessels.
debride the wound of any remaining pieces of the
spines venom-containing integumentary sheath. Soak
the wound area in very hot water (110F/43 C) for 30
to 60 minutes to neutralize the venom.
completely debride the wound, control hemorrhage,
s u t u r e , p r o v i d e t e t a n u s p r o p h y l a x i s a n d a
broad-spectrum antibiotic, and elevate the extremity.
For minor injuries, a steroid cream to the wound area
may relieve discomfort. For serious injurieswounds
that are deep, very painful, or causing the patient
distressstabilize the patient and transport
immediately to a hospital.
In the case of contact with stonefish, scorpionfish,
zebra, or lionfish, immerse the wound in very hot water
for a minimum of 30 minutes until the pain is
decreased. Inject emetine hydrochloride directly into
the wound within 30 minutes, and provide meperidine
(or other opiate) for pain. Monitor the victims vital
signs closely. Obtain antivenom (from local zoos or
aquariums) for all serious cases.
SEA SNAKE INJURIES.Sea snakes are found
in the warm water areas of the Pacific and Indian
Oceans. Their venom is VERY poisonous, but their
fangs are only 1/4 inch long. The first aid outlined for
land snakes also applies to sea snakes.
LEARNING OBJECTIVE: Recall drug
abuse assessment and treatment procedures
and patient handling techniques.
Drug abuse is the use of drugs for purposes or in
quantities for which they were not intended. Drugs of
Figure 5-6.Stingray sting.