Pediatric emergency medicine trisk 1995 1995
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the Portuguese man-of-war may discharge even when it is dead and washed up on
the beach. Because of the length and transparency of the tentacles in the water,
swimmers are often stung without seeing the animal.
The toxin contains polypeptides and degradative enzymes. Local effects
include pain and irritation. Systemic reactions include headache, myalgias, fever,
abdominal rigidity, arthralgias, nausea, vomiting, pallor, respiratory distress,
hemolysis, renal failure, and coma. Death may occur if the area stung is extensive
in relation to the size of the victim.
The unexploded nematocysts are inactivated with topical application for 30
minutes with vinegar (3% acetic acid), a slurry of baking soda, or meat tenderizer
(papain). Papain should not be left on for more than 15 minutes. Vinegar is
generally the best disarming agent for hydrozoan stings; however, for Portuguese
man-of-war, vinegar may be ineffective and may sometimes paradoxically
activate the nematocysts. The affected area should be washed with seawater or
normal saline and if Portuguese man-of-war sting is suspected it should be dipped
in hot seawater (40° to 45°C [104° to 113°F]) for 20 minutes. The affected limbs
should be immobilized. There is no antivenin available for Physalia or the
scyphozoans, with the exception of the sea wasp, Chironex fleckeri, of Australia.
Shock may require cardiorespiratory support. General supportive measures for
systemic reactions include antihistamines, corticosteroids, and opiates for pain.
Muscle spasms have been treated with 10% solution of calcium gluconate 0.1
mL/kg (10 mg/kg) given intravenously, although the efficacy is controversial.
Local dermatitis should be treated with a topical corticosteroid cream, and topical
treatment with 1% lidocaine is effective in pain control.
Class Scyphozoa
The common purple jellyfish (Pelagia noctiluca ) is only mildly toxic. Local skin
irritation is the major clinical manifestation. Sea nettle (Chrysaora quinquecirrha
) is a common jellyfish found along the Atlantic coast. Clinical manifestations are
the same as those for purple jellyfish. Lion’s mane (Cyanea capillata ) is a highly
toxic creature that can reach a width of 244 cm, with tentacles as long as 61 cm.
The animal is found along both coasts. Contact with the tentacles produces severe
burning. Prolonged exposure causes muscle cramps and respiratory failure.
Treatment of scyphozoan stings is the same as above for hydrozoan stings.
Class Anthozoa
The anemones found within United States tidal zones are only mildly toxic. Coral
cuts and stings can be a problem for swimmers off the Florida coast. The stinging
