Treating Portuguese Man-of War Jellyfish Stings

First Aid & Treatment for Physalia Jellyfish Stings

The Portuguese Man-of-War (Physalia) can be found in any ocean when the water becomes warm. They are most often seen when strong winds have blown them near or onto the shore. These creatures are characterized by their blue, violet, or pink balloon-like float, which trails clusters of tentacles and polyps. The tentacles, which may extend 165 feet (~50 meters) in length, house the stinging nematocysts. The nematocysts sting upon contact. The man-of-war sting can cause a life-threatening reaction, although this is rare. More commonly, inappropriate first aid worsens the sting from what it would normally be. Many properly-treated stings resolve on their own, sometimes as quickly as 15-20 minutes. That's why it is important to take prompt and proper action in the event of a man-of-war sting. Here's what to do (and not to do):

Symptoms of Man-of-War and Jellyfish Stings

First, know your jellyfish! A man-of-war is different from a true jellyfish and both are different from a box jellyfish. If you don't know what caused the sting, carefully lift off any remaining tentacles and rinse with seawater. Don't scrub the area and don't apply any chemical (e.g., vinegar, fresh water, commercial product), as inappropriate use can cause injury or death. Don't make the sting worse. Unless the person has a reaction to the venom, stings heal well on their own. Here are the symptoms of a man-of-war or jellyfish sting:

• Painful raised red lesions running along the site of tentacle contact (most common symptom)
  
• The lesions may become filled with fluid. Sometimes these will heal with pigmentation.
  
• Muscle spasms in the affected area
  
• Systemic reactions: nausea, vomiting, headaches, dizziness, muscle weakness, runny nose, difficulty breathing, and irregular heart rate (these symptoms are more likely to occur in sensitive individuals or those with extensive stings)
  

First Aid for Man-of-War Stings

• Prevent further stings. Carefully lift off tentacle remnants, using a stick or gloved fingers. Do not rub the tentacles off, as this will cause more nematocysts to sting.
  
• Next, rinse the affected area with seawater. Do NOT use fresh water or vinegar, as these may cause the stinging cells to discharge all at once and may greatly worsen the sting! Do not scrub the affected area. [vinegar, papain (as in meat tenderizer), baking soda, urine, or aluminum sulfate all may deactivate the toxin, but they may also cause the stinging cells to discharge all at once, possibly intensifying the injury]
  
• Ice may be applied to reduce pain and swelling.
  
• Pain can be countered with topical treatment of products containing lidocaine or benzocaine (as in those products used for sunburn).
  
• Diphenhydramine (Benadryl) cream may be applied for persistent itching.
  
• Seek immediate medical attention if the person stung is having any difficulty breathing or maintaining consciousness.
  
• Seek medical attention for muscle spasms.
  
• Infection is possible, so seek medical attention if the pain persists, the rash worsens, a feeling of overall illness develops, lymph nodes become swollen, a red streak develops between lymph nodes and the sting, or the area becomes hot, red, and tender.
  
• It is not uncommon for the sites of man-of-war stings to 'flare up' with irritation periodically for up to 6-8 weeks following the sting. Unless the signs of infection are seen, these symptoms tend to resolve on their own.