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.

/pdf/jellyfish-stings-and-their-management-a-review-4ug69np1y6.pdf

Jellyfish stings and their management: a review.

Australian venomous jellyfish, envenomation syndromes, toxins and therapy.

The International Liaison Committee on Resuscitation (ILCOR) First Aid Task Force was formed in 2013 to review and evaluate the scientific literature on first aid in preparation for development of international first aid guidelines, including the 2015 American Heart Association (AHA) and American Red Cross Guidelines Update for First Aid . The 14 members of the task force represent 6 of the international member organizations of ILCOR. Before 2015, evidence evaluation for first aid was conducted by the International First Aid Science Advisory Board and the National First Aid Advisory Board. Although the group responsible for evidence evaluation has changed, the goals remain the same: to reduce morbidity and mortality due to emergency events by making recommendations based on an analysis of the scientific evidence.

A critical review of the scientific literature by appointed ILCOR First Aid Task Force members and evidence evaluators resulted in consensus on science statements with treatment recommendations for 22 selected questions addressing first aid interventions. These findings are presented in “Part 9: First Aid” of the 2015 ILCOR International Consensus on First Aid Science With Treatment Recommendations ,1,2 and they include a list of identified knowledge gaps that may be filled through future research. The ILCOR treatment recommendations are intended for the international first aid community, with the understanding that local, state, or provincial regulatory requirements may limit the ability to implement recommended first aid interventions. The current AHA/American Red Cross First Aid guidelines are derived from this work. New topics found in the 2015 First Aid Guidelines Update include first aid education, recognition of stroke, recognition of concussion, treatment of mild symptomatic hypoglycemia, and management of open chest wounds. Other topics have been updated based on findings from the corresponding ILCOR reviews.

The roots of first aid have been recorded throughout …

Part 15: First Aid: 2015 American Heart Association and American Red Cross Guidelines Update for First Aid.

The American Heart Association (AHA) and the American Red Cross (Red Cross) cofounded the National First Aid Science Advisory Board to review and evaluate the scientific literature on first aid in preparation for the 2005 American Heart Association (AHA) and American Red Cross Guidelines for First Aid. 1 In preparation for the 2010 evidence evaluation process, the National First Aid Advisory Board was expanded to become the International First Aid Science Advisory Board with the addition of representatives from a number of international first aid organizations (see Table). The goal of the board is to reduce morbidity and mortality due to emergency events by making treatment recommendations based on an analysis of the scientific evidence that answers the following questions: 

View this table:

Table. 
International First Aid Science Advisory Board Member Organizations



A critical review of the scientific literature by members of the International First Aid Science Advisory Board is summarized in the 2010 International Consensus on First Aid Science With Treatment Recommendations ( ILCOR 2010 CPR Consensus ), from which these guidelines are derived.2 That critical review evaluates the literature and identifies knowledge gaps that might be filled through future scientific research.

The history of first aid can be traced to the dawn of organized human societies. For example, Native American Sioux medicine men of the Bear Society were noted for treating battle injuries, fixing fractures, controlling bleeding, removing arrows, and using a sharp flint to cut around wounds and inflammation.3

Modern, organized first aid evolved from military experiences when surgeons taught soldiers how to splint and bandage battlefield wounds. Two British officers, Peter Shepherd and …

Part 17: First Aid

The recent bloom of a giant jellyfish Nemopilema nomurai has caused a danger to sea bathers and fishery damages in the waters of China, Korea, and Japan. The present study investigated the cytotoxic and hemolytic activities of crude venom extract of N. nomurai using a number of in vitro assays. The jellyfish venom showed a much higher cytotoxic activity in H9C2 heart myoblast than in C2C12 skeletal myoblast (LC(50)=2 microg/mL vs. 12 microg/mL, respectively), suggesting its possible in vivo selective toxicity on cardiac tissue. This result is consistent with our previous finding that cardiovascular function is a target of the venom. In order to determine the stability of N. nomurai venom, its cytotoxicity was examined under the various temperature and pH conditions. The activity was relatively well retained at low environmental temperature ( or=60 degrees C). In pH stability test, the venom has abruptly lost its activity at low pH environment (pH<or=4). Interestingly enough, however, its activity was not significantly affected even at the highest pH environment tested (pH<or=12) in the present study. Additionally, hemolytic activity of the venom was examined using the erythrocytes of cat, dog, human, rabbit and rat. Venom concentration-dependent hemolysis could be observed from 10 microg/mL of protein equivalents or higher with variable potencies in different species, among which dog erythrocyte was the most susceptible to the venom (EC(50)=151 microg/mL). SDS-PAGE analysis of N. nomurai venom showed the molecules of 20-40 kDa and 10-15 kDa appeared to be the major protein components of the venom.

Cytotoxicity and hemolytic activity of jellyfish Nemopilema nomurai (Scyphozoa: Rhizostomeae) venom.

Objective: To investigate the effectiveness of hot water immersion for the treatment of Physalia sp. (bluebottle or Portuguese Man-of-War) stings. Design: Open-label, randomised comparison trial. Primary analysis was by intention to treat, with secondary analysis of nematocyst-confirmed stings. One halfway interim analysis was planned. Setting: Surf lifesaving first aid facilities at two beaches in eastern Australia from 30 December 2003 to 5 March 2005. Participants: 96 subjects presenting after swimming in the ocean for treatment of an apparent sting by a bluebottle. Interventions: Hot water immersion (45° C) of the affected part versus ice pack application. Main outcome measures: The primary outcome was a clinically important reduction in pain as measured by the visual analogue scale (VAS). Secondary outcomes were the development of regional or radiating pain, frequency of systemic symptoms, and proportion with pruritus or rash on follow-up. Results: 49 patients received hot water immersion and 47 received ice packs. The two groups had similar baseline features, except patients treated with hot water had more severe initial pain (VAS [mean ± SD]: 54 ±22 mm versus 42 ±22 mm). After 10 minutes, 53% of the hot water group reported less pain versus 32% treated with ice (21%; 95% CI, 1%– 39%; P = 0.039). After 20 minutes, 87% of the hot water group reported less pain versus 33% treated with ice (54%; 95% CI, 35%–69%; P = 0.002). The trial was stopped after the halfway interim analysis because hot water immersion was shown to be effective (P = 0.002). Hot water was more effective at 20 minutes in nematocyst-confirmed stings (95% versus 29%; P = 0.002). Radiating pain occurred less with hot water (10% versus 30%; P = 0.039). Systemic effects were uncommon in both groups. Conclusions: Immersion in water at 45° C for 20 minutes is an effective and practical

https://espace.cdu.edu.au/eserv/cdu:2283/Isbister_2283.pdf

A randomised controlled trial of hot water (45˚C) immersion versus ice packs for pain relief in bluebottle stings

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A randomised controlled trial of hot water (45˚C) immersion versus ice packs for pain relief in bluebottle stings