“Stings” by jellyfish and stingrays are common during the summer months. As as an emergency physician (EP) having practiced along the southern California and Gulf coasts, I have treated numerous beach-goers that were stung by these marine animals.
As a surfer I have personally experienced the discomfort of being stung by them as well. Jellyfish tentacles release thousands of very tiny stinging cells (nematocysts) that attach to the surface of the skin releasing venom (poison), whereas, the stingray uses its hard barbed tail that is serrated with small venom-containing spines that penetrate the skin.
How can a jellyfish sting me?
There are several ways a person can get stung by a jellyfish. The jellyfish may be difficult to see as it floats and bobs around on the water’s surface as the swimmer collides with the jellyfish. In addition, jellyfish tentacles can vary in size from a few feet to over a hundred feet, and as the tentacles float easily in the water it can brush up against the swimmer’s body. Also, stepping on a dead jellyfish that has washed up onto the shore can still sting.
What do I do if I get stung by a jellyfish?
One’s first reaction is to scratch the area that was stung, as I did. Bad idea. Try to refrain from scratching, rubbing or scrubbing the area that was stung because the stinging cells continue to release more venom when you do that and it worsens the already itchy, red painful area. Go to the lifeguard station since they usually have what is needed for jellyfish stings. The sting of a jellyfish is not an emergency but it may cause discomfort or pain, red marks, itching, numbness or tingling. If the tentacle it still on the skin remove it with a stick, or some type of object, but be careful not to scrape it off. Do not remove the tentacle with your fingers because the stinging cells will be transferred to your fingers.
How do you treat a jellyfish sting? To-date the most effective way to break down and prevent further release of the jellyfish venom is to rinse the affected skin with hot water. The venom is broken down by hot water but not by cold water. Apply Lidocaine or Benzocaine, cover the area with a dry dressing and you may need to take over-the-counter medications for pain and itching. The discomfort may last around 30 minutes but the redness and itching may linger for several hours or days.
A less effective method is to rinse the area with salt water and then with vinegar or lemon/ lime juice. Freshwater releases more venom while salt water does not so do not wash the area with your water bottle. Vinegar and the citrus fruits are weakly acidic and it neutralizes the venom and reduces the discomfort.
Several long-standing home remedies have been used over the years to treat jellyfish stings that include meat tenderizer, baking soda, alcohol, fresh water, soda, lotions and creams, sand and even urine; yes urine. These all have been shown to be minimally effective, if at all, in treating jellyfish stings. Now for the answer to what many people want to know, “does peeing on a jellyfish sting really work?” If there is nothing else around to use, pee on it, it’s better than nothing, speaking from personal experience and other surfers’ and researchers reports. Urine can be some-what effective because urine is very weakly acidic.
I recommend a jellyfish first aid kit to be kept in the car before heading off to the beach. This kit should include either of the following: Lidocaine/Benzocaine spray/gel, vinegar, lemon/lime or its juices, and tweezers.
A stingray has a wide flat body made out of cartilage and a spine in their serrated tail that has a very sharp point. Stingray envenomation necessitates medical care for pain control, wound care and symptomatic management. The venom (poison) from a stingray is a neurotoxin, it affects a chemical in the brain that may cause a variety of symptoms including fever, chills, nausea, vomiting, diarrhea, weakness, headache, dizzy/lightheadedness, muscle cramps, tremors, seizures, paralysis and decreased blood pressure. Deaths from stingrays are very rare but have occurred when the stingray spine has penetrated the chest or abdomen as was the case of the Steve Irwin the Crocodile Hunter.
How can a stingray sting me?
Typically it occurs in beach-goers, surfers and scuba divers who inadvertently step on the stingray. Most surfers know to do the stingray- shuffle when walking in the shallow waters to avoid stepping on a stingray. The stingray- shuffle is just that. You shuffle your feet as you wade or “shuffle” out to deeper waters. The shuffling of the feet disturbs the ocean floor and sand as it scares off the stingray. Stingrays do not attack people. But if stepped on they will use their tail in a defensive move to get -you -off -their -back. In a defensive move the stingray whips it barbed tail and usually penetrates the lower leg (foot, ankle toes). When the barbed tail inserts its tail, let’s say in your foot, it leaves behind spines that break off as it pulls its tail out of the foot. These spines contain venom that continues to be released until they are removed or the venom neutralized. Stingrays use their venomous barbed tail to fend off marine predators in the wild. Rarely, the stingray may cause death by direct penetration to the torso of the person if swimming in deeper waters.
What do I do if I get stung by a stingray?
Go to the lifeguard first for immediate care. Then you may need to go to the emergency department for continued medical management.
What happens first, and speaking from personal experience, is a sharp pain where the tail poked you followed by continuous severe pain at the site that may also progress up the leg. The best way I can describe the pain I experienced was as if someone took a hot sharp fireplace poker and shoved it in my foot and then set my leg on fire with hot burning charcoal. You may experience other symptoms caused by the venom as previously mentioned. As for me, within seconds, my entire leg was paralyzed from foot to hip and I could not walk.
How do you treat a stingray envenomation? With hot water and debridement of the wound by an EP. The venom of the stingray breaks down when exposed to heat. When the wound is immersed in hot water the venom breaks down and stops the pain and other symptoms caused by the venom. The temperature of the hot water should be as hot as the person can tolerate without producing burns. In addition, pain medications are usually necessary to control the excruciating pain. Local anesthetic of the wound may decrease the pain. The wound needs to be explored for retained spines that need to be removed and other debris. The wound that the barbed tail causes can lead to dying off the soft tissue (tissue necrosis), non-healing wounds or ulcerations and infections caused by bacteria found on the skin and those found in the ocean’s water.
Antibiotics are usually necessary to prevent infection of the wound and normal wound healing. Continued medical management of the wound may take several days or weeks.
My personal experience included hot water immersion of my foot at the lifeguard’s station for an hour. But the water was not hot enough and the pain and paralysis were not resolving so I was taken to the local emergency department. I received a pain shot and had the nurses immerse my foot in the nearly boiled hot water from their coffee maker. And yes, it did burn my skin but the pain from the stingray outweighed the pain from the scalding water. The EP injected a local anesthetic to the wound and removed several spines and irrigated the wound with hot water. Finally, the pain was starting to subside and slowly over several hours I regained full movement of my left leg. After 10 days on crutches, antibiotics, pain medications, and daily dressing changes the wound finally healed without any further pain or swelling.
I recommend a stingray first aid kit to include several heat packs. Utilize the hot-water-in-5 minute packs and seek immediate medical attention.
Julie Gorchynski MD, MSc, FACEP is a professor in the Department of Emergency Medicine emergency medicine residency program at the University Texas Health Science Center in San Antonio Texas.