Heated Debates: Hot-Water Immersion or Ice Packs as First Aid for Cnidarian Envenomations?

Wilcox, Christie; Yanagihara, Angel A.

doi:10.3390/toxins8040097

Cited by 36 publications

(30 citation statements)

References 69 publications

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“…There is much debate about whether heat is recommended in the treatment of cnidarian stings, although the preponderance of evidence supports its use [14]. Our findings strongly support the use of heat, as the application of hot packs was able to significantly reduce the activity of injected venom, to the point of completely counteracting the negative effects of scraping for A. alata (Figure 4).…”

Section: Discussionsupporting

confidence: 67%

“…Studies have shown that the outcomes also vary based on first-aid and clinical-care measures [10,11,12,13]. The activity of venom, which is already deposited into the tissue of the victim at the sting site, can be markedly reduced by using venom-inhibiting treatments, such as hot-water immersion [10,11,14,15] and dermal-permeating inhibitors [15]. Since only <1% of tentacle cnidae discharge upon initial contact with human skin [16], ineffective procedures for removing still-adherent live tentacles have the potential to greatly worsen sting outcomes by increasing the initial venom load.…”

Section: Introductionmentioning

confidence: 99%

“…While the preponderance of evidence supports the safe, effective, and advantageous use of vinegar as a rinse solution [16,17,18,19] and hot-water immersion or hot packs for pain relief after vinegar rinsing [14], suggestions for appropriate first aid in the absence of vinegar vary greatly. One of the most commonly repeated recommendations is the use of scraping with a credit card or razor to remove tentacles and/or undischarged cnidae [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40].…”

Section: Introductionmentioning

confidence: 99%

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Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations

Yanagihara

Wilcox

2017

Toxins

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Cnidarian envenomations are the leading cause of severe and lethal human sting injuries from marine life. The total amount of venom discharged into sting-site tissues, sometimes referred to as “venom load”, has been previously shown to correlate with tentacle contact length and sequelae severity. Since <1% of cnidae discharge upon initial tentacle contact, effective and safe removal of adherent tentacles is of paramount importance in the management of life-threatening cubozoan stings. We evaluated whether common rinse solutions or scraping increased venom load as measured in a direct functional assay of venom activity (hemolysis). Scraping significantly increased hemolysis by increasing cnidae discharge. For Alatina alata, increases did not occur if the tentacles were first doused with vinegar or if heat was applied. However, in Chironex fleckeri, vinegar dousing and heat treatment were less effective, and the best outcomes occurred with the use of venom-inhibiting technologies (Sting No More® products). Seawater rinsing, considered a “no-harm” alternative, significantly increased venom load. The application of ice severely exacerbated A. alata stings, but had a less pronounced effect on C. fleckeri stings, while heat application markedly reduced hemolysis for both species. Our results do not support scraping or seawater rinsing to remove adherent tentacles.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations

Yanagihara

Wilcox

2017

Toxins

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“…Consequences of Cnidaria stings may range from minor local irritation to severe local and systemic reactions including excruciating pain and life-threatening cardiovascular collapse depending on the Cnidarian species, age of the victim and size of the area contacted. In addition, Cnidarians outbreaks may interfere with human activities such as tourism, bathing, aquatic events, fishing and aquaculture, causing substantial economical burden1234. On the other hand, Cnidarians venom is a rich source of bioactive substances that may have therapeutic potential and other useful applications567.…”

mentioning

confidence: 99%

Crude venom from nematocysts of Pelagia noctiluca (Cnidaria: Scyphozoa) elicits a sodium conductance in the plasma membrane of mammalian cells

Morabito

Costa

Rizzo

et al. 2017

Sci Rep

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Cnidarians may negatively impact human activities and public health but concomitantly their venom represents a rich source of bioactive substances. Pelagia noctiluca is the most venomous and abundant jellyfish of the Mediterranean Sea and possesses a venom with hemolytic and cytolytic activity for which the mechanism is largely unknown. Here we show that exposure of mammalian cells to crude venom from the nematocysts of P. noctiluca profoundly alters the ion conductance of the plasma membrane, therefore affecting homeostatic functions such as the regulation and maintenance of cellular volume. Venom-treated cells exhibited a large, inwardly rectifying current mainly due to permeation of Na+ and Cl−, sensitive to amiloride and completely abrogated following harsh thermal treatment of crude venom extract. Curiously, the plasma membrane conductance of Ca2+ and K+ was not affected. Current-inducing activity was also observed following delivery of venom to the cytosolic side of the plasma membrane, consistent with a pore-forming mechanism. Venom-induced NaCl influx followed by water and consequent cell swelling most likely underlie the hemolytic and cytolytic activity of P. noctiluca venom. The present study underscores unique properties of P. noctiluca venom and provides essential information for a possible use of its active compounds and treatment of envenomation.

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“…Another more recent systematic review of the literature found the majority of studies supported the use of hot water immersion in the treatment of jellyfish stings. Importantly the review did not find any studies that showed any worsening of symptoms or poorer outcomes (Wilcox and Yanagihara, 2016).…”

Section: Discussionmentioning

confidence: 95%

Successful use of heat as first aid for tropical Australian jellyfish stings

Little

Fitzpatrick

Seymour

2016

Toxicon

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a b s t r a c tCurrently the Australian Resuscitation Council (ARC) recommends dousing with vinegar followed by ice as first aid for jellyfish stings in tropical Australia, with limited evidence to support this recommendation (Li et al., 2013). We report our successful experience in using hot water immersion as first aid in treating two people stung by venomous tropical Australian jellyfish, one by Chironex fleckeri and one by Carukia barnesi.© 2016 Elsevier Ltd. All rights reserved. Clinical recordA 35 yo M cinematographer was filming documentary on Irukandji jellyfish at Palm Cove, Queensland. He was coming to the shore holding a camera housing, and removed his glove to lift the housing out of the water. As he placed his left hand underwater he contacted a jellyfish, where the tentacle ran from ½ way down the extensor surface of his forearm, running around the web space of his L hand across his palm and then between the ring and middle finger, and ending dorsally at the wrist joint. It was estimated to be 30 cm of tentacle, which was typical for Carukia barnesi.Within 5 minutes his entire forearm and hand was immersed in hot water (as hot as he could tolerate) in a plastic container. This was left there for about 20 minutes, with the water being replaced several times as soon as the water cooled.He was taken to the ED at Cairns Hospital, was observed for 5 hours and did not require any analgesia medication.The jellyfish, wrapped around the victims arm, was captured and later identified as Carukia barnesi.A 40yo M biologist was at Palm Cove collecting Box jellyfish (Chironex fleckeri). Whilst collecting one animal, he was stung across both hands and fingers on both the dorsal and palmer aspects by a Chironex fleckeri box jellyfish with a bell 25cm diameter. He had immediate severe pain, which the patient described 'brought him to tears'. He immediately rubbed his hands in wet sand and within 5 minutes he placed both hands in a plastic container of hot water (as hot as he could tolerate) for about 10 minutes. He had almost immediate relief of pain, and the severe pain recurred as the water temperature cooled and had the hot water replaced about four times. After ten minutes the pain had settled and was minimal, although he had marked swelling of his hands that settled over 48 hours. He required no analgesia medication. He had no permanent scarring.

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Heated Debates: Hot-Water Immersion or Ice Packs as First Aid for Cnidarian Envenomations?

Cited by 36 publications

References 69 publications

Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations

Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations

Crude venom from nematocysts of Pelagia noctiluca (Cnidaria: Scyphozoa) elicits a sodium conductance in the plasma membrane of mammalian cells

Successful use of heat as first aid for tropical Australian jellyfish stings

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