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Should you apply vinegar to all jellyfish stings?

The short answer is, no. Here's why and how to treat the different types of jellyfish stings.
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Summer is here, and so is the increased chance of being stung by jellyfish whilst you’re out swimming in the ocean. Everybody has their own theory on the best treatment for jellyfish stings including urine, vinegar, seawater and hot water.

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To vinegar or not to vinegar? Experts agree vinegar (due to its acetic acid content) is the best treatment for box jellyfish and their smaller cousins, the irukandji. The vinegar works by inhibiting the stinging cell discharge. However, vinegar should NOT be applied to a bluebottle sting, as it can actually stimulate the discharge and cause further pain. If stung by a blue bottle, you should rinse well with seawater to remove the microscopic stinging cells, then use hot water or ice for the pain. The Royal Australian College of General Practitioners (RACGP) and the Australian Resuscitation Council (ARC) both recommend this as being the most appropriate treatment for blue bottle stings. Additionally, you should never substitute vinegar with methylated spirits or alcohol, as this will make the sting worse.

vinegar
• Vinegar to remedy jellyfish and other marine stings on the Four Mile Beach in Port Douglas, Australia. (Credit: Getty)

Bluebottle jellyfish: Bluebottle stings are the most common jellyfish stings in Australia. More than 10,000 people report being stung by bluebottle in Australia each year. In peak year, this figure can reach up to 30,000. The bluebottle is generally found in southern waters of eastern Australia.

Bluebottle
Bluebottle (Credit: Getty)
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Box jellyfish: The box jellyfish is found in the tropical oceans around northern Australia. Box jellyfish have been known to extend as far south as Exmouth on the west coast of Australia. They are typically large, with substantial bodies and numerous tentacles on each corner. Depending on the species, they can range in size from 10 to 30cm in length.  They are difficult to see in water, as their bodies are transparent. A box jellyfish sting will cause immediate severe pain, often likened to an iron or hot oil burns. The tentacles are often left on the skin, and will cause additional stinging if not neutralized by vinegar. Severe box jellyfish stings will have a “ladder-like” appearance, and will “frost” the skin. Substantial stings covering half of one limb can be fatal. Apply vinegar immediately and seek medical attention urgently. Dial 000 for an ambulance. Do not re-enter the water.

box jelly fish
Box jellyfish (Credit: Getty)

Irukandji jellyfish: Irukandji are a group of small jellyfish whose stings can cause serious illness in healthy humans. They are generally found in the northern waters of Australia, however they have been found as far south as Fraser Island in Australia. While caution is necessary, there have only ever been three recorded deaths from Irukandji stings and if prompt medical treatment is received, a full recovery usually occurs within 24 – 48 hours.  Their stings start out as a mild sting however after 20 to 30 minutes, the sting can escalate into the potentially fatal irukandji syndrome, which includes high blood pressure, vomiting, body spasms and profuse sweating. Irukandjis are rare, but their stings can be life-threatening. Apply vinegar immediately and seek medical attention urgently. Dial 000 for an ambulance. Do not re-enter the water.

Irukandjis jellyfish
A deadly new species of irukandji jellyfish, caught off the coast of Broome and considered to be one of the world’s most poisonous creatures, in Darwin, 23 April 2004. (Credit: Getty)
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Here is a handy table from The Royal Australian College of General Practitioners, outlining how to treat different types of jellyfish stings.

Table: Summary of the clinical effects, first aid and treatment of the most common medically important jellyfish

Jellyfish stings

Linear/tentacle-like stings

Irukandji-like stings

Bluebottle and minor jellyfish

Major box jellyfish

 

Other box jellyfish

 

Clinical effects

Typically, these stings cause immediate local intense pain for 1–2 hours, and associated linear erythematous eruptions

These stings cause severe local pain and associated erythematous eruptions along the lines of tentacle contact. In large surface area contact exposures cardiovascular collapse and death can occur

Irukandji syndrome is typically delayed (20–30 mins) with generalised severe pain and systemic effects (tachycardia, agitation, hypertension) and in a small proportion cardiac injury/pulmonary oedema

First aid

  • Wash sting site with seawater and remove tentacles
  • Hot water immersion (45°C for 20 minutes*)
  • Avoid vinegar as it may worsen the pain
  • Apply vinegar and remove tentacles
  • Commence immediate cardiopulmonary resuscitation on any patient who is unconscious
  • Apply vinegar and remove any remaining tentacles

Further medical management

Generally no further intervention is necessary

Transport to hospital for:

  • Analgesia (oral and IV)
  • Consider antivenom in patients with cardiovascular collapse not responsive to standard advanced life support

Transport to hospital for:

  • Analgesia (oral and intravenous)
  • Investigation and treatment of cardiac effects (troponin, ECHO)
  • Cardiac monitoring

*Evidence only for bluebottle stings but likely to work with other minor jellyfish stings

jellyfish
Jellyfish warning (Credit: Getty)

Although extremely unlikely, it is possible that a bluebottle sting may mimic anaphylaxis also known as an anaphylactic reaction (a severe allergic reaction that can be life-threatening).

  • If a person who has been stung by a bluebottle develops distressing chest tightness or difficulty breathing and is getting worse, call 000 to get urgent medical help.
  • If the sting area is large (e.g. affects more than half of the arm or leg) or involves a sensitive area such as the eye, seek medical help.
  • In tropical Australia, if you cannot identify the jellyfish as a harmless jellyfish or bluebottle, treat with vinegar and call for medical help.
  • If there is continuing pain, itchiness or blistering at the site of the sting, visit a doctor.

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