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Toxins 2017, 9(3), 105; doi:10.3390/toxins9030105

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

1
Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI 96822, USA
2
Békésy Laboratory of Neurobiology, Pacific Biosciences Research Center, University of Hawaii at Mānoa, Honolulu, HI 96822, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Bryan Grieg Fry
Received: 3 February 2017 / Revised: 9 March 2017 / Accepted: 13 March 2017 / Published: 15 March 2017
(This article belongs to the Section Animal Venoms)
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Abstract

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. View Full-Text
Keywords: first aid; marine envenomation; box jelly; Alatina alata; Chironex fleckeri; jellyfish; hot water immersion; heat treatment; shaving first aid; marine envenomation; box jelly; Alatina alata; Chironex fleckeri; jellyfish; hot water immersion; heat treatment; shaving
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Yanagihara, A.A.; Wilcox, C.L. Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations. Toxins 2017, 9, 105.

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