First aid and resuscitation
Note: Survival, for both adults and children, depends on immediate cardiopulmonary resuscitation.
Initial treatment for major box jellyfish stings comprises:
- immediate cardiopulmonary resuscitation (CPR) for cardiovascular collapse—crucial for survival of both adults and children1
-
first aid
- immediately remove any tentacles by hand or wash them off with sea water (not fresh water)
- apply vinegar liberally to the sting site and surrounding areas once tentacles are removed—vinegar deactivates the remaining nematocysts (stinging cells) and prevents further envenoming
- apply ice packs
- give oral or parenteral analgesia.
Transport all patients, except those with minor stings, to hospital. In the case of life-threatening envenoming, ongoing resuscitation is essential. Do not use intramuscular antivenom in the prehospital setting, irrespective of haemodynamic compromise, because it does not reach the systemic circulation for hours.