The answer is predicated on our knowing what the correct treatment is — and we don’t
In this issue of the MJA, Isbister and colleagues report that hot water immersion was no more effective than ice packs for treating the pain of stings by the box jellyfish (Chironex fleckeri).1 This finding is surprising, as jellyfish venoms are heat-labile,2 but unsurprising, given that heat treatment for some patients did not begin until 4 hours after the patient was stung.
- 1. Isbister GK, Palmer DJ, Weir RL, Currie BJ. Hot water immersion v icepacks for treating the pain of Chironex fleckeri stings: a randomised controlled trial. Med J Aust 2017; 206: 258-261.
- 2. Carrette T, Cullen P, Little M, et al. Temperature effects on box jellyfish venom: a possible treatment for envenomed patients? Med J Aust 2002; 177: 654-655. <MJA full text>
- 3. Australian Resuscitation Council. Envenomation: jellyfish stings (guideline 9.4.5) July 2010. https://resus.org.au/?wpfb_dl=41 (accessed Feb 2017).
- 4. Loten C, Stokes B, Worsley D, et al. A randomised controlled trial of hot water (45°C) immersion versus ice packs for pain relief in bluebottle stings. Med J Aust 2006; 184: 329-333. <MJA full text>
- 5. Hartwick R, Callanan V, Williamson J. Disarming the box-jellyfish: nematocyst inhibition in Chironex fleckeri. Med J Aust 1980; 1: 15-20.
- 6. Welfare P, Little M, Pereira P, Seymour J. An in-vitro examination of the effect of vinegar on discharged nematocysts of Chironex fleckeri. Diving Hyperb Med 2014; 44: 30-34.
- 7. Carrette TJ. Etiology of Irukandji Syndrome with particular focus on the venom ecology and life history of one medically significant carybdeid box jellyfish Alatina moseri. Thesis: James Cook University, Cairns, 2014. http://researchonline.jcu.edu.au/40748/ (accessed Feb 2014).
- 8. Seymour JE, Carrette T, Cullen P, et al. The use of pressure immobilization bandages in the first aid management of cubozoan envenomings. Toxicon 2002; 40: 1503-1505.
- 9. Pereira P, Carrette T, Cullen P, et al. Pressure immobilisation bandages in first aid treatment of jellyfish envenomation: current recommendations reconsidered. Med J Aust 2000; 173: 650-652. <MJA full text>
- 10. Corkeron MA. Magnesium infusion to treat Irukandji syndrome. Med J Aust 2003; 178: 411. <MJA full text>
- 11. McCullagh N, Pereira P, Cullen R, et al. Randomised trial of magnesium in the treatment of Irukandji syndrome. Emerg Med Australas 2012; 24: 560-565.
- 12. Winter KL, Isbister GK, McGowan S, et al. A pharmacological and biochemical examination of the geographical variation of Chironex fleckeri venom. Toxicol Lett 2010; 192: 419-424.
- 13. Kintner AH, Seymour JE, Edwards SL. Variation in lethality and effects of two Australian chirodropid jellyfish venoms in fish. Toxicon 2005; 46: 699-708.
- 14. Underwood AH, Seymour JE. Venom ontogeny, diet and morphology in Carukia barnesi, a species of Australian box jellyfish that causes Irukandji syndrome. Toxicon 2007; 49: 1073-1082.
- 15. Boulware DR. A randomized controlled field trial for the prevention of jellyfish stings with a topical sting inhibitor. J Travel Med 2006; 13: 166-171.
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