Ocean Safety

MARINE STINGS AND CUTS
Remedies for Seaside Perils

Nothing’s more fun than a day at the beach-unless you or your child has a close encounter with a stinging jellyfish, Portuguese man-of-war, sea urchin or coral.  Though jellyfish aren’t common on Maui beaches, you never know!

Though most plentiful in warm climates, jellyfish and their cousin, the Portuguese man-of-war, are common to just about every North American beach area. They drift along on top of the water with their tentacles trailing, ready for the unwary swimmer. But these creatures and any broken-off tentacles can still sting when they’re just lying around on the beach or floating in the water, even after a couple of days.

Sea urchins don’t actually bite or sting, but they have spines that can puncture the skin and release venom. And while coral may look like exquisite rock, it’s really a fragile colony of tiny creatures that can cause a painful wound if a child happens to step on it or scrape a leg against it.

It’s best that all these injuries be seen by a physician. But here’s what you can do before you reach the doctor.

Jellyfish and Portuguese Man-of-War

Get to dry land. ”If the child is stung in water, take him out of the water,” says Kenneth W. Kizer, M.D., M.P.H., professor of emergency medicine and medical toxicology at the University of California, Davis, School of Medicine and a specialist in wilderness medicine. Depending on how much venom is released, a sting can be quite serious. Because the child may panic or even lose consciousness, it’s crucial to get him out of the water.

Reach for your credit card. Jellyfish and Portuguese man-of-war tentacles have tiny parts that resemble miniature harpoons. When these venom-filled ”harpoons,” called nematocysts, puncture the skin, the result is painful. You want to get the tentacles and nematocysts off as quickly as possible, says Glenn G. Soppe, M.D., a physician in San Diego, California, who lectures on aquatic bites and stings. MEDICAL ALERT

When to See the Doctor

Jellyfish and man-of-war stings may cause pain, cramps, nausea and tingling as well as a hivelike rash, says Kenneth W. Kizer, M.D., M.P.H., professor of emergency medicine and medical toxicology at the University of California, Davis, School of Medicine and wilderness medicine specialist.

For these stings, it’s imperative to seek medical attention if the child complains of tightness in the throat or if he experiences shortness of breath or difficulty breathing. Children with any underlying health problems, such as diabetes, arthritis, and/or immune problems should be taken to the nearest medical center immediately, says Dr. Kizer.

Coral injuries can lead to infection: ”The problem with coral is that it’s sharp, jagged and fragile,” says Dr. Kizer. ”Little pieces of coral tend to break off in the wound, making it very prone to infection. And some of the coral secretions can be toxic.” These wounds demand special attention by a doctor who is familiar with coral injuries, according to Dr. Kizer.

Puncture wounds from sea urchins, stingrays and any spiny fish should also be treated by a doctor as soon as possible, although you should immerse the wound in hot water (110° to 115°F) immediately to relieve pain.

Although you can’t see the nematocysts, you can scrape them off with a credit card, says Dr. Kizer. Just brush the edge of the card across the sting area. ”If possible, wear surgical gloves while you’re doing this,” says Dr. Kizer. You want to be sure you don’t get stung, too.”

Rinse with saltwater. ”Use only saltwater to rinse the wound,” says Dr. Kizer. Fresh water can actually cause the little ”harpoon cells” to fire off and inject more venom, he cautions. Don’t rub the skin and never rub it with sand because this will cause the nematocysts to fire off more venom.

Neutralize them. You also want to neutralize the nematocysts so they don’t inject any more venom. The best neutralizer is vinegar, but you can also use a slurry of baking soda and water or a mixture of rubbing alcohol and meat tenderizer blended into a liquid paste, says Dr. Kizer.

”In Hawaii, where I used to practice, we used alcohol mixed with meat tenderizer all the time,” he says. ”The alcohol keeps the nematocysts from firing, and the meat tenderizer breaks down the venom.” He recommends that you mix just enough alcohol to the meat tenderizer to make a thin paste, like ketchup. Apply this paste to the wound and leave it there until the pain goes away, usually anywhere from 5 to 30 minutes. ( Because some children’s skin may be sensitive to ingredients in meat tenderizer, it’s best to monitor your child to see if irritation or an allergic reaction occurs.)

Use painkillers. ”Because many of these injuries cause inflammation, over-the-counter products such as acetaminophen [Children's Tylenol] can be helpful,” says Dr. Kizer. Check the package directions for the correct dosage for your child’s age and weight. If your child is under age two, consult a physician.

Give a jellyfish lesson. ”The best treatment for jellyfish stings is prevention,” says Dr. Kizer. Point out jellyfish lying on the beach and warn your child not to touch them. ”Jellyfish can remain venomous for at least a day or two after they’ve washed up on the beach,” he points out.

Coral and Sea Urchins

Remove spines with tape. If your child steps on coral, you can remove the fine, hard-to-get pieces by applying a piece of adhesive tape to the abrasion site and then removing it, says Constance L. Rosson, M.D., of the Good Samaritan Hospital in Portland, Oregon. When you pull the tape off, you pull up the tiny spines. Then bathe the area with vinegar, suggests Dr. Rosson.

Clean it out. If the wound is bleeding, apply pressure for a few minutes to stop the bleeding. Then use saltwater or fresh water to clean out the wound. ”Remove any obvious foreign material,” says Dr. Kizer. ”And remember that these kinds of injuries are at very high risk for infection,” he says.

Get into hot water. The toxins released by sea urchins can be broken down by heat. For these wounds, soak the body part in hot water, around 110° to 115°F, 30 to 90 minutes, says Dr. Kizer. That’s warmer than body temperature, but not hot enough to scald. ( This treatment also works for other stinging fish such as scorpion fish, lionfish and catfish.)

Raise the limb. Swelling may occur with both coral and sea urchin wounds. Elevate the area, if possible, to discourage swelling, says Dr. Kizer.

Check tetanus records. ”The bacteria that cause tetanus live in the ocean, and this may be a problem for coral and spine puncture wounds,” says Dr. Kizer. After the child’s first shots, she should get them every ten years, plus a booster if she has a nasty injury and the last shot was more than five years ago, he says.

Prepare with protection. To help your child avoid sea urchin stings, point out tide pools or rocky areas where these creatures are often found, suggests Dr. Kizer. He recommends reef shoes or aquatic shoes with hard, spine-proof soles and mesh tops for any child who’s walking or swimming in a beach area that has sea urchins or coral.