Photo by Molly Hagbrand
The setting
You and your friend are enjoying some early morning sunshine and perfect waves while surfing on the Pacific Ocean. While waiting for the next break, you are sitting on your surfboard taking in the beautiful scenery when you hear your friend shriek. You ask what’s going on and they yell, “I think I just got stung by a jellyfish!” You both carefully paddle to the shore, and when you reach the beach, you begin your patient assessment.
SOAP Report
Subjective
The patient is a 20 year old female whose chief complaint is pain in the right arm. The mechanism of injury was hitting a jellyfish while paddling on a surfboard. The patient is currently A+Ox4.
Objective
Patient Exam: The patient is found sitting on the beach. The physical exam reveals red/brown spots and swelling on the right arm. No other injuries are found, and there are intact CSMs in all four extremities.
Vital Signs
|
Level of Responsiveness (LOR) |
A+OX4 |
|
Heart Rate (HR) |
88, strong, regular |
|
Respiratory Rate (RR) |
18, regular, easy |
|
Skin Color, Temperature, Moisture (SCTM) |
Mucous membranes pink, skin warm, dry |
|
Blood Pressure (BP) |
Strong radial pulse present |
|
Pupils |
PERRL |
|
Temperature (T°) |
Not taken |
History
|
Symptoms: |
Pain and a stinging sensation in the right arm. |
|
Allergies: |
Patient denies any allergies. |
|
Medications: |
Patient takes a daily multivitamin. |
|
Pertinent Hx: |
Patient denies any pertinent medical history. |
|
Last in/out: |
Patient reports drinking 1 cup of coffee, 1 glass of water, and eating a piece of toast this morning. Patient reports urinating and defecating before surfing this morning. |
|
Events: |
The patient was paddling on their surfboard when they thought they hit a jellyfish. |
STOP READING!
What is your assessment and plan? Take a few minutes to figure out your own assessment and make a plan. Don’t cheat—no reading on without answering this first!
Assessment
• Possible jellyfish sting.
Plan
• Protect yourself from also getting stung.
• Clean the area with hot water and soak the area in hot water (105℉/ 41℃) for 30-90 minutes.
• Consider pain medication.
Anticipated Problems
• Increased pain.
• Possible infection.
Comments
Jellyfish stings are painful and uncomfortable. Nematocysts are specialized stinging capsules found in members of the phylum Cnidaria including jellyfish, box jellyfish, sea anemones, corals and Portuguese man-of-wars. The nematocyst discharge delivers a barbed, venomous stinger with an incapacitating venom. The venom allows the animal to kill and digest its prey.
If you’re swimming and get stung by a jellyfish, it’s important to stay calm and not panic. Protect yourself, as injury is common both in the water and when removing nematocysts on shore. If you can see an obvious nematocyst, pick it off with tweezers. Don’t scrape, rub, or rinse with fresh water, as these may cause the nematocyst to release more venom.
To deactivate the nematocysts, soak the area in hot water (105℉/ 41℃) for 30-90 minutes. Soaking the wound in vinegar is useful for box jellyfish, but may worsen the discharge in other species of jellyfish. It’s ideal to test a small area for adverse effects before soaking in vinegar. The patient will likely benefit from over-the-counter pain medications to reduce discomfort. If pain persists, a rash worsens, the patient feels overall illness developing, or starts to show signs of infection like red streaking, or the area becomes warm/red/tender, evacuation is warranted.
End of the Tale
You happened to have an extra-large thermos of hot water in your beach bag. Instead of enjoying a hot drink after surfing, you soak your friend's arm in the hot water, using a plastic bag to hold the water for soaking. You don’t see any obvious nematocysts on the arm. After roughly 30 minutes of soaking, the pain begins to subside a bit.
You decide that surfing is done for today, and that you’ll continue to monitor the sting site. If it continues to hurt, your friend agrees they’ll head to the local clinic. Your buddy is grateful that you knew what to do!
