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First Aid hints for ocean injuries

by Betty Smith (reprint)

Going to the beach is the most common form of recreation in Hawai‘i, and normally the most hazardous thing about it, once sunblock is applied, is the traffic that must be endured to get there. However, as some students recently learned, even the luxuriously warm waters of Hawai’i contain a few potential, if relatively minor, dangers.


The three most common injuries caused by Hawaiian marine organisms are: coral cuts, sea urchin spikes, and jellyfish (usually Portuguese man-of-war) stings.

Coral cuts
The belief that coral left in a wound will grow is an “old-wives tale.” Once outside the sea, the tiny animals within their calcium covering die. The body reacts to this foreign material by trying to coat it and slough it off. This process sometimes feels as if the coral is growing.

The biggest problem with coral cuts is infection. Once the skin is opened, bacteria from the sea water enter the wound and begin to multiply. If the number is large enough, they can overwhelm the immune system and become a local infection. The signs are usually evident within 24 hours: redness, pain, and increased warmth. In two to three days, pus may appear.

Preventing infection in coral cuts is relatively simple. Immediate first aid is to remove the coral from the wound and to wash the wound thoroughly with fresh tap water and soap. To prevent infection, wash out the wound immediately, or at least within the first hour before the bacteria start to grow. (If the wound is deep, or if there is any question of not getting out all the foreign material, consult a physician.) Once the wound is clean, keep it covered for five to seven days, being sure to change the covering daily. If any signs of infection occur, consult your doctor immediately. over-the -counter antibiotic ointments are rarely needed unless there are early signs of infection, or if there was a greater than six-hour delay before the cut was washed out.

Sea urchin spikes
There are two varieties of sea urchin spikes, large thick ones the size of nails, and tiny ones the size of fine sewing needles. Each spike has hundreds of small barbs so they are very difficult to remove. Only the large spikes need to be removed. The small ones are readily dissolved by the body in two or three weeks.

Sea urchin spikes are hollow, and the pain they cause is due to a toxin which is released through them. To stop the pain and prevent the toxin from spreading, apply heat, because it changes the protein structure of the toxin. Place the foot or injured area in a pan or pail of water that is as hot as can be endured but not so hot that it will burn. Keep doing this for 10 to 15 minutes, and be sure to add hot water every five minutes to keep the temperature up. This will coagulate the protein and the pain will be gone for good.

If you don’t have access to hot water, two alternative methods of treatment which are practical are vinegar or meat tenderizer. Vinegar is acetic acid; it also changes the structure of the protein. Soak the injured area in vinegar for at least 10 to 15 minutes. Meat tenderizer also breaks down the toxin. It must be mixed with water and applied in a paste over the injury. Again, leave it on the injury for 10 to 15 minutes.

Portuguese man-of-war stings
Cnidoblasts are small, stinging mechanisms the Portuguese man-of-war jelly fish uses to sting and paralyze its food. The cnidoblasts are located on small filaments, like hairs, called lilceo springs which fire on contact, injecting a protein toxin. Killing the animal doesn’t help. These stings (cnidoblasts) remain cocked and ready to fire on contact for 23 days after the animal is dead and washed on the beach. Worse, rubbing the sting area, or any area where a tentacle is still on the body, will cause any untriggered stingers to fire.

The toxin affects the human body by causing the local release of a histamine which causes a skin rash, like hives, the normal effect of the sting. However, the toxin can cause, in some cases, a massive deadly reaction called anaphylaxis or anaphylactic shock. This is a rare occurrence where the air passage swells up, like the welts on the skin, blocking air intake. This usually occurs in the first 20-30 minutes. If the hives are widespread, or there is any problem with breathing, the victim must be seen by a doctor in an emergency room immediately.

The first aid treatment for man-of-war stings consists first in controlling the natural impulse to rub the area with one’s hand or sand. To prevent further firing of any cnidoblast on the surface of the skin, gently wipe the area with denatured rubbing alcohol. If you don’t have that, whiskey will do. The most effective way to destroy the protein toxin is a paste of meat tenderizer left on for 10 or 15 minutes. Heat is NOT recommended, since it causes more histamine release and can thus make the welts worse.

Source: Karl T. Pregitzer, M .D., Kaiser Permanente



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