Blue Bottle Jellyfish

Bluebottle (Physalia)

The bluebottle jellyfish is responsible for thousands of stings on Australian beaches each year. Clinical features include intense local pain and dermal erythema. Hot water immersion provides safe symptomatic relief. Unlike Physalia stings in other parts of the world, major systemic envenoming does not occur.

Management

  • Stings are mild, self‑limiting and respond to first‑aid measures
  • Reassure the patient
  • Place under a hot shower for 20 minutes (ideal temperature 45ºC). The shower should be hot but not scalding or uncomfortable
  • Administer simple oral analgesia such as paracetamol
  • Do not apply a pressure immobilisation bandage (PIB) or vinegar, as this may worsen local symptoms
  • Transport to hospital is not usually required

Antivenom

  • None available.

Differential diagnosis

  • Pain associated with irukandji syndrome is usually delayed, severe and generalised. Significant linear dermal markings or welts are notseen
  • Envenoming by the box jellyfish (Chironex fleckeri) is associated with immediate pain and obvious dermal markings (large welts). Tentacles may be seen adherent to the skin.

Handy tips

  • Ice packs until recently were the recommended first‑aid treatment for stings. The superiority of hot water has now been conclusively demonstrated.
  • Most patients do not require any care beyond first-aid

Reference

  • Loten C, Stokes B, Worsley D, Seymour JE, Jiang S, Isbister GK. A randomised controlled trial of hot water (45 degrees C) immersion versus ice packs for pain relief in bluebottle stings. Med J Aust. 2006 Apr 3;184(7):329-33. [PMID 16584366]
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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books |

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