b'Category 4 - VinegarChapterBox Jellyfish Or Any Tropical JellyfishBox Jellyfish are found mainly in the coastal northern tropical waters from Gladstone on the East Coast around to Exmouth on the West Coast of Australia. The Box Jellyfish has a long series of tentacles and is extremely dangerous to humans. The Irukandji is a small (2cm diameter bell) jellyfish and symptoms may not appear until 30 minutes later.Death can occur within 5 minutes following massive envenomation. Current research indicates that cause of death is due to respiratory failure or cardiac electrical disturbances resulting in cardiac arrest. Anti-venom is available for the Box Jellyfish.How to RecogniseImmediate severe and intense burning pain is felt. Visible welts (raised red markings) or frosted ladderpatterns on the skin which may be quite extensive.Tentacles may still be stuck to the skin.Headache, nausea and vomiting.Irrational behaviour and restlessness.Breathing difficulty, which may progress to cardiac arrest.Severe muscle cramps in the limbs, chest and abdomen.How to ManageApply DRSABCD (be careful not to be stung yourself).Call Ambulance 000.Prevent the patient from rubbing the affected area.Flood the area completely with any type of household vinegar (this de-activatesthe stinging capsules) for a minimum of 30 seconds.If vinegar is not available, carefully pick off any adherent tentacles (this is notharmful to the first aider).Thoroughly rinse the affected area with seawater (not fresh water).Only once vinegar has been liberally applied to neutralize stings and when patient is stable,place the affected area in warm to hot water.Calm and reassure the patient.Closely monitor patient for response, airway, normal breathing while waiting for Ambulance. Be prepared to resuscitate.The Role of Vinegar and Water on Jellyfish StingsVinegar is used to inactivate the discharge of stinging capsules (nematocysts) of all known box jellyfish and to prevent further injection of venom. Immediate application of vinegar will also help for any unknown tropical jellyfish sting.Vinegar may cause stinging capsules to discharge in some other jellyfish stings so therefore should ONLY be used in tropical areas where potentially fatal stings may occur.Vinegar cannot relieve pain already present.Recent studies have shown that any water applied to a jellyfish sting once the skin is dry will cause undischarged stinging capsules to discharge. However, the extreme temperatures of the water (hot/heat or cold/ice) can, paradoxically provide pain relief.164 Bites and Stings'