Table 3.
Treatment guidelines and corresponding level of scientific evidence for Scyphozoans and Physalia spp. (references in superscript).
| Physalia | Scyphozoans | |||
|---|---|---|---|---|
| P. physalis | C. quinquecirrha | P. noctiluca | C. capillata | |
| Sea water rinsing | A(1) [1,2], B(4) [51] | B(4) [46,48], F(2) [51] | A(4) [109,110] | A(4) [109] |
| Hot water/packs | A(1,4) [43-45], F(4) [55] | F(4) [55] | ||
| Tentacle removal | B(4) [1,2] | B(4) [1,2,106] | B(4) [1,2,110] | B(4) [110] |
| Topical Vinegar | A(1,4) [46,47], B(4) [46,48,55], C(4) [7,49] | C(4) [46], D(4,2) [51] | C(4) [109] | C(4) [106] |
| Ice packs | A(1,4) [43-45] | F(4) [46,48] | A(4) [45] | |
| Fresh water | B(4) [49] | F(2) [51] | ||
| BaCl2 | B(4) [110] | B(4) [110] | ||
| MgCl2 | B(4) [110] | B(4) [110] | ||
| NaOH | C(4) [46] | |||
| NaCl | C(4) [110] | |||
| NaClO | C(4) [46] | C(4) [46] | ||
| Choline-Cl | C(4) [110] | |||
| MgCl2 solution | B(4) [110] | C(4) [46] | ||
| Urea | F(4) [51] | |||
| Stingose § | A(1) [47], B(4) [46] | B(4) [46] | ||
| Acetone | C(4) [46] | C(4) [46] | ||
| Bromelain 10% | A(1) [47], C(4) [51] | C(4) [46], F(2) [51] | ||
| Papain | A(1,4) [54], F(4) [55] | A(4) [46], B(4) [46] | ||
| Baking soda slurry † | B(1) [47],C(4) [46] | B(4) [46,109] | B(4) [46] | A(4) [42,110] |
| Methylated spirits | C(4) [49], D(1) [47] | B(4) [109] | A,B(4) [109] | |
| Ammonia | C(4) [46,51] | C(4) [51], D(4,2) [51] | ||
| Ethanol | C(4) [51] | C(4) [51], D(2) [51] | C(4) [109] | |
| Topic lidocaine | A,B(4) [51] | A(4,2) [51], B(4) [51] | ||
| Opiates i.v. | A(4) [31] | |||
| MgSO4 ♥ i.v. | ||||
| Reserpine i.v. | E(4) [56] | |||
| Phentolamine i.v. | ||||
| Glyceryl trinitrate ♣ | ||||
| Antihistamine i.v. | E(4) [57] | E(4) [108] | E(4) [108] | E(4) [108] |
| Anti-venom | F(4) [78] | F(4) [78] | ||
| PIB | ||||
A: pain relief; B: blocking of venom discharge; C: increased venom discharge; D: pain exacerbation; E: systemic benefits; F: ineffective; ♥ Magnesium sulfate; § 20% Al2(SO4)3; † NaHCO3; ♣ sublingual; PIB: Pressure Immobilization Bandage; Level of scientific evidence according to the Agency for Healthcare Research and Quality [113]: 1 = Randomized controlled trials; 2 = Experimental paired/crossover study; 3 = Observational studies with controls; case series; 4 = Studies without controls, studies based on physiology and basic science, case reports and expert opinion.