title: Pressure immobilisation bandages in first-aid treatment of jellyfish envenomation: current recommendations reconsidered.
abstract: OBJECTIVE
  To evaluate whether applying pressure equivalent to that of pressure immobilisation bandages (PIB) causes release of additional venom from discharged jellyfish nematocysts.
  
  
  METHODS
  In-vitro experiment--the venom beads released from electrically activated Chiropsalmus sp. nematocysts were viewed under direct microscopy before and after applying 40 mmHg pressure (replicating the pressure of PIB); and saline washings of discharged nematocysts before and after applying pressure were tested for toxicity (time to ventricular standstill after injecting into live prawns).
  
  
  RESULTS
  Applying 40 mmHg pressure caused the venom beads to visibly increase in size, consistent with pressure expressing further venom from the discharged nematocysts. First washings of the nematocyst shafts before compression produced ventricular standstill in prawns within 60 seconds (n=3); second washings did not produce standstill during 540 seconds of observation (n=3); and washings after applying 40 mmHg pressure showed a return of toxicity, with ventricular standstill in all prawns within 180 seconds (n=3).
  
  
  CONCLUSIONS
  Discharged nematocysts are by no means empty and harmless. Applying pressure results in further release of nematocyst venom. The currently recommended practice of applying PIB in the initial treatment of patients stung by a jellyfish may exacerbate the envenomation, and thus should not be recommended.
authors.affiliation: Department of Emergency Medicine, Cairns Base Hospital,  QLD. peter_pereira@health.qld.gov.au
authors.forename: P L
authors.initials: PL
authors.lastname: Pereira
authors.forename: T
authors.initials: T
authors.lastname: Carrette
authors.forename: P
authors.initials: P
authors.lastname: Cullen
authors.forename: R F
authors.initials: RF
authors.lastname: Mulcahy
authors.forename: M
authors.initials: M
authors.lastname: Little
authors.forename: J
authors.initials: J
authors.lastname: Seymour
mesh_terms: D000818:Animals; D001458:Bandages; D001733:Bites and Stings / Q000628:therapy*; D003064:Cnidarian Venoms / Q000378:metabolism*; D000075202:Contraindications; D005392:First Aid / Q000379:methods*; D011312:Pressure; D037401:Scyphozoa / Q000502:physiology*
chemical_list: D003064:Cnidarian Venoms