Serious Physalia (Portuguese man o’war) stings: implications for scuba divers

Abstract

The objective of this study was to describe a serious jellyfish envenomation in a scuba diver by an Atlantic Physalia physalis, to review the related literature and to recommend safe diving practices that may reduce the risk of serious jellyfish envenomation in divers. A healthy scuba diving instructor wearing a full wetsuit and gloves but no hood ascended from a night dive and surfaced directly under a large Atlantic Physalia jellyfish. He suffered multiple severe stings to the unprotected areas of his face and neck. He developed acute subjective respiratory distress with hyperventilation, muscle pain and spasms, and impaired consciousness en route to hospital, more than 10 min following envenomation. He recovered quickly in hospital with oxygen, aminophylline and intravenous fluid administration. Delayed recovery of the envenomated skin took several weeks and serology was positive for Physalia venom antibodies. Full protective clothing (e.g. a full, long sleeved wetsuit, plus gloves and hood when appropriate) should be worn by scuba divers on all dives. Ascent routines in diving should include looking directly upwards at the surface with one wetsuited arm outstretched towards the surface throughout the ascent. Removal of tentacles should not be attempted by the diver until he or she has exited from the water.