A 52-year-old Thai female was stung by a jellyfish on her knee incurred while swimming in the sea on Kood island in the Gulf of Thailand. She initially felt like electric shot at her left knee with severe burning pain. Her left leg rapidly developed erythema and showed brownish-red colored marks as showed in the Figure 1. A few minutes later while rushing back to the resort, she had difficulty in breathing and could walk a few steps further before collapse. Her vital signs at emergency room were as following: BP 152/72 mm.Hg, pulse 114 beats/minute, respiratory rate 22 beats/minute, body temperature 36.8° Celsius.

Which of the following is the most appropriate immediate first aid treatment at the skin lesions?

1. Apply a pressure immobilization bandaging and cover the lesion with ice pack
2. Pour liberally the affected area with (4-6% acetic acid) vinegar at least 30 seconds
3. Rinsing off the skin lesion with fresh sterile water
4. Rub the skin lesion with a sea herb (morning glory or Ipomoea pescaprae)
5. Scrub the skin lesion with alcohol gel/alcohol solution

See full explanation in the JMAT, August 2018 issue