Animal	Type of envenomation	First aid*	Clinical presentation	Laboratory tests
Venomous fish (e.g., stingray, catfish)	Local, cytotoxic, or penetrative traumatic	Remove victim from water Stingray spines located near vital organs should not be touched, and the wound should not be rubbed or handled Stanch significant bleeding with carefully applied local pressure Hot water immersion or exposure for short-term analgesia (up to two hours) Acetaminophen is ineffective but may be given for psychological comfort Contraindicated: nonsteroidal anti-inflammatory drugs, use of illicit drugs or alcohol	Local pain (may be severe) Bleeding (significant in some cases) Edema and erythema Lymphadenopathy and lymphangitis Vomiting and abdominal pain in some cases Hypotension and shock Penetrative stingray wounds to vital organs may cause rapid systemic effects and can be fatal	Usually not required; evaluate on a case-by-case basis
Treatment
Airway, breathing, and circulation are first priority
Wound care
Ongoing pain may require nonsedating analgesia or regional nerve block
Tetanus prophylaxis and follow-up
Secondary infections require broad-spectrum antibiotics
Hot water immersion or exposure for short-term analgesia (up to two hours)
Fluid resuscitation is advised
Consider imaging and surgical consultation for penetrative traumatic envenomation before spine removal

Jellyfish (cnidarian)	Local	Remove victim from water Carefully remove adherent tentacles with gloved or otherwise protected hands; do not handle tentacles with bare hands Submerge or shower affected area in hot water (uncomfortable, but not scalding) for five to 10 minutes; repeat at 15-minute intervals for up to two hours Acetaminophen is ineffective Contraindicated: application of alcohol or vinegar, nonsteroidal anti-inflammatory drugs, use of illicit drugs or alcohol	Moderate to severe local pain Typical sting contact marks Occasionally, systemic effects (e.g., headache, vomiting, abdominal pain) Rarely, respiratory arrest and cardiac failure or arrest	Usually not required; evaluate on a case-by-case basis
Jellyfish (cnidarian)	Local			Usually not required; evaluate on a case-by-case basis

Airway, breathing, and circulation are first priority
Wound care
Ongoing pain may require nonsedating analgesia or regional nerve block
Tetanus prophylaxis and follow-up
Secondary infections require broad-spectrum antibiotics

Sea anemones	Local	No first aid recommendations Serious stings should be evaluated by a physician	Local pain, erythema, and edema of variable severity	Usually not required; evaluate on a case-by-case basis
Same as for jellyfish
Severe pain can be managed with modest use of opioids (hydrocodone/acetaminophen)