A Case of a Portuguese Man-O-War Envenomation in Southern Rhode Island

Sean Bilodeau, Department of Emergency Medicine, Tufts University School of Medicine-Maine Medical Center, Portland, ME.
Teresa Howard, University of New England College of Osteopathic Medicine, Biddeford, ME.
Alexis S. Kearney, Department of Emergency Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI.

Abstract

We present the case of a 16-year-old patient who was stung by a Portuguese Man-O-War (Physalia physalis) in southern Rhode Island (RI) while surfing. P. physalis are not typically found in southern RI waters and envenomations are rare. Emergency medical services (EMS) are often the first clinicians to arrive on scene following an injury and are crucial to alleviating the immediate pain and long-term consequences of P. physalis envenomations. RI state decontamination and treatment protocols for P. physalis envenomations differ from national guidelines. Notably, RI EMS protocols recommend dousing the affected area with vinegar, contrary to national EMS protocols and research studies which indicate that the application of vinegar may increase nematocyst discharge. We examine the current literature for the decontamination and treatment of Portuguese Man-O-War envenomation and provide guidance for treatment of envenomated patients.