the Portuguese man-of-war may discharge even when it is dead and washed up on the beach Because of the length and transparency of the tentacles in the water, swimmers are often stung without seeing the animal The toxin contains polypeptides and degradative enzymes Local effects include pain and irritation Systemic reactions include headache, myalgias, fever, abdominal rigidity, arthralgias, nausea, vomiting, pallor, respiratory distress, hemolysis, renal failure, and coma Death may occur if the area stung is extensive in relation to the size of the victim The unexploded nematocysts are inactivated with topical application for 30 minutes with vinegar (3% acetic acid), a slurry of baking soda, or meat tenderizer (papain) Papain should not be left on for more than 15 minutes Vinegar is generally the best disarming agent for hydrozoan stings; however, for Portuguese man-of-war, vinegar may be ineffective and may sometimes paradoxically activate the nematocysts The affected area should be washed with seawater or normal saline and if Portuguese man-of-war sting is suspected it should be dipped in hot seawater (40° to 45°C [104° to 113°F]) for 20 minutes The affected limbs should be immobilized There is no antivenin available for Physalia or the scyphozoans, with the exception of the sea wasp, Chironex fleckeri, of Australia Shock may require cardiorespiratory support General supportive measures for systemic reactions include antihistamines, corticosteroids, and opiates for pain Muscle spasms have been treated with 10% solution of calcium gluconate 0.1 mL/kg (10 mg/kg) given intravenously, although the efficacy is controversial Local dermatitis should be treated with a topical corticosteroid cream, and topical treatment with 1% lidocaine is effective in pain control Class Scyphozoa The common purple jellyfish (Pelagia noctiluca ) is only mildly toxic Local skin irritation is the major clinical manifestation Sea nettle (Chrysaora quinquecirrha ) is a common jellyfish found along the Atlantic coast Clinical manifestations are the same as those for purple jellyfish Lion’s mane (Cyanea capillata ) is a highly toxic creature that can reach a width of 244 cm, with tentacles as long as 61 cm The animal is found along both coasts Contact with the tentacles produces severe burning Prolonged exposure causes muscle cramps and respiratory failure Treatment of scyphozoan stings is the same as above for hydrozoan stings Class Anthozoa The anemones found within United States tidal zones are only mildly toxic Coral cuts and stings can be a problem for swimmers off the Florida coast The stinging