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KNOWING WHAT TO DO and taking fast, appropriate action can reduce pain and the risk of complications in someone who's been stung by a bee, wasp, or hornet. If the victim is allergic to the venom or suffers multiple stings, fast action can mean the difference between life and death. Timely first aid can help her in two ways, by:
* reducing the amount of venom entering her system
* managing her clinical reactions to venom, which can range from local pain and swelling to life-threatening anaphylaxis.
When coming to the aid of an insect sting victim, follow these guidelines.
* Try to keep her calm and avoid arm waving and other sudden movements. Trying to shoo off bees, wasps, and hornets tends to provoke them.
* Take precautions to avoid being attacked yourself. If attacked, protect your face, keep your mouth closed, and try to outrun the insect or swarm.
* Move the victim away from the source of insects, such as a beehive, and help her into a comfortable position.
* Assess and support her airway, breathing, and circulation.
* If she's having trouble breathing, have her sit upright. If she's showing signs of shock, such as pallor, diaphoresis, decreased mentation, or rapid pulse, place her supine with her legs elevated to promote venous return to the heart.
* Assess her for signs and symptoms of an allergic reaction, including urticaria (hives), pruritus (itching), dyspnea, bronchospasm, edema in areas beyond the sting site-particularly swelling of the face or throat-tachycardia, hypotension, diarrhea, unconsciousness, and cardiovascular collapse.
* Call 911 if she has signs and symptoms of an allergic reaction.
* If the victim has a known allergy to insect stings and has her own epinephrine pen or anaphylaxis kit, help her self-administer the medication. Also help her take an oral antihistamine such as diphenhydramine (Benadryl) if she can swallow safely. A liquid preparation may be easier to swallow.
* If a stinger is present, remove it as quickly as possible using whatever tool is readily available. For example, scrape it out with the edge of a credit card or a dull knife blade, or extract it with a needle or tweezers. The stinger continues to inject venom even if it's detached from the insect.
* Clean the wound and apply an antiseptic/antibiotic ointment to the site to prevent infection.
* Apply a cold or ice pack to reduce swelling and pain.
If the victim is allergic to bee, wasp, or hornet stings and the crisis has passed, make sure she has a replacement epinephrine pen or anaphylaxis kit and advise her to keep it with her at all times. Encourage her to wear a medicalalert bracelet or pendant to alert emergency personnel to her allergy. Also advise her to have pest-control workers regularly inspect her home and property for hives or nests and remove them.
She should screen her windows to prevent bees, wasps, and hornets from entering. Also advise her to keep lids on trash cans, cover food containers when outdoors, and avoid wearing scented body-care products that could attract insects. Inform her that wearing white clothing in bee-infested areas may decrease the bees' potential for aggression.
If you transfer the victim's care to a health care provider, report whether or not a stinger was present and when and how you removed it. Also report your assessment findings, emergency care interventions, and the victim's response.
* a needle, tweezers, credit card, or knife blade
* a cold or ice pack
* antiseptic/antibiotic ointment
* the victim's epinephrine pen if she has one
* commercially available "sting sticks" or topical anesthetic agents to relieve pain. (These aren't a substitute for measures that reverse the harmful effects of venom.)
Linda Laskowski-Jones is vice-president of emergency, trauma, and aeromedical services at Christiana Care Health System in Wilmington, Del.
Auerbach PS, et al. Field Guide to Wilderness Medicine, 2nd edition. St. Louis, Mo., Mosby, 2003.
Elston D. Bites and stings: Be ready to respond quickly. The Clinical Advisor. 8(7):20-32, 2005.
Laskowski-Jones L. Interventions for clients with common environmental emergencies. In Ignatavicius D, Workman L (eds), Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 5th edition. Philadelphia, Pa., W.B. Saunders, 2006.
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