1 / 10

Bee Stings ( H y m e n o p t e r a )

Bee Stings ( H y m e n o p t e r a ). Diagnosis, Treatment, and Management of Systemic Reactions by Deborah Wolff-Baker. Pathophysiology of an allergic reaction.

doria
Download Presentation

Bee Stings ( H y m e n o p t e r a )

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Bee Stings (Hymenoptera) Diagnosis, Treatment, and Management of Systemic Reactions by Deborah Wolff-Baker

  2. Pathophysiology of an allergic reaction Immunoglobulin E (IgE) mediated release of histamines, leukotrienes, prostaglandins, and other inflammatory factors, causing local or systemic symptoms. • The venom of bees, wasps, and yellow jackets is similar and can cause cross-reactions. • Reactions can be varied in intensity from mild local, to large local, to severe anaphylaxis.

  3. Statistics Prevalence and Frequency of Stings in the United States: • More than one million stings annually • A large local reaction occurs in 17-56% of those stung • Wasps and bees cause 30-120 deaths per year • Most common in males r/t more frequent exposure • Peak incidence of death from anaphylaxis in those between 35-45 years of age • Rapid onset is the rule: 50% of deaths occur within 30 minutes of sting and 75% within four hours • Most commonly a severe reaction follows a previous milder one. The shorter the interval between stings, the more likely a severe reaction will take place • Fatal reactions can occur as the first generalized reaction, but this is rare

  4. Assessment Subjective: HPI: • What activity and location preceded the sting? • Type of insect activity in the area? • Was the insect visualized? • How long ago did the sting occur? • Did you remove the stinger? • Is there more than one sting site? • Do you have pain, trouble breathing, itching, stomach ache, nausea or vomiting? PMH: • Any history of previous stings, or reaction to stings? FH: • Any family history of insect allergies? If history suggests anaphylaxis is imminent, institute treatment immediately!

  5. Assessment cont. Objective: • Assess site: warmth, redness, swelling, drainage, tenderness • Is the stinger still present? • Is there more than one site? • Compromised distal circulation or sensation? • Vital signs: tachycardia, hypotension, increased respiratory rate, O2 sat. • Heart/Lungs: wheezing or stridor • Pallor • Anxiety Bee sting with erythema

  6. Determine Extent of Reaction • Differentials: • Foreign body • IV drug use • Local infection • Cellulitus • Vasovagal reaction • Asthma • Mild local reaction: • Redness, itching, pain, swelling • Large local reaction: • Will increase in size for 24-48 hours • Swelling > 10cm • Possible involvement of more than one joint area • 5-10 days to resolve • Systemic reaction: Includes a spectrum of manifestations ranging from mild to life threatening: • Cutaneous responses such as urticaria and angiodema • Bronchospasm • Large airway obstruction including tongue or throat swelling and laryngeal edema • Hypotension and shock

  7. Treatment Plan Mild Local Reactions: • Remove any remaining stinger by flicking with the edge of a sharp object. DO NOT squeeze the attached venom sac. • Wash wound and apply ice or cool compresses locally. • Administer an antihistamine such as Benadryl at 5mg/kg/day divided every eight hours for pruritus x 24-48 hours. • Oral analgesics as needed for discomfort • Calamine lotion or one part meat tenderizer mixed with four parts of water to relieve discomfort. • Elevate extremity Large Local Reactions: • Add Prednisone 40mg PO to above regimen and taper over 4-7 days

  8. Treatment Plan cont. Systemic Allergic Reaction: • Epinephrine 0.01mg/kg of 1:1000 aqueous solution IM repeated at 5-15 minute intervals. (Administer above the sting site.) • Antihistamines such as Benadryl or Hydoxyzine • H2 antagonists such as Cimetidine or Ranitidine • Inhaled bronchodilators such as nebulized Albuterol at 20 minute intervals for wheezing and airway constriction • Glucocorticoids And, if severe anaphylaxis, maintain airway and call 911 immediately for ambulance transport to ER !

  9. Follow Up and Instructions • Potential for rebound or late phase anaphylaxis within 6-12 hours after exposure • Serum sickness can occur up to 14 days after sting: S/S are fever, arthralgia, lymphadenopathy, skin eruptions • Potential for infection at the sting site • Instruct signs and symptoms of infection, serum sickness and anaphylaxis to report • Instruct in bee sting avoidance and medic alert bracelet • Refer for allergy testing with possible RAST and desensitization-venom immunotherapy (VIT) • Rx: Epi-pen and Benadryl and instruct patient in use • Follow up visit in 24 hours for systemic reaction to sting • Patient usually hospitalized 24 hours for observation in cases of severe anaphylaxis

  10. References • Uphold, C., & Graham, M. (2003). Insect Sting and Brown Recluse Spider Bite. InClinical Guidelines in Family Practice (pp 950-954). Barmarrae Books, Gainesville, FL. • Tierney, L., McPhee, S., Papadakis, M., (2006), Current Medical Diagnosis and Treatment, 45th Edition. (pp 791-792). Lange/McGraw-Hill. • Burns, C., Dunn, A., Brady, M., Starr, N., Blosser, C., (2004). Pediatric Primary Care 3rd Edition, (pp 1147-1148). Saunders, St. Louis, MO. • http://www.guideline.gov/summary/summary.aspx?doc_id=6888&mode=ful&ss=15 Stinging Insect Hypersensitivity: A Practice Parameter Update. National Guideline Clearinghouse. • http://www.emedicine.com/EMERG/topic360.htm Linzer Sr, L., (2/9/06) Pediatric Anaphylaxis. • http://www.emedicine.com/EMERG/topic55.htm Vankawala, H., (8/21/06) Bee And Hymenoptra Stings.

More Related