ENVIRONMENTAL EMERGENCIES
Bees
■ Barbed stingers →stinger remains in victim (one sting/bee).
■ The process kills the bee.
■ Killer bees have similar toxin potency but attack in large numbers →
greater overall venom load.
■ Venom contains proteins and enzymes (histamine, bradykinin, etc.).Wasps
■ Nonbarbed stinger →can sting multiple times.
■ Similar venom to beesFire ants
■ Small and light reddish-brown to brown
■ Contain unique alkaloid venom
In general, three types of reactions are possible:
■ Local toxic reaction
■ Allergic reaction
■ Serum sicknessMECHANISM OFTOXICITY
■ Local reaction to venom
■ Exposure to venom in sensitized individual →mast cell degranulation →
allergic reaction.
■ Each species has unique antigens.
■ Development of delayed (type III) immune response →systemic symp-
toms and rash (serum sickness).SYMPTOMS/EXAM
■ Local reaction
■ Bees and wasps: Irritation, itching, and redness at sting site that may
last for 2–3 days
■ Fire ants: Intense burning, papules that may turn to sterile pustules in
24 hours
■ Allergic reaction
■ Ranging from diffuse pruritus and urticaria to anaphylaxis
■ Vast majority occur within 30 minutes
■ Serum sickness
■ Onset of symptoms 7–10 days after the sting
■ Fever, arthralgias, and malaise (flulike symptoms)
■ Rash (most commonly angioedema/urticaria)TREATMENT
■ Local wound care and tetanus prophylaxis
■ Remove stingers by fastest means possible to reduce venom exposure.
■ Oral antihistamine
■ Treat anaphylaxis
■ Provide Rx for EpiPen if severe allergic reaction (up to 60% recurrence
with future exposure).Bark Scorpion StingMost U.S. scorpion species are not highly toxic and stings result in local pain
only. Pancreatitis is associated with one species (Tityus trinitatus).Serum sickness is a delayed
immune response occurring
7 – 10 days after antigen
exposure.Three possible reactions to
hymenoptera envenomation:
■Local toxic reaction
■Allergic reaction
■Serum sickness