Emergency Medicine

Toxinology Emergencies 199

Bee and Wasp Stings

(iii) Systemic stonefish envenomation: give one vial (2000 units) of

stonefish antivenom i.m. for every two puncture marks visible.

5 Sea urchins and fire coral
(i) Relieve pain by immersion in hot water at 40–45°C without
scalding or by using a local anaesthetic block, followed by
exploration, irrigation and debridement as necessary, and give
tetanus prophylaxis.
(ii) Give an antibiotic such as doxycycline 100 mg orally once daily
for 5 days (not in children or pregnant patients), for deep or
necrotic wounds.

BEE AND WASP STINGS

DIAGNOSIS

1 There are more deaths from anaphylaxis following bee or wasp stings than
from all the other venomous bites and stings combined.

2 Local pain predominates and may be followed by a severe anaphylactic
reaction causing laryngeal oedema, bronchospasm, hypotension and
collapse (see p. 27).

MANAGEMENT

1 Remove a bee sting by scraping the sting out with a knife, without squeezing.

2 Anaphylaxis:
(i) Assess and secure the airway, give oxygen, gain i.v. access and
commence fluid resuscitation for shock.
(ii) Give 1 in 1000 adrenaline (epinephrine) 0.3–0.5 mg (0.3–0.5 mL)
i.m. early. Give 1 in 10 000 adrenaline (epinephrine) or 1 in
100 000 adrenaline (epinephrine) 0.75–1.5 g/kg, i.e. 50–100 g
slowly i.v. if circulatory collapse occurs.

3 Arrange for patients prone to anaphylaxis from bee or wasp stings to carry a
pre-filled adrenaline (epinephrine) syringe (EpiPen
®

or Anapen

®

) at all times.