labored breathing, difficulty in swallowing, and confusion, he is having a severe
reaction. Watch the victim for signs of shock and treat immediately.
2-15. TREATMENT
This entire group of arthropods stings their victims and often leave the stinger
and venom sac imbedded in the skin. Remove the stinger by gently scraping it with a
fingernail, a blade, or other thin metal object. Removal prevents further venom injection
from the venom sac. Do not PULL the stinger out because this action releases more
venom. Do not rupture the venom sac if at all possible. Toxins from this group are
similar to the venom of viperine snakes in having a hemolysin factor but their primary
effect seems to be the strong histamine they contain. A previous history of being stung
by any of the group does not necessarily mean that an individual cannot have a
moderate to severe reaction from stings at a later time in life. Wash the sting site with
soap and water and apply an ice pack or a solution of 10% ammonia. A systemic
reaction within 20 minutes after the sting means a threat to the patient's life, and it is
necessary to get to the victim as fast as possible. Treat patients that have mild
constitutional reactions if they occur within an hour. Time is a critical factor when a
victim reports a systemic reaction to an insect sting. If he has any symptoms in addition
to the local reaction, or even if he has a severe local reaction to a sting on the face, or
neck developing within 20 minutes of the sting, administer epinephrine (Adrenalin,
Asmolin) as rapidly as possible. If the patient reports an onset of mild symptoms of a
constitutional reaction between 20 minutes and an hour after being stung, the urgency
of treatment is not so great, though the patient should be seen and treated with
epinephrine. The shorter the interval between the sting and the development of
symptoms of a systemic reaction, the greater the risk.
2-16. PROPHYLAXIS
Patients who have suffered systemic or increasingly severe local reactions
should carry emergency treatment kits. Hyposensitization is a must for those who have
had constitutional reactions and it is advised for some with severe local reactions.
Patients should take measures to avoid being stung if at all possible, and should wear
an emergency ID device apprising others in case this is needed. Victims known to have
a sensitivity to HYMENOPTERA venom should avoid places where stinging insects are
located (camp and picnic sites); stay away from the insect's feeding ground (flowers,
fruit orchards, garbage, clover fields); refrain from going barefoot outdoors since yellow
jackets nest on the ground; do not use perfume, scented soap, or bright colors because
these items attract bees; keep the car windows closed when traveling; use rapid-acting
insecticide to spray garbage cans; hire a professional exterminator for wasp/hornet
nests or bee hives in the home area; and consider undergoing immunotherapy with
venom extract.
MD0588
2-8