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  1. Hymenopterans (Bees, Wasps and Ants)
  2. Clinical Management

Clinical Management

This is relevant for all animals belonging to Hymenopterans (Bees, Wasps and Ants).

General problems

Patient history with regard to pre-existing conditions and medications:

Known Hymenoptera allergy?

Other pre-existing conditions and medications of relevance.

How severe is the allergic reaction?

Inquire re:

  • When did the sting(s) occur?

Assess:

  • state of consciousness.

Measure:

  • blood pressure/pulse,
  • breathing (respiratory rate)
  • oxygen saturation (pulse oximeter),

Systemic allergic reaction grading system 

Consult Table 7 of

Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, Geller M, Gonzalez-Estrada A, Greenberger PA, Sanchez Borges M, Senna G, Sheikh A, Tanno LK, Thong BY, Turner PJ, Worm M. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020 Oct 30;13(10):100472. PMID: 33204386; PMCID: PMC7607509. 

Has the patient been stung in the oral cavity?

Assessment: laryngeal oedema.

Are there multiple stings with the risk of a toxic course of envenoming?

Inquire re:

  • When did the stings occur?

Assess:

  • state of consciousness.

Measure:

  • blood pressure/pulse,
  • breathing (respiratory rate).

Count: the number of stings (simultaneously removing any stings remaining in the skin according to first aid methods.

Classification with multiple stings: when toxic symptoms are present, it is likely that >50 stings have occurred.

Systemic supportive treatment

A general understanding of emergency medicine is required, or can be found in emergency medicine guidelines, e.g. ABCDE approach, WHO-ICRC Basic Emergency Care.

Comprehensive ABCDE approach
ICRC Basic Emergency Care: approach to the acutely ill and injured (SAMPLE and ABCDE approach: first module)

see also for multiple bees stings:

França FO, Benvenuti LA, Fan HW, Dos Santos DR, Hain SH, Picchi-Martins FR, Cardoso JL, Kamiguti AS, Theakston RD, Warrell DA. Severe and fatal mass attacks by 'killer' bees (Africanized honey bees--Apis mellifera scutellata) in Brazil: clinicopathological studies with measurement of serum venom concentrations. Q J Med. 1994 May;87(5):269-82. PMID: 7938407. 

Exclusion of a clinically relevant allergic reaction

Monitoring for signs and symptoms of an allergy for at least 24 h. 

Local treatment Sting, including the surrounding reaction

  • Assessment of the wounds according to the usual criteria.
  • Swelling: assessment of the extent and increase in magnitude.
  • Observation regarding secondary infection.
  • Cleaning, disinfection and dressing of the wound. Immobilisation of the extremity with a splint.
  • Padding and monitoring to prevent pressure necrosis and disturbance of the blood circulation if the oedema increases.

Tetanus

Tetanus prophylaxis.