Insect Bites And Stings
Insect bites and stings are among the most common traumatic complaints. The more serious include those from ticks, brown recluse spiders, black widow spiders, scorpions, bees, wasps, yellow jackets, and fire ants. Emergencies develop when a number of stings occur at one time or when the patient develops an allergic response to the protein substances in the insect venom.
With a bee, wasp, or yellow jacket sting, the shorter the interval betWeen the sting and systemic signs and symptoms, the worse the prognosis. Without prompt treatment, signs and symptoms may progress to cyanosis, coma, and death.
The toxic effects of the injected venom or a hypersensitivity response to it cause reactions to insect bites and stings.
The non-emergency symptoms vary according to the type of insect and the individual. Most people have localized pain, redness, swelling, or itching. You may also feel burning, numbness, or tingling.
Identification of the insect is difficult unless the patient was stung by a honeybee or a bumblebee. These insects usually leave a stinger (with venom sac) in the lesion. Tests showing hemolytic anemia or thrombocytopenia may indicate a brown recluse spider bite; hematuria and an increased white blood cell count may point to a black widow spider bite.
For a tick bite, treatment involves removing the tick, applying antipruritics for itching, and providing symptomatic therapy for severe symptoms, such as assisted ventilation for respiratory failure. Treatment for Rocky Mountain spotted fever and Lyme disease includes such antibiotics as tetracycline, erythromycin and penicillin.
Symptomatic treatment may include calcium gluconate I.V. to control muscle spasms, diazepam for severe muscle spasms, adrenaline or antihistamines for hypersensitivity symptoms, oxygen by nasal cannula or mask for respiratory difficulty, and tetanus immunization and antibiotics to prevent infection.
For a scorpion sting, antivenin (made from goat serum) may be used if available. (For information on how to obtain this agent, contact the Arizona Poison and Drug Information Center,  626-6016.) Symptomatic treatment may include calcium gluconate I.V for muscle spasm and phenobarbital I.M. for seizures.
For bee, wasp, yellow jacket, or fire ant stings, treatment of local reactions includes applying ice to the affected area. If the entire extremity shows signs, treatment involves elevating the affected extremity and administering 25 to 50 mg oral diphenhydramine every 4 hours. More severe reactions may require administration of prednisone for 5 to 7 days.
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