The nature and amount of assistance depends on where the sting occurred (on the street, in the field, at home, in the apiary, in the apitherapist’s office). It is important to consider the location of the body where the sting occurred (limb, face, neck, eye, etc). The volume and nature of emergency care depends on the severity of local and general clinical manifestations of intolerance to bee venom.
When a bee (wasp) sting, accompanied by severe symptoms of intolerance, it is necessary to remove the sting immediately. For relief of local symptoms (pain, burning, swelling, redness) one of the following methods can be used:
- wash the wound (the place of sting) with alcohol or put an alcohol compress on it;
- wipe the place of the sting several times with a swab moistened with one of the following solutions – iodine tincture, solution of potassium permanganate;
- smear the place of sting with calendula ointment with lanolin base;
- smear the place of the sting with dandelion juice (squeeze a stem or basket of a flower) or juice of garlic, onion;
- apply to the sting site mashed leaves and baskets of wormwood;
- put ice or a wet towel on the sting site for 10 minutes;
- a towel moistened with hot water can be put on this place (heat neutralizes chemicals causing inflammation);
- in case of severe allergic edema, lubricate the place of the sting with glucocorticoid ointment (hydrocortisone, prednisolone);
The above measures reduce pain at the sting site, limit tissue swelling and inflammation. If local manifestations are expressed significantly, then the patient should be taken orally for 1-3 days any of the antihistamines (diphenhydramine, tavegil, zyrtec, and claritin). With an increase in body temperature to 38° C and above, one or two tablets of paracetamol should be taken. In case of general (systemic) manifestations of intolerance to bee venom the physician must follow recommendations clearly, consistently and in full. It is absolutely clear that physician and his office should be equipped and provided with everything necessary for the emergency treatment.
Intolerance of I Degree of Severity
- Remove the sting immediately;
- Lay the patient down;
- Inject around the sting site with 0.1% adrenaline solution in an amount of 0.2-0.3 ml;
- Apply a tourniquet (if possible) above the stinging point for 20-25 minutes (no more!);
- Inject intramuscularly 2 ml of 1% solution of dimedrol or 1 ml of 0.1% solution of tavegil;
- Place ice over the sting site for 10 minutes;
- In case of a pronounced local reaction, perform at the sting site a circular layered infiltration injection with novocain;
- With pronounced skin manifestations of allergy, inject intravenously 10 ml of 10% solution of calcium chloride or calcium gluconate, and intramuscularly 125-250 mg of hydrocortisone or 60-120 mg of prednisolone;
- In case of unstable blood pressure, intramuscularly inject 2 ml of a 25% solution of cordiaminum or 1-2 ml of a 10% solution of caffeine;
- After relief of the symptoms of intolerance, the patient is observed for 1-1.5 hours and if symptoms recur, inject subcutaneously or intramuscularly 0.5-1 ml of 5% solution of ephedrine;
After stinging, with the increase of intolerance symptoms, an adult patient can be given 25-40 ml of vodka or a mixture of 200 ml of water, 20-40 ml of vodka, 20 g of honey to drink, or every 3 hours take inside 1 cup of the mixture: boiled water – 1000 ml; vodka – 200 ml; honey – 100 g; ascorbic acid 1 g. Children and elderly people take the same mixture without vodka (1 liter of boiled water + 100 g of honey + 500 mg of ascorbic acid). With an increase in general weakness, give a glass of strong tea or coffee to drink or a glass of warm milk with a tablespoon of honey. The patient should drink plenty of liquid (like rosehip broth or alkaline water).
Intolerance of II Degree of Severity
- Follow all the recommendations for intolerance of I degree;
- Considering the possibility of vomiting, aspiration of vomitus and retraction of the tongue, it is necessary to turn the patient’s head to the side and push the lower jaw forward;
- Increase the dose of local injection of adrenaline to 0.5 ml, at the same time injecting another 0.3-0.5 ml of 0.1% solution of adrenaline subcutaneously into the other hand. In the absence of a pronounced effect, every 15 minutes the injection of adrenaline is repeated until complete elimination from the collapse. The total dose of adrenaline up to 2 ml;
- In case of severe bronchospasm, inject intravenously up to 90-120 mg of prednisolone, and in the absence of collapse, inject intravenously 10 ml of 2.4% solution of aminophylline in combination with 10 ml of 40% glucose solution;
- In case of laryngeal edema, the appearance of marked stridor respiration and respiratory failure, tracheotomy is indicated;
- At the expressed general phenomena of intoxication, the introduction of intravenous alkalinizing solutions is shown and the forcing of diuresis taking into account the level of blood pressure – to introduce intravenously 20 mg of furosemide;
- If the therapy produces no effect, blood pressure cannot be taken, the pulse is absent, and consciousness is disturbed, it is necessary to inject intravenously 1 ml of 0.1% solution of adrenaline per 20 ml of 40% glucose solution;
Intolerance of III Degree of Severity
- Perform all activities in case of intolerance of II degree;
- With very low blood pressure, inject intravenously 1 ml of 0.1% adrenaline solution, or 0.5 ml of 1% phenylephrine hydrochloride solution, or 1 ml of 0.2% noradrenaline in 10 ml of 40% glucose solution;
- If the condition remains very severe, repeat the single-dose intravenous injection of solution 0.1% adrenaline – 1 ml in 40% glucose – 20 ml and arrange the drip solution: glucose 5% -500 ml and adrenaline-0.1% – 2 ml, or glucose 5% – 500 ml and noradrenaline – 0.2% – 5 ml;
- Introduce intravenously 60-90 mg of prednisolone;
- In case of bronchospasm, inject intravenously solution of 2.4% aminophylline – 10 ml, and then prednisone;
- For pulmonary edema, inject solution of 0.5% of strophanthin – 0.5 ml in 20 ml of saline or inject intravenously solution of 2.4% aminophylline – 10 ml in 40% glucose – 10 ml;
- Oxygen should be started as early as possible;
- Cover the patient with hot-water bottles;
- Introduce intravenously alkalizing solutions;
- When cardiac arrest, perform an indirect heart massage and artificial respiration (mouth-to-mouth);
A patient who has experienced an allergic reaction of grade II or III needs to stay in hospital for 8–10 days undergoing antihistamine treatment and prednisone 20-50 mg per day orally with a gradual decrease in dose. After discharge from the hospital, patients who have suffered a shock should be observed by the local physician for 3-4 weeks. The patient may experience: general weakness, headache, memory loss, signs of myocardial damage (pain, shortness of breath, tachycardia), kidney problems (lower back pain, nocturia, oliguria, hematuria, proteinuria, and increased blood pressure), liver (itchy skin, jaundice, enlarged liver) and even the development of liver failure.