Doctor, what is the best way to treat bee/wasp stings and snakebites?

Spring and summer bring more outdoor activity, and therefore more opportunity for injury. In our area, bee and wasp stings are common problems with uncommon serious effects. Rattlesnake bites are uncommon but an important medical problem due to their frequently serious effects. In the emergency department, we see both. Unfortunately, sometimes we see people who could have treated their problem safely at home, and at other times we see people who did the wrong thing or delayed care – to their harm.

One or even a few bee, wasp or hornet stings most often are notable only for their local effects, which usually are not serious. If the stinger remains stuck in the skin after the actual sting, you should remove it immediately by scraping it out with a dull flat edge such as with a credit card or similar (never use tweezers – the venom sack will be emptied further into the skin). The wound should be washed with warm, soapy water. As long as the reaction remains localized, it can be treated at home with elevation of the affected area and intermittent ice packs (ice in a baggie placed over a dry washcloth over the affected area) for about 20 minutes every two hours. Ibuprofen will help relieve local discomfort. In the emergency room, we usually add Benadryl in age-appropriate doses for about 24 hours. These medicines can be safely used at home by most people. Many reactions will be reddened initially; if the redness increases or persists beyond the first one to two days, your doctor should evaluate the wound for possible infection and the need for antibiotic therapy. A tetanus booster is recommended if the victim has not had one within the past 10 years.

In the case of allergy to stings or in the case of many simultaneous stings, reactions can be severe and even rapidly life threatening. Among other symptoms, sweating, weakness or a light-headed feeling, facial or airway swelling, trouble breathing or wheezing, palpitations or chest pain, generalized rash or itch, or abdominal cramping with vomiting or diarrhea demand urgent medical attention. A 9-1-1 call is the safest way to get medical attention for a significant reaction. Later, after you have recovered from a significant reaction, you should discuss with your physician the carrying of an EpiPen kit, which can be used to start treatment at home in the event of a future reaction.

Although rattlesnake bites may be severe and rightly feared, because they are less common, more people actually die from stinging insects! Approximately 25 percent of rattlesnake bites are “dry” bites with no venom injected, but every bite should be evaluated medically as soon as possible. Even bites that initially appear inconsequential can develop severe tissue damage over hours. Do not try to bring the offending snake in with you to the emergency room; it wastes valuable time and subjects you and anyone around you to further bites (even a severed head can reflexively close its fangs and inject venom again). There is no point to a careful ID – all North American poisonous snakebites will be treated with exactly the same anti-venom – so leave the snake at his home!

In the field, before receiving medical attention, you should remain calm and avoid unnecessary movement to delay circulation of the venom. For the same reason, keep the injured area below the level of the heart and splint it if possible and timely. All rings and other jewelry should be removed because severe swelling may occur even far from the wound. If you have access to one, a Sawyer Extractor (vacuum pump) can be used in the field, but its use should not delay more complete medical care. The bite should definitely not be incised or lanced to try to remove venom. No tourniquets should be used. A loose band (about as tight as a normal sock top) can be placed higher up on a limb that was bitten. At this point, it is definitely time to see a doctor, and better still, a doctor with experience treating snakebite victims before you.

Most emergency departments along the foothills carry snakebite anti-venom. We now use CroFab, a much safer anti-venom than the not-so-old product used a few years ago. That was made with horse serum and caused frequent allergic and serum sickness reactions in victims on top of the snakebite problem. Despite medical advances, snakebite treatment at the hospital can still be complex and will often involve a team of physicians, nurses and pharmacists for the best outcome.

Have a great summer. Enjoy the outdoors and the many recreation options available here but be careful too. I hope not to see you in the emergency department!