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  • William W. Forgey, MD

Bites and Stings

Updated: Oct 7

Excerpt from The Prepper's Medical Handbook. Page reference numbers point to more in-depth treatment and self-reliant care available within the book. Future posts on this topic will address treatment for specific bites and stings. VENEMOUS STINGS

On grid or off grid, these things will find you. Stings from bees, wasps, yellow jackets, hornets, and fire ants—all members of the order Hymenoptera—produce lesions that hurt instantly, and the pain lingers. The danger comes from the fact that some people are hypersensitive to the venom and can go into immediate, life-threatening anaphylactic shock. The pain of the sting can be alleviated by almost anything applied to the skin surface. Best choices are cold compresses, hydrocortisone 1% cream, or the triple antibiotic with pramoxine ointment from the Topical Bandaging Module. Oral pain medication–OTC or Rx can be given as necessary. Delayed swelling can be prevented and treated with oral antihistamines such as diphenhydramine, 25 mg taken 4 times daily, from the Non-Rx Oral Medication Module. A generalized rash, asthmatic attack, or shock occurring within 2 hours of a sting indicates anaphylaxis, which requires special management. Anaphylactic Shock While most commonly due to insect stings, anaphylactic shock may result from a serious allergic reaction to medications, shellfish, and other foods—in fact, anything to which one has become profoundly allergic. Some non-stinging insect bites can also produce anaphylactic shock, like bites from the cone-nosed beetle (a member of the Reduviidae family), which can be found in California and throughout Central and South America. We are not born sensitive to these things but become allergic with repeated exposure. Those developing anaphylaxis generally have warnings of their severe sensitivity in the form of welts (urticaria) forming all over the body immediately after exposure, the development of an asthmatic attack with respiratory wheezing, or the onset of symptoms of shock. While these symptoms normally develop within 2 hours and certainly before 12 hours, this deadly form of shock can begin within seconds of exposure. It cannot be treated as indicated in the section on “normal” shock on page 13. The antidote for anaphylactic shock is a prescription drug called epinephrine. It is available for emergency use in vials or the special automatic injectable syringe called the EpiPen; see figure 8-1. Automatic injection syringes are quite expensive. Vials of epinephrine are less expensive but will require an accurate small-barrel (1 cc) syringe to properly measure and inject. The normal dose for an adult is 0.3 cc of the 1:1000 epinephrine solution given IM. This is quite easy to do, and even if a dose larger than 0.3 cc is administered (even twice that dose), it will cause no harm in either an anaphylaxis or asthma emergency. While it is not necessary to treat the itchy, generalized rash, the epinephrine should be given if the voice becomes husky (signifying swelling of the airway) and if wheezing or shock occurs. This injection may have to be repeated in 15 to 20 minutes if the symptoms return. The EpiPen Jr is available for use in patients weighing less than 66 pounds (30 kilograms) when the dose is 0.15 cc of the same solution. Antihistamines are of no value in treating the shock or asthmatic component of anaphylaxis, but they can help prevent delayed allergic reactions. If you have oral or injectable Decadron, give a 4 mg tablet or 4 mg injection for long-term protection, as each dose of this medication lasts approximately 12 hours. On the grid evacuate anyone experiencing anaphylactic reactions even though they have responded to the epinephrine. They are at risk of the condition returning, and they should be monitored carefully over the next 24 hours. People can die of anaphylaxis very quickly, even in spite of receiving aggressive medical support in a hospital emergency department. Beyond 24 hours they are no longer at risk of an anaphylactic reaction. If the patient is still alive after that time, vital signs are stable, and there is no manifestation of anaphylaxis, the evacuation can be terminated. USE OF EPIPEN

The EpiPen (figure 8-1) is an auto-injection system with two injection units available per box. It is available in adult and child doses. Using the EpiPen involves three simple steps: 1. Pull off the blue safety cap. 2. Place the orange tip on the outer thigh, halfway between the hip and knee (lateral side), preferably against the skin, but it can be used through thin clothing. 3. Push the unit against the thigh until it clicks, and hold it in place for a count of 10. Due to the high cost of this device, I suggest your physician prescribe vials of epinephrine and appropriate syringes for administration. Vials are sealed glass containers or rubber-stopper sealed vials. The glass vial system will require etching the ampule neck with a glass cutter and then snapping it off. Some glass vials are pre-etched and require only a careful snap to open. I always snap these vials cuddled in a thin towel. Draw the fluid up in a small-gauge needle and give the shot IM.





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