Page 231 - ATP-P 11th Ed

Disposition
1. Urgent evacuation if evidence of severe envenomation (cardiovascular collapse,
anaphylaxis, paralysis, ascending edema of limb)
2. Evacuation not required if signs and symptoms do not indicate severe envenom-
ation after 24 hours of observation.

Insect / Arthropod Envenomations Protocol SECTION 2

SPECIAL CONSIDERATIONS – INSECT/ARTHROPOD BITE
1. In cases of suspected black widow spider bites, consider other causes for acute
abdominal pain.

Hymenoptera (Bee, Wasp, Hornet)
Signs and Symptoms
1. Pain
2. Swelling/edema
3. Puncture site(s) from stinger or fangs
4. Warmth
5. Erythema
6. Signs of anaphylaxis
Management
1. If signs and symptoms of anaphylaxis present, treat per Anaphylactic Reaction Protocol.
2. Remove stinger by scraping from side.
3. Apply ice or cold water.
4. Apply topical 1% hydrocortisone cream.
5. Apply topical lidocaine.
6. Ibuprofen (Motrin ) 800mg PO tid × 7 days
®
7. Diphenhydramine (Benadryl ) 25–50mg q6hr prn PO/IV
®

220 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 221