How are Hymenoptera stings treated in the emergency department (ED)?

Updated: Nov 08, 2018
  • Author: Randy Park, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Epinephrine is the mainstay of treatment for anaphylaxis. Corticosteroids should be administered in severe cases of envenomation, with the caution that steroids do little to improve symptoms acutely and no definitive evidence exists that corticosteroids reduce recurrent or prolonged anaphylaxis. [16]

H2 blockers such as ranitidine and cimetidine may be given intravenously. [17] Administration of one of these medications combined with diphenhydramine is superior to diphenhydramine alone. [1]

In cases of refractory anaphylaxis, glucagon may be helpful if concomitant beta-blockers are preventing adequate response to epinephrine treatment. [1]

Vasopressors such as epinephrine or dopamine can be used to provide vascular support.

Patients developing respiratory arrest require ventilatory support.

Blood products may be required in the event of disseminated intravascular coagulation (DIC).

Repeated doses of epinephrine may be indicated for severe cases.

In the event of cardiopulmonary arrest due to anaphylaxis, intravenous epinephrine should be administered as a first-line agent. [1]

Consider further inpatient care for all patients with life-threatening reactions. Observe for sufficient duration to ensure symptoms do not rebound after initial treatment. Rebound phenomena may occur up to 12 hours after sting. Respiratory and circulatory support may be needed if secondary organ damage has occurred.


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