Most stings just hurt. The one that kills is the allergic reaction. If breathing changes, the tongue or throat swells, or the person becomes dizzy or collapses — call 000 and give an adrenaline device if one is available.
Get the sting out quickly, and how matters less than how fast
A honey bee leaves its sting behind, and the venom sac keeps pumping while it is in the skin. Wasps and European wasps do not leave a sting and can sting repeatedly.
- Remove the sting by pulling it out or scraping it away sideways with a fingernail or the edge of a credit card.
- Do not use tweezers. Squeezing the venom sac pushes more venom in.
- Wash the area and keep it clean and dry.
- Apply ice or cool running water for the swelling and pain — but not to the eye.
The old debate about scraping versus pinching matters far less than speed. Get it out, and get it out now.
What is normal, and what is not
- Normal: sharp pain, redness, swelling and itching around the sting site, settling over hours to a couple of days.
- A large local reaction: swelling spreading well beyond the sting — a whole forearm, say. Uncomfortable and alarming, but not the same as anaphylaxis.
- Anaphylaxis: symptoms away from the sting site, especially affecting breathing or circulation. This is the emergency.
Signs of anaphylaxis — any one is enough
- Difficult or noisy breathing
- Swelling of the tongue, or swelling or tightness in the throat
- Wheeze or persistent cough
- Difficulty talking, or a hoarse voice
- Persistent dizziness or collapse
- Pale and floppy, in young children
- With insect allergy, abdominal pain or vomiting is treated as anaphylaxis
Lay the person flat. Do not let them stand or walk. Give the adrenaline device, call 000, and give a second dose after 5 minutes if there is no response. Full detail on how to use an EpiPen.
If the person collapses and is not breathing normally, start CPR — see DRSABCD.
Stung in the mouth or throat
Swelling there can block the airway even without an allergy. Call 000, keep the person upright and calm, and give them something cold to suck while you wait.
Multiple stings
A single sting is a pain problem. Many stings at once becomes a venom-dose problem, particularly for a child. Seek medical attention, and call the Poisons Information Centre on 13 11 26 for advice.
If you know you are allergic
Carry your adrenaline device, keep your ASCIA action plan with it, make sure the people around you know where both are, and check the expiry date. A device left in a hot car is a device that may not work.
This is a summary of what is taught in class, not a substitute for training. Skills like this are assessed practically for a reason — reading about them is not the same as having done them. In a real emergency, call 000.
Learn it properly
Recognising and responding to anaphylaxis is taught in HLTAID011 first aid including CPR and HLTAID012 childcare first aid. Best First Aid Training runs both at Parramatta, Penrith, Blacktown and Liverpool.
Sources: NSW Poisons Information Centre, Bites and stings; Australasian Society of Clinical Immunology and Allergy, ASCIA Action Plan for Anaphylaxis.
