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Insect Bites and Stings template



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QuestionsAnswers
Assessment Findings in Bee/Wasp StingsLocal Redness Pruritus Pain Edema Cellulitis Anaphylaxis
Assessment Findings in Mosquito/Flea BitesUrticarial Wheal Itching Central Punctum Secondary bacterial infection (impetigo)
Assessment Findings in Tick BitesPresence of tick (which may go undetected for several days) Erythematous halo Pruritus if tick body parts remain under skin
Assessment Findings in Spider/Caterpillar BitesPunctate marks on the skin Severe burning, stinging at site when bite occurs Severe pain, swelling, burning, stinging for several hours after bite Necrosis locally Abdominal pain (Black Widow) Local reaction can progress to systemic reaction in certain indiv; characterized by fever, chills, aches, rash, nausea, vomiting, diarrhea, cramps, shock
Diagnostic Studies for Insect Bites/StingsUsually none indicated CBC Culture and sensitivity if secondarily infected
Nonpharmacologic Management of Insect Bites/StingsCool compress for itching/edema Elimination of fleas Firmly grasp tick with forceps to remove Remove stinger Elevation of extremity for severe edema Application of ice to spider bite (AVOID HEAT) Examination of unprotected body parts after exposure to potential tick infested area Possible debridement
Pharmacologic Management of Insect Bites/StingsAntipruritics/ Antihistamines/ Analgesics/ Steroids Application of insect repellent Tetanus prophylaxis for spider bites Topical/systemic antibiotics for secondarily infected bites Epipen for anaphylaxis Short course steroids for severe local reactions which extend beyond two joints Anti-Venom
First Generation Antihistamine/ Antipruritics for Insect Bites/StingsDiphenhydramine/ Hydroxazine Non selectively block histamine binding sites centrally (brain) and peripherally Common side effects are sedative and relief of itching Don't use in symptomatic prostatic hypertrophy because of anti-cholinergic effects (inability to urinate) Monitor additive effects with EtOH, other sedative drugs Cautious use in elderly where exaggerated effects may produce excessive sedation, dizziness, confusion, hypotension
Second Generation Antihistamine/ AntipruriticsZyrtec/Allegra/Claritin Selectively block peripheral histamine binding and so sedation is not as common as with first generation agents Advantage is lack of sedation Once daily dosing
Consult/Referral for Insect Bites/StingsDon't delay treatment! Reactions usually take place within 2-60 minutes ER for severe reactions Surgeon/Dermatology for severe local reaction



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