Case of the Month
November 2003

Insect Sting

You are called to the scene of a 28-year-old women lying on the ground in the backyard of her house. The call comes in as a “Sick, unknown” and the medics have not been sent. You arrive and find the patient is stuperous but replies “something stung me” in response to your question about what happened. Her pulse is 115 and thready and her blood pressure is 80 by palpation. Her respirations are not labored and you do not hear any wheezes. She has no rash on her body. Because of the low blood pressure you request paramedics be dispatched.

Your partner asks if you should get out the epinephrine (EpiPen) and you reply, “absolutely, let’s call the paramedics and describe the situation.” The paramedics in turn contact their base station physician and permission is given by the physician for you to administer the epinephrine to the patient. She responds dramatically to the shot and, by the time the paramedics arrive, her blood pressure is 125 / 75. She is also alert.

Remember, anaphylactic shock can manifest itself with respiratory compromise (throat swelling, lip swelling), hives and rash, GI symptoms, or vascular collapse (shock). One or more of these manifestations may be present. In this case the patient had vascular collapse and presented in shock without respiratory compromise. She needed the epinephrine. The guidelines for administration of EpiPen to an adult without a prescription for EpiPen require you to contact Medical Control (in Bellevue and Redmond this means the area hospital ED physician or responding paramedics – for other regions it means contact the responding paramedics who will in turn contact their base station physician).