The mechanism of hornet stings.
The hornet (Vespoidea) belongs to the insect order Hymenoptera, the suborder of the suborder Needletail, also known as hornets, wasps, grass wasps, etc. There are about 5,000 species known worldwide. The toxins of wasps include biogenic amines (such as histamine, dopamine, etc.), kinins, mast cell degranulation peptides, neurotoxic proteins, phospholipase A2, hyaluronidase and many other components, and local wounds can be painful, red, swollen, papular and erythematous, or black nailhead-like necrotic lesions after being stung by wasps.
The general performance of the wasp sting.
(A) the performance of the sting site: the sting appears painful, swelling, 12-48 hours to aggravate the spread of the expansion, can be ulcerated to form ulcerated surface of different sizes.
(ii) Allergic reactions: appear minutes to hours after the sting, manifesting as a rapidly expanding rash, suffocation, dyspnea, nausea and vomiting, and in some patients, diarrhea. Anaphylactic shock can occur in some cases and is a major cause of early death.
(iii) Hemolysis: urine is tea-colored to soy sauce-colored, back pain, renal function changes, and later may show varying degrees of anemia.
(iv) Kidney injury: can be caused by the direct action of toxins on renal tubules or by hemolysis, manifesting as generalized edema, oliguria, and changes in renal function.
(v) Liver injury: mostly due to immune complex deposition resulting in hepatocyte necrosis, manifested as elevated serum enzymes associated with liver injury.
(vi) neurological and cardiovascular effects: the changes due to different toxins are different.
Third, the general treatment principles.
(i) Local treatment: Hornets do not leave stings in the body, and bees may leave stings in the body. If there is a stinger apply sticky tape to remove it and rinse thoroughly with water. Ice packs are effective in reducing local reactions. For severe allergy, 0.1% epinephrine 0.5ml can be injected subcutaneously. Topical application of water-adjusted Jidexam snake medicine can be applied.
(ii) Adrenal glucocorticoids: used when there is a serious allergic reaction, hemolysis, and also have a mitigating effect on other effects of bee stings.
(iii) Blood purification therapy: Blood perfusion can better remove toxins from the blood. Serious patients can be treated with 2 consecutive instillations.
(iv) symptomatic support treatment: according to the patient’s performance and condition, take the corresponding symptomatic support measures
IV. Main prevention methods.
Summer and autumn are the seasons when hornets are more active, mostly in areas with lush plants in the field. When visiting the countryside or going to work in the field, wear long-sleeved clothing and pants. If you meet with a swarm of bees, you should take shelter as soon as possible and not take the initiative to beat or drive them away. Once you have attracted a swarm of bees, take protective measures immediately, such as hiding in a building, closing doors and windows, getting down on the ground to reduce the exposed area, covering your body with clothing or other membranes, and especially protecting your face, hands and other exposed parts. If you are stung by a bee, check for poisonous stings in the skin, remove the stings and flush the wound with water. Do not touch the hornet’s nest by non-professionals.
V. Principles of serious medical treatment.
(a) Patients with the following conditions can be initially assessed as critically ill and need to be admitted to hospital as soon as possible.
Unstable vital signs; organ dysfunction, requiring close monitoring and/or organ function support therapy; serious underlying disease, bee sting injury or its complications may affect the treatment of underlying disease.
(B) Evaluation of the functional status of each organ system.
1. It is recommended that the sequential organ failure score (SOFA) system be used to evaluate cardiovascular, respiratory, coagulation, hepatic, central nervous system, and renal functions (Table).
2. Evaluation of other manifestations of the functional status of the organ system.
Various types of arrhythmias affecting circulatory function; disseminated intravascular coagulation (DIC); rhabdomyolysis and myoglobinuria; upper gastrointestinal bleeding.
(C) Treatment principles.
1. Basic therapeutic measures.
Remove the stinger as soon as possible; treat the skin with local acidic solution (such as vinegar); fully hydrate; some experts suggest the use of hydrocortisone 200 mg/day for 3 C 5 days when the sting skin is significantly red and swollen. The effectiveness of the above treatment cannot be confirmed yet, and it is recommended to use it with caution according to the patient’s condition.
Supportive treatment of the circulatory system.
①Indications: In patients with tissue hypoperfusion, resuscitation therapy is recommended according to a quantitative treatment protocol. Tissue hypoperfusion is defined as persistent hypotension or blood lactate levels ≥ 4 mmol/L after initial fluid resuscitation therapy.
②Resuscitation therapy goals: Resuscitation goals within the first 6 hours should include all of the following: central venous pressure (CVP) 8C12 mmHg, mean arterial pressure (MAP) ≥ 65 mmHg, urine output ≥ 0.5 ml/kg/hr, central venous (superior vena cava) oxygen saturation (ScvO2) ≥ 70%, or mixed venous oxygen saturation (SvO2) ③ Measures for resuscitation treatment. Adequate fluid resuscitation: crystalloid fluid (≥ 30 ml/kg) is appropriate for initial fluid resuscitation therapy; albumin may be considered when patients require large amounts of crystalloid fluid for resuscitation; because artificial colloid fluid significantly increases the risk of acute kidney injury, renal replacement therapy or even death in patients, it is recommended not to use it or to use it with caution after fully considering the risks and benefits. Timely use of antihypertensive drugs: If the patient is still persistently hypotensive after adequate fluid resuscitation therapy, consider the use of antihypertensive drugs, such as norepinephrine; if you choose to use dobutamine, you should be alert to dobutamine-induced tachyarrhythmias. Cardiotonic therapy if necessary: If the patient has adequate intravascular volume and satisfactory mean arterial pressure, but there is still persistent hypoperfusion manifestations, dobutamine or the addition of dobutamine to the antihypertensive drugs (if already used) may be considered. When intravascular volume is adequate or there is no tissue hypoperfusion manifestation, fluid intake restriction can be considered to avoid unnecessary volume overload. 2. Respiratory support therapy. If a patient presents with acute respiratory distress syndrome (ARDS) or other conditions leading to acute respiratory failure, oxygen therapy should be actively initiated according to the condition and the patient’s response to treatment should be promptly assessed. If invasive mechanical ventilation is required, the target tidal volume should be set at 6 ml/kg (ideal body) Monitor the patient’s plateau pressure: the initial plateau pressure should be ≤30 cmH2O in passively aspirated patients; for patients with ARDS, a permissive hypercapnia strategy is recommended; to reduce the risk of misaspiration and prevent ventilator-associated pneumonia, the head of the bed should be kept elevated by 30° when receiving mechanical ventilation. According to the change of patient’s condition, periodic autonomic breathing tests should be performed according to the offline treatment plan in order to evacuate mechanical ventilation as soon as possible. 3. Blood product infusion. Once tissue hypoperfusion is corrected and the condition is free of special conditions such as myocardial ischemia, severe hypoxemia, acute bleeding or lactic acidosis, transfusion of red blood cells may be considered in adult patients with hemoglobin < 7.0 g/dL. (i) If there is no bleeding or no invasive operation planned, no fresh frozen plasma transfusion is required to correct laboratory coagulation abnormalities. ② When platelet count ≤ 10,000/mm3 (10 x 109/L) should be transfused prophylactically even in the absence of significant bleeding; if the patient is at significant risk of bleeding, platelets should be transfused prophylactically when the platelet count is ≤20,000/mm3 (20 x 109/L); maintaining a higher platelet level is recommended in the presence of active bleeding, surgery, or invasive procedures (≥50,000/mm3 [50 x 109/L) 4. Glycemic control. Blood glucose should be managed according to the treatment plan to control blood glucose levels <10 mmol/L. The use of capillary blood for bedside testing can significantly overestimate blood glucose levels and needs to be interpreted with caution. 6.Nutritional support therapy. According to the patient's tolerance, transdigestive feeding should be started within 48 hours as far as possible; low caloric feeding can be implemented in the acute stage; parenteral nutrition should be considered only when enteral nutrition is not possible and recovery is not expected within 7 days. 7. Stress ulcer prevention. Stress ulcer prevention is indicated when the patient has significant coagulopathy and is on prolonged mechanical ventilation; histamine H2 receptor blockers are preferred. 8. renal support therapy. Patients with rhabdomyolysis should have adequately hydrated and alkalinized urine; congestive heart failure with acute renal failure, severe acid-base and/or electrolyte disturbances, and ineffective diuretic therapy are indications for renal replacement therapy. 9. Indications for renal replacement therapy. Prefer continuous renal replacement therapy over intermittent treatment modalities in hemodynamic instability. There is no evidence that renal replacement therapy or other blood purification treatment measures improve clinical prognosis by removing toxins, and should be used with caution based on clinical experience and condition, with full consideration of possible complications. 10. Anti-infection treatment. Bee stings are non-infectious diseases and do not require empirical antibiotics in the early stages, with emphasis on various infection control measures to effectively prevent hospital-acquired infections.