Insect Bites and Stings Nurse Management Guidelines
Red Flag Exclusion Criteria
Child at risk of significant harm
Suspected non-accidental injury
Unplanned repeat ED presentation
Suspected snake bite, Red Back or Funnel Web spider bite
Allergic response (any of the following)
Difficulty / noisy breathing
Swelling of lips, tongue, face, eyes
Swelling / tightness in throat
Difficulty talking and / or hoarse voice
Difficulty swallowing
Pain distal from bite / sting site
Vomiting
Abdominal pain
Wheeze or persistent cough
Generalised erythema or urticarial rash
Past history of severe allergic reaction or known allergy to an insect bite or sting
Signs of envenomation / neurotoxic paralysis (any of the following)
Drooping of eye lids (ptosis)
Decrease / paralysis of eye movements (ophthalmoplegia)
Limb weakness
Respiratory abnormalities
History of workplace injury
Yellow or Red Zones observations or additional criteria outlined in the NSW Health Standard Observation Charts
NOTE: separate NMG for Tick Bite and Marine Creatures
Additional Observations
If limb affected, conduct a full set of neurovascular observations
Additional History
Full history of bite or sting:
Date and time
Location / size of injury
Possible perpetrator
First aid treatment prior to ED including NSW Ambulance
Tetanus immunisations
Consider contacting Poisons Information (13 11 26) for further guidance
Management Principles
Remove insect and stinger if still attached to skin
When removing stingers, use a sideways scraping motion to avoid further envenomation
Inspect patient’s clothing and remove any other insects and stingers
Apply a cold pack at 20 minute on / off intervals for pain relief and to reduce swelling
Provide further analgesia as required according to pain scale – refer to Pain (any cause) NMG
Consider administration of Tetanus Toxoid as per immunisation history and Tetanus Toxoid Standing Order
Document assessment findings, interventions and outcomes
References / Further Resources
NSW Health (2013) Snakebite and Spiderbite Clinical Management Guidelines 3rd Edition, NSW Ministry of Health, Sydney
Australasian Society of Clinical Immunology and Allergy (2013) Health Professional Information Paper Anaphylaxis Australasian Society of Clinical Immunology and Allergy Inc., Australia
NSW Poisons Information Centre - 131 126 or visit www.poisonsinfo.nsw.gov.au