1. Wash sites with soap and water 2. Apply ice packs or cold compresses 3. Apply baking soda and water paste _SYSTEMIC:_ 1. Epinephrine (1:1,000) subcutaneous injection (0.2-0.5 ml in adults and 0.1-0.3 in children). Repeat in 5-10 min if necessary 2. Antihistamine (Benadryl, 50 mg IM)—Adult 3. Oral antihistamines (Chart 1) 4. Treat for shock as necessary (Chart 2) BEES AND WASPS REACTIONS _IMMEDIATE:_ Pain _LOCAL:_ Within 1-4 hours—Appearance and subsidence of wheal and red flare; may see intense local swelling in region of sting _SYSTEMIC:_ 1. Mild reaction—Generalized urticaria, itching, malaise, anxiety 2. Moderate reaction—Any of the above plus generalized edema, tightness in the chest, wheezing, abdominal pain, nausea, vomiting, dizziness 3. Severe reaction—Any of the above plus labored breathing, difficulty in swallowing, hoarseness or thickened speech, marked weakness, confusion, feeling of impending disaster 4. Shock—Cyanosis, fall in BP, collapse, incontinence, unconsciousness 5. Delayed serum-sickness-like reaction (10-14 days after sting)—Fever, lymphadenopathy, malaise, headache, urticaria, polyarthritis _ANAPHYLAXIS AND SUDDEN DEATH:_ Many cases reported, usually in adults TREATMENT _LOCAL FIRST AID:_ 1. Remove bee stinger from sting site by gently scraping with fingernail or blade to prevent further venom injection from attached venom sac 2. Wash site with soap and water 3. Apply ice packs or ammonia in 10% solution 4. Apply baking soda and water paste 5. Elevate and rest involved limb _SYSTEMIC:_ 1. Epinephrine (1:1,000) subcutaneous injection (0.2-0.5 ml in adults and 0.1-0.3 ml in children). Repeat in 5-10 min if necessary 2. Analgesics (ASA, Tylenol) for pain 3. Antihistamines (Chart 1)—Useful only for urticarial and pruritic reactions 4. Treat for shock as necessary (Chart 2) _LONG-TERM MANAGEMENT:_ (for hypersensitive patients) 1. Medic-alert tag or bracelet 2. Emergency treatment kit and instructions for use 3. Program for desensitization SCORPIONS REACTIONS _IMMEDIATE:_ Severe sharp pain _LOCAL:_ 1. Dangerous neurotoxic species—Pins-and-needles sensation with no local swelling or discoloration (found in Arizona only) 2. Comparatively harmless species (not neurotoxic)—Local swelling and discoloration at sting site _SYSTEMIC_ (neurotoxic species only—within 1-3 hours): 1. Hypoesthesia and numbness or drowsiness 2. Itching of nose and throat 3. Impaired speech and tightness of jaw muscles 4. Restlessness and muscle twitching 5. Muscle spasms with pain, nausea, vomiting, incontinence, convulsions 6. Respiratory and/or circulatory distress