Summer is here, people who like outdoor activities will often encounter bees in the wild, and sometimes, they will be stung by bees accidentally.
Many people have the experience of being stung by a bee. Generally, a bee sting is only a little red, swollen and painful on the wound, and it is not life-threatening.
However, sometimes, a person is stung by a bee, and it is indeed dangerous. If the rescue is not timely and the rescue method is improper, the patient may also die in a short period of time.
At noon that day, I was taking a nap and was woken up by the ringing of the phone.
A colleague from the emergency department asked me hastily on the phone: An elderly male patient who was stung by a bee is already in shock, what should I do?
I gave detailed rescue advice after briefly asking about the situation.
A colleague complied immediately, using various first aid measures.
The patient improved quickly and was transferred to the ward for further treatment.
I am responsible for the following treatment for this patient.
So I learned the ins and outs of his bee sting.
The patient is a 66-year-old rural old man from Bamboo Horse, we call him Uncle Zhang.
He has cervical spondylosis and his neck has been stiff and painful.
Six months ago, when he was working in the field, he felt a small bug crawling on the back of his neck, so he slapped it down.
Unexpectedly, he photographed a bee.
The bee stings his neck hard before dying.
Because there was no one else in the field, and he couldn’t see the situation on his neck, when he returned home and asked his family to take out the bee stinger, the neck on his back was already swollen. Very impressive.
He knew there was no danger of bee stings, no treatment, and no hospital visits.
After a few days, the swelling on Uncle Zhang’s neck subsided, and his neck pain no longer exists.
Later he didn’t know where it came from that bee stings healed all kinds of joint pains, and he had an experience that he felt: bee stings healed his neck pain.
In the past few days, Uncle Zhang’s neck hurts again.
According to his experience, he felt that the neck pain could be treated with bees.
He went to a beekeeper and repeatedly asked the beekeeper to sting him in the neck with a bee.
The beekeeper couldn’t resist his pleas and finally caught a few bees and stung him in the neck.
One sting is not enough, Uncle Zhang asked for more stings.
After the third bee stung Mr. Zhang’s neck, he began to feel dizzy, dizzy, and soon developed chest tightness, shortness of breath, and could not stand up.
The beekeeper panicked. Fortunately, the beekeeper had a car. Fortunately, the place where the bees were raised was not far from our hospital. Our hospital emergency room.
As a result, Uncle Zhang saved his life.
In the afternoon, after Uncle Zhang was out of danger, his neck pain was gone!
He summed up his experience: Too many bees stung him. Next time your neck hurts, a bee sting is enough!
When I heard it, I was shocked and told Uncle Zhang, this is not good! You will lose your life!
Next, let me tell Uncle Zhang some medical knowledge.
What happened to Uncle Zhang is the most typical type I hypersensitivity reaction.
According to the mechanism of type Ⅰ hypersensitivity reaction, its occurrence process can be divided into three stages: sensitization stage, excitation stage and effect stage
First, the sensitization stage
refers to the first entry of allergens into the body with allergic constitution and stimulates the production of specific IgE antibodies. IgE binds to IgE Fc receptors on the surface of mast cells and basophils with its Fc fragment to sensitize them. The IgE-bound mast cells and basophils formed at this stage are called sensitized cells, and the body containing sensitized cells is in a sensitized state that typically lasts for months, years, or longer.
Second, the excitation stage
refers to the stage where the same allergen re-enters the body, specifically binds to IgE on sensitized cells, degranulates it, releases and synthesizes active mediators.
Generally, only multivalent allergens bind to two or more IgE molecules on sensitized cells, resulting in cross-linking of IgE receptors (Fc ε R 1) on the cell surface. In turn, it causes a series of activation reactions in cells, leading to cell degranulation, releasing intragranular reserve mediators such as histamine, kininogenase, etc., and can newly synthesize some active mediators such as leukotrienes, prostaglandins and platelet activationfactor etc. In addition, anaphylatoxins (C3a, C5a), bee venom, snake venom, anti-IgE antibodies, morphine, codeine, etc. can also directly cause mast cell degranulation.
Third, the effect stage
refers to the stage in which local or systemic pathological changes are caused after the active mediator binds to the corresponding receptor on the effector organ.
The pathological changes caused by type Ⅰ hypersensitivity reaction can be divided into two types: early phase reaction and late phase reaction. Early-phase reactions occur within seconds after exposure to allergens and can last for several hours, mainly caused by histamine; late-phase reactions generally occur within 6 to 12 hours after exposure to allergens and can last for several days, mainly caused by LTs and PGD2, PAF and active mediators released by eosinophils also play a role.
Simply put, six months ago, after Uncle Zhang was stung by a bee on his neck, the bee venom acted as an antigen to sensitize his body. Today, after his sensitized body is exposed to the same antigen again , hypersensitivity reactions that occur within minutes, type I hypersensitivity reactions.
Similar situations often occur in patients bitten by venomous snakes.
The first bite by a venomous snake is generally not fatal, and the second bite by the same venomous snake will cause the patient to die quickly.
In 1995, a person bitten by a poisonous snake died in a hospital in my hometown.
The patient himself is a person who sells snake medicine.
The first time he was bitten by a cobra, he was no big deal. The second time he was bitten by a cobra, he died within ten minutes. At that time I witnessed the whole process.
It wasn’t until I studied medicine that I realized that he died of a type I hypersensitivity reaction
After knowing the cause, the rescue and treatment of patients like Uncle Zhang is very simple, which is to follow the rescue process of anaphylactic shock.
1. Immediately remove the stinger from the wound. Wasp stings have no stinger in the wound, while bees do.
2. Make sure the patient’s airway is open and give oxygen.
In the event of a life-threatening airway obstruction in the patient, immediate endotracheal intubation or bedside tracheotomy is performed.
3. Immediately give epinephrine, 0.01mg/kg for children, the maximum dose is 0.5mg/time, subcutaneously or intramuscularly, repeat every 15 minutes if necessary; 0.5mg for adults for the first time, Subcutaneous or intramuscular injection, repeated as appropriate. Adrenaline can rapidly relax bronchospasm through β-receptor effect, and constrict small peripheral blood vessels through α-receptor effect; it can also resist the release of some mediators of type I allergy, so it is the drug of choice for the treatment of this disease. If hypotension occurs or does not respond to the initial epinephrine dose, administer 1:10,000 epinephrine intravenously and infuse 20 ml/kg of normal saline; if hypotension persists, administer epinephrine or dopamine intravenously.
4. Glucocorticoids, the course of treatment should not exceed 3 days, dexamethasone 10mg, diluted with 100ml of 5% glucose injection and then intravenously infused, usually for 1 to 3 days.
5. Other symptomatic and supportive treatments.
If a person is stung once by a bee and then stung a second time within a short period of time, there is a high chance of developing this rapidly and fatal allergic reaction.
Of course, this doesn’t happen to everyone, on the contrary, the probability of it happening is very low.
Precisely because the probability of occurrence is very low, this situation is not well known.
Lynx hopes that every doctor and every ordinary person can know and understand this kind of disease, so once they encounter it, they will not delay rescuing the patient because of ignorance.