Clinical Challenges in Assessing and Treating Insect Bites and Stings Urgent message: When presented with a patient who has experi- enced an insect bite or sting, the most crucial role for the urgent care clinician is to triage for anaphylaxis, venom toxicity, and local tissue damage. Kent A. Knauer, MD Introduction ow that summer is here, it is likely that ur- gent care practition- ers—especially those practicing in suburban and rural areas—will see an increasing number of pa- tients who have experi- enced an insect bite or sting. Though data are scarce, it is accepted that the most common such events lead- ing to an urgent care visit are multiple stings or bites or larger than normal localized swelling—especially worri- some if on the face or neck. Frequently, there is a small puncture wound visible in the central part of the lesion. It is important to establish whether a stinger is still present in the wound, and whether the swelling indi- cates an early cellulitis. More crucial, however, is the need to recognize potential severe injury from some uncommon spider bites. Positive identification of a spider is rare, however; in fact, the identity of the w w w. j u c m . c o m © IndexStock/Larry F. Jernigan N stinging or biting insect is not clear in most cases. Another area of concern is the potential presence of ad- ditional organ involvement such as throat symptoms, possible airway swelling, or a generalized rash. This often occurs in a setting of much patient and/or family alarm. The worst reactions are truly anaphylactic in nature and require prompt aggres- sive therapy. Some patients need referral to an allergist for further evaluation and treatment. The Players: Arthropods Over 60% of the world’s an- imal species are arthropods. Fortunately, only a small number are venomous and able to cause harm to hu- mans. Among the most common complaints are po- tentially dangerous stings and bites from arachnids (spiders and scorpions) and Hymenoptera species (bees, wasps, and ants). 1 This article excludes a discussion of scorpion stings; a good resource regarding such JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | J u l y/A u g u s t 2 0 0 7 11