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Scenario — Anaphylaxis following bee sting at community cricket carnival
Patient Information
Dispatch
A 35YO male has been stung by a bee on the oval and is now complaining of throat tightness and difficulty breathing. (Jake Morrow)
Incident History
Pt was fielding during a community cricket match when he was stung on the forearm by a bee approximately 5 minutes ago. He reports throat tightness, difficulty breathing and generalised itching. Bystanders report he appeared flushed and started scratching before sitting down on the ground.
Emergency Contact
Sarah Morrow (Wife) 0412 554 873
Initial Rapid Assessment
Response
Alert
Airway
Patent. Audible wheeze on exhalation. Patient reports throat tightness and hoarse voice.
Breathing
Laboured. Increased work of breathing with accessory muscle use. Audible wheeze. RR 26/min.
Circulation
Radial pulse rapid and weak. Skin — generalised urticaria across chest, neck and arms. Flushed face. Palmar sweating.
Disability
GCS 15/15 (E4V5M6). Orientated to time, place and person. Anxious and distressed.
Exposure
Bee sting site visible on right forearm — stinger still present. Raised wheal 2cm diameter. Urticarial rash generalised across trunk and upper limbs.
Vitals
Time SpO2 Resp Dist RR Pulse BP CRT GCS PERL Temp BGL Pain
Initial 91% (RA) Moderate 26 128 86/52 3s 15 4 4 ++ – – 6
10 mins 97% (O2 NRB 15L) Mild 18 102 104/66 2s 15 4 4 ++ – – 3
History Taking
Signs/Symptoms
Throat tightness, difficulty breathing, audible wheeze, generalised itching and flushed skin. Patient reports his voice feels 'different'.
Onset
Approximately 5 minutes after bee sting to right forearm while playing cricket.
Pain
Throat tightness rated 6/10. Sting site mild local pain.
Quality
Tightness and constriction in throat. Breathing described as difficult and wheezy.
Radiates
Nil radiation of throat tightness.
Severity
6/10
Allergies
No known allergies. No prior anaphylaxis. First known bee sting reaction of this severity.
Medications
Nil regular medications. No antihistamines taken prior to EHS arrival.
Pertinent History
No known allergies. No prior anaphylaxis. No cardiac history. No MAOI use. First known severe reaction to bee sting. No history of asthma.
Last Oral Intake
Sandwich and water approximately 1 hour ago.
Treatment
Nil treatment prior to EHS arrival. Bystander attempted to remove stinger with fingers.
Events Leading
Patient was fielding during a community cricket carnival on a local oval when stung by a bee on the right forearm. He noticed immediate local pain then rapidly developed generalised itching, throat tightness, hoarse voice and shortness of breath. He sat himself on the ground and called for help.
Scenario Progression and Treatment Objectives

((If EpiPen is not administered within 3 minutes of assessment, patient's GCS drops to 13 and wheeze becomes silent — indicating severe airway obstruction. Prompt: 'Jake is becoming increasingly difficult to rouse and his breathing has gone very quiet.'))

((If patient is sat upright or allowed to stand post-adrenaline, patient becomes pale, diaphoretic and suddenly loses consciousness. Prompt: 'Jake stands to walk to the FAP tent and collapses to the ground.'))

((If stinger is not removed or noted, bystander asks: "Should I have pulled that stinger out?" — prompting assessment and removal of stinger to stop ongoing venom injection.'))

((If oxygen is not applied within 4 minutes, SpO2 drops to 87% on RA. Prompt: 'Jake says his lips feel numb and his breathing is getting worse.'))

This patient is suffering from anaphylaxis secondary to a bee sting, presenting with multi-system involvement including upper airway compromise (hoarse voice, throat tightness), lower respiratory involvement (wheeze, increased work of breathing), cardiovascular compromise (hypotension, tachycardia) and cutaneous features (generalised urticaria, flushing).

  • Perform primary survey — airway, breathing, circulation, disability, exposure
  • Remove bee stinger from right forearm as soon as possible to prevent further venom injection
  • Administer Adrenaline Auto-Injector (EpiPen) 300 MICROg IM into outer mid-thigh — anaphylaxis with multi-system involvement
  • Position patient supine with legs extended — do NOT allow patient to sit upright, stand or walk
  • Apply oxygen via non-rebreather mask at 10–15 litres per minute — target SpO2 94–98%
  • Perform vital sign survey — HR, BP, RR, SpO2, GCS, CRT
  • Reassess patient response to adrenaline at 5 minutes — note improvement in BP, HR, SpO2, wheeze
  • If no significant improvement at 5 minutes: repeat EpiPen 300 MICROg IM — adrenaline can be repeated at 5-minute intervals as clinically required
  • Contact CSPSOC for further advice and to arrange ambulance transport — advise time-critical anaphylaxis patient
  • Advise patient he must NOT walk or stand — minimum 1 hour post first adrenaline dose before mobilisation assessment
  • Document time of adrenaline administration, dose, route and patient response
  • Advise patient of biphasic reaction risk — must be transported to a medical facility for minimum 4-hour observation post last adrenaline dose
  • Scenario ends on arrival of ambulance and IMISTAMBO handover
  • Attention to hand hygiene will be given throughout the scenario.

Clinical references: Anaphylaxis · Adrenaline Auto-Injector · Adrenaline Autoinjector 'EpiPen' · Oxygen Delivery