Scenario — Anaphylaxis following insect sting — paediatric female

intermediate Medical · Pediatric · 8yr · female

Patient Information

Dispatch	You are called to a patient (Lily Nguyen, 8-year-old female) who has been stung by a bee at the school carnival and is now having difficulty breathing with a rash spreading across her body.
Patient	Lily Nguyen — 8yr (25kg)
Incident History	Pt stung by bee on left forearm approximately 5 minutes ago. Parents removed the sting. Pt developed hives on arms and face, began complaining of throat tightness and is now wheezing.
Emergency Contact	Minh Nguyen (Father) — 0412 883 247

Initial Rapid Assessment

Response	Alert
Airway	Patent but patient reports throat feels 'tight'. No stridor audible at this time. Mild lip swelling noted.
Breathing	Audible wheeze on expiration. Increased work of breathing with accessory muscle use. RR elevated.
Circulation	Radial pulse rapid and weak. Skin flushed with raised urticarial wheals spreading across both forearms and face. Pale around mouth.
Disability	GCS 15 (E4V5M6). Alert and distressed. Orientated to time, place and person.
Exposure	Urticarial wheals on bilateral forearms and face. Bee sting site visible on left forearm — sting removed by parent. No other injuries noted.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	92% (RA)	Moderate	28	128	88/60	3s	15	4 4 ++	–	–	6
10 mins	98% (O2 NRB 10L)	Mild	20	104	102/68	2s	15	4 4 ++	–	–	3

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from anaphylaxis secondary to a bee sting, presenting with multi-system involvement including urticaria, angioedema, bronchospasm, and haemodynamic compromise.

Facilitator Triggers — if trainees miss a critical step

! (If trainee does not identify anaphylaxis and attempts to treat as localised allergic reaction only — Lily's wheeze becomes louder and she begins to drool. Father says 'she looks worse, please do something'.)
! (If EpiPen is not administered within 3 minutes of patient contact — Lily's GCS drops to 13, she becomes more drowsy and her SpO2 drops to 88% on room air.)
! (If trainee attempts to sit Lily upright in a chair — father assists her to stand. Prompt trainee: Lily becomes pale and nearly faints. She must be positioned supine or semi-recumbent with legs outstretched.)
! (If oxygen is not applied — SpO2 remains at 92% or drops. Prompt: Lily's lips are turning slightly blue.)
! (If trainee does not reassess BP after EpiPen — Lily remains tachycardic and pale. Prompt: 'Is Lily improving?')

Treatment Objectives

1. Ensure scene safety — school carnival environment, confirm no further bee/insect threat in the immediate area.
2. Don appropriate PPE.
3. Perform Primary Survey — confirm patent but threatened airway (lip swelling, throat tightness), moderate respiratory distress with wheeze, weak rapid radial pulse, urticarial rash across two or more body systems.
4. Identify anaphylaxis — multi-system involvement (skin + respiratory + cardiovascular) following bee sting trigger.
5. Position Lily supine with legs outstretched — do NOT allow her to sit upright in a chair or stand. Semi-recumbent acceptable only if respiratory distress demands it.
6. Remove trigger — confirm bee sting removed by parent (already done). Check no stinger fragments remain in left forearm.
7. Administer Adrenaline Auto-Injector (EpiPen) 300 MICROg IM to outer mid-thigh — Lily weighs 25 kg, which is over 20 kg, therefore EpiPen (adult 300 MICROg) is indicated, NOT EpiPen Jr.
8. Administer oxygen via non-rebreather mask at 10–15 L/min — titrate to target SpO2 94–98%.
9. Perform Vital Signs Survey — RR, SpO2, BP, HR, CRT, GCS.
10. Record full observations and pain score.
11. Reassess clinical response at 5 minutes post EpiPen — if no significant improvement, prepare second EpiPen for repeat dose at 5-minute interval as clinically required.
12. Monitor persistently — do NOT mobilise Lily for a minimum of 1 hour following one dose of adrenaline.
13. Contact CSPSOC for further advice and to arrange ambulance transport — advise of paediatric anaphylaxis, EpiPen administered, current observations.
14. Advise father: Lily must be transported to hospital for monitoring for minimum 4 hours after last adrenaline dose due to risk of bi-phasic reaction.
15. Scenario ends on arrival of ambulance and IMISTAMBO handover.
16. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Anaphylaxis · Adrenaline Autoinjector 'EpiPen' · Oxygen Delivery · Primary Survey · Pulse Oximetry · Blood Pressure · Pulse & Respirations

How did you go?

← Prev ← → navigate · Space reveal

🖨 Export PDF Next →

Signs/Symptoms	Throat tightness, difficulty breathing, audible wheeze, hives on face and arms, lip swelling, feeling dizzy.
Allergies	No known allergies. No previous bee sting reactions. No previous EpiPen use.
Medications	Nil regular medications.
Pertinent History	No known asthma. No previous allergic reactions. First known bee sting.
Last Oral Intake	Sausage sizzle and water approximately 45 minutes ago.
Events Leading	Patient was participating in the school carnival egg-and-spoon race when she was stung by a bee on the left forearm. Within minutes she started scratching her arms, then complained her throat felt tight and started wheezing.
Treatment Prior	Parent removed bee sting from left forearm. No medications given prior to EHS arrival.

Onset	Approximately 5 minutes after bee sting to left forearm.
Pain	Throat tightness rated 6/10. Sting site sore but not primary concern.
Quality	Tightness in throat. Wheeze on breathing out. Skin feels itchy and burning.
Radiates	Nil radiation of pain.
Severity	6/10 throat tightness.