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Scenario — Anaphylaxis following insect sting — paediatric 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.
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
Signs/Symptoms
Throat tightness, difficulty breathing, audible wheeze, hives on face and arms, lip swelling, feeling dizzy.
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.
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.
Treatment
Parent removed bee sting from left forearm. No medications given prior to EHS arrival.
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.
Scenario Progression and Treatment Objectives

((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?'))

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

  • Ensure scene safety — school carnival environment, confirm no further bee/insect threat in the immediate area.
  • Don appropriate PPE.
  • 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.
  • Identify anaphylaxis — multi-system involvement (skin + respiratory + cardiovascular) following bee sting trigger.
  • 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.
  • Remove trigger — confirm bee sting removed by parent (already done). Check no stinger fragments remain in left forearm.
  • 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.
  • Administer oxygen via non-rebreather mask at 10–15 L/min — titrate to target SpO2 94–98%.
  • Perform Vital Signs Survey — RR, SpO2, BP, HR, CRT, GCS.
  • Record full observations and pain score.
  • 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.
  • Monitor persistently — do NOT mobilise Lily for a minimum of 1 hour following one dose of adrenaline.
  • Contact CSPSOC for further advice and to arrange ambulance transport — advise of paediatric anaphylaxis, EpiPen administered, current observations.
  • 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.
  • Scenario ends on arrival of ambulance and IMISTAMBO handover.
  • 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