How to Manage Bites and Stings

Stinging Insects

(Hymenoptera)

• Bees
• Hornets, wasps, yellow jackets
• Fire Ants

• Quickly scrape the stinger (if present) off with a thin, dull edge (e.g., the edge of a credit card, fingernail).^1-3
• Wash the area with soap and water.^1,4
• To reduce discomfort, itching, redness, and swelling: apply a cold compress for about ten minutes at a time, give an oral analgesic and/or an oral antihistamine (e.g., diphenhydramine), or apply a topical corticosteroid (e.g., 0.5% or 1% hydrocortisone cream) or topical anesthetic (e.g., lidocaine).^2-4
• Seek immediate medical attention if there are any signs of systemic allergic reaction (e.g., hives, trouble breathing).⁴

• Only bees leave their stingers. Other stinging insects do not leave their stinger and can sting repeatedly.²
• Removing the stinger by squeezing the entry point, such as with tweezers, may release more venom into the skin.¹
• Venom immunotherapy may be considered in patients who have had a prior anaphylactic reaction to prevent life-threatening reactions with future stings.^3,5
• Avoid home remedies (e.g., meat tenderizer) due to lack of benefit.³

Scorpion

• Wash the area with soap and water.^1,4
• To reduce discomfort, itching, redness, and swelling: apply a cold compress for about ten minutes at a time, give an oral analgesic and/or an oral antihistamine (e.g., diphenhydramine), or apply a topical corticosteroid (e.g., 0.5% or 1% hydrocortisone cream) or topical anesthetic (e.g., lidocaine).^3,4
• Seek immediate medical attention if there are any signs of a serious reaction (e.g., changes in blood pressure, muscle spasms) or systemic allergic reaction (e.g., hives, trouble breathing).⁴

• Most scorpions in the U.S. are relatively harmless.⁶
• The bark scorpion (found in AZ, NM, and parts of CA) is the only scorpion in the U.S. that causes serious reactions.⁶
• Serious symptoms can include restlessness, muscle spasms, abnormal movements (head, neck, and eyes), anxiety, agitation, diaphoresis, and drooling.⁶
  
  • Children and older adults are at higher risk of serious symptoms.^6,17

  • Adults may also present with increased heart rate and blood pressure, weakness, increased respirations, and muscle spasms.⁶

• Anascorp (U.S.) is antivenom for Centruroides scorpion stings, indicated for treatment of serious reactions.^6,7
• If stung by a scorpion, contact the local poison control center (see contact information below).¹⁸ Children may require immediate medical attention.^4,17
• Avoid application of home remedies (e.g., garlic, red onion, meat tenderizer) due to lack of benefit.²⁰

Jellyfish

• Remove tentacles with the edge of a credit card, a stick, or covered fingers. Rinse the affected area in seawater.^8,9
• Familiarity with the types of jellyfish found in the geographic location is very important to determine the best management of stings.
• For example, for many types of jellyfish, vinegar (4% to 6% acetic acid) should be used on the sting as soon as possible, for at least 30 seconds.^1,8
• This helps remove the tentacles and stop the venom from entering through the skin.¹
• A baking soda slurry (50% sodium bicarbonate and 50% seawater) may be used if vinegar is not available.^1,9
• If the sting is from a bluebottle jellyfish (also called Portuguese man-of-war), rinse only with seawater, NOT vinegar.¹ Vinegar can increase the release of venom.¹
• Once stinging has stopped and tentacles are removed, shower or immerse the area in water as hot as can be tolerated (about 113 °F) for at least 20 minutes to reduce pain.¹
• Use an oral analgesic, oral antihistamine, topical corticosteroid, or topical 4% lidocaine if needed for pain or itching.^1,8

• Consult a lifeguard on site or contact the local poison control center to help identify the jellyfish.
• Avoid fresh water or rubbing the area, which can increase the release of venom.⁸
• Avoid dead jellyfish or broken tentacles found on the beach as they can still cause serious stings.⁸
• Avoid application of human urine, meat tenderizer, alcohol, ethanol, ammonia, and other home remedies due to a lack of benefit.¹⁰

Stingray, sea urchin, spiny fish

• Flush the wound with saline (if available), tap water, or ocean water.¹
• Soak the wound with water as hot as can be tolerated for at least 20 minutes, or until the pain is relieved.¹
• Alternatively, if no hot water is available, pack the area with hot sand.¹

• Watch for signs of infection.¹

Snake

(e.g., rattlesnake, copperhead, cottonmouth [water moccasin], coral snake)

• Seek immediate medical care unless the snake is positively identified as nonvenomous.¹
• Wash the wound with soap and water.¹
• Keep the site of the bite still and lower than the heart.¹
• Remove jewelry and loosen tight-fitting clothing.¹¹

• Application of a pressure bandage to slow the spread of venom can be effective for neurotoxic venoms (e.g., cobras, sea snakes, coral snakes); however, they can trap venom to worsen tissue damage with bites from snakes typically found in North America (e.g., rattlesnakes).¹¹
• Do not apply ice, suction, or a tourniquet.^1,11
• Do not cut the wound or apply electricity.^1,11
• Stay away from a snake that has bitten. They may bite more than once or bite reflexively after death.¹⁹
• Anavip (U.S.) and CroFab (U.S.) are pit viper antivenins used for bites from copperheads, rattlesnakes, and water moccasins.¹² In Canada, these are available only through Health Canada’s Special Access Programme.

Spider

(e.g., black widow, brown recluse [violin, fiddleback], northwestern brown [hobo])

• Seek immediate medical attention if you think the spider bite is from a black widow or brown recluse spider.¹
• Wash the area with soap and water.¹
• To reduce discomfort, itching, redness, and swelling: apply a cold compress for about ten minutes at a time, give an oral analgesic and/or an oral antihistamine (e.g., diphenhydramine), or apply a topical corticosteroid (e.g., 0.5% or 1% hydrocortisone cream).¹

• Brown recluse spiders are found mainly in midwestern and southwestern U.S.¹
• Black widow spiders are found throughout North America.
• Antivenin (Lactrodectus mactans) is available for patients with symptoms (e.g., muscle cramps and paralysis, seizures, etc) from black widow spider bites.¹³
• Bites from black widow spiders are painful and can be deadly, especially in the elderly or young children.¹
• Brown recluse spider bites are not painful initially. Pain may develop within an hour.¹

Tick

• Remove the tick with fine-tipped tweezers. Grasp the tick as close to the skin as possible, use steady even pressure, and pull it straight out.^14-16
• Wash the bite area with soap and water or rubbing alcohol after removal.^14-16
• Save the tick for identification. Store up to ten days (in fridge, if alive or freezer, if dead).^14-16

• Do not try to burn the tick off or apply nail polish remover or petroleum jelly. These may cause the tick to embed farther into the skin.¹
• Tickborne diseases (e.g., Lyme disease, Rocky Mountain Spotted Fever) are a risk with tick bites. See our algorithm, Stepwise Approach to Lyme Disease: From Tick Bite to Treatment, for information about early intervention and Lyme disease prophylaxis.