Insect Bites

HISTORY:

Rash following an insect ‍bitesting ‍ ‍hoursdays ago

Location: ‍rightleft ‍ ‍facearmleg

Treatments tried: ‍nonecold applicationantihistamines, ‍effectiveineffective

‍pain

‍itching

‍redness

‍swelling

‍discharge

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

Tetanus vaccination: ‍up-to-dateincompleteunvaccinated



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Skin: ‍no rash



ASSESSMENT:

‍Insect bites ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Lyme disease serology at 0 and 6 weeks

- Advise that most insect bites and stings are not allergic reactions but rather local inflammatory reactions

- ‍Topical corticosteroids

- ‍Antihistamines

- ‍Analgesics

- ‍Epinephrine if severe allergic reaction

- ‍Antibiotics if cellulitis

- Ice packs

- Avoid scratching

- Avoidance of known insects

- Education on insect bite prevention (e.g. insect repellent, protective clothing)

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as difficulty breathing, swelling of the lips or tongue, or dizziness

- Go to ER if severe allergic reaction occurs

- Referral to allergist if severe reaction or history of severe reactions