Insect Bites

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a rash following an insect ‍bitesting that occurred ‍ ‍hoursdays ago

Location is on ‍rightleft ‍ ‍facearmleg

Alleviating factors: ‍nonecold applicationantihistamines, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍pain

‍itching

‍redness

‍swelling

‍discharge

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍difficulty moving the affected area



‍diabetes, ‍immunodeficiency

Tetanus vaccination: ‍up-to-dateincompleteunvaccinated





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Insect bites ‍likelysuspectedpossible

DDx: insect bites, insect stings, insect bites reaction, insect stings reaction, cellulitis, allergic reaction, anaphylaxis, insect bite hypersensitivity, bedbugs bites, scabies, urticaria, contact dermatitis, Lyme disease, impetigo, erythema multiforme, papular urticaria, cutaneous larva migrans





PLAN:

Investigations:

- Lyme disease serology at 0 and 6 weeks

Treatments:

- 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)

Further care:

- 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