Case study

A concerned mother walks into the pharmacy, panicking that her young son has just been stung  by a bee. You agree to see Elliot, aged 8, and note he has a sting on his knee and is visibly distressed.

1.  What are the appropriate next steps at this point?

a. Look for symptoms suggestive of a systemic reaction to the sting

b. Ask Elliot’s mum if he has a history of serious reactions to bites or stings

c. Dial 999 immediately on seeing Elliot’s distress

d. Check to see if the sting is still visible in the skin

2.  After examining Elliot, you are confident he has no signs of a systemic reaction to the bee sting. The sting is still visible in the skin. What should you do next? 

a. Leave the sting where it is. Removing it may distress Elliot further

b. Remove the sting by scraping it sideways with a fingernail, piece of card or credit card

c. Squeeze the sting firmly between two fingers to remove it from the skin

You remove the sting and clean the area. Elliot is calmed down by his mum, who then asks how she can prevent this happening again.

3. What advice can you give to prevent insect bites and stings in the future?

a. Wear brightly coloured clothing

b. Avoid walking barefoot or in sandals

c. Avoid areas where there is a greater chance of being stung such as outdoor settings with food and drinks

d. Wear strongly scented perfumes, soaps and shampoos to deter insects

Elliot’s mum asks if he will need an antibiotic to prevent an infection.

4. How should you respond?

a. Explain that you do not provide antibiotics in these circumstances

b. Advise her to return if Elliot develops any signs or symptoms of infection

c. Provide a short course to be used in case an infection develops

MCQs

5. If a decision is made to offer an antibiotic, what length of treatment should be provided?

a. 3 days

b. 5 days

c. 7 days

d. 10 days

6. Which of the following would warrant an immediate admission to a hospital casualty unit?

a. First bee sting

b. Previous systemic allergic reaction to a bite or sting

c. Patient has been stung in the mouth

d. Patient has been stung on the face

7. If tick infested areas cannot be avoided:

a. Exposed skin should be covered with long-sleeved shirts and trousers should be tucked into socks

b. An insect repellent containing DEET should be considered

c. Brightly coloured clothes should be worn so it is easier to spot any ticks

d. Skin should be inspected at regular intervals and visible ticks removed

8. In which of the following circumstances should the person be referred to their GP practice?

a. Severe pain

b. A bullseye rash is present

c. There is swelling of the affected area

d. The skin is hot to touch

9. What are the three key diagnostic criteria for a severe and life-threatening systemic hypersensitivity reaction?

a. Swelling of the mucous membranes

b. Airway compromise

c. Collapse

d. Itching

Answers on following screen.

Case study and questions provided by Agilio, author of NICE Clinical Knowledge Summaries (CKS), which has developed free Pharmacy First e-learning courses. Register here to complete each course.