Bee Sting: First Aid and When to Call 115

Key takeaways

Most stings only hurt and swell at the spot. What kills is anaphylaxis — a severe allergic reaction that unfolds over minutes — so the most important thing after first aid is having someone stay beside the person and watch.
If the sting is still in the skin, get it out as soon as possible, and get it out by SCRAPING SIDEWAYS: a fingernail, the edge of a stiff card, or a piece of gauze. Do not squeeze it, and do not use tweezers.
Many stings at once from a swarm, or a sting inside the mouth or the throat, is a reason to go to hospital now even in someone with no allergies at all.
Do not put leaves, lime paste, urine or toothpaste on the spot. They draw no venom out, they invite infection, and they make it harder for a doctor to assess the injury.

Most stings only hurt, swell and redden at the spot, and can be watched at home. What kills is anaphylaxis, a severe allergic reaction that unfolds over minutes. So once you are away from where it happened and the sting is out, the most important thing is not stopping the pain — it is having someone beside the person, watching for difficulty breathing, swollen lips or faintness.

Recognising it: an ordinary sting and a worrying one

An ordinary sting shows itself at once: a sharp jab, then burning, a raised red lump, some swelling around it, itching. It is at its worst on the first day and then eases. If the sting is still lodged in the skin, you will see a small dark tip in the middle of the lump.

A sharp jab at the moment of the sting, then burning and itching around the lump; that spot feels hotter than the skin beside it
A raised red lump, usually with the puncture point in the middle; swelling spreading around the lump and then receding after a day or two
Swelling on the face, an eyelid or a hand looks more alarming because the skin there is loose — but swelling at the sting site itself is not yet anaphylaxis
A sting on a hand or a foot can feel tight, making it hard to grip or to walk for a few days

The distinction that matters: swelling spreading at the area that was stung is a local reaction, and mostly only needs watching. Anaphylaxis shows up in OTHER places on the body — an itchy rash all over, swollen lips, difficulty breathing, faintness — and it comes fast, usually within minutes to under an hour. Having been stung many times without trouble does not mean this time will be the same.

What to do straight away

Nothing below needs a prescription. Do it in this order.

Get away from where it happened. According to CDC, if several insects are attacking at once, run away from the area and get indoors; do not jump into water, because some species will hover and wait above the surface.
If the sting is still in the skin, get it out as soon as possible by scraping sideways across it: a fingernail, the edge of a stiff card, or a piece of gauze. Do not squeeze, and do not use tweezers.
Wash the spot with clean water and soap.
Cool it with an ice pack wrapped in a cloth, for at least 20 minutes if it is swelling; raise the arm or leg that was stung.
Take off rings, bangles and watch straps near the stung area before it swells.
Write down the time of the sting and how many stings you can count, and stay with the person for the hours that follow.
Anyone whose doctor has prescribed an adrenaline auto-injector should keep it within reach and use it exactly as they were instructed if any sign in the box below appears.

What NOT to do

Do NOT squeeze or pinch the sting out, and do not use tweezers — pressing on the venom sac still attached to it pushes more venom into the skin
Do NOT swat at an insect flying around you: stand still or walk away, because swatting is what makes it sting
Do NOT put leaves, lime paste, urine, toothpaste, heat balm or alcohol on the spot — they draw no venom out, they invite infection, and they make assessment harder for a doctor
Do NOT scratch, and do not burst the swelling; scratching increases the swelling, the itching and the risk of infection
Do NOT put a tourniquet above the sting
Anyone with a sign from the box below should not be given anything to eat or drink, not even painkillers: their throat may be swelling and they choke easily

The medicines commonly used for a sting are an antihistamine to ease the itching, a topical corticosteroid cream, and an ordinary painkiller such as paracetamol (acetaminophen). They are named so you recognise what you have been given — which one, cream or tablet, and for how long are decisions for a doctor or a pharmacist.

When you must go to hospital

Call 115 (the emergency number in Vietnam) NOW, do not wait to see whether it eases, if the person who was stung has ANY of the following: swollen lips, a swollen face, a swollen tongue, or a feeling of choking and tightness in the throat; difficulty breathing, fast breathing, wheezing, a hoarse voice, difficulty speaking; an itchy rash coming up fast all over the body; vomiting or severe abdominal pain arriving at the same time; faintness, collapse, pouring sweat, pale cold skin; skin, lips or tongue turning blue, grey or ashen; sudden confusion, drowsiness, not rousing when called; a child gone floppy and not responding as usual. Also go to a medical facility NOW, even if none of the signs above is present: many stings at once from a swarm; a sting inside the mouth, in the throat or on the tongue; the person has had anaphylaxis from a sting before. While you wait: lay them down with the legs raised, and do not let them sit up or walk about; if they are vomiting, lay them on their side. Having used an adrenaline auto-injector still means going to a medical facility, because the symptoms can come back. — BE SEEN WITHIN 24–72 HOURS if: there is more than one sting, even just a few; the sting is near an eye; the spot becomes swollen and hot, more painful, oozes pus or has a red streak spreading from it; there is fever; there is dizziness or a lot of tiredness; the swelling is not receding.

What can be done at home, and when you have to go to a facility

Most stings can be watched at home, provided the family knows the exact point at which to call 115 and does not rub or plaster anything on the spot. At home, Y Te Xanh (GreenCare) can do this much: a doctor takes the history, examines the sting, measures the vital signs and says clearly which cases must be admitted; a remote consultation by video call so you can ask before deciding to go in; a nurse changing the dressing on a sting that has been grazed open. Anaphylaxis, a swarm attack or a sting inside the mouth means hospital — with a sign in the box above, go in first and call afterwards.

According to CDC, after a sting from a bee, a wasp or a hornet you should have someone stay with you to watch for an allergic reaction, wash the site with water and soap, remove the sting by scraping a piece of gauze or a fingernail across it and never by squeezing it or using tweezers, and then apply ice to reduce the swelling. CDC also states that anaphylaxis is a severe, life-threatening allergic reaction needing emergency care at once. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.

Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.

Sources

CDC — Insects and Scorpions at Work
NHS — Insect bites and stings

Frequently asked questions

How long does a bee sting take to settle?

The pain and burning usually ease within one to two days, and the swelling goes down over a few days to about a week. If the spot becomes redder, hotter or more painful after a few days, oozes pus, or has a red streak spreading from it, think infection and go to be seen rather than waiting for it to pass.

Why must tweezers not be used to pull a sting out?

Because there is a venom sac at the base of the sting. Tweezers, or fingers, pressing on it squeeze the remaining venom into the skin. The recommended way is to scrape SIDEWAYS across the sting with a fingernail, the edge of a stiff card or a piece of gauze. And it matters just as much to do it early — do not spend time hunting for a tool.

Stung several times but with no allergy — is hospital still necessary?

Yes. Many stings at once is a reason to go to hospital now even in someone who has never had an allergic reaction, because at that point the problem is the amount of venom in the body, not an allergy. NHS also places being stung more than once in the group that needs medical attention, not the group you deal with at home.

Do leaves, lime paste or urine on a sting draw the venom out?

No. The venom is already under the skin and there is no way to draw it back out through the surface. Those things only add the risk of irritation and infection, and they make the injury harder to see when a doctor examines it. What does help is washing with clean water and soap, then cooling the spot.

Last time I was stung it only swelled — does that make this time safe?

Not necessarily. Anaphylaxis can happen at a later sting even when every earlier one only swelled locally. That is why every sting still needs someone nearby watching for the first few hours. Anyone who has had a severe reaction to a sting should ask their doctor about carrying emergency medication and about wearing a card or a bracelet stating the allergy.

Is a sting different in a child?

The first-aid principles are the same: get away, scrape the sting out, wash, cool and watch. What differs is the threshold for worry: the smaller the child, the more the same amount of venom does, so several stings means going in early. The signs worth noticing in a child are floppiness, drowsiness, not responding as usual, blueness around the lips, or breathing that sounds unlike them.