Patient history with regard to pre-existing conditions and medications:

1. known Hymenoptera allergy?

2. coronary heart disease?

3. beta-blocker use?

Inquire re:

• When did the sting(s) occur?

Assess:

• state of consciousness.

Measure:

• blood pressure/pulse,
• breathing (respiratory rate).

Classification of allergic reactions (Müller 1988):
1. Local reaction:

• local swelling (diameter: >10 cm?; duration: >24 h?).

2. Systemic reactions:

• Grade I: generalised urticaria, pruritus, nausea, fear.
• Grade II: grade I symptoms plus 2 or more of the following: angio-oedema (if this symptom appears in isolation, this is already a grade II reaction), a feeling of tightness in the throat or chest, vomiting, diarrhoea, abdominal cramps, dizziness.
• Grade III: grade I and II symptoms plus 2 or more of the following: respiratory distress, rhonchi, stridor (if any of one of these symptoms appears in isolation, this is already a grade III reaction), dysphagia, dysarthria, hoarseness, weakness, drowsiness, fear of death.
• Grade IV: grade I–III symptoms plus 2 or more of the following: fall in blood pressure, collapse, loss of consciousness, incontinence (urine, faeces), cyanosis.
• Uncommon reactions: see Therapy phase: Hospital.

Inquire re:

• When did the stings occur?

Assess:

• state of consciousness.

Measure:

• blood pressure/pulse,
• breathing (respiratory rate).

Count: the number of stings (simultaneously removing any stings remaining in the skin according to first aid methods: see Therapy phase: First aid / lay people).

Classification with multiple stings: when toxic symptoms are present, it is likely that >50 stings have occurred.