Encounters with wildlife can be enriching and educational moments that remind us just how dependent we are on nature. Just ask the many hiking converts who have been hitting Bukit Timah Nature Reserve to walk off cabin fever and the pandemic angst, or the beach lovers who have been wading into Sentosa's waters to cool off.
"Allergic reactions are one of the most feared complications arising from any sting," said Dr Jonathan Chong from DTAP Clinic. Signs of an allergic reaction include a generalised rash over the body, difficulty breathing, and swelling of the face, eyes and neck, he said.
These signs can develop rapidly over the course of a few minutes and can be lethal, he added, referring to the life-threatening condition known as anaphylaxis.
However, if the symptoms are mild and self-limiting, and there are no stingers in the skin, said Dr Chong, self-treatment is possible.
How, then, do you treat such wounds? Do you try to remove the stinger? And what is the best way to minimise the pain? Here's what to do if you accidentally get on nature’s wrong side and get stung.
The damage: The barb near the base of a stingray's tail is like a sheathed, serrated blade with venom glands. According to a report on injuries by marine creatures published in the Singapore Medical Journal (SMJ), when the barb pierces flesh, the sheath breaks, allowing venom to enter the wound.
The venom causes blood vessels to constrict and the resulting poor blood circulation and lack of oxygen can lead to the skin turning blue and the affected tissues to die.
Explained Dr Chong: "Stings from stingrays will often result in a combination of a puncture wound and a cut in the skin. The pain can persist for hours, is often severe and can radiate up the affected limb. There is usually also profuse bleeding from the wound".
There may also be symptoms like nausea, vomiting, diarrhoea, cold sweat, fainting or seizures, according to Dr Keith Ho, the chief of the Urgent Care Centre at Alexandra Hospital.
In our practice, bee stings are far more commonly encountered than stingray or jellyfish stings.
First aid action: The first thing to do is to get the victim out of the water, and either call for the lifeguard or an ambulance, said Dr Chong. Check that the victim's airway is not blocked and he is still breathing; otherwise, a trained person should perform cardiopulmonary resuscitation or CPR.
"Visible, superficial stingray barbs or debris can be removed with a pair of tweezers or by hand," said Dr Chong. However, if it's a deep, puncture wound, especially in the neck, chest or abdomen, do not attempt to remove the barb but let the emergency medical team handle it, he cautioned.
To reduce the pain, Dr Chong recommended immersing the affected limb in hot water (40 to 45 degrees Celsius). "A hot shower is also possible," he said. If hot water is not available, apply a heat pack on the wound. Otherwise, use a cold pack or make one by wrapping ice in a dry plastic bag instead.
Chances for self-treatment are low, according to Dr Ho, as stingray wounds generally require a tetanus shot (if yours isn't up to date) – and an inspection of the injured area for any foreign body, non-viable tissue and severity of infection.
The damage: Jellyfishes’ gelatinous domes are usually harmless but touch their trailing tentacles and you can expect a world of pain. The burning, stinging sensation that results is caused by several million stinging cells launching spirally-coiled threads – each ending with a toxin-containing barb – into your skin when touched, said Dr Ho.
In fact, this very function of the stinging cells does not cease even when the jellyfish is washed up on the beach – or even when its tentacles are still attached to your skin. This is why, according to the SMJ report, you should not scratch, rub or wash the affected area with fresh water as it may activate undischarged stingers and cause further damage.
First aid action: Help the person out of the water immediately and call 995, advised the National Parks Board (NParks). While waiting for medical help to arrive, keep the person calm and still to minimise the tentacles from further discharging venom.
To reduce the pain, apply vinegar directly to the wound, either by dousing or spraying, for about 30 seconds to deactivate the stingers, said Dr Chong. NParks noted that if the vinegar worsens the pain (non-box jellyfish stings may get more painful), stop using it and just flush with seawater. But do not apply fresh water, urine or other substances.
After that, proceed to pluck visible tentacles off the skin and rinse the area with seawater, said Dr Chong. Do not rub the sting site to get the tentacles off as that may worsen the pain. A word of caution: If you don't have tweezers and are picking the tentacles off with your bare fingers, you may feel a light stinging sensation. Rinse your hands with seawater when you are done.
The damage: "In our practice, bee stings are far more commonly encountered than stingray or jellyfish stings," said Dr Chong, who sees two to four patients with bee stings a week, especially younger children.
If you are not allergic to bee stings, the encounter is actually more fatal for the bee – if it’s a honey bee – than for you. That’s because honey bees have barbed stingers that get stuck in your skin after stinging you. To get away, the bee has to disembowel itself and dies. Wasps, hornets and other bees are spared this fate as their stingers are not barbed – which also means they can sting multiple times.
The venom, which contains components that cause pain, itching, allergic reactions and damage to the tissues, is released in the first few seconds of stinging. You get a red, painful and itchy bump; or anaphylaxis if you are allergic to the venom, said Dr Ho.
"About 10 per cent of people may have a stronger reaction, developing more pronounced redness and swelling over the sting site that gradually enlarges over one to two days," said Dr Chong. "This can take up to 10 days to subside."
Nevertheless, Dr Ho noted that generally, you can self-treat bee stings "if there are only a few stings, the local reaction is small, and the pain or itch minimal". "Medical attention is generally required if there are multiple stings (risks of kidney and/or liver failure, or muscle breakdown) or signs of anaphylaxis (rash, hoarse voice, abdominal symptoms, breathing difficulties and/or fainting)."
First aid action: If a stinger is left behind in the wound, scrape it out by using the edge of a credit card as soon as possible, advised Dr Ho.
To reduce the pain, Dr Chong recommended washing the affected area with soap and water, and applying a cold pack to the sting site. "If the sting is on an arm or a leg, elevation of the affected limb may help to reduce pain and swelling as well."
Then, observe the victim for signs of serious allergic reactions, which would require immediate medical attention.