10 Most Common Bicycling Injuries

Bee Stings

As a bike medic – I am frequently asked what is the safest thing you can do while riding a bicycle – well, besides wearing a helmet – I usually say to keep your mouth closed and zip up your jersey when going downhill. That is how most bee stings happen. Bee stings are probably the most common medical incident that I have had to treat. If you are riding downhill with an unzipped jersey – the bee is sucked into the opening of the jersey – the bee cannot get out – thus the sting. Hearing a bee buzzing inside your jersey typically produces a very upset patient (PT) and many times the PT ends up having a wreck. However, after they (PT) do stop their bike – there is a struggle to get out of their clothes – as fast as possible. If the PT is stationary – use your scissors to assist. As for riding downhill with your mouth open – a bee stuck inside your mouth and you can imagine – multiply all discomfort by two.

Bee stings are no joke. Besides the obvious – bee stings hurt – there is always the threat of anaphylaxis shock (someone that is allergic to bee stings and goes into a life threatening shock). Most of us have heard of these sorts of situations, people eating nuts or shellfish in a food dish and going into shock. Well the same sort of reaction is possible with bee stings. A few quick questions to the PT helps a lot – determine if the PT has a prior history of being allergic to bee/wasp/any sort of stings. However, a word of caution – even if the PT does not have a prior history – this incident may be their first allergic reaction. If you are with a PT that has been stung – observe the patient for at least 10 minutes for symptoms of shock before releasing. Actually, 20 minutes is the recommended medical time. However, keeping a bicyclist sitting for 20 minutes is not usually successful – after 10 minutes with no reaction – they usually release themselves and start riding.

If the patient has a very strong history of allergic reactions to stings – I would initiate the EMS system and call 911as soon as advised of the allergic condition. Do not hesitate on this – if they start having a reaction – usually it will come on fast. As with all medical issues – there are always variations.

After determining if the patient is allergic – observe the site of the sting. Frequently, the stinger and the attached sac of venom are still in the patient. Be cautious in removing the stinger and do not inject the remaining portion of the stinger pouch into your patient. After removing the stinger – clean the wound, ice, and then observe the patient for a full 10 minutes (again 20 minutes is better).

At this point I will divide the treatment into two portions. First, what to look for if the patient is presenting with signs and symptoms (S&S) of an allergic reaction/anaphylaxis shock. The second portion with discuss how to assist the patient in administering an epi-pen (epinephrine auto-injector).

First point:

Again observe for at least 10 minutes – 20 minutes is better. If the PT states they are allergic to bee stings – you should already have called EMS. More than likely the PT will start having signs and symptoms (S&S) within that time. Especially if the patient states they have a prior history of anaphylaxis shock – start observing for:

  • Hives and/or swelling of face, eyes, lips, tongue, etc.;
  • Rapid breathing, cough, or labored, noisy breathing;
  • Pt may feel tightness of throat and/or chest (serious stuff) and/or a feeling of impending doom;
  • Rapid heart rate (do vitals – including respirations if you know how).

If the PT starts presenting with these S&S – if you have not already contacted 911 – have someone call 911 – do not hesitate – and you the 1st Aid provider- stay with the PT. Probably the PT will become scared – especially as their airway starts becoming compromised. Stay with the PT and let them know the 911 is on the way. Find out if they have an Epi-pen. If the PT is having trouble breathing – assist the PT in finding the “position of comfort” for breathing – typically the PT prefers to “tri-pod” or sit leaning forward with their extended arms on their knees – this is usually the position that PTs find easiest to breathe – however – it is the PTs call – whatever is their position of comfort. Try to keep the airway open – if the PT becomes unconscious – monitor their breathing – rescue breathes – if they stop breathing – start CPR. Like I said – bee stings are serious – people can and do die from them.

The epi-pen. The Epinephrine Auto –Injector – for starters – epinephrine is adrenalin and the auto injector is made to inject the epinephrine thru clothes (like jeans and certainly thru bike shorts). As an EMT, a procedure has to be adhered too – is the pen prescribed for that patient, is the medication cloudy, etc. As a 1st Aid provider – if the PT has an epi-pen and they are demonstrating S&S of anaphylaxis shock – let the PT deal with the epi-pen if possible – however, you may assist the PT in administering the auto-injector. The shot is supposed to be administered into the “meat” of the thigh muscle – for a full 10 seconds (make a note of the time). Let the PT do it if possible. As a 1st Aid provider – be aware that the effects of the epi-pen are not long lasting – therefore, stay with the PT – although the immediate effects should provide significant comfort for the PT, these effects are short lived and if the EMS has not arrived after 10 minutes or so – it is quite possible that the S&S of anaphylaxis shock will start presenting again. Stay with the PT and it may become necessary to assist with breathing and eventually to conducting CPR. They will be scared – attempt to comfort them.

If you are a medic or 1st Aid provider on a bicycle tour/etc. – for PTs that are stung and then continue riding – I always radio the next AID station with the riders number and warn them that a rider has had a bee sting and to review for S&S. I also tell the rider to be sure and contact the medical tent at the next aid station and let them know that you were stung and that you have been treated, including times of events – when stung – treatment times – etc. Obviously, once the sting has occurred – keeping an ongoing record of events is very important. One last thing – it is always a good idea to have the PT contact their Primary Care Doc when stung by a bee or even better stop into their local ER or Emergency Care facility after being stung by a bee.

Naturally – yes, years ago, I was stung in the mouth (tongue) while descending a hill and yes, when two nurses examined my mouth they informed me that I was correct in thinking that I had been stung by a bee because the stinger (and venom sac) were still in my tongue. The nurses would not put their hands in my mouth but they did hold a mirror as I took the stinger out. After the stinger was out – surprising how much less it seemed to hurt. Ice helped with the pain – actually it was all I needed for pain. Although I had a direct hit to the tongue – it did swell but was not an issue. After icing – about 15 minutes later – it was pretty much back to normal. Obviously, I am not allergic to bee stings – for someone that is allergic – a direct hit to the tongue (which is not uncommon) would be a very serious situation. As stated earlier – do not hesitate to contact EMS – that is what they are there for. Always keep in the back of your mind – this PT could become unresponsive and it may be necessary to do CPR. It is always better to be doing CPR with an ambulance on the way and you can hear the sirens coming than it is to be doing CPR with no ambulance coming or you just called and it will be at least 10 minutes. Make the call to 911.