eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2020-09-17 8 12 491 493 10.12691/ajmcr-8-12-16 AJMCR202081216 article Ryota Nishio 1 Ken-ichi Muramatsu 1 Hiroki Nagasawa 1 Ikuto Takeuchi 1 Kei Jitsuiki 1 Youichi Yanagawa yyanaga@juntendo.ac.jp 1 Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University While felling trees along a national roadside in a remote area, a 38-year-old man suddenly cried out that he had been stung by a wasp on his left hand. His colleague came over to him, and he fell unconscious, so his colleague called an ambulance. When emergency technicians found him, he was in cardiopulmonary arrest. His initial rhythm was asystole. He receive advanced cardiac life support but was unable to obtain return of spontaneous circulation, possibly due to his anaphylactic shock and complication with Kounis syndrome resulting in a low cardiac output, as he showed temporal complete bundle branch block with tachycardia PEA, repeated ventricular fibrillation, and elevated cardiac enzymes. The presence of a sting mark may also have been a sign of his severe state and complication of Kounis syndrome. The establishment of a new framework, such as permitting non-medical staff to inject adrenaline into patients with anaphylaxis, might be required. http://pubs.sciepub.com/ajmcr/8/12/16/ajmcr-8-12-16.pdf anaphylaxis Kounis syndrome sting mark adrenaline