Author Topic: Alternative to EPI Pen  (Read 57524 times)

Offline nano.

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Alternative to EPI Pen
« on: November 18, 2009, 02:38:06 PM »
Sorry if this is old news but I found out an interesting tidbit of information I figure I'd pass on.

In wanting to have all the bases covered with my EDC first aid kit, I was interested in wanting to get an EPI pen. I don't need one but wanted one "just in case".

Since it's only available in a prescription form, the alternative I found out about through my doctor was liquid benedryl. Apparently 50cc's (double dose) of this taken will help greatly reduce the trachea from closing until you can get someone to the hospital if needed.

Anyone on here in EMT agree? I currently carry pill form of benedryl, but am going to add the liquid version to the mix.

Thoughts?

Offline phargolf

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Re: Alternative to EPI Pen
« Reply #1 on: November 18, 2009, 05:16:06 PM »
I am a newbie to this forum but an old hand at prepping, so i hope i am not stepping on any toes since this is my first post. Here goes-Benadryl (generic name diphenhydramine) can help an allergic reaction, But the form of it, whether liquid or tablet does not matter, only the total MG given matters. No, it cannot replace an EPIPEN (which is epinephrine, or adrenalin to us old geezers) for an anphylactic shock reaction where the trachea and respiratory system have problems. BUT keeping an epipen isn't easy either because they have such a short shelf life(most of the ones i get in my pharmacy have about 1 yr on them if i am lucky) and they are very expensive. Bottom line is keep benadryl in your emergency kit and epipen only if you have someone with verifiable allergies to insect stings mainly. IMHO thanks

Offline nano.

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Re: Alternative to EPI Pen
« Reply #2 on: November 18, 2009, 07:13:01 PM »
yeah that's what I got as an answer. I don't have an allergy to it, and because of that getting a script would be next to impossible. This alternative is something I am going to incorporate into my first aid kit because I want something to carry that at least would be better then nothing and could at least keep someone from dying if needed.

Offline Doc K

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Re: Alternative to EPI Pen
« Reply #3 on: November 18, 2009, 07:48:38 PM »
Good topic...

Diphenhydramine (Benadryl) is not a great alternative to an epinepherine (Epi-Pen) for an anaphylactic reaction, but I would use it if I had nothing else.  There is a lot of biochemistry involved in explaining the differences between how the two work, but the difference is quite substantial.  However, anti-histamines (Benadryl) can be useful if given early enough and at a high enough dose.  Will it prevent a full blown allergic reaction (to anything, not just bees)?  No, and I would never rely on it alone, but as you said it can slow things down until epinepherine is given.

Also, just a random fact... If a person is on a Beta-Blocker (usually for their heart), epinepherine may not work to prevent anaphylaxis.  In these cases, glucagon (yeah the diabetic medicine) may need to be used.

Doc K

Offline phargolf

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Re: Alternative to EPI Pen
« Reply #4 on: November 18, 2009, 07:53:48 PM »
Thanks Doc K- i did not know that about betablockers and epinephrine in anaphylactic shock- who says you can't teach and old dog! ;D ;D

Offline nano.

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Re: Alternative to EPI Pen
« Reply #5 on: November 19, 2009, 05:10:58 AM »
Good info Doc K!

Is there another alternative to Benadryl we should be looking at?

I was thinking a show where Jack could interview a doctor or EMT to talk about different things to carry in your BOB and first aid kits like this would be pretty cool..


Offline Doc K

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Re: Alternative to EPI Pen
« Reply #6 on: November 19, 2009, 04:48:10 PM »
As far as over the counter meds for allergic reaction, Benadryl is the best and cheapest.
You can use the second generation antihistamines as well (things like Claritin), but they are not as good for an acute attack.
If the reaction is bad, nothing beats Epi!

Offline phargolf

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Re: Alternative to EPI Pen
« Reply #7 on: November 19, 2009, 05:18:42 PM »
In an emergency situation how will you know the patient is on a betablocker? Not being a smartaleck just wondering what emergency room procedure is-or is it a case of try epi first and if it doesn't work try glucagon?

Offline Doc K

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Re: Alternative to EPI Pen
« Reply #8 on: November 19, 2009, 06:53:24 PM »
Well, hopefully, you'll know a bit about the person first. 
If you are in a remote situation (wilderness setting or post TEOTWAWKI), and you are in charge of meds, you should know the medical issues of the people you are with. 

Glucagon is more of an ER type thing in general though. 
The average person is not going to wander upon a person with anaphylaxis and work on them long enough to need glucagon.
IF you are an ER provider AND you are failing with Epi AND you don't have medical information about the patient AND you are suspecting a beta-blocker you are probably going to be intubating or doing a cricothyrotomy as you are considering glucagon.

Glucagon bypasses the regular epi pathway (the beta-2 receptors which the beta-blockers are... well, blocking) and jumps to stimulate the cyclic-AMP pathway.  This allows the Epi to work in spite of the beta-blocker's beta blocking effects. 

So, it is not used INSTEAD of, but IN CONJUCTION with, Epinepherine.  And you will need to monitor glucose levels closely following dosing.

Doc K

Offline LvsChant

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Re: Alternative to EPI Pen
« Reply #9 on: November 19, 2009, 07:46:50 PM »
Beekeepers are recommended to keep epi-pens as a part of their regular gear, I think I learned on the forum from Archer. I'm assuming an MD would prescribe an epi-pen for them even if there was no known sting allergy present?

Offline Doc K

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Re: Alternative to EPI Pen
« Reply #10 on: November 20, 2009, 05:00:49 PM »
I would.  I wouldn't have an issue with it.

Doc K

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #11 on: November 29, 2009, 01:05:41 AM »
I'm just brainstorming, but I believe Primatene Mist is available over the counter, and the active ingredient is epinepherine.

I don't know the concentration, or if it even matters, but http://www.rxlist.com/primatene-drug.htm claims that each metered dose contains 0.22 mg epi.

Back when we used to give drugs down the tube, we'd double the dose. We no longer give drugs via ETT because there is no evidence that it even works. In any case, the IV/IM dose for epi in anaphylaxis or severe asthma is 0.3 - 0.5 mg. But if I was sucking rocks and I knew I was having a severe allergic reaction, and benadryl wasn't working, I might start with 2 puffs and increase from there.

Idk.. fml.. please for the love of God don't ever do this and sue me. You can really screw yourself up.

Also, as far as clues that point toward beta-blocker usage (if your pt can't talk to you), I look for a heart rate that does not increase after giving epi. During a stressful event like this someone's HR should be pretty high. The 1 mg of glucagon most diabetics and ambulances carry is not going to be near enough to take care of the problem, but it might get someone started on the right road until you can find more. Onset of action for IV glucagon is 1 minute and the most common SE is that your pt immediately pukes all over you, btw.
« Last Edit: November 29, 2009, 01:10:46 AM by Asclepius »

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #12 on: November 29, 2009, 01:10:01 AM »
I'll post this again since nobody gave shit one the first time I posted it. Everyone just wants to talk about herbal garbage and "type 3 diabetes" rather than what actually works or could be useful:

Epi-pen reuse
http://electricant.net/projects/wmed/epipen/epipen.htm

Offline Doc K

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Re: Alternative to EPI Pen
« Reply #13 on: November 29, 2009, 06:26:12 AM »
I'll post this again since nobody gave shit one the first time I posted it. Everyone just wants to talk about herbal garbage and "type 3 diabetes" rather than what actually works or could be useful:

not sure where the anger is coming from on this one...

...BUT...

Epi-pen reuse
http://electricant.net/projects/wmed/epipen/epipen.htm

...this link is really cool!

Doc K

Offline cohutt

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Re: Alternative to EPI Pen
« Reply #14 on: November 29, 2009, 07:17:14 AM »
Primatene dosages vs epi dosages?

http://www.drugs.com/ppa/epinephrine.html


Offline 123123

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Re: Alternative to EPI Pen
« Reply #15 on: November 29, 2009, 07:23:42 AM »
I'll post this again since nobody gave shit one the first time I posted it. Everyone just wants to talk about herbal garbage and "type 3 diabetes" rather than what actually works or could be useful:

Epi-pen reuse
http://electricant.net/projects/wmed/epipen/epipen.htm

Must be on the pharmaceutical companies pay role. That's what folks think when you say stuff like that. Most docs are trying to pay for school and that new hummer so they really need the money. I don't have health insurance and I cant afford to run to the doc every time I get a boo boo so I know about "herbal garbage" and I thank God for it. BTW I also know there is a time and place for prescription drugs so I am not disregarding that. Think before you yell so loud it makes you look bad. Thanks for the link as well, it is very helpfull!!

 Doc K what is the MOST Diphenhydramine you can dose for an anaphylactic reaction  (NOT just a bee sting but a severe reaction)

Offline Doc K

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Re: Alternative to EPI Pen
« Reply #16 on: November 29, 2009, 08:21:26 AM »
Doc K what is the MOST Diphenhydramine you can dose for an anaphylactic reaction  (NOT just a bee sting but a severe reaction)

Typically, it is 100 mg per dose with a 400 mg per day maximum.
Under certain circumstances, I would consider dosing higher if that was the only medicine I had.

Too much (i.e. toxic levels) can cause delirium, sedation, seizures, and anticholinergic symptoms (dry mouth, light sensitivity, inability to urinate, etc.)

Doc K

Offline 123123

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Re: Alternative to EPI Pen
« Reply #17 on: November 29, 2009, 09:02:03 AM »
Thats what I was looking for. (pm sent)   Thanks Doc K for all your input!!

Offline drthumbs

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Re: Alternative to EPI Pen
« Reply #18 on: November 29, 2009, 05:50:37 PM »
One little note, anything taken PO will have a longer time for onset...up to 30 minutes.  An anaphylactic reaction will often not give you that kind of time. food for thought.

Offline Orionblade

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Re: Alternative to EPI Pen
« Reply #19 on: November 30, 2009, 04:19:06 PM »
How many epi pens would you prescribe a beekeeper? Would 2 or 3 be acceptable and in alignment with retaining the future use of your DEA number? I certainly wouldn't want 50 or something ridiculous, but  I'd like to have one at my place and another to keep on me while working, maybe even a secondary in-the-fridge backup - also it would be nice to have two that are 6 months (or otherwise roughly half thier shelf life) apart in terms of expiration date, both to spread cost on replacement and to better ensure that I've got a still-good pen on hand.

+1 for the dismantling instructions.

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #20 on: December 03, 2009, 02:51:12 PM »
Think before you yell so loud it makes you look bad.

Go ahead and rub some bark on yourself when you're in anaphylaxis. I don't care. We can see who looks bad then.

Offline 123123

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Re: Alternative to EPI Pen
« Reply #21 on: December 03, 2009, 04:02:20 PM »
Go ahead and rub some bark on yourself when you're in anaphylaxis. I don't care. We can see who looks bad then.

. I said I know there is a time and place for prescription drugs, so.....relax. If you have nothing to add to the topic than we don't have time to waste on you.

EDITED BY PATRIOT2980 FOR CONTENT. LET'S ALL PLAY NICE.
« Last Edit: December 04, 2009, 07:33:09 PM by Patriot2980 »

Offline Patriot:Ex Machina

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Re: Alternative to EPI Pen
« Reply #22 on: December 04, 2009, 12:45:00 PM »
Let's get this back on topic.
Asclepius, your statement that no one gave a "sh$%t" about your previous post is not in keeping with a civil tone in conversation.

Everybody,
play nice, no bad mouthing each other and get it back on topic.
« Last Edit: December 04, 2009, 07:32:26 PM by Patriot2980 »

Offline DivineMomentsofTruth

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Re: Alternative to EPI Pen
« Reply #23 on: December 08, 2009, 08:50:36 PM »
Cool EPI-Pen disassembly ..... I learned something that I hope to God I never have to use. Thank You.



Offline DeltaEchoVictor

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Re: Alternative to EPI Pen
« Reply #24 on: December 08, 2009, 09:06:01 PM »
Must be on the pharmaceutical companies pay role.

123123

Snide remarks also aren't in keeping with a civil tone in conversation.  Please refrain from resorting to personal attacks. 

Thanks
DEV

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Re: Alternative to EPI Pen
« Reply #25 on: December 09, 2009, 10:03:59 PM »
Just another idea, and one that I now use in place of a $100 (or more) annual epi pen injector kit.  Not as fast to deploy as the epi pen, but with practice one can do it in under 1 min.

1 vial Epinephrine 1:1000 1ml (do not be confused with 1:10,000 solution)  cost: less than $3 per ampule
(Adults: 0.3 to 0.5 ml injected subcutaneously, Child under age 12: 0.01ml/kg not to exceed 0.3ml)
you get 2-3 adult doses out of one 1ml ampule

2 insulin (1cc) syringes with needles, cost: less than $1

1 Sage P2 Sharps Shuttle Container, cost: about $3
(holds all of the above in a compact crush proof water-tight container, and room to throw in some instructions, Benadryl tabs, and a couple alcohol prep pads too)

Total cost: less than $10, and only the ampule of epi needs replaced each year the syringes maybe every 3 years.

If we (providers) can teach folks to inject themselves with insulin, we certainly can teach them to safely draw up and use epi 1:1000.
I still write a script for the epi pen if a person cannot demonstrate the ability to safely draw up and inject .3 ml of sterile saline into themselves.

As always, consult with your provider before taking any advice over the Internet.






 

« Last Edit: May 01, 2013, 12:20:36 AM by Archer »

Offline phargolf

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Re: Alternative to EPI Pen
« Reply #26 on: December 10, 2009, 07:16:28 PM »
Great info! Yes that is a much cheaper way and can be rotated fairly easy. I think you and I could do that under pressure but i am not sure my wife could(and she might be the one giving me the shot, ;D ;D), not shooting down the idea just something else for me to worry about-I had already set my kit up your way with the epi vials also! ;D

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #27 on: December 12, 2009, 05:41:32 AM »
Remember to use a filter needle.

While we're on that topic, does anyone know if research has ever been done to prove that we actually need to use filter needles on those crack glass amps?

Offline Doc K

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Re: Alternative to EPI Pen
« Reply #28 on: December 13, 2009, 01:18:38 PM »
How many epi pens would you prescribe a beekeeper? Would 2 or 3 be acceptable and in alignment with retaining the future use of your DEA number? I certainly wouldn't want 50 or something ridiculous, but  I'd like to have one at my place and another to keep on me while working, maybe even a secondary in-the-fridge backup - also it would be nice to have two that are 6 months (or otherwise roughly half thier shelf life) apart in terms of expiration date, both to spread cost on replacement and to better ensure that I've got a still-good pen on hand.

I would give as many as is reasonable.  I never give just one, because a person can have a second flare a few minutes after the first dose.  The minimum (and usual) I prescribe is 2.  For beekeepers, I would recommend keeping 2 with your gear that you take to the hives - like in a carrying bag or toolbox that holds the smoker, lighter, extra fuel, tools, Epi, etc.  If you don't store those things together in a cool dark place, then I would keep a checklist.  You don't go to the hives unless you have everything on the list.  This will make sure you have your Epi, but will also make sure you don't forget something else as well.  Since most beekeepers (unless that is your main source of income) don't go to their hives on a daily basis, I think this makes sense.


Remember to use a filter needle.
While we're on that topic, does anyone know if research has ever been done to prove that we actually need to use filter needles on those crack glass amps?

I believe that this has been studied pretty well... from what I could find:
- Waller D, George C. Ampoules, infusions, and filters. British Medical J. 1986;292:714-715.
- Shaw N, Lyall E. Hazards of glass ampoules. British Medical J. 1985;291:1390.
- Carbone-Traber K, Shanks C. Glass particle contamination in single-dose ampules. Anesth Analg. 1986;65:1361-1363.
- Turco S, Davis N, Glass particles in intravenous injection. New Eng J Med. 1972:287:1204-1205.
- Furgang F. Glass particles in ampules. Anesthesiology. 1973;41:525-526.
- Gillies I, Thiel W, Oppenheim R. Particulate contamination of Australian ampoules. J Pharm. Pharmacol. 1986;38:87-92.

Hope this helps,
Doc K
- Sabon R, Cheng E, Stommel K, Hennen C. Glass particle contamination: Influence of aspiration methods and ampules types. Anesthesiology. 1989;70:859-862.


walker

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Re: Alternative to EPI Pen
« Reply #29 on: December 13, 2009, 08:25:29 PM »
Thanks for the input DocK!

Most of the research you cited involved drawing up medication from glass ampules for IV use, and they often use 18-21 ga needles to draw up the medicine.  Certainly, use a filtered syringe for drawing up medication from a glass ampule for IV use.  We are talking about SQ or IM use for an epi kit, using a MUCH smaller needle like 27ga or smaller.

I would not have any hesitation on using a 27ga needle or smaller to draw up epi from a glass ampule and use it SQ or IM, and I have not found any research to clearly say this is unsafe.  I certainly would not fault anyone from packing a couple filter needles with the kit as I have described.  If you know of any research that clearly shows using a filter needle is necessary for IM/SQ injectable meds, I would be more than willing to change my approach and throw in some filter needles.

Thanks again for your thoughts and additional feedback.
« Last Edit: May 01, 2013, 12:20:17 AM by Archer »