Author Topic: Alternative to EPI Pen  (Read 57525 times)

Offline Sapper22

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Re: Alternative to EPI Pen
« Reply #30 on: December 18, 2009, 11:26:24 AM »
My service's SOG's require a filtered needle to be used when drawing up promethazine (the only other drug we carry in ampules other than 1:1000 epi) for iv administration.  Protocol  is as stated above, 27ga on a 1mL syringe, our N/V protocol is 21ga filtered needle to draw up the promethazine. That being said, I think that I will start using filtered sharps for epi as well.  Can't hurt anything I suppose. Great info! Thanks.

Offline Orionblade

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Re: Alternative to EPI Pen
« Reply #31 on: February 05, 2010, 02:28:01 AM »
Dumb question - what the hell does a filtered needle do for you if all the glass junk winds up on the patient end of the needle?

Do you pop the filtered needle off, and pop a nonfiltered on to do the injection?

Just seems that if you didn't you'd be back-washing the filter into the patient, and not doing alot of good.

*ponders*

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #32 on: February 05, 2010, 09:24:14 AM »
Dumb question - what the hell does a filtered needle do for you if all the glass junk winds up on the patient end of the needle?

Do you pop the filtered needle off, and pop a nonfiltered on to do the injection?

Just seems that if you didn't you'd be back-washing the filter into the patient, and not doing alot of good.

*ponders*

You use the filtered needle to draw up the med, then unscrew the filtered needle and dispose of it. You then attach a regular, small gauge needle for injection.

Offline Orionblade

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Re: Alternative to EPI Pen
« Reply #33 on: February 15, 2010, 08:20:22 PM »
Now THAT makes sense.

*dies a fiery death of confusion*

Thanks. Sometimes I just think too much.

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Re: Alternative to EPI Pen
« Reply #34 on: February 15, 2010, 08:49:19 PM »
Thanks for all the info here, this is an important "must do" on my list.  Almost (no shit) lost my wife to a bee sting in 2002, the ER doc here in BFE had his game on and recognized it for what it was ( I had no clue what was going on.)  He saved her life, all with one shot.

This is something a lot of people might not even think about until they read it here.....thanks

Stay healthy   

Offline archer

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Re: Alternative to EPI Pen
« Reply #35 on: February 15, 2010, 09:22:58 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?
My allergist prescribed an Epi-pen because I asked for it, even thought I tested negative for reactions to bee stings. My bee mentor has become allergic to stings, so has an Epi-pen but his first defense is a bottle of Benadry.

Remember to use a filter needle.
Um, dumb question, what exactly is a filter needle? I know what it sounds like, want to make sure.

Offline Orionblade

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Re: Alternative to EPI Pen
« Reply #36 on: February 16, 2010, 02:24:41 AM »
The benadryl might get him to his epi pen, but if he's developed an allergy, then he's well on his way to a few more stings taking him away from this world. Reactions get more severe with repeated exposure, generally, since your immune system is initially primed for the antigen, then re-primed, it goes straight into a secondary reaction and *poof* anaphylaxis.

Sometimes not, though, but if I had an allergy, and had to tend bees, I'd have that epi pen duct taped to my thigh or forearm.

Offline archer

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Re: Alternative to EPI Pen
« Reply #37 on: February 18, 2010, 09:25:43 PM »
The benadryl might get him to his epi pen, but if he's developed an allergy, then he's well on his way to a few more stings taking him away from this world. Reactions get more severe with repeated exposure, generally, since your immune system is initially primed for the antigen, then re-primed, it goes straight into a secondary reaction and *poof* anaphylaxis.

Sometimes not, though, but if I had an allergy, and had to tend bees, I'd have that epi pen duct taped to my thigh or forearm.


He carries it in his bee suits pocket next to his cell phone. And I know how to give it incase.
Edit: He used to not be allergic to them, but 2 yrs ago *poof* he started having serious problems.

Offline Orionblade

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Re: Alternative to EPI Pen
« Reply #38 on: February 19, 2010, 09:17:41 PM »
Good man.

Also, major suckage on developing the allergy.

Offline LvsChant

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Re: Alternative to EPI Pen
« Reply #39 on: February 20, 2010, 02:57:29 PM »
any chance for working with an allergist to desensitize? If he's going to continually be around bees, it seems like it would be worth the trouble.

Offline archer

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Re: Alternative to EPI Pen
« Reply #40 on: February 20, 2010, 05:38:20 PM »
any chance for working with an allergist to desensitize? If he's going to continually be around bees, it seems like it would be worth the trouble.

He is actually going to the same allergist I have and gets weekly de-sensitizing shots for bees. I went thru de-sensitizing shows when I was a kid for my allergies and these days I only take allergy pills during the worst parts of the allergy season.

Offline Doc K

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Re: Alternative to EPI Pen
« Reply #41 on: March 01, 2010, 07:56:18 PM »
He is actually going to the same allergist I have and gets weekly de-sensitizing shots for bees. I went thru de-sensitizing shows when I was a kid for my allergies and these days I only take allergy pills during the worst parts of the allergy season.

Desensitizing shots can work for many allergies.  However, you have to keep getting the shots for the rest of your life (if you are an adult) to stay desensitized to that allergen (for instance bees). 

ALLERGIC REACTIONS
An allergic response happens because our immune system creates antibodies to an allergen (mold, cat dander, ragweed pollen, bee venom, etc.).  These antibodies can mount a huge immune response that tell other cells to release a whole lot of histamine.  Histamine tells the blood vessels to relax.  This relaxation leads to fluids leaking out of the vessels and causes swelling all over the body - worst case is in the airway.  A person can swell up like a balloon and their throat can swell shut.  Anti-histamines (like benadryl) directly blocks the histamine causing the reaction, but slowly.  Epinepherine (adrenaline) works opposite histamine (increases heart rate and tightens blood vessels).

DESENSITIZATION
It is important to note that desensitizing does not stop the antibodies from attacking the antigen.  When you give a desensitizing injection, you give the person a tiny amount of the antigen.  The antibodies bind to the antigen and are "locked up".  This antigen-antibody complex is destroyed by the immune system.  It takes a while, but the body will replace those antibodies that were lost... eventually.  This is the key to desensitization.

If you keep giving frequent, but tiny doses, of antigen to a person who is allergic, the body will eventually "run out" of antibodies... until it makes more.  The balance is to give just enough antigen to reduce the supply of antibodies, but not enough to cause too much histamine to be released that causes a full-blown allergic reaction.

CHILDREN AND ALLERGIES
Kids often "outgrow" the allergy.  This means the body eventually stops making the antibodies to a specific allergen.  For some reason, not completely understood, children don't make long lasting antibodies and/or the body decides not to replace the ones that get used.  So this is why some adults can say that they used to be allergic to something and then "grew out of it."  Often, these kids to receive desensitization therapy to prevent a life-threatening allergic reaction.  But it is their young immune system that is responsible for the loss of the allergic reaction as an adult, not the desensitization therapy.  Often, kids with many bad allergies loose the severe reaction to them and keep mild reactions to them.

ADULTS AND ALLERGIES
Adults are not so lucky.  If they choose to do desensitization (for job or hobby), then it is for life if they want it to work.  Initially it is a few shots a week with tiny doses, then the frequency drops (3 times a week to 2 times a week, to once a week, to once a month, etc.)  Eventually, a person may only need an allergen shot one a month or once every few months (if you're lucky).  BUT if you miss a few doses, your immune system replenishes the supply of antibodies.  If you are exposed to that allergen again, then you will have a full blown anaphylactic allergic reaction.  The only way around this lifelong shot regimen is to continue to be exposed to the antigen... for example: Once you are getting regular bee venom shots on a monthly basis, an allergic bee keeper may get stung by a bee.  This sting may do the same job as the desensitization shot... MAYBE.  That bee keeper will not know if the dose he got from that bee was more or less that what he was getting in the shots.  It MAY keep him "immune", but it also may give him a false sense of security.  The next bee sting may come a little too late and give a little too much venom and he could have a life threatening reaction again.

BOTTOM LINE
If you choose to have desensitization as an adult, it is for life.
You may get lucky and have an immune system that forgets to produce more antibodies as a kid (common) or as an adult (very rare).
If you spend your time in an area with a high rate of allergic reactions (bee keeping) ask your doctor for some epinepherine BEFORE you need it.

Hope this helps,
Doc K

Offline archer

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Re: Alternative to EPI Pen
« Reply #42 on: March 01, 2010, 11:50:34 PM »
Wow Dr K, that explains a lot I was a early teen when I got my shots, Did it for 3 years so it looks like the shots combined with growing older is what made me 'grow out' of my allergies. Very interesting info. Thanks! +1 to you!

Offline LvsChant

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Re: Alternative to EPI Pen
« Reply #43 on: March 02, 2010, 07:04:35 AM »
Glad to have that information! Thanks Doc.

Offline romeo hotel

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Re: Alternative to EPI Pen
« Reply #44 on: March 02, 2010, 10:01:54 PM »
Great info doc! +1

Offline Orionblade

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Re: Alternative to EPI Pen
« Reply #45 on: March 19, 2010, 08:52:35 PM »
Another great post, Doc.

It'd [bee] interesting to see if there was a way to trick the body into recognizing the bee venom antigen was "self". IIRC from my limited immunology studies, anti-self antibodies are obliterated within a day or two of your immune system coming online - not sure what cell type regulates that...

Anyhow, one quick question - would you give a benadryl or two, AND an injection (epi pen), or are we talking about two different titration rates that don't overlap well?

I'm just thining if you give a shot, and it's a long walk/run/ride to the hospital, then you might be dropping back into anaphylaxis by the time you get there, would the benadryl start coming online by the time the epi started to taper off, and help give you a few more minutes of reaction time?

Offline Dainty

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Re: Alternative to EPI Pen
« Reply #46 on: April 17, 2010, 06:32:42 AM »
I have a few questions that may or may not be dumb...

In the event that there is no epi-pen or liquid benadryll, are there any alternatives that might be employed with even the slimmest chance of possibly helping?

Epinephrine is adrenaline, correct? So in theory would it be possible to relieve anaphylaxis by, say, having the subject frightened out of their wits? I feel terribly silly even asking that, but since the general advice in medical emergencies is to "remain calm" it seems that if there's any possibility that panic could actually relieve a specific life-threatening situation it'd be nice to have that filed away in my brain.

Another question: how effective a treatment is cooling down a person suffering an anaphylaxis reaction? Is it possible that, if done soon enough, it could relieve the situation entirely? I have heard twice of immersion in cold water being used for anaphylaxis, though in the one case liquid benadryll had already been administered (jumping in a cold shower was recommended by the triage nurse), and in the other case paramedics were standing by with epinephrine in case it was needed (I saw this latter case on Survival School). So I'm uncertain as to its effectiveness. I'm having difficulty researching this potential treatment because googling gives results about cold urticaria and I'm not seeing it mentioned as a treatment in any mainstream information on managing anaphylaxis. Can anyone give me more information?

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #47 on: April 17, 2010, 02:57:00 PM »
I cannot speak to the effectiveness of cold immersion on anaphylaxis, since anaphylaxis is a life threatening reaction where your body is trying to shut out the irritant and in the process shuts out your air too (sounds more like the nurse was suggesting a treatment for an asthma attack).

But, I do know that my friend scared someone out of supraventricular tachycardia once because he didn't have any adenosine or a monitor with him, and valsalva maneuvers weren't working.

Crazy!

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #48 on: April 17, 2010, 04:36:09 PM »

Epinephrine is adrenaline, correct? So in theory would it be possible to relieve anaphylaxis by, say, having the subject frightened out of their wits?

Or, you could bone Amy Smart in public. I seen it in a movie once.

Offline Dainty

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Re: Alternative to EPI Pen
« Reply #49 on: April 18, 2010, 12:11:49 AM »
I cannot speak to the effectiveness of cold immersion on anaphylaxis, since anaphylaxis is a life threatening reaction where your body is trying to shut out the irritant and in the process shuts out your air too (sounds more like the nurse was suggesting a treatment for an asthma attack).

The incident I read about was quite clearly anaphylaxis. Reading a blog post from the perspective of the mother, her young son had a known anaphylactic reaction to peanuts, and yet she still kept them in the house. His sister had been eating peanuts, and neglected to wash her hands before wrestling with her brother. In under a minute the little boy's face was severely swollen. The mother grabbed a bottle of liquid benadryl and he drank straight from the bottle. They were hoping to avoid an ER trip, so she talked with the triage nurse who swiftly instructed her to place him in the bathtub with cold water. Though they had an epi-pen, it was not administered and they did not end up going to the ER, because the incident was sufficiently controlled through liquid benadryl and cold water immersion. But it was definitely a very severe reaction...a picture taken after the worst was over showed an extremely swollen face. I wish I could give you a link but I cannot find it; I read about it several years ago.

The other incident was on survival school, episode 2 (you can watch it for free here) where a man was stung by multiple bees and immediately developed a rash and swelling (in areas not even stung). The SERE medic instructed the man to remove his clothing and get into a stream to cool down his body temperature, and it worked, though he had to stay there for 45 minutes. He was not yet in anaphylactic shock, but they figured it was heading in that direction; they said "had he let it go another 24 hours it could have been a medical pull for him". So it appears to me that it was a much slower progression, but it still seems it was resolved with nothing more than cold water immersion.

But, I do know that my friend scared someone out of supraventricular tachycardia once because he didn't have any adenosine or a monitor with him, and valsalva maneuvers weren't working.

Crazy!

That is crazy!

Offline OKGranny

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Re: Alternative to EPI Pen
« Reply #50 on: April 18, 2010, 12:43:59 AM »
The first time I had a severe allergic reaction to something I was 40 years old, the reaction was to something I had been eating for years that had never shown any signs it bothered me. From where we live to the closest hospital was a 20 minute drive breaking every speed record, by the time we got there my blood pressure was 65/0, I couldn't breathe and for whatever reason my skin was boiled lobster red everywhere. Since that time 2 other things that I had never ever been allergic to before have caused anaphalactic shock. Benadryl and Epi go everywhere with me and I agree the vials are much cheaper and a better way to go. My point to this ramble is that if you do something like keep bees, be prepared because you just simply never know when or if you'll develop an allergic reaction. I honestly wouldn't like to bet my life that dumping me in a cold bath or somehow frightening me would stop the reaction.

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #51 on: April 18, 2010, 12:01:30 PM »
I wonder if the cold worked to improve vascular tone, and perhaps kept them from dropping their BP. I guess anything is worth a try at that point.

Be careful with the glass ampules; they constantly break in my kit.

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #52 on: April 18, 2010, 12:02:42 PM »
Porking Amy Smart is still my favorite idea, however.

Offline Doc K

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Re: Alternative to EPI Pen
« Reply #53 on: April 18, 2010, 06:29:25 PM »
Sorry, I missed the questions on this thread... I think I was out of town when these were initially posted.

Anyhow, one quick question - would you give a benadryl or two, AND an injection (epi pen), or are we talking about two different titration rates that don't overlap well?

I'm just thining if you give a shot, and it's a long walk/run/ride to the hospital, then you might be dropping back into anaphylaxis by the time you get there, would the benadryl start coming online by the time the epi started to taper off, and help give you a few more minutes of reaction time?

Excellent thinking.  You are right on with the anaphylaxis returning.  If a person has a anaphylaxis reaction, there is a pretty good chance they will need more than one dose.

Now there is nothing wrong with giving Epi and Benadryl.  However, Benadryl (Diphenhydramine) is not great at treating a full blown anaphylaxis reaction to an allergy.  It does HELP reduce the histamine response (which causes the swelling, itching, etc.), but it is better for smaller reactions that are not body wide (which is what anaphylaxis is).

This is why I always give two Epi pens at a time or I give a Twinject (this come with two doses in one pen). 




Epinephrine is adrenaline, correct? So in theory would it be possible to relieve anaphylaxis by, say, having the subject frightened out of their wits? I feel terribly silly even asking that, but since the general advice in medical emergencies is to "remain calm" it seems that if there's any possibility that panic could actually relieve a specific life-threatening situation it'd be nice to have that filed away in my brain.

Not a bad thought, but I don't think the amount of epinepherine produced naturally is enough to counteract the anaphylactic reaction.  In reality, I can think of few things more terrifying and fear producing than slowly dying from a gradually swelling airway.  Unfortunately, many people die every year just this way.  I am sure their adrenal glands are wide open pumping out epinepherine (adrenaline), but it is just not enough.




Reading a blog post from the perspective of the mother, her young son had a known anaphylactic reaction to peanuts, and yet she still kept them in the house. His sister had been eating peanuts, and neglected to wash her hands before wrestling with her brother. In under a minute the little boy's face was severely swollen. The mother grabbed a bottle of liquid benadryl and he drank straight from the bottle. They were hoping to avoid an ER trip, so she talked with the triage nurse who swiftly instructed her to place him in the bathtub with cold water. Though they had an epi-pen, it was not administered and they did not end up going to the ER, because the incident was sufficiently controlled through liquid benadryl and cold water immersion. But it was definitely a very severe reaction...a picture taken after the worst was over showed an extremely swollen face. I wish I could give you a link but I cannot find it; I read about it several years ago.

So, this story really, really bothers me.  There is a recent study done on pediatric deaths from anaphylaxis.  The article basically reported on children in a research group that had anaphylaxis from a known allergy such as peanuts, wheat, or egg (like my 2 year old son).  Every child had epinepherine with them.  All the children who lived were given epinepherine within a few minutes of the facial swelling.  All the kids who died did not receive epinepherine at all or got it after 30+ minutes (if I remember correctly, or could have been 45 minutes).  This kid in this story is very, very lucky.  The mother and nurse need a knock in the head and some proper education about the use of epinepherine.  If there is facial swelling in a kid who has known allergies (and even in a person without known allergies), you give epi!  I don't think the mom would have been too concerned about an ER bill when her son died. 

Bottom line, if you wait too long, even epinepherine will not stop anaphylaxis.  There is a point of diminishing returns with epi.  Each person is different, so you never know. 


Another question: how effective a treatment is cooling down a person suffering an anaphylaxis reaction? Is it possible that, if done soon enough, it could relieve the situation entirely?   The other incident was on survival school, episode 2 (you can watch it for free here) where a man was stung by multiple bees and immediately developed a rash and swelling (in areas not even stung). The SERE medic instructed the man to remove his clothing and get into a stream to cool down his body temperature, and it worked, though he had to stay there for 45 minutes. He was not yet in anaphylactic shock, but they figured it was heading in that direction; they said "had he let it go another 24 hours it could have been a medical pull for him". So it appears to me that it was a much slower progression, but it still seems it was resolved with nothing more than cold water immersion.

There is nothing that I know of about cold water or any cold exposure to treat anaphylaxis.  Not sure where that is coming from.  But it appears to be somewhat of a common "field medicine" treatment modality.  If you have no other option, then what can it hurt?  Maybe there is some effect from slowing blood circulation and maybe slowing and/or preventing mast cell degranulation of histamine... I don't know if anyone truly knows.

In the case of the multiple bee stings... this actually may not be anaphylaxis.  A lot of swelling and a rash where the bees stung (even a really big one that spreads a lot) is not anaphylaxis - it's called a large local reaction.  Now if he had swelling and rash where the bees did not sting, then that would be anaphylaxis. 

Also, just to throw a monkey wrench into the common understanding of anaphylaxis - just because a person had a prior full blown anaphylaxis reaction to something (like bees) doesn't mean that they will have another one when they are stung again.  The odds are greatly increased, but there is no "sure thing" with anaphylaxis.  It just goes to show that there is still a lot to know in medicine.   

BUT, if you have an epi pen, use it!!

:)


Doc K

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #54 on: April 18, 2010, 11:44:27 PM »
But what of vascular tone? Could the old wives tale of cold water actually be affecting vascular tone in anaphylactic shock?

Offline Dainty

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Re: Alternative to EPI Pen
« Reply #55 on: April 19, 2010, 04:56:44 AM »
For the record, again, the only reason I asked my questions was to know if, in the absence of an epi-pen, antihistamines, or medical care there were any other potential alternatives, since to me a last ditch effort sounds a little better than simply waiting to die. I'm not planning on risking my life to try it out, and I'm not suggesting anyone else do so either.

In the case of the multiple bee stings... this actually may not be anaphylaxis.  A lot of swelling and a rash where the bees stung (even a really big one that spreads a lot) is not anaphylaxis - it's called a large local reaction.  Now if he had swelling and rash where the bees did not sting, then that would be anaphylaxis.

Right. As I mentioned, there was swelling in areas other than the bee stings (they said he was swelling wherever he sweated the most...showed where his underwear had been and that whole section was swollen, even though no bee had stung anywhere near it). Since it's the military, I was assuming that they'd have correctly assesed the situation as a serious reaction, but I guess there's always a chance for error.

But what of vascular tone? Could the old wives tale of cold water actually be affecting vascular tone in anaphylactic shock?

Wow, I'm surprised that medics in the US military are relying on an "old wives tale"; I'd have thought they were better trained than that! Maybe we should send them a letter to inform them of their error.
« Last Edit: April 19, 2010, 05:04:54 AM by Dainty »

Offline Doc K

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Re: Alternative to EPI Pen
« Reply #56 on: April 19, 2010, 07:53:47 AM »
But what of vascular tone? Could the old wives tale of cold water actually be affecting vascular tone in anaphylactic shock?

That could be the mechanism.  From what I have seen/learned on cold water immersion, there is not a big spike in blood pressure.  Now, could it be preventing the hypotension (low blood pressure... low vascular tone) from occuring in the extremities and thereby keep the core blood pressure relatively higher?  Maybe.  The problem is that this would be an almost impossible study to perform to truly get a clear answer.

Interesting thoughts.

Offline Doc K

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Re: Alternative to EPI Pen
« Reply #57 on: April 19, 2010, 08:31:41 AM »
Dainty - I can't tell if you are upset or being sarcastic here.  That is the problem with text as a means of communication - you can't see a person's face or hear their tone of voice.

I took your questions at face value.  I thought you had some legitimate questions, and I thought I answered them fairly well.  If you took something that I said negative, my apologies. 

For the record, again, the only reason I asked my questions was to know if, in the absence of an epi-pen, antihistamines, or medical care there were any other potential alternatives, since to me a last ditch effort sounds a little better than simply waiting to die. I'm not planning on risking my life to try it out, and I'm not suggesting anyone else do so either.

I don't think you were suggesting anything of the sort.  Cold water may be helpful, but it may not.  Other than epinepherine, histamine blockers, and invasive medical care (intubation, IV's, pressors, etc.), I don't think there is much else to do.  It's not that I am trying to be unhelpful, but there doesn't appear to be anything else.


Right. As I mentioned, there was swelling in areas other than the bee stings (they said he was swelling wherever he sweated the most...showed where his underwear had been and that whole section was swollen, even though no bee had stung anywhere near it). Since it's the military, I was assuming that they'd have correctly assesed the situation as a serious reaction, but I guess there's always a chance for error.

I wasn't saying he did not have anaphylaxis.  I was just trying to differentiate a large local reaction from anaphylaxis.  One needs emergency medical care and the other does not.  Anaphylaxis is a body wide reaction that has varying degrees of severity.  It can be minor (like hives) to major (like full blown shock).  It doesn't always progress to shock, in fact it often does not.  But you never know. 

In the video A1C Moran had an anaphylaxic reaction to multiple bee stings.  It was likely a mild form of anaphylaxis, but it was anaphylaxis.  If I was there, he would have been given an epinepherine injection immediately.  It is not clear from the video, but it seems more that the medic (not a physician) was trying to treat the swelling from the bee stings.  This would likely do very little to stop shock, and I do not think it did anything to prevent his anaphylactic reaction from becoming anaphylactic shock.   I would not have waited to see if the cold water brought the swelling down, because I am not that concerned about his hives.  I am concerned that he could be one of the people who develps full blown shock and/or airway swelling. 


Wow, I'm surprised that medics in the US military are relying on an "old wives tale"; I'd have thought they were better trained than that! Maybe we should send them a letter to inform them of their error.

I am pretty sure you meant this sarcastically, but again I cannot be sure.  Either way, you make a good point.

I am an Air Force physician and an Allergy-Extender (meaning I handle all the allergy stuff at small bases that don't have a full time Allergist).  I have had formal training in Allergy care and anaphylactic treatment.  Placing a person in cold water to treat anaphylaxis is NOT the right thing to do.  This person should have been given an epinepherine shot (or an antihistamine at the bare minimum).  TV shows often tell the story how the producers want it to be told, so we don't know what was going on "behind the scenes".

I am actually really glad you showed me this video.  A letter will not be sent.  A phone call will be made.

Doc K

Offline Asclepius

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Re: Alternative to EPI Pen
« Reply #58 on: April 19, 2010, 06:15:38 PM »
They were hoping to avoid an ER trip, so she talked with the triage nurse who swiftly instructed her to place him in the bathtub with cold water.


Q: What kind of an ER nurse unlawfully dispenses medical instructions over the phone, discouraging a parent from seeking proper medical care for a child having a potentially life threatening allergic reaction?

A: Not one who values their job.


If I had a nickel for every dumbass thing a nurse told me...

Offline Dainty

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Re: Alternative to EPI Pen
« Reply #59 on: April 20, 2010, 12:18:05 AM »
Dainty - I can't tell if you are upset or being sarcastic here.  That is the problem with text as a means of communication - you can't see a person's face or hear their tone of voice.

I took your questions at face value.  I thought you had some legitimate questions, and I thought I answered them fairly well.  If you took something that I said negative, my apologies.

I don't think you were suggesting anything of the sort.  Cold water may be helpful, but it may not.  Other than epinepherine, histamine blockers, and invasive medical care (intubation, IV's, pressors, etc.), I don't think there is much else to do.  It's not that I am trying to be unhelpful, but there doesn't appear to be anything else.

Thanks, Doc K. I apologize for being slightly upset; I really do appreciate your answers and your expertise, and should have made more of an effort to indicate that. Repeating my disclaimer was in response to OKGranny's statement of "I honestly wouldn't like to bet my life that dumping me in a cold bath or somehow frightening me would stop the reaction." I wanted to make sure I wasn't being misunderstood, since it appeared that part of my post had been missed. I do have difficulty not being upset when I feel like I'm being treated as stupid for asking an out-of-the-box question; I'm working on that. :)

In the video A1C Moran had an anaphylaxic reaction to multiple bee stings.  It was likely a mild form of anaphylaxis, but it was anaphylaxis.  If I was there, he would have been given an epinepherine injection immediately.  It is not clear from the video, but it seems more that the medic (not a physician) was trying to treat the swelling from the bee stings.  This would likely do very little to stop shock, and I do not think it did anything to prevent his anaphylactic reaction from becoming anaphylactic shock.   I would not have waited to see if the cold water brought the swelling down, because I am not that concerned about his hives.  I am concerned that he could be one of the people who develps full blown shock and/or airway swelling.

Very helpful to know. I didn't realize that there was such a thing as "very mild anaphylaxis", but it's useful to hear what it is and see an example of it.

I am pretty sure you meant this sarcastically, but again I cannot be sure.  Either way, you make a good point.

I am an Air Force physician and an Allergy-Extender (meaning I handle all the allergy stuff at small bases that don't have a full time Allergist).  I have had formal training in Allergy care and anaphylactic treatment.  Placing a person in cold water to treat anaphylaxis is NOT the right thing to do.  This person should have been given an epinepherine shot (or an antihistamine at the bare minimum).  TV shows often tell the story how the producers want it to be told, so we don't know what was going on "behind the scenes".

I am actually really glad you showed me this video.  A letter will not be sent.  A phone call will be made.

Doc K

Half sarcastically, half seriously. I have such a high respect for the military that I assumed the medic's actions in response to the reaction was legit, but if it is questionable (and it seems like you would definitely be the person to know) then I'm glad to hear you're contacting them on the matter.