ONLY an EpiPen for anaphylactic shock?

Thomas Linton

Thomas Linton

Joined
Jun 16, 2003
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Wilderness first aid issue.

What do you think of advice for anaphylactic shock that only discusses use of an EpiPen? It was my impression that giving/taking antihistamines was also critical? Did the conventional wisdom change when I wasn't lookin'? :confused:
 
Thomas Linton here is the results of Anaphylactic shock:: "Anaphylactic shock, the most severe type of anaphylaxis, occurs when an allergic response triggers a quick release from mast cells of large quantities of immunological mediators (histamines, prostaglandins, leukotrienes) leading to systemic vasodilation (associated with a sudden drop in blood pressure) and edema of bronchial mucosa (resulting in bronchoconstriction and difficulty breathing). Anaphylactic shock can lead to death in a matter of minutes if left untreated." Once it hits this level you better hope you have an Epi pen. In some cases giving Benadryl will help slow the effects. I know my wife is allergic to bees but Benadryl will help her and she basically only swells up pretty bad, but other do react to a lot of things differently. Doug
 
In cases of severe swelling from allergic reactions an epi pen is necessary but then you are going to have to get a benadryl down them before the effects of the epi pen wear off. Most likely you are going to have to give them another hit with the epi before the benadryl kicks in. Of course learning something over the internet is very dangerous so don't just take my word for it.
 
I'm allergic to bees, so I carry an EpiPen. When I'm stung I'm supposed to take one shot, then immediately take antihistamines. Then after a few minutes, I'm to take a second shot of EpiPen. So, yes, antihistamines are still vital, apparently, as I've been told this procedure by at least 5 doctors and EMS
 
DPKnives said:
Thomas Linton here is the results of Anaphylactic shock:: "Anaphylactic shock, the most severe type of anaphylaxis, occurs when an allergic response triggers a quick release from mast cells of large quantities of immunological mediators (histamines, prostaglandins, leukotrienes) leading to systemic vasodilation (associated with a sudden drop in blood pressure) and edema of bronchial mucosa (resulting in bronchoconstriction and difficulty breathing). Anaphylactic shock can lead to death in a matter of minutes if left untreated." Once it hits this level you better hope you have an Epi pen. In some cases giving Benadryl will help slow the effects. I know my wife is allergic to bees but Benadryl will help her and she basically only swells up pretty bad, but other do react to a lot of things differently. Doug
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Thats very well said. Benadryl is awesome to carry, but it wont do the trick for severe reactions.
 
j williams said:
Thats very well said. Benadryl is awesome to carry, but it wont do the trick for severe reactions.
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But that wasn't the OP's question. Epi wears off fairly quickly. If you are anywhere but 5 minutes from the ER, you should have some antihistamine too.

I'd recommend a person knows how benedryl affects them before needing to rely on it. The reason is the common side effect of drowsyness. If you are by yourself and get stung, then zap yourself with your handy epi pen, then take a benedryl, then try to drive to an ER, you might fall asleep and have a car accident.

So best advice is to experiment with Benedryl prior to needing it. Of the available OTC's Benedryl is still the best chance of doing the most good, Zyrtec is probably second.
 
I have had two epi-sodes of Anaphylactic shock, we still don't know why. I guess I'm going to need to see an allergist while I'm in the US.

I have only had to hit myself with an Epi-pen once. The first time I had a reaction I was totally unprepared because I had never been through it before. My hands started to itch and turn red, then they started to ITCH, and then they really, really started to ITCH. When it started to spread to my feet, face, ears, stomach, etc I knew I was in serious trouble. They rushed me to the hospital.

The second time I was sound asleep and woke up suddenly with this feeling of doom, something just wasn't right. My hands started to itch, and almost immediately my feet as well. This time I ripped off my wedding ring as last time it was very uncomfortable as my fingers turned to sausage. I got dressed and knew I had to get to the hospital. By the time I got downstairs I was already passing out. I hit my leg with the Epi-pen. The effect is very fast, things seemed to stabilize where they were and my blood pressure came back. It really clears your head but you are still in a sorry state. The effect of the Epi-pen gives you about a half hour but good luck driving in that condition. IMO you would still be dependent on others to get you to help.

They say that if you take the antihistamines at the very onset of symptoms that they will slow the reaction. I carry them in my kit along with the Epi-pens. One thing that is also important is to let the people you are with know how to give you an Epi-pen and when, what to do etc. Mac
 
I once responded to a young teenager that had been stung by a bee. Her friend tried to help her out by sticking her with the Epi-pen but had never done it. The friend pops the top off, thumb over end and jabs it at the young girl. Only to have the needle penetrate through her thumb and out the nail then squirt the Epi out all over the place. Both now needed the medics.

Badge54
 
Badge,

One of my fears is that someone will give me one through the side of the leg and inject my Altoids tin. I actually explain that part to people. Mac
 
In conventional first aid they taught us to carry an epi-pen, self dose under an attack, and call 911.

In wilderness first aid, the definition of wilderness situation being that you are 2 h or more from EMS services, they taught us to carry at least 2 epi-pen doses plus antihistamines. In the event of an attack, you administer to yourself or the patient an epi-pen hit, give them anti-histimines and constantly observed them for the next hour. If they require another epi-pen shot again you hit them again and then feed them more anti-histimines. As said before it takes between 20-30 min for the anithistimines begin their effects, while the epi-pen results may not last long enough.

However, in some cases the shock of the single epinephrine administration will be enough to interupt the cascade of the allergic reaction. You don't know though and must be prepared for the symptoms to come back. The need to administer an epi-pen dose is also supposed to be followed by medical treatment. In a wilderness situation, once things are stablized that means getting the patient out of dodge.

You can now buy two-shot epi-pens.

Pict thanks for the description of the onset of allergy - never experienced it myself but your description was really helpful.
 
Keep in mind that was just my personal experience based on two reactions. It may be different for other people. It may sound weird but the sense of doom, dread, whatever puts you right on the edge of panic. All you know is that something is very, very wrong, then the other symptoms start up and justify all your fears.

I didn't actually pass out either time but if I had been driving a car I would not have made it, even with the epi. The first time I was in the hospital when the world started to fade. The second time I just got to the bottom of the stairs and sank to the ground. If I had stayed on my feet I would have gone down hard. In both cases when I got to the hospital I was not able to get out of the car.

One other thing is that I turned bright red like a lobster and my skin became 100x more sensitive. Needle sticks were like getting stabbed. Mac
 
If you have a bad enough reaction to a sting, and dose up with epi, and benadryl, either get someone to drive you, or call an ambulance. Dont hit the road medicated.

Always assume the reaction will come back, even if symptoms subside. Meaning, watch your Patient, always be ready to admin more epi, or benadryl, but dont snow the guy with benadryl. Also be ready to take action with an airway intervention if need be.
 
Badge54 said:
I once responded to a young teenager that had been stung by a bee. Her friend tried to help her out by sticking her with the Epi-pen but had never done it. The friend pops the top off, thumb over end and jabs it at the young girl. Only to have the needle penetrate through her thumb and out the nail then squirt the Epi out all over the place. Both now needed the medics.

Badge54
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I had a firefighter do the same thing prior to our arrival. On top of that the epi was expired!!

Right dose, right route, right med , right Pt. And not expired are always things to look at prior to taking or admin any med.
 
I didn't have any of the itching or severe spreading when I had my reaction. I did turn red and feel feverish, as well as began to have trouble breathing. So like Mac said everyone could have different experiences with reactions.
 
It was my understanding that you should use both the EpiPen and antihistamines. This was based on research of the suggested treatment at a time when we had a kid in our Troop who was HIGHLY allergic to anything dairy. A drop of cheese hitting the hot griddle in the dinning hall would cause him to pass out a few minutes later.

Second EpiPen
We also had a highway patrolman kill him self with a second injection. The first left him confused so, although he had been told no more than one, he hit himself with the second EpiPen. Found dead in his cruiser and the COD was overdose. I guess you need a doc's opinion on whether you are up to a second dose.


No issue about driving in the backcountry, and we are always in a group of at least ten -- I suppose in theory as few as four but never that few in practice.
 
Random thoughts from a sleep deprived paramedic....

1. Do explain to your companions how to use your epipen. The frequency of thumb injections is disturbing. Having 2 patients in the back of an ambulance isn't typically fun, or conducive to recieving good care- especially considering the lifesaving medication that you needed 5 min. ago is now dripping out of your buddies bloody thumb.

2. Benadryl- When I give it IV, it still takes 15 to 20 minutes to begin working. If you are taking it PO, it will take longer. Yes, it is a useful second line treatment. No, it is not going to help you with the acute, life-threatening symptoms.

3. Multiple epi doses- talk to your MD. Epi is hard on your heart. It increases contractility, rate, automacity. If you have cardiac problems these effects can lead to bad stuff- infarction and/or arrythmia. If your airway is swelling shut though, a heart attack might be relatively low on your list of immediate concerns. Talk to your doc.

4. Airway management- this is nightmare territory for paramedics, ER docs, and everyone else who manages airways. If it is a severe reaction, an OPA isn't going to cut it. Intubation will range from incredibly difficult to impossible- and if successful, it will often be of a inadequate size to maintain adequate perfusion. Cricothyrotomy anyone?

5. Please don't drive yourself to the ER after all of this. You will be gorked from the epi crash plus all of the antihistamines. Plus, there is the chance of the symptoms coming back. Let us do that. We are nice folks, for the most part.
 
If you are allergic and know it and are stung, the benedryl comes first.

If symptoms continue to elevate (airway constriction, continued swelling, rapid breathing due to sting, etc..) then the epinephrine. You need to get to a hospital once it is administered. This is a consideration if you are back country and can't get to one in a timely fashion.

Also, with stings the venom can remain in the system for 72 hours.
So you may not react or react much from the first incident but if you get stung again within 72 hour period the effect is cumulative and you may have a severe reaction from a single sting at a later time.
 
D25's points resonate with what I was taught. Go with the priorities. Breathing/air ways first, cardiac and spinal second. If airway blockage necessitates the 2nd epi, you have to take the cardiac arrest as a risk - perform CPR if the heart stops. You can keep the patient alive for a while if CPR is administered right at the point of cardiac arrest. You've got about 3 minutes if their breathing stops and blockage due to airway constriction will prevent rescue breathing.

Intubation isn't the kind of thing a first responder can do...
 
What a great forum!! Learn all sorts of things here. :thumbup:

5. Please don't drive yourself to the ER after all of this. You will be gorked from the epi crash plus all of the antihistamines.
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"gorked out"

Over-medicated to an extreme degree, and therefore appearing as if in a persistent vegetative state (see Gork, the acronym for God Only Really Knows).

That lady at the nursing home was WAY gorked out on her pain and nausea meds. When I get that old, please remember I have a DNG (Do Not Gork order)
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I had no idea that medical slang was compiled into some sort of refrence. That sort of scares me.:D
 
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