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Ahh, it's from the online Urban Dictionary. 
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ONLY an EpiPen for anaphylactic shock?
- Thread starter Thomas Linton
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BTW, if you put the benedryl (tablet) under your tongue, you will absorb it faster and get a quicker effect. It'll taste terrible but so what, at least you are alive to taste the bitter pill.
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I believe liquid Benedryl and its generic equal absorb pretty quickly.
When I almost bought it from a reaction to tree nuts, I took a big swig of the liquid, the a few minutes I took a capsule, which breaks down faster than a tablet.
I had no idea I was having an anaephalactic reaction even after I looked in the mirror wondering why my tongue felt strange and saw the back of my throat was getting smaller.
I then ended up taking another healthy swig of the liquid, and we headed to the hospital.
The ER docs and nurses asked why I didn't use my Epipen which I carry for bee stings.
I didn't know that was what a reacton was like.
They did say the Benedryl probably saved me from some major distress at a quicker rate.
They kept me for 12 hours because the reacton, as stated before, can re-surface.
I always carry the liquid Benedryl and 2 Epipens now.
When I almost bought it from a reaction to tree nuts, I took a big swig of the liquid, the a few minutes I took a capsule, which breaks down faster than a tablet.
I had no idea I was having an anaephalactic reaction even after I looked in the mirror wondering why my tongue felt strange and saw the back of my throat was getting smaller.
I then ended up taking another healthy swig of the liquid, and we headed to the hospital.
The ER docs and nurses asked why I didn't use my Epipen which I carry for bee stings.
I didn't know that was what a reacton was like.
They did say the Benedryl probably saved me from some major distress at a quicker rate.
They kept me for 12 hours because the reacton, as stated before, can re-surface.
I always carry the liquid Benedryl and 2 Epipens now.
In my late teens I found out I was allergic to Yellow Jackets. I was walking to class and had brushed my arm against the wall and it felt like I had hit a piece of the concrete. To my surprise I found a Yellow Jacket stuck to my arm. Not sure of the turn of events, but I wound up in the science room with the science teacher applying moistened cigarette tabacco to the sting site. Went off to my next class and during that time hives began to appear. The school secretary and one of the teachers drove me to a local doctor and I guess at that point they must have given me epinephrine. (Didn't ask at the time what it was, but thats my guess.)
So for the past 20 some odd years I've been paranoid about running into Yellow Jackets again. Since early this year I have been carrying around the Benadryl strips as part of my EDC/BOB/outdoors kit. I really wish that there was a comparison some where of how fast the strips work versus the liquids and tablets. Before I found the strips I was considering using the Childrens Benadryl Perfect Measure, but they are really bulky. I just looked them up and they are 12.5 mg each compared to the normal adult dosage of 25mg, so another reason not to carry them unless you have kids.
The one downside I've found to the strips is that you can not tear the strip open because there is no notch. There are two small cuts, but they do not go to the edge of the package. You have to use scissors or a knife to cut it open. It's also best to open it length wise to get to the strip as doing it by width makes it darn near impossible unless you pay attention to where the strip is in the package.
I really should see a doctor about a prescription Epi-pen. It would ease my mind having it with me while camping.
So for the past 20 some odd years I've been paranoid about running into Yellow Jackets again. Since early this year I have been carrying around the Benadryl strips as part of my EDC/BOB/outdoors kit. I really wish that there was a comparison some where of how fast the strips work versus the liquids and tablets. Before I found the strips I was considering using the Childrens Benadryl Perfect Measure, but they are really bulky. I just looked them up and they are 12.5 mg each compared to the normal adult dosage of 25mg, so another reason not to carry them unless you have kids.
The one downside I've found to the strips is that you can not tear the strip open because there is no notch. There are two small cuts, but they do not go to the edge of the package. You have to use scissors or a knife to cut it open. It's also best to open it length wise to get to the strip as doing it by width makes it darn near impossible unless you pay attention to where the strip is in the package.
I really should see a doctor about a prescription Epi-pen. It would ease my mind having it with me while camping.
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Regarding generics, there is no reason to favor the brand over the generic...it offers nothing more than a higher price for the same active chemical.
Regarding epi pens. Make sure you keep track of the expiration dates. Epi expires quicker than many meds and unlike a lot of meds, it won't work at all when expired.
Regarding epi pens. Make sure you keep track of the expiration dates. Epi expires quicker than many meds and unlike a lot of meds, it won't work at all when expired.
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The strips are no better than the other dose forms, from what I've seen. They are handier for kids and the elderly who don't swallow well. Other than that, they likely cost more and are certainly more susceptiable to moisture than tabs/caps.
The liquid is the most bioavailable (which means how much drug is absorbed to actively work), at 100% bioavailable. But the liquid is the least convenient to carry.
Tablets under the tongue...
Most meds will be effective past their exp date, about 6 months.
Epi pens exp dates are to be taken more seriously.
At about $100 a crack I will still keep the old ones around as back-ups until they discolor.
At this point (as mentioned earlier they are often improperly administered) you can take one and do a practice injection into an orange or grapefruit which is great practice for when you may have to self administer or inject the patient.
Epi pens exp dates are to be taken more seriously.
At about $100 a crack I will still keep the old ones around as back-ups until they discolor.
At this point (as mentioned earlier they are often improperly administered) you can take one and do a practice injection into an orange or grapefruit which is great practice for when you may have to self administer or inject the patient.
DO NOT RELY ON THE INTERNET FOR MEDICAL TRAINING! All of the posters to this thread are genuinely trying to help others but some of the suggestions contradict each other and while helpful in some instances, could be detrimental in others.
Also anaphylaxsis and an allergic reaction are NOT the same. I am very allergic (hypersensitive) to poison ivy, poison oak, etc. It does not give me an anaphylactic reaction however. Administration of medication should always be taken seriously. Epi-pens can be lifesavers. They are also capable of killing someone, either directly or indirectly. Please seek professional training or at the minimum talk to your personal physician about specific situations regarding you or your family.
Now that the disclaimers are out of the way, my advice is that in a true medical emergency epi comes before diphenhydramine. Treating an allergic reaction OTOH, start with the benadryl and monitor. If epi is aministered it is time to get help. This may mean EMS, it may mean having a group member drive. In any case, your day is done.
Stay Safe.
Also anaphylaxsis and an allergic reaction are NOT the same. I am very allergic (hypersensitive) to poison ivy, poison oak, etc. It does not give me an anaphylactic reaction however. Administration of medication should always be taken seriously. Epi-pens can be lifesavers. They are also capable of killing someone, either directly or indirectly. Please seek professional training or at the minimum talk to your personal physician about specific situations regarding you or your family.
Now that the disclaimers are out of the way, my advice is that in a true medical emergency epi comes before diphenhydramine. Treating an allergic reaction OTOH, start with the benadryl and monitor. If epi is aministered it is time to get help. This may mean EMS, it may mean having a group member drive. In any case, your day is done.
Stay Safe.
annr
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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'?
I'm not an expert, BUT my impression is that although there is a working definition of anaphylactic shock, including that it is an emergency situation, not all cases are the same and MDs may not always be able to figure out the cause of an attack.
I was treated w/o an EpiPen. When I arrived at the ER I was on the cusp of passing out, probably due to low BP and shivering like a leaf. Things were swelling and itching. I had had the presence of mind to scarf a Benydryl before leaving my house. I got the feeling that the MD wanted to be more conservative due to health history, as someone mentioned, Epi has side effects.
Even though the ER attending didn't know why I had the problem he did not prescribe an EpiPen. He wanted my regular MD to do that. Now I refill a Rx for a pair of EpiPens even though I have never had to use them.
I was told to take the Benydryl and then the Epi and go to the ER ASAP. This was advice from an expert in the field of anyphylaxis, academic and clinical. But I have never seen if/how well this works, fortunately.
The message I took away from it all is that it is best to see a specialist and have him assess the situation, look for triggers and based on knowing you, your job, family,etc. give you the most likely course of future events and how to handle them.
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annr
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I forgot to mention the third leg of the treatment plan : prendisone. I received a Rx for a 7-10 course of prendisone from the ER doc. I believe that this was to completely quash the reaction. When I left the ER I was stable and alert, but had certainly not returned to "normal".
I don't know if this is standard, but it seems another reason to get to the ER.
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First, thanks to all who have contributed.
I should have mentioned why I asked.
The Boy Scout Wilderness Survival Merit Badge pamphlet discusses anaphylactic shock. It mentions stings and allegies as potential causes. It advises consultion with a physician before traveling and passing the advice of the physician on to "leaders of their group." As the sole example of first aid for anaphylactic shock, it mentions the EpiPen. It does not mention oral antihistamines or any other first aid. It does not discuss symptoms of anyphylactic shock other than restriction of breathing.
To me, this content raises several questions.
I only posed one here.
My question assumed the victim was experiencing anaphylactic shock.
My question assumed the victim is in the wilderness.
Unless a "specialist" is a member of the group or happens along, there would be no such resource present.
I certainly want to cite heavyweight authority on wilderness first aid when I point out to BSA what I suspect is incomplete advice, especially when I will be raising several other problems with the pamphlet, such as BSA's blithe advice that iodine is "effective" and "easy" for disinfecting water, suggesting oak as the ideal wood for fire-by-friction, advocating t-shirts for wear in high UV, and mentioning the only the "pocketknife" as the "steel" for flint-and-steel fire-making without consideration that it will probably be stainless steel.
But if it was wrong to ask my question here, that is on me, not any who respond.
Taking "professional" in its best sense, it would be nice if all Scouts and Scouters received professional training, but only some of us have had that benefit, not all are current (How many breaths per compression? None.) and those trained by professionals may not be present. Do what? Do nothing?
Again, my thanks to the typically helpful members here.
I should have mentioned why I asked.
The Boy Scout Wilderness Survival Merit Badge pamphlet discusses anaphylactic shock. It mentions stings and allegies as potential causes. It advises consultion with a physician before traveling and passing the advice of the physician on to "leaders of their group." As the sole example of first aid for anaphylactic shock, it mentions the EpiPen. It does not mention oral antihistamines or any other first aid. It does not discuss symptoms of anyphylactic shock other than restriction of breathing.
To me, this content raises several questions.
I only posed one here.
My question assumed the victim was experiencing anaphylactic shock.
My question assumed the victim is in the wilderness.
The advice you relate is the same as the advice that I thought that I recalled for wilderness cases of anaphylactic shock. The rationale for the order of medication was, IIRC, that if the victim passed out, you could use the EpiPen but the victim could no longer swallow the Benydryl. In contrast, in a non-wilderness setting, treatment with medicationsto follow up the temporary effects of an EpiPen would not be precluded by unconsciusness.
Unless a "specialist" is a member of the group or happens along, there would be no such resource present.
Respectfully, Eyegor, I have been given conflicting diagnosis and advice on personal medical issues by Board-Certified physicians. I fear that conflict in advice is not dispositive. I guess I am looking for information to guide a search of reputable authorities, hoping to find a consensus in THEIR advice.
I certainly want to cite heavyweight authority on wilderness first aid when I point out to BSA what I suspect is incomplete advice, especially when I will be raising several other problems with the pamphlet, such as BSA's blithe advice that iodine is "effective" and "easy" for disinfecting water, suggesting oak as the ideal wood for fire-by-friction, advocating t-shirts for wear in high UV, and mentioning the only the "pocketknife" as the "steel" for flint-and-steel fire-making without consideration that it will probably be stainless steel.
But if it was wrong to ask my question here, that is on me, not any who respond.
The question assumes anaphylactic shock. My understanding is that anaphylactic shock is a severe allergic reaction.
As noted, BSA suggests consultation with a physician before setting off. The issue that motivated my question is discussing the EpiPen as the sole option for first aid in the wilderness.
Taking "professional" in its best sense, it would be nice if all Scouts and Scouters received professional training, but only some of us have had that benefit, not all are current (How many breaths per compression? None.) and those trained by professionals may not be present. Do what? Do nothing?
Why, please? You are not alone in that ordering of treatment, but all the sources I can locate do not discuss first aid in a wilderness setting where professional care is most probably hours away - hours after the EpiPen wears off.
Again, the question assumes anaphylactic shock for whatever reason. Again, I thought anaphylactic shock was an allergic reaction of a particularly severe and widespread nature. But I am certainly not a former spert.
Again, the question assumes we are in the wilderness. No EMS for hours,at best. Highly probable that there willl be no "drive" either (We could be dealing with people on vehicles in the wilderness.).
Again, my thanks to the typically helpful members here.
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annr
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Thomas,
I don't know if it was your intention to close the thread, but...
Now that you mention the BSA and their characterization of anaphilaxsis I wanted to add that I was surprised by the manifestation I experienced, unlike that I had read about, and perhaps the BSA list of symptoms and triggers could be more broad.
I believe that my life was saved by a phone call. The operating diagnosis was exercise induced anaphylaxis possibly associated with aspirin. This was never proven except that I had been on the NordicTrack when the reaction began and had consumed aspirin more that six hours prior. (I was told that the food/med needed to have been consumed less that 6 hours before the exercise and had to be something to which you had had at least one prior exposure.) Answering the phone allowed me to stop and question why the soles of my feet had been slightly itchy for about 10 minutes.
I had never had an attack and didn't realize it for poss. another 15-20 minutes. Then I looked in the mirror and noticed that one of my eyes was starting to swell shut. I debated an ambulance but thought I had a better shot in the car with a hospital at every turn in Boston.
My point: bee stings aren't the only thing that could strike an individual. Exercise is a well-known trigger and certain foods and exercise create a toxic mix. Boy Scouts exercise.
My last question is about liability/expectations now that you mention the BSA. I am just curious what the expectations are for the troop leader or the scouts when they think or know that a reaction is in progress. BTW my reference for the expert was to get his input before the next attack. I also wonder what an expert CAN do out in the middle of nowhere.
I don't know if it was your intention to close the thread, but...
Now that you mention the BSA and their characterization of anaphilaxsis I wanted to add that I was surprised by the manifestation I experienced, unlike that I had read about, and perhaps the BSA list of symptoms and triggers could be more broad.
I believe that my life was saved by a phone call. The operating diagnosis was exercise induced anaphylaxis possibly associated with aspirin. This was never proven except that I had been on the NordicTrack when the reaction began and had consumed aspirin more that six hours prior. (I was told that the food/med needed to have been consumed less that 6 hours before the exercise and had to be something to which you had had at least one prior exposure.) Answering the phone allowed me to stop and question why the soles of my feet had been slightly itchy for about 10 minutes.
I had never had an attack and didn't realize it for poss. another 15-20 minutes. Then I looked in the mirror and noticed that one of my eyes was starting to swell shut. I debated an ambulance but thought I had a better shot in the car with a hospital at every turn in Boston.
My point: bee stings aren't the only thing that could strike an individual. Exercise is a well-known trigger and certain foods and exercise create a toxic mix. Boy Scouts exercise.
My last question is about liability/expectations now that you mention the BSA. I am just curious what the expectations are for the troop leader or the scouts when they think or know that a reaction is in progress. BTW my reference for the expert was to get his input before the next attack. I also wonder what an expert CAN do out in the middle of nowhere.
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Closed? By no means. Still looking for an authority who expressly says, in words or substance, "Here's how you deal with it in the wilderness."
The Merit Badge pamphlet lists no symptoms beyond "restricts breathing passages." That level of information seems both too narrow and insufficiently specific. Failure to chew should not draw an EpiPen and there are many other symptoms listed in what I can find on the net.
Liability/expectations? The BSA policy is: "[D]o the best you can with the knowledge and the resources you have at hand." Taking Red Cross wilderness first aid courses (First Aid; First Responder; Medical Technician) is encouraged, but not required by any means.
The Merit Badge pamphlet lists no symptoms beyond "restricts breathing passages." That level of information seems both too narrow and insufficiently specific. Failure to chew should not draw an EpiPen and there are many other symptoms listed in what I can find on the net.
Liability/expectations? The BSA policy is: "[D]o the best you can with the knowledge and the resources you have at hand." Taking Red Cross wilderness first aid courses (First Aid; First Responder; Medical Technician) is encouraged, but not required by any means.
annr
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Did you see this one?
Use of epinephrine for anaphylaxis by emergency medical technicians in a wilderness setting.
Fortenberry JE, Laine J, Shalit M.
San Francisco/Fresno-Central San Joaquin Valley Medical Education Program, University of California.
STUDY OBJECTIVE: To describe a case series of emergency medical technician-basic (EMT-B)-administered epinephrine for anaphylaxis in a wilderness setting. DESIGN: Case series of patients in anaphylaxis who received epinephrine subcutaneously from EMT-Bs. SETTING: National park rural/wilderness emergency medical service system covering 863,000 acres and serving approximately 2 million annual visitors. PARTICIPANTS: Prehospital care providers were National Park Service rangers with EMT-B training. Patients in the series were visitors to Sequoia and Kings Canyon National Parks with anaphylaxis resulting from insect stings. INTERVENTION: Subcutaneous administration of epinephrine by EMT-Bs trained in recognition, understanding, and treatment of anaphylaxis. RESULTS: Eight patients with anaphylaxis resulting from Hymenoptera stings, from June 1992 through September 1993, received EMT-B-administered epinephrine. All patients improved clinically after treatment with epinephrine within 25 minutes. No major side effects occurred. CONCLUSION: Our data suggest that EMT-B-administered epinephrine is safe when used by EMT-Bs in the rural/wilderness setting, with appropriate physician supervision. Further study in large trials will be required to demonstrate safety and efficacy.
PMID: 7755201 [PubMed - indexed for MEDLINE]
Underline and bold by me. Hmmm...."with appropriate physician supervision." I have written to authors of papers like this and received replies.....
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Did not see that one.
In Scouting, the theory is that at least two adults will be present. But who knows why a survival situation has arisen? Maybe the Scouts have, against all policy, become separated from the minimum of two adults. Maybe the adults are the victims. So my scenario is either Scouts or adults in Scouting - "Scouters" - confronted by anaphylactic shock in the wilderness. No EMT's. No physicians. Do what? Do nothing?
What's the latest and best book on wildrness first aid?
In Scouting, the theory is that at least two adults will be present. But who knows why a survival situation has arisen? Maybe the Scouts have, against all policy, become separated from the minimum of two adults. Maybe the adults are the victims. So my scenario is either Scouts or adults in Scouting - "Scouters" - confronted by anaphylactic shock in the wilderness. No EMT's. No physicians. Do what? Do nothing?
What's the latest and best book on wildrness first aid?
We are all here to help one another. Thomas your assertation that anaphalaxsis is a particularly severe allergic reaction is near enough to the truth. The reason that your MB pamphlet may only mention airway constriction is that it is the definitive (and most serious) difference that makes anaphylactic shock a true medical emergency. Now let me address a few of your other comments.
WEMTs will normally use Epi first due to limited time. You need to stop the histamine cascade before swelling occludes the airway. In the ABCs if you lose A, nothing else matters. Some ALS providers can do needle crics or a surgical cric. Others cannot. In any event, your patient is now in extremis. You asked about other treatments. Monitor ABCs (Airway, Breathing, and Circulation). Don't forget; Anaphylactic shock. Treat for shock.
In true wilderness areas, if epi has been administered it is still time to consider evac. In a scouting context this may mean sending one or more Scouters back to the trail head for help. It may mean radio contact and helicopter evac. It all depends on circumstances. On a scout wilderness canoe trip we had someone fall and suffer a severe laceration to the medial thigh. Two scouters headed upstream and overland for the vehicles. The rest of us made him comfortable, controlled bleeding, monitored ABCs and headed downstream approx 23 miles to the nearest road access. Approx. 30 hours later the vehicles arrived and this scout was driven to the nearest medical facility. Needless to say, the two week paddle was cut short. Nothing to do with epi or allergic reactions. Just an example of how an evac may work.
No one has said do nothing. Be prepared and Do Your Best. Also remember, merit badge pamphlets are just that, pamphlets. They are not manuals, textbooks, or in depth tomes of knowledge. Only an overview. I commend your quest for more info. A great place to start is the BSA Fieldbook chapter on Survival. Better than the WS pamphlet IIRC. It has been many years though. You asked about textbooks. All of these have been out for awhile but I think are very good:
Medicine for Mountaineering. (but applicable to all wilderness areas)
Ditch Medicine (mainly combat medics)
Where there is no Doctor (Peace Corps and Missionary type medicine and public health)
Good Luck.
WEMTs will normally use Epi first due to limited time. You need to stop the histamine cascade before swelling occludes the airway. In the ABCs if you lose A, nothing else matters. Some ALS providers can do needle crics or a surgical cric. Others cannot. In any event, your patient is now in extremis. You asked about other treatments. Monitor ABCs (Airway, Breathing, and Circulation). Don't forget; Anaphylactic shock. Treat for shock.
In true wilderness areas, if epi has been administered it is still time to consider evac. In a scouting context this may mean sending one or more Scouters back to the trail head for help. It may mean radio contact and helicopter evac. It all depends on circumstances. On a scout wilderness canoe trip we had someone fall and suffer a severe laceration to the medial thigh. Two scouters headed upstream and overland for the vehicles. The rest of us made him comfortable, controlled bleeding, monitored ABCs and headed downstream approx 23 miles to the nearest road access. Approx. 30 hours later the vehicles arrived and this scout was driven to the nearest medical facility. Needless to say, the two week paddle was cut short. Nothing to do with epi or allergic reactions. Just an example of how an evac may work.
No one has said do nothing. Be prepared and Do Your Best. Also remember, merit badge pamphlets are just that, pamphlets. They are not manuals, textbooks, or in depth tomes of knowledge. Only an overview. I commend your quest for more info. A great place to start is the BSA Fieldbook chapter on Survival. Better than the WS pamphlet IIRC. It has been many years though. You asked about textbooks. All of these have been out for awhile but I think are very good:
Medicine for Mountaineering. (but applicable to all wilderness areas)
Ditch Medicine (mainly combat medics)
Where there is no Doctor (Peace Corps and Missionary type medicine and public health)
Good Luck.
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No offense intended.
Here are a couple of typical internet pages on anaphylactic shock, the first from the UK and the second from the U.S.:
Thank you for the references, Eyegor. I'll do my best to get ahold of them.
Here are a couple of typical internet pages on anaphylactic shock, the first from the UK and the second from the U.S.:
This is the universal advice that I can find in the last couple of days - Epi first. Still, they all are implictly or explicitly in the context of fast access to professional medical care - not such care 10, 20, or 30 hours later.
You didn't say "Do nothing." I didn't say "Do Nothing." We agree. Is there a problem with raising the question just in case you and I are not the Final Authority?
Do you think the pamphlet in question should mention ONLY an EpiPen? That the question that I posed and which brought me here in a quest for more info. I thought, subject to being convinced otherwise, that even an overview should mention promptly administering antihistamines.
I did look at the First, Second and Third Editions of the Fieldbook. The Third Edition Fieldbook did have a brief section on wilderness survival (15 pp) and another on first aid. All three had lots of information on skills useful in survival. None of the books mentioned any particular treatment for anaphylactic shock. The current Fieldbook has no sections on wilderness survival or first aid. http://www.bsafieldbook.org/fieldbook.jsp
Thank you for the references, Eyegor. I'll do my best to get ahold of them.
annr
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I rang up the board certified allergist/ immunologist. The first words out of his mouth were, "That's why you have an Epi-Pen." I mentioned antihistimine and he said, "yes". Later he brought up prednisone. As we spoke I could see that treatment could be delivered on a case by case basis and with more medical knowledge/experience and/or supplies there are many techniques that could make a difference.
His patients do go on long trips in the wild; he instructs them on the use of those items (seemed like mainly Epi, ?but may depend on the person) and says that ultimately you do the best that you can with what you have. One man only goes to a place where he assumes that he can be rescued by helo; that's his informed decision to take that risk. As far as a lot of "what ifs", he didn't seem so worried since you can only use what you have, but using good judgment can be critical and I don't know how you necessarily get that out of a book: assessing the situation, timing the injections. There is a lot of data on much of this, but I don't know if a layman would want to learn all of this or if it would be meaningful without a clinical component.
Personally, I wish that I would have know about more than 'airway obstruction' as that is the one symptom that I did not have and I'm glad to be made to think of this again.
If I were in your position I might try to find an MD at a local hospital and speak with them. I think that you have many reasonable questions. I don't know if you will get an unqualified answer ....
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