|
reno
Nov 29, 2004, 10:50 PM
Post #51 of 108
(7319 views)
Shortcut
Registered: Oct 30, 2001
Posts: 18283
|
In reply to: ... for joe/joan climbing guide, all he/she needs to know is epi and benadryl for anaphylaxis. And again, professional wilderness medicine organizations, who have all been around for a long time and know of what they speak, all pretty much say the same thing. Not too much information, don't over simplify it, but give just what is needed...
Exactly what I believe.
And if you're giving medications, you need to know what the risks are. Agreed?
|
|
|
|
|
drector
Nov 29, 2004, 11:14 PM
Post #52 of 108
(7319 views)
Shortcut
Registered: Aug 27, 2002
Posts: 1037
|
You guys blew it. Mostly the guy who keeps saying "yes, if the victim is gonna die then give him the shot" but then says "and be aware of all the medical mumbo-jumbo that can go wrong at that point."
I for one will now let someone die before I give any kind of medication because you've scared me into thinking that anything I do will have consequences that, due to my ignorance, will be harmful.
Gee, thanks.
Dave
|
|
|
|
|
reno
Nov 30, 2004, 12:04 AM
Post #53 of 108
(7319 views)
Shortcut
Registered: Oct 30, 2001
Posts: 18283
|
In reply to: You guys blew it. Mostly the guy who keeps saying "yes, if the victim is gonna die then give him the shot" but then says "and be aware of all the medical mumbo-jumbo that can go wrong at that point."
That would be me, right? How is providing you with information about a potential situation "blowing it?"
If you take a trad leader class, and your instructor says "In a crack like this, place this piece of gear, but understand that there are various factors involved that might go wrong," how is that different?
I've seen dozens of threads on this site about fall-factor physics... mostly theoretical expressions of what "might" happen. Funny how we'd rather talk complex theory regarding a fall, but do not want to discuss simple reality regarding an injury.
In reply to: I for one will now let someone die before I give any kind of medication because you've scared me into thinking that anything I do will have consequences that, due to my ignorance, will be harmful.
Then you missed the point, and might find it difficult to find climbing partners.
Look at it this way: You take a class, and in that class, someone tells you "Give the Epi Pen if your partner gets stung by a bee and has allergies to bee stings."
You give the Epi Pen. Your partner doesn't get better. He dies. You feel like garbage. You vow to never climb again, because the anguish is more than you can bear.
The problem is that your instructor never bothered to mention "Even though you give the Epi Pen, it doesn't always work. And there can be problems. So I'm going to prepare you to know why this can be."
Had he done that, you'd understand that you did the right thing by giving the Epi, and that sometimes, to put it in the vernacular, "Shit happens."
Does that clarify things?
You're welcome.
|
|
|
|
|
napoleon_in_rags
Nov 30, 2004, 12:20 AM
Post #54 of 108
(7319 views)
Shortcut
Registered: Oct 31, 2004
Posts: 586
|
Back to Shaky Legs....
I think there is no reason why you should not climb outside. You do need to make sure your partner(s) knows about your condition, knows where you keep the Epipens, knows how to escape a belay, and knows how to rescue you if you are incapacitated.
You have to trust your belayer a little more than your avereage climber. I would be careful about climbing with some random schmuk from the gym at a crag you have never been to before.
A climbing buddy of is deathly alergic to wasps and we talk it out every time before we rope up.
|
|
|
|
|
napoleon_in_rags
Nov 30, 2004, 12:24 AM
Post #55 of 108
(7319 views)
Shortcut
Registered: Oct 31, 2004
Posts: 586
|
By the way - insect, Where do you teach WEMT - I was thinking about recerting by taking that.
|
|
|
|
|
sixleggedinsect
Nov 30, 2004, 12:43 AM
Post #56 of 108
(7319 views)
Shortcut
Registered: Apr 14, 2004
Posts: 385
|
In reply to: By the way - insect, Where do you teach WEMT - I was thinking about recerting by taking that.
I teach WFR/WFA for SOLO, most of whose courses are in new england. If that's not your area, WMA and WMI have plenty of courses in different parts of the country.
are you doing WEMT instead of WFR for a reason? i see a lot of WEMT students who really wish they had done WFR instead. i wont talk you out of it. just want to make sure everyone makes the right decision.
wait- you said recert. which course are you looking for?
anthony
|
|
|
|
|
karlbaba
Nov 30, 2004, 3:03 AM
Post #57 of 108
(7319 views)
Shortcut
Registered: Jul 10, 2002
Posts: 1159
|
Interesting info
So as long as we're on the subject, let's say we're in a wilderness setting any my partner gets stung and starts presenting symptoms of anaphylaxis. It's a suprise to her and thus she's not carrying an Epi pen (but I'm carrying benedryl)
Is it worth trying to scare the crap out of her (or him?) and pack the gums and under the tongue with Benedryl?
Is there a body position that would lessen the effects of Hypovolemia? Would putting on a pair of lycra tights make any difference?
Naturally, it's better to do things properly, but whats the next best thing for the unprepared?
Peace
karl
|
|
|
|
|
reno
Nov 30, 2004, 3:09 AM
Post #58 of 108
(7319 views)
Shortcut
Registered: Oct 30, 2001
Posts: 18283
|
In reply to: Interesting info So as long as we're on the subject, let's say we're in a wilderness setting any my partner gets stung and starts presenting symptoms of anaphylaxis. It's a suprise to her and thus she's not carrying an Epi pen (but I'm carrying benedryl) Is it worth trying to scare the crap out of her (or him?) and pack the gums and under the tongue with Benedryl?
Probably not worth the time to "scare the crap out of her," since she's most likely ALREADY scared (not being able to breathe is quite frightening, really.) The Benadryl is a great idea. Most adults do quite well with 50 mg of Benadryl (one or two capsules, depending on how it's packaged.)
In reply to: Is there a body position that would lessen the effects of Hypovolemia? Would putting on a pair of lycra tights make any difference?
Flat on back, legs elevated, covered with a warm blanket or coat. Lycra is pointless.
In reply to: Naturally, it's better to do things properly, but whats the next best thing for the unprepared?
The two best skills you can have for backcountry medical emergencies, IMHO, is 1) knowing when you need to find help ASAP and knowing when you have a little time or can continue, and 2) the ability to keep a cool head.
|
|
|
|
|
ladylayback
Nov 30, 2004, 3:23 AM
Post #59 of 108
(7319 views)
Shortcut
Registered: Sep 7, 2004
Posts: 66
|
Immediately after using the 1st epi-pen take at least 50mg of oral benadryl, but I would take 100mg. The epi pen is fast acting and the bendryl is long lasting. The mechanism of action of each medication is slightly different. If you follow up with the benadryl you shouldn't continue to have the reaction. The benadryl is good for at least 2 hours, besides, you haven't used your second epi-pen yet. You should be able to get out and to a hospital without much problem. By the way, I'm a paramedic.
|
|
|
|
|
reconbeef
Nov 30, 2004, 3:48 AM
Post #60 of 108
(7319 views)
Shortcut
Registered: Sep 13, 2004
Posts: 25
|
In reply to: Flat on back, legs elevated, covered with a warm blanket or coat. Lycra is pointless.
Intresting article just came out on this, questioning the effictiveness of the legs up (Trendelenburg). Basically the study indicates that this
maneuver fails to increase BP and/or cardiac output in most patients, does
not improve tissue oxygenation, results in displacement of only 1.8% of
total blood volume, and actually decreases cardiac output in the
hypotensive patients.
An additional study that compared T-berg
positioning and leg raising in hypotensive patients concluded that any
benefits of T-berg (higher MAP and cardiac output) were outweighed by
adverse effects.
We still teach it in wilderness medicine because, well, you don't have much else to work with. Just thought I'd pass it along, you can check out the full study if you want (sorry, no link).
See:
Myth: The Trendelenburg Position Improves Circulation in Cases of Shock
Johnson S, et al. Can J Emerg Med 2004;6:48
|
|
|
|
|
epic_ed
Nov 30, 2004, 4:47 AM
Post #61 of 108
(7319 views)
Shortcut
Registered: Jun 17, 2002
Posts: 4724
|
In reply to: ... the rest of the lay public, the people who are reading this forum, will have absolutely nothing to think about except that a paramedic in a forum they read said they could do some damage by giving epi pen doses.
FWIW, that's not how I took his post. In fact, I think you're making a big deal out of a little information that seems was included to simply cover his ass. I think most of us non-medical, thumbless idiots take exactly what is necessary and appropriate from Reno's original post -- that is, use multiple epi doses if necessary. I'm not sure why you have such a crab in your package about how he worded his message. Seems you're more interested in being "right" than you are in doing anyone a service by straightening out some periphrial information that might lead to some misconceptions by us average morons in "real life" situations.
Ed
|
|
|
|
|
alpnclmbr1
Nov 30, 2004, 5:14 AM
Post #62 of 108
(7319 views)
Shortcut
Registered: Dec 10, 2002
Posts: 3060
|
Since it seems like I may get a good answer...
What are the pro's and con's of using an asthma inhaler as a makeshift replacement for an epi-pen.
Do you still follow the same procedure(as with an epi) with the benadryl in combination with the inhaler?
|
|
|
|
|
karlbaba
Nov 30, 2004, 5:28 AM
Post #63 of 108
(7319 views)
Shortcut
Registered: Jul 10, 2002
Posts: 1159
|
Thanks for the responses. Sounds like there are interesting questions about the position, which is significant since in a wilderness setting, (particularly rockclimbing) having somebody lie down and elevate their feet is sacrificing other opportunities.
Any thoughts on ways to help keep (or force) the airway open while waiting for the Benedryl to take effect in the event of unexpected ana with somebody with no epi?
PEace
karl
|
|
|
|
|
reconbeef
Nov 30, 2004, 5:44 AM
Post #64 of 108
(7319 views)
Shortcut
Registered: Sep 13, 2004
Posts: 25
|
In reply to: What are the pro's and con's of using an asthma inhaler as a makeshift replacement for an epi-pen.
Epi-pens don't make very good pipes. Now Inhalers on the other hand...
Ok, the other difference is that Epi-pens and Inhalers do totally different things. In a situation where you really needed an epi-pen (ie, you were seeing the light and feeling at peace), an inhaler would do as much good as above pipe. Actually, a pipe might do you more good in this case, go out with a bang and such.
There really is no substitute for an epi-pen, which is why they are so wickedly expensive. The manufacturer (Lilly?) has a lock on an essential piece of medical equipment for a not insubstanital portion of the American public. Word on the street is that the old Ana-Kits are coming back, but I haven't seen any around in a while.
If you really have a sensitivity to.... well anything, best bet is get a script from yer doc and carry it as an insurance kit. Plus, it's a nice little pick me up when you've been climbing for 22 hours, and you've still got 5 pitches left.
-James
|
|
|
|
|
cbare
Nov 30, 2004, 5:50 AM
Post #65 of 108
(7319 views)
Shortcut
Registered: Sep 18, 2004
Posts: 64
|
That is a great question alpnclmr1. First, you really need to give epinephrine as a front line drug in anaphylaxis. It is the only med that will reverse the life threatening problems associated with anaphylaxis. Then, you can start giving more defenitive therapies and there are a whole lot of them. Dont worry I will cover the what if all I have is an inhaler scenario in just a minute. In any event an inhaler may help depending on what is in the inhaler. Many inhalers have a steroid in them. Advair is a commonly used steriod inhaler. While steroids are helpful in anaphylaxis the usually take a while to start working, so a steriod inhaler would definatly not be in the primary treatment list. Other inhalers have a beta adronergic agonist in them. That is just a big word for something that mimics or activates a part of the nervous system that is responsible for the fight or fight response. ie. running away from a hungry tiger. Many of these inhalers contain a medication called albuterol or ventolin. Albuterol works bu acting on special recepters in the lungs and heart called beta receptors. Activation of beta receptors in the lungs (called beta 2 receptors) causes smooth muscles to relax and open up and hopefully allow more air in. You want this if you are having problems with airway swelling or spasm like in asthma or anaphylaxis. Becuase albuterol also acts on the heart, (beta 1 receptors) many people who take albuterol may develop a rapid pulse and sometimes elevations in blood pressure. Actually albuterol is chemically similar to epinephrine and acts in many similar ways. Sometimes you may hear someone say give him a bronchodilator. Albuterol is a prime example of a bronchodilator. Just a big word that means to open the bronchial passeges in the lungs. So, the answer to your question is both simple and complex. Let me say again, the epi pen should be the primary medication for treatment of anaphylaxis. However, if all you have is an albuterol inhaler I am not going to say don't use it because if thats all you got, then you may have to use it. Just like someone who posted earlier stated, he had a reaction and all he had was benadryl. He used it and he ended up living. Not ideal, but the wilderness is not an ideal environment. Sorry about being redundant, I just have to warn people about the dangers of using meds in a mannor that they are not typically used because I work in an environment where I have all the meds and resources at my disposal, but that is not the case in the styx. Typically people in anaphylaxis will get epinephrine, then an antihistamine like benadryl, then other therapies will be considered such as an albuterol treatment to help open the airway or some of the other therapies. I hope this helps answer your question. Again, sorry about all of the jargon it is more of cover my butt thing and a hope you understand things better thing. The basic answer is, if all you have is an inhaler you may have to use it. Thanks again,
cbare.
|
|
|
|
|
cjstudent
Nov 30, 2004, 6:06 AM
Post #66 of 108
(7319 views)
Shortcut
Registered: Oct 21, 2003
Posts: 369
|
In reply to: In reply to: What are the pro's and con's of using an asthma inhaler as a makeshift replacement for an epi-pen. Epi-pens don't make very good pipes. Now Inhalers on the other hand... Ok, the other difference is that Epi-pens and Inhalers do totally different things. In a situation where you really needed an epi-pen (ie, you were seeing the light and feeling at peace), an inhaler would do as much good as above pipe. Actually, a pipe might do you more good in this case, go out with a bang and such. There really is no substitute for an epi-pen, which is why they are so wickedly expensive. The manufacturer (Lilly?) has a lock on an essential piece of medical equipment for a not insubstanital portion of the American public. Word on the street is that the old Ana-Kits are coming back, but I haven't seen any around in a while. If you really have a sensitivity to.... well anything, best bet is get a script from yer doc and carry it as an insurance kit. Plus, it's a nice little pick me up when you've been climbing for 22 hours, and you've still got 5 pitches left. -James
I carry epi ampules instead of the epi-pen. Sure for the person who has no training, the epi pen is pretty idiot proof. But for the WFR, or other trained individual, the epi ampules are a good (cost saving) alternative to the pens. Of couse u have to know the correct dosage, hence the need for the training. In NC, you can get certified to administer epi. Apparently the state has seen the light on the need for your average joe to know what epi is and how to use it since it is the front line drug in anaphalaxis. I have both the NC Epi cert along with my WFR. (and the fact that I'm a pharmacy tech but thats beside the point)
And i didn't read all 5 pages of this thread. But for what its worth, I carry a very small first aid kit with me climbing multi-pitch routes. The thing only weights a few ounces, and is about 4x2x2". I carry 3 epi ampules in there (with syringes) and benadryl. That might not work for U but thats what I carry.
|
|
|
|
|
reconbeef
Nov 30, 2004, 7:03 AM
Post #67 of 108
(7319 views)
Shortcut
Registered: Sep 13, 2004
Posts: 25
|
In reply to: But for the WFR, or other trained individual, the epi ampules are a good (cost saving) alternative to the pens.
It's intresting, one wilderness medical school does instruct in multi-dose vials for their WFRs, but most teach epi-pens. The reason is that while the vials are no sweat for those of us who work routinely around medications, the bulk of those getting their WFRs are not in the medical field. I'm just not sold that you can cert someone in a week and 2 years later (while they are watching some fixin' to die) they get all the mechanics of drawing up medicine and injecting it right.
"Wait, was that 3 or .3? I better give 30 just to be safe...."
|
|
|
|
|
clausti
Nov 30, 2004, 7:44 AM
Post #68 of 108
(7319 views)
Shortcut
Registered: Oct 5, 2004
Posts: 5690
|
edit: delete.
|
|
|
|
|
sandbag
Nov 30, 2004, 8:01 AM
Post #69 of 108
(7319 views)
Shortcut
Registered: Jan 12, 2003
Posts: 1443
|
In reply to: Just for s--- and giggles, say I'm allergic to Benadryll.
I have a 'scrip for Atarax, in 10mg doses that I carry 'cause I'm allergic to spider bites and a bunch of other random s---. Never gone into anaphelectic shock, but did have to go to the ER and get some antihistamine shot into me and hook and IV up when I was at the beach once.
Ok, I guess the point is, Anybody know if my Atarax is just as effective, in conjuction with the epinepherine, as Benadryl [they are different chemical forumas from what I can discover], if I *were* to have a severe allergic reaction? tru pill, not capsul with powder.
thats a crappy allergy to have, is it really an allergy to Diphenhydramine, or is it a complication from other drugs you may be taking like MAOIs or other contrindicated meds?
|
|
|
|
|
cbare
Nov 30, 2004, 1:03 PM
Post #70 of 108
(7319 views)
Shortcut
Registered: Sep 18, 2004
Posts: 64
|
Atarax or hydroxyzine and Benadryl or diphenhydramine share many similarities in the way the act. Both medications inhibit histamine and thus help with signs and symptoms of allergies. Benadryl acts by directly competing with histamine at the H1-receptor site. It binds to the receptor and does not allow histamine to activate the receptor. This mechanism is how we get the anti allergy effects. ie- drying of nasal membranes and other effects of benadryl. In addition, histamine receptors play a role in the brain and nervous system so you get other effects of benadryl ie fatigue & drowsiness. In addition benadryl has antiemetic ( anti nausea/vomiting) properties because of the whole histamine receptor thing. I do not really want to dive deep into the chemistry and prefer to keep it simple. Atarax acts in a similar way to benadryl, but atarax actually acts directly in the brain within it's subcortical areas (a big word that means below the cortex-the cortex is the upper brain where thinking, personality, and all that good stuff occurs--subcortical refers to the lower brain levels where the heart, blood vessel, sleep, and breathing centers are located) to cause antihistamine responses along with antinausea and anticholnergic responses. ( anticholnergic is a big word that describes blocking the neurotransmitter acetylcholine--in essence you can simply think of it as blocking the part of the nervous system that slows thing down and is responsible for nasal and airway secretions, salivation, gastric juice production and many other tasks---blocking acetylcholine will dry things up among other effects. Just to add a little more confusion benadryl has anticholnergic effects as well and yep H1 receptors play a role in that but I don't really want to take it any farther.) So now that your confused let me sum it up. Both medications act as antihistamines and act is both similar and different ways. Both meds will also cause drowsiness and other effects, but atarax usually makes people more sleepy. Atarax also has other uses for it's profound antinausea and sedation effects, ie to prevent nausea and vomiting during surgery, to help people with certain psychiatric disorders, and help with alcohol withdrawl. Sometimes atarax is a better antihistamine than benadryl and visa versa. This really depends on the individual person. If you cannot take benadryl, I think that atarax is an appropriate substitute. Just remember that there a multitude of antihistamines avaliable. ie chlorpheniramine (chlor tab) You may have problems with these as well, but at least there are options. The best thing to remember is that epinephrine is the standard for treating anaphylaxis, then we can worry about other treatments such as antihistamines. Hope this helped, cbare.
|
|
|
|
|
cjstudent
Nov 30, 2004, 1:28 PM
Post #71 of 108
(7319 views)
Shortcut
Registered: Oct 21, 2003
Posts: 369
|
In reply to: In reply to: But for the WFR, or other trained individual, the epi ampules are a good (cost saving) alternative to the pens. It's intresting, one wilderness medical school does instruct in multi-dose vials for their WFRs, but most teach epi-pens. The reason is that while the vials are no sweat for those of us who work routinely around medications, the bulk of those getting their WFRs are not in the medical field. I'm just not sold that you can cert someone in a week and 2 years later (while they are watching some fixin' to die) they get all the mechanics of drawing up medicine and injecting it right. "Wait, was that 3 or .3? I better give 30 just to be safe...."
I think my WFR class is different than most. I know most of them are quick week classes, but my WFR was taught through my university. So we didn't just get a weeks worth of class, I got a whole semester of classes along with weekends when we went out and did scenarios. And we spent alot of time on Epi....alot! But this is getting into an argument on ways to teach Epi and the different schools.
I mean if u are dumb and can't remember if its 3, 30, or .3 you should write it down. Or even better buy a 3/10cc syringe. everyone seemed to throw there 2 cents worth in so i did...and thats why I also said "That may not work for YOU but thats what I carry"
|
|
|
|
|
reno
Nov 30, 2004, 2:02 PM
Post #72 of 108
(7319 views)
Shortcut
Registered: Oct 30, 2001
Posts: 18283
|
In reply to: Intresting article just came out on this, questioning the effictiveness of the legs up (Trendelenburg). See: Myth: The Trendelenburg Position Improves Circulation in Cases of Shock Johnson S, et al. Can J Emerg Med 2004;6:48
Yeah. I think there was another one in Ann. Emerg Med a couple months ago. My issues are all in boxes, and it's too darn early in the morning to start fighting with Med Line, but IIRC, they said the same thing.... "Doesn't do as much good as we once thought."
But, as you mentioned, in the wilderness setting, we don't have much else, so you do what you can.
|
|
|
|
|
reno
Nov 30, 2004, 2:10 PM
Post #73 of 108
(7319 views)
Shortcut
Registered: Oct 30, 2001
Posts: 18283
|
In reply to: Since it seems like I may get a good answer... What are the pro's and con's of using an asthma inhaler as a makeshift replacement for an epi-pen. Do you still follow the same procedure(as with an epi) with the benadryl in combination with the inhaler?
Dan:
cbare gave a really good and detailed answer above.
The one thing I didn't see him mention (I might have simply overlooked it,) is this:
It is possible for the airway passages to be so constricted that an inhaler won't be effective (i.e. you can't inhale it deeply enough to get it where it needs to be... the alveolar/capillary membrane.)
That's not saying it's a worthless or bad idea. Just that I'm not so sure it'll be all that effective.
For what it is worth, Primatine Mist (the stuff you can buy at the pharmacy without a doctor prescription) is simply inhaled Epinepherine (the medication, not the 18 pitch route in RR.) ;)
So... short version: Probably won't hurt, might help, worth a try, but don't get your hopes up.
|
|
|
|
|
cbare
Nov 30, 2004, 3:46 PM
Post #74 of 108
(7319 views)
Shortcut
Registered: Sep 18, 2004
Posts: 64
|
In response to Reno. You are correct sir, I did fail to mention that inhaled meds are not really effective if the airway is swollen to the point of being unable to get medications deep enough to be of any benifit. This is why epinephrine is so important, It reverses the life threats. Then once you are somewhat stable and actually able to breath, you may consider bronchodilators and all of the other treatments for anaphylaxis. You are also correct about primatine mist. I totally forgot about the over the counter inhalers. Oh well insert foot in mouth. Thanks for the comment, cbare.
|
|
|
|
|
alpnclmbr1
Nov 30, 2004, 4:07 PM
Post #75 of 108
(7319 views)
Shortcut
Registered: Dec 10, 2002
Posts: 3060
|
Thanks a lot guys. This has to be one of the better threads of late.
|
|
|
|
|
|
