Epi-pens

[Paulicarp]

It seems like epi-pens are a smart thing to have in a diving first aid kit in case a diver has an anaphylactic response to a jelly sting. Yet they are (as far as I know) only available by prescription and they are $80-$100. Is there an over the counter and more cost effective way to be prepared for this?

[Joshua Smith]

Benadryl and a cell phone. As long as the victim is conscious, give them a couple benadryl and have them chew the tasty little pills up (gets into the bloodstream faster than swallowing them) while you call 911.

[spatman]

It seems like epi-pens are a smart thing to have in a diving first aid kit in case a diver has an anaphylactic response to a jelly sting.

how common is anaphylactic response?

[Mongodives]

White vinegar is a good thing to have as well to pour onto the sting. (works well on box jelly's as well as man o wars to take the pain away before getting professional help)

those most likely to suffer anaphylatic shock from a jelly sting are likely to be allergic to bee stings and probably have an epi pen and should be letting people know that and where it is.

[Maverick]

I have epi-pens all over the place, and never seem to have one when i need it. I am allergic to bee's bad, but not honey bees. so i have one in all my cars, boat, and first aid kit. but like josh said a double dose of bennies and a trip to the er is good. but if you are only in pain you dont need either. some people dont know what a anaphylactic reaction actually looks like, but once you see it you know.

so no kind of an epensive item for your kit. the people who need it, have it, and those that don't will get one next time.

[Gooch]

As a fmr firefighter/ems guy, you will only have access to the pens if the person affected has them or if you are permitted to have them (ems) so it's a moot point. You can assist a person that has them if you are trained enough to help administer them and have some permission. If you fall into none of the above (most folks) the benedryl and wait for the firefighters is the best routine- you can render first aid up to your level of training, but don't exceed it.

Most times, the good guys will be there quickly anyway, so call for help, just wait, make the patient comfortable, and do what is within your training to help

[LCF]

If you can still find them, Primatene mist inhalers contain .22 mg of epinephrine.

However, I would caution that this kind of medication really should be administered with caution. Epinephrine is dangerous for people with high blood pressure or coronary artery disease. We use it only when we are fairly sure that we are dealing with a serious anaphylactic reaction. These are more common in people who have had some kind of major reaction before, and there is a family tendency toward severe allergic reactions as well.

If you have had a serious reaction (generalized hives, or wheezing or serious edema) you should have an epi-pen, and you won't have any problems getting a prescription for one. If you haven't, you are probably just better served to carry Benadryl, and remember that 911 is your friend.

[Zen Diver]

Vinegar is no longer recommended for jelly stings except for box jellies. Flush with hot water after scraping any residual nematocytst (stinging cells) off with a razor, credit card etc.

Valerie
(DAN Instructo)

[2loud4u]

For those that dont know, an adult epi contains .3 mg Epinephrine. The Jr version is half that at .15mg. I would have to agree with Maverick on this... Those that have a need for one will already have one.

I can just see a bunch of us running around with Primatene mist inhalers giving mulitple doses of .22 mg doing more harm at that point than good because most are not trained in this. Just because we have one doesnt mean we should use it. We dont know what medications they might be taking and is already in their bloodstream, that again could make things worse.

I could suggest you can carry childrens Benadryl because it comes in a liquid (works very fast) and this should only be used if the airway is clear and they are not unconsciousness. And of course a cell phone (I think almost everyone already has these).

Brendan

[60south]

Not everyone dives (or travels or backpacks) in civilization.

When you're literally days away from cell phone coverage or EMS, you start to think about these things.

I highly recommend taking a Wilderness First Responder course where they teach, among many useful things, how to use an epi-pen.

[Mongo]

.

[LCF]

Administration of an epi-pen or a Primatene inhaler (which is, after all, an OTC med) in an otherwise healthy person who didn't need the drug, is going to cause a high heart rate, high blood pressure, and likely a feeling of anxiety, and not much more.

The problem is the person who already HAS high blood pressure, or coronary artery disease, or a cerebral aneurysm. There is a reason epi-pens are by prescription. A Primatene inhaler is a cheaper, non-prescription dose of the same drug (slightly lower dose) but should not be administered indiscriminately. It is an OPTION for someone who has a history of anaphylaxis, and knows they are having another reaction but doesn't have an epi-pen at hand.

[Sounder]

Not everyone dives (or travels or backpacks) in civilization.

When you're literally days away from cell phone coverage or EMS, you start to think about these things.

I highly recommend taking a Wilderness First Responder course where they teach, among many useful things, how to use an epi-pen.

Also - Epi is a short-term solution. Epi-pens are given to patients under the idea that they're administering it while Meds/Fire are rolling. If you're "that far" away from help, and epi-pen isn't going to be a solution to your issue. It might be a short-term solution until a large dose of Benedryl kicks in, but that's STILL not guaranteed (lots of "if's" in that scenario).

A good communication tool and knowledge of how/who to get a hold of when you need help is the best remedy. For me, if I can't get help proper assistance when I need it, I'd be seriously reconsidering that dive/hike/etc.

[airsix]

So the bottom line here is that next time I see Sounder swim through a Lion's Mane I don't get to stab him with an autoinjector underwater. I mean, that was the whole point of this discussion, right? Bummer. Next topic please.

-Ben

[60south]

For me, if I can't get help proper assistance when I need it, I'd be seriously reconsidering that dive/hike/etc.

Then don't sail to that remote atoll. Don't work at the polar field camp. Don't backpack in the wilderness for a week.

It's a dangerous world.

We can't possibly learn how to safely and effectively help others and ourselves, so why risk it?

[fmerkel]

RCW 18.73.250
Epinephrine -- Availability -- Administration.
(1) All of the state's ambulance and aid services shall make epinephrine available to their emergency medical technicians in their emergency care supplies. The emergency medical technician may administer epinephrine.
"This act may be known and cited as the Kristine Kastner Act."
[http://www.mrsc.org/mc/rcw/RCW%20%2018% ... 20.250.htm]

Kristine Kastner died at age 12 from eating walnuts at a kid's party, (the article says peanuts but is incorrect), her epi-pen failed and 911 responders did not have epi. Kristine's Mom formed a support group for people (in this case primarily mothers with kids) having anaphylaxis- FEAST [http://wafeast.org/] Some years later they lobbied for EMT to carry epi. Oddly that group fought it for some of the same reasons that are being tossed around here. IMO, not reasonable medical thinking. When to administer is not that hard to sort out, especially if you even have a little training.

As LCF has pointed out the primary caution is giving it to people with various cardiac problems (see the link below for the bigger picture if you like reading that stuff). It could potentially be harmful. So if I see someone who has ingested nothing in the last several hours suddenly fall over I'll probably consider giving CPR rather than an epi-pen.

OTOH if someone with a known history has recently come in contact with a know anaphylaxis trigger, is gasping for breath and croaking something like, "sting, peanut, just ate something bad - NEED EPI", I think maybe an epi-pen is the right answer. If they are say under 50 it's almost a no brainer.

If you give epi to a normal person they are just going to get the shakes for awhile. No biggie, really.
Some of those Mom's have stabbed themselves with the real thing practicing. It mostly cures them of their reluctance to give it for a borderline situation. For a person with anaphylaxis it is potentially life saving. To not give it is life threatening. If you do use it EVER, it should be in conjunction with a call to 911. Secondary relapses are common and probable. Epi is short acting stuff. People should have 2 or more of them. FWIW there is also a device called a [Twinject] that is 2 doses in a single unit.

http://www.drugs.com/pro/epipen.html
CARE AND STORAGE
* Keep the EpiPen® or EpiPen® Jr auto-injector nearby and ready for use at all times.
* Store at 25°C (77°F); excursions permitted to 15°C-30°C (59°F-86°F) (See USP Controlled Room Temperature). Contains no latex. Protect from light.
* Do NOT store in refrigerator.
* Do NOT expose to extreme cold or heat. For example, do NOT store in your vehicle's glove box.
Your auto-injector has an expiration date

Notice - temperature and light sensitive, and have an expiration date. If discolored or forms particulates it needs to be discarded. These things are not good candidates for Save-a-Dive kits that will sit and bake in a closed car for a couple years and mostly be ignored. Probably it will be garbage when you want it, if you ever do. Hopefully a person with sensitivities WILL have one and will take care of it and have it available if needed. If you ARE that person it should be part of your buddy check.

Fritz

[Sounder]

For me, if I can't get help proper assistance when I need it, I'd be seriously reconsidering that dive/hike/etc.

Then don't sail to that remote atoll. Don't work at the polar field camp. Don't backpack in the wilderness for a week.

It's a dangerous world.

We can't possibly learn how to safely and effectively help others and ourselves, so why risk it?

Call me "risk-averse." I don't have any Polar field camp trips or voyages through pirate-invested waters to remote atolls planned for 2010.

When I've run out of adrenaline-seeking adventure within the bounds of modern rescue, I'll consider expanding my horizons.

[CaptnJack]

For me, if I can't get help proper assistance when I need it, I'd be seriously reconsidering that dive/hike/etc.

Then don't sail to that remote atoll. Don't work at the polar field camp. Don't backpack in the wilderness for a week.

It's a dangerous world.

We can't possibly learn how to safely and effectively help others and ourselves, so why risk it?

Call me "risk-averse." I don't have any Polar field camp trips or voyages through pirate-invested waters to remote atolls planned for 2010.

When I've run out of adrenaline-seeking adventure within the bounds of modern rescue, I'll consider expanding my horizons.

Exactly, and you don't dive either so jellyfish ain't gonna be a problem

[Sounder]

For me, if I can't get help proper assistance when I need it, I'd be seriously reconsidering that dive/hike/etc.

Then don't sail to that remote atoll. Don't work at the polar field camp. Don't backpack in the wilderness for a week.

It's a dangerous world.

We can't possibly learn how to safely and effectively help others and ourselves, so why risk it?

Call me "risk-averse." I don't have any Polar field camp trips or voyages through pirate-invested waters to remote atolls planned for 2010.

When I've run out of adrenaline-seeking adventure within the bounds of modern rescue, I'll consider expanding my horizons.

Exactly, and you don't dive either so jellyfish ain't gonna be a problem

Aaah, with grad-school behind me the tides of change are upon us...