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Brakecheck wrote:Xaque, I did a little research and this is what I came up with.

The causes of anaphylaxis are divided into two major groups:

...Non-IgE mediated: These reactions, the so called "anaphylactoid" reactions, are similar to those of true anaphylaxis, but do not require an IgE immune reaction. They are usually caused by the direct stimulation of the mast cells and basophils. The same mediators as occur with true anaphylaxis are released and the same effects are produced. This reaction can happen, and often does, on initial as well as subsequent exposures, since no sensitization is required...


Interesting stuff.

Very interesting! I stand corrected... (huh, I must have dozed off during that part of the lecture... I better tell my cohort who also agreed with me on the subject!

On a side note, and this is really just nitpicking, but Dr. Strangelove, I beleive you have the dose of Epi wrong.

It is 0.15mg for pediatrics, and 0.3mg for adults initial dose. The 1mg dose is used for Cardiac Arrest...

Anyhoo.... I'd better get back to work.

-Xaque-

Hi, Xaque

The dose for kiddies is as you say +/- and that dose is for every 10kg body weight(IIRC), but for adults you have to get enough in as quickly as possible.
It is far better to overshoot than undershoot in this case, and since you're going IM in a shocky person you have to give a bit more than if you're IV.
0.3mg might be fine IV in a controlled situation, but in this case, the sky is in fact falling, they might be ready to arrest and 1mg would not be too much. Besides, the half life of epi is about 15 min, so even if the BP and P go way up it won't be too long before it comes back down to normal.
The worst thing you can do is undertreat this life-threatening condition.
Remembering the words of Oscar Wilde: Nothing succeeds like excess. But, if all you have is 0.3 give it.

I see that the epi-pen is a 0.3mg dose, but in the OR and on crash carts ALL we have are 1 mg prefilled syringes and when we need epi we usually give all of it--IV. That 0.3 dose is just a little more than what is used for an asthma attack.

John

Great thread. I need to get my epi pen prescription refilled, and get some new benadryl for the bike.

Take a benadryl and a pepsid ac together, do not have time to read all the posts this am but this combo works for yellow jackets and honey bees even though two diff venoms. Honey bee stings the body can eventually build a resistance too, yellow jackets works the opposite the more you are stung the more likely a bad reaction (this can be over a long time)Some years I get stung 25 - 100+ times by yellow jackets one year probably 200+ times the past threes years maybe only 10-15 times all together due to not much surveying going on and some years are just worse than others and good or bad luck. I have been a bee keeper in the past and friend is a major bee keeper in the southeast and warned me about the danger from a high volume of stings from yellow jackets (Wasps) I have seen him get stung hundreds of times in one day one the hands marking or replacing queen bees in hives , you have to do this procedure in bare hands, better him than me.
Hope this helps someone.
Mike
If you are allergic I would still seek medical help.

A story about Benadryl.

With a few other riders, we set out across Canada from the east to the MOA rally in West Bend Wisconsin a few years back.
We boarded the Lake Express Ferry in Muskegon MI, with a hundred or so other riders, and got off the ferry in Milwaukee.

We rode to a one night stay at a Holiday Inn in West Bend. As I entered the hotel parking lot, I unzipped my Jacket to let some air in it was hot. I rode past the bushes to the hotel entrance and I felt a sharp pain in the upper stomach, like a pin prick.

I rubbed the area and went into the hotel to check in..... about 6-7 minutes later, standing in the lobby, the room started spinning.
It was outrageous, I could not stand up.
I was helped to my room by my son, and when I got my shirt off, I had a "bite" on my upper stomach.
I took a several millimeter chunk out of my skin, like a small circular scalpel would do. There was a "hole" in me!
My only guess is I cruised through a spider web and upset the tenant immensely.

Then, the reaction started. Blotches all over my body, swollen ears, and face, accelerated heartbeat..... luckily, I do pack Benadryl, and immediately swallowed 8 of them and laid down as my heart raced faster than I can ever remember. The internal pounding was frightening. soon, I fell asleep, and I slept till 4am, and woke with all the blotches gone.

Our resident EMT challey, when hearing the tale months later warned me to get a epipen, as I what I experienced was anaphylactic shock, and I could have died. I have never had a reaction like this from a bee sting, which leads to a spider.
(I am also dangerously allergic to Poison Ivy/Oak/Sumac)

But, I can say that Benadryl works (in massive amounts).

I did look much worse than this when the reaction hit.

As others have pointed out, for those who have had allergic reactions in the past, what started as a modest reaction will invariably be worse the next time and much worse, maybe even lethal, the time after that. An epi-pen really should a standard part of your outdoor kit, though it does require a prescription. Should not be difficult to get your family doc to give you the Rx for one though and the cost is modest.

As far as Herb's tale of a spider bite, my trite advice about arachnids is: All spiders can bite and most of them will.

And a word about bee stings. I'd bet a decent chunk of change that nearly everyone saying that they were stung by a bee is wrong about the culprit. The overwhelming majority of insect stings attributed to bees are are in fact wasp stings, nearly always by yellowjackets. Bees usually have to be provoked to sting and only do so once: They die after stinging because their barbed stinger gets ripped out of their little bee abdomen, along with most of their bee viscera. The bee's stinger remnant is usually clearly visible in the center of the stung area, and should be removed (carefully, so as not to inject even more venom).

Wasps, like yellowjackets on the other hand do not need much, or even any, provocation to sting. They don't loose their stinger and often sting multiple times. Worse, they leave a chemical trail of their nefarious handiwork, kind of a neon sign on you that says "Sting me again!" to their malevolent wasp brethren. I'm sure that they also gloat over the fact that those silly humans wrongly blame their distant bee relatives for their wasp mischief.

All good info. Not sure about the advisability of 8 benadryl though. More may not be better, Different may be. Taking more benadryl may lead to not more anti histamine, but only more sedation and that could be very dangerous

I think most people lump "bees" and "wasps" and "Yellow jackets" together, though not disputing the above. But the treatment for allergic reactions is as above. When in doubt call 911, esp if you're going downhill. And even if your epi pen is expired, if you think you need to use it, use it. The only thing likely to happen is that is it not as strong.

Just a question. We in the northwest have been experiencing an unusually prolific yellow jacket year, during which I have been stung multiple times. I am horribly allergic to honey bee stings, but with the yellow jackets, I only exhibit the "normal" local reactions like localized redness and moderate pain.
I keep hearing that wasps "bite" as well as sting. Is this correct?