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dirtineye
Apr 18, 2006, 12:00 AM
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I got to eexperience severe anaphalaxis today, because of an allergic response to a drug, and almost died. Without rapid treatment, I would have died.
Some of the symptoms were relevant to climbing, so, here's what it feels like.
Non-climbing related: Hives, itching, hot, sweaty, bizarre disembodied feeling.
Climbing related: pressure in head, weeping stuff in chest and throat, pressure in chest, increasing loss of hearing and vision. Maybe the bizarre disembodied feelign is climbing related too. Low blood pressure, 80/40 known.
I know the cause of the low BP, but I can't remember it from my WFR stuff, oh wait, I think it's partly hypo volemic shock, not sure.
Got huge doses of benedryl, atropine and epinephine, push IV.
Those climbing related symptoms I mention, if you get them in climbing, it could be HACE or HAPE, as well as other reasons but if it is severe and rapid onset, you will have very little time to do anything.
You might get a slight warning, as I did. I don't know first hand, but I've been trained and read that shock is usually more gradual and in stages. But you better not ignore a warning, I promise you that.
It built from barely noticable to pronounced, I am about to die, Oh well." in short order.
If you ever have to deal with these sypmtoms in yourself or another, act quickly. There is no wait and see.
Edited to add:
Talked to the doc:
Decadron was given, along with a lot of other drugs.
I thought they had used atropine, but she didn't remember ordering it. she's checking on it. THings were a little hectic and I might have mis-heard.
I wnat to give a good acconut because the symptoms and treatment of anaphallaxis are relevant to climbing, via HACE HAPE, or internal injuries and maybe one other thing that happens in climbing. and I want to make sure people know what it feels like from the inside
Decadron is a drug used for high altitude sickness.
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shanz
Apr 18, 2006, 12:01 AM
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Glad your ok
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roboclimber
Apr 18, 2006, 12:58 AM
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Anaphylaxis and HACE and HAPE don't really relate to each other, but I too am glad you are okay. Decadron is used for alot of acute inflammatory processes.
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dirtineye
Apr 18, 2006, 1:18 AM
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In reply to: Anaphylaxis and HACE and HAPE don't really relate to each other, but I too am glad you are okay. Decadron is used for alot of acute inflammatory processes.
IT's the vision, and breathing, pressure in head and weeping tissues, especially in brain and lungs that is relevant to HACE and HAPE, when they are more extreme, that I am referring to. I wanted to describe those sensations so people hwo have never felt them could get some idea of what that is like, and that if you start feeling that way, you better act on it right away.
The other symptoms I had were allergic.
Unfortunately the decadron did me no good, but they had a boat load of stuff to use, I can't remember them all.
THere are other ways anaphalactic shock and hypovolemic shock can occur, and some of the symptoms are the same as what I gave.
According to my doc, at least I think this is what she said, sweating, lung trouble and vision trouble are the worst things, along with bad BP.
I'm pretty drugged right now, maybe I'm makding some mistakes though, not remembering things right etc.
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miavzero
Apr 18, 2006, 1:23 AM
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Darn you dirt!
I thought you were talking about the cool route in the black hill (highly recommend it!)
Glad you are hanging in there.
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wonderwoman
Apr 18, 2006, 4:13 PM
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That's so scary! Glad that you're still with us!
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putputgolfer
Apr 18, 2006, 11:36 PM
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does anyone know what you can do to treat anaphalaxic shock in the field if you do not have epinefrin? I would figure large doses of benedrol would be involved.
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tarzan420
Apr 18, 2006, 11:48 PM
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In reply to: does anyone know what you can do to treat anaphalaxic shock in the field if you do not have epinefrin? I would figure large doses of benedrol would be involved. |
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dirtineye
Apr 19, 2006, 1:31 PM
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The epinephine keeps you alive long enough for the benedryl to work.
my case was extreme, there were several other drugs given, all IV push,including decadron, some steroids and epinephine.
All you are going to have in the field is benedryl capsules, so you had better start your epinephrine at first indication, and get at least 50 mg benedryl down before the throat closes. Standard does is 25 MG (one cap) It will take 20 minutes for the benedryl to work.
The important thing is, you do not have much time to decide what to do. You can't sit and wait on this kind of reaction.
I'm going to upgrade my WFR to WEMT as soon as I can, and I am going to get more than one epi pen for my medical kit, along with a box of benedryl.
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jon
Apr 19, 2006, 1:58 PM
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an alternative to epi-pens is epi vials & syringes....way cheaper & you can manipulate how much epi to give. i have mine inside one of those tooth brush holder tube made for traveling.
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sixleggedinsect
Apr 25, 2006, 9:56 PM
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In reply to: does anyone know what you can do to treat anaphalaxic shock in the field if you do not have epinefrin? I would figure large doses of benedrol would be involved.
epinephrine. benadryl. (btw, generic benadryl (diphenhydramine) is a-ok for the folks rushing to walmart to buy a box..)
as mentioned, the antihistamine is what is really treating the root problem (assuming isolation from the allergen source). benadryl is the basic recommendation, and there are various types. if you are concerned with rapid absorption, you could consider other forms. liquid is taken in slightly faster than gel caps, which are absorbed slightly faster than tablets. there are also chewables (quicker than norm tablets too). however, liquids/gels tends to get destroyed in the FA kit. i keep tablets and cross my fingers.
another thing worth mentioning is that if you dont have benadryl on hand, any other antihistamine will be better than nothing, and may work just as well.
In reply to: an alternative to epi-pens is epi vials & syringes....way cheaper & you can manipulate how much epi to give.
absolutely true, but the additional training required, and the potential for Very Bad Things if you f*ck up, make it a questionable recommendation for joe-climber.
example: you go to your primary care provider, tell them you have a WFA cert, and that you want epinephrine in your kit without the brand name price tags. she (miraculously) gives you a prescription for vials and a couple insulin syringes. two years later some chick is dying from eating cashew trail mix at snacktime and it's your show. now, was it .3 cc you;'re supposed to give her, or .15? or was it 1.5cc or 3cc? and where? how? how fast? sweaty hands? dont drop the vial!
too much could kill her, too little could kill her, spilling the vial could kill her, administering to an inappropriate place could kill her.
the epi pen takes almost all of the potential botches out of the equation. i think that if you were not already acquainted with the existence of draw-up epi and its use, then it is probably not the right choice for you.
In reply to: I wnat to give a good acconut because the symptoms and treatment of anaphallaxis are relevant to climbing, via HACE HAPE, or internal injuries and maybe one other thing that happens in climbing. and I want to make sure people know what it feels like from the inside
im not really sure what you're trying to tell us here. some symptoms of anaphylaxis include nausea, difficulty breathing, possible changes in level of consciousness. these three also apply to about 90% of all other medical problems.
so perhaps the big point is that some wilderness-oriented first aid training is a nice thing to have on board? agreed! (although i would disagree that WEMT is the best choice for most folks, nor does it prepare you better for dealing with anapylaxis than a WFR.)
cheers,
anthony
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mhabicht
Apr 25, 2006, 10:28 PM
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Editied by me because it was a little over the top...
Final points- go get trained.
Epi only really helps with symptoms.
Antihistamine prevents rebound or if given early enough will prevent reactions. (make sure you stop climbing for the day once you take it. major CNS depressant)
Multidose vials are good for severe rxns that require many shots during transport to the hospital. (dont share needles or stick yourself)
Make sure they are having a reaction! Better to wait an see then waste your only dose only to need it again twenty minutes later.
Careful poking strangers or clients without permission
Evacuate if you had an anaphylatic reaction. Your trip is over! You can have lots of complications that will show themselves hours/days later. (its not like the movies where suddenly everything is perfect)
That was the scope of the post.
-Michael
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kman
Apr 25, 2006, 10:47 PM
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In reply to: I know the cause of the low BP, but I can't remember it from my WFR stuff, oh wait, I think it's partly hypo volemic shock, not sure.
Shit man...that's some low BP you had there.
The low BP would be from having vascular dialation as a result of anaphylactic shock.
In reply to: administering to an inappropriate place could kill her
**edit**Hard to f up an auto-injector However, I do agree with you as per the dose, spillage and all that other stuff. Although the little containers have some pretty overly complicated instructions.
.3mg Adult
.15mg child
The premeasured epi-pens are pretty simple to use so it's best for people to stick to them. They don't even make the other ones anymore. No longer available up here anyway, could be different down there.
Contraindication for epi is significant head trauma. Everyone should take at least a basic WFR course to know this shit.
Epi then chase with Benadryl. The epi should last about 20 min and that's how long it takes Benadryl to work approx. If you don't have Benadryl then you better hope a medic is < 20 minutes away or that you have another pen to buy you about 20 more min.
The following is not endorsed by anyone. Use this method at your own risk. I learned it from a Paramedic that taught advanced wilderness.
Some people have epinephrine inhalers for asthma. In a pinch they may work to clear up the "A" problem.
Glad to hear you made it out o.k.
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kman
Apr 25, 2006, 10:51 PM
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Of course the above is for info only and before you do any of this shit you need to take a course...
Another mention for the inhaler thing is some people have sensitivities to them and you should never give a prescription to some one other than who it was prescribed for yadda yadda yadda.
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sixleggedinsect
Apr 25, 2006, 11:14 PM
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In reply to: In reply to: administering to an inappropriate place could kill her Kind of hard to f that one up since you can administer via subcutaneous, intramuscular or intravenously.
what?!! how does that apply here? the knowledge about how to administer is beyond a discussion on an internet forum! these different methods are not interchangeable! this comment reveals your ignorance!
i can easily imagine a dull but enthusiastic responder recognizing a systemic reaction in a patient with a condition that would make it especially important to administer epi correctly. let's say they have a cardiac condition. adminstering a dose (let alone an incorrectly large dose) IV (inadvertently or not) might be all it takes to finish them off, when all they were was a little wheezy.
In reply to: Contraindication for epi is significant head trauma. Everyone should take at least a basic WFR course to know this s---.
from the manufacturers of the epi-pen:
"CONTRAINDICATIONS: There are no absolute contraindications to the
use of epinephrine in a life-threatening situation."
yes! thats right! to even begin to talk about contraindindications is to take a discussion of epi use beyond the wilderness/layman standards of care.
but i agree wholeheartedly that a WFR course is a great thing. lots of folks cant lay down the time/cash for it, but a WFA plus some reading/self-motivation is almost as good.
anthony
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mhabicht
Apr 25, 2006, 11:26 PM
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ABout those "NO CONTRAINDICATIONS" Drug use is contraindicated in inept morons! (not that you are a moron but someone else might be!!)
I would say that you better have a clue before you dose up a 58 year old male with coronary disease who is actually just choking on a peanut and not having a reaction to a peanut. The vaso constriction you cause might just set him into V-fib or cause an MI. oops....
People with fun new tools in their tool belt like to use them even if they are trying to hammer in a screw or screw in a nail. Make sure you know what a screw looks like compared to a nail. I like anaologies... go get training....
just a thought....
-michael
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sixleggedinsect
Apr 25, 2006, 11:49 PM
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In reply to: ABout those "NO CONTRAINDICATIONS" Drug use is contraindicated in inept morons! (not that you are a moron but someone else might be!!)
You are right in all your points. I would add that drug use is contraindicated in the ignorant as well as the incompetent.
that is really what this thread does for me. drive home how great the wilderness medical education is for outdoor folk.
anyways, this thread really never dished out the DL on ana/epi. we just all said 'take the course, fer chrissake'. in an effort to be progressive, ill include a few links. for the folks who are not in the know about recognizing/treating anaphylaxis:
a decent overview:
http://www.epipen.com/
symptoms:
http://www.epipen.com/anaphylaxis_whatis.aspx#symptoms
dey labs (maker of the epipen) does not highlight the important of antihistamine as much as a wilderness care provider might. for one reputable doctor's wilderness treatment regimen, see
http://www.wildmed.com/field_protocols/anaphylaxis_protocol05.01.html
note: the prednisone (steroids) regimen suggested is beyond most folks' FA kits, and is a distant third place treatment to the benadryl/epi rounds.
regards,
anthony
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take_1chance
Apr 25, 2006, 11:54 PM
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epinephrine comes in an injector called epipen that can be easily carried in case of anaphlaxis, buy only last 30-40mins, which is hopefully long enough to get to a ER. anaphlaxis tends to have a sudden onset of 2-3 minutes, with symptom's as mentioned caused by blood vessels dilating and bronchi constricting. epinephrine will constrict the blood vessels and dilates the bronchi making it possible to function long enough to get help. im not sure if benadril will help or not.
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sixleggedinsect
Apr 25, 2006, 11:59 PM
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In reply to: epinephrine comes in an injector called epipen that can be easily carried in case of anaphlaxis, buy only last 30-40mins, which is hopefully long enough to get to a ER. anaphlaxis tends to have a sudden onset of 2-3 minutes, with symptom's as mentioned caused by blood vessels dilating and bronchi constricting. epinephrine will constrict the blood vessels and dilates the bronchi making it possible to function long enough to get help. im not sure if benadril will help or not.
FYI: another example of a well-meaning, but uninformed, posting on your favorite rockclimbing website.
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kman
Apr 26, 2006, 12:35 AM
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Edited instead of entering a pissing match.
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kman
Apr 26, 2006, 12:46 AM
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In reply to: In reply to: epinephrine comes in an injector called epipen that can be easily carried in case of anaphlaxis, buy only last 30-40mins, which is hopefully long enough to get to a ER. anaphlaxis tends to have a sudden onset of 2-3 minutes, with symptom's as mentioned caused by blood vessels dilating and bronchi constricting. epinephrine will constrict the blood vessels and dilates the bronchi making it possible to function long enough to get help. im not sure if benadril will help or not. FYI: another example of a well-meaning, but uninformed, posting on your favorite rockclimbing website.
So why don't you enlighten everybody instead of being an ass?
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kman
Apr 26, 2006, 12:48 AM
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In reply to: Editied by me because it was a little over the top... Final points- go get trained. Epi only really helps with symptoms. Antihistamine prevents rebound or if given early enough will prevent reactions. (make sure you stop climbing for the day once you take it. major CNS depressant) Multidose vials are good for severe rxns that require many shots during transport to the hospital. (dont share needles or stick yourself) Make sure they are having a reaction! Better to wait an see then waste your only dose only to need it again twenty minutes later. Careful poking strangers or clients without permission Evacuate if you had an anaphylatic reaction. Your trip is over! You can have lots of complications that will show themselves hours/days later. (its not like the movies where suddenly everything is perfect) That was the scope of the post. -Michael
^What he said.
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sixleggedinsect
Apr 26, 2006, 12:59 AM
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In reply to: So why don't you enlighten everybody instead of being an ass?
dear Kman,
i dont really want to type out the WFR ana lecture. but, if you will look back a few posts, i did make an effort to 'enlighten' anyone interested by posting some links which cover the appropriate material.
while i made no great attempt to by polite in my post, i think the real disservice is when someone gives bad information and no one points it out.
regards,
anthony
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kman
Apr 26, 2006, 1:04 AM
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In reply to: i think the real disservice is when someone gives bad information and no one points it out
You have a point there.
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mhabicht
Apr 26, 2006, 4:33 AM
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take_1chance wrote:
In reply to: epinephrine comes in an injector called epipen that can be easily carried in case of anaphlaxis, buy only last 30-40mins, which is hopefully long enough to get to a ER. anaphlaxis tends to have a sudden onset of 2-3 minutes, with symptom's as mentioned caused by blood vessels dilating and bronchi constricting. epinephrine will constrict the blood vessels and dilates the bronchi making it possible to function long enough to get help. im not sure if benadril will help or not.
Just to be a PITA (pain in the ass) This information seems perfectly correct to me just a little late in the conversation.
Quit yer b#(*&ing and go climb.
YOU ASKED FOR IT- so here goes
Effects of EPI-
Alpha 1 receptors-
vasoconstriction of skin and guts and bronchi
urine retention
mydriasis
increase glucose release from liver
decrease renin
ejaculation
Alpha 2 receptors
negative feedback on more Epi production
platelet aggregation
decrease insulin secretion
Beta 1 receptor
SA node- increase heart rate
AV node increase conduction velocity (this is what kills the cardiac guy)
Increase cardiac output
Beta 2 receptors
are EPI only (not nor-epi because they are not innervated)
Vasodilation of muscle areas and brain (headache)
uterine relaxation
increase insulin secretion
I hope that clears a few things up.. ha ha ha ha
-michael- still cranking away- at pharmacology
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