# Epi-Pen



## rache (Jun 22, 2006)

i keep one, but i didn't know there was such a thing as certification.


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## CWBees (May 11, 2006)

I keep two pens but I don't know what you mean by certified. Two of my brothers kept bees and had systemic reactions so stopped keeping them. I felt it made sense to have the Epipen around in case my immune system malfunctions one day and I have a systemic reaction.


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## Ron Young (Aug 16, 2006)

The certification I am speaking of was mentioned in the local beekeepers meeting this month. I understand it is part of the Master Beekeepers Certificaiton through our state, or at least one of the objectives. I am an EMT, so I have a state qualification to administer the pen to others, so maybe this is what it is refering too.


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## Michael Bush (Aug 2, 2002)

I've never even seen one. I HAVE heard of one.







I have had bees since 1974.


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## CWBees (May 11, 2006)

I have an Epipen DVD that I received from my doctor. I have never watched it but I guess it shows you how to use it. I also received a fake Epipen to practice with.


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## rache (Jun 22, 2006)

i figure, if someone's in my yard going into anaphylactic shock, then i'm qualified to use it.


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## Ross (Apr 30, 2003)

I had (have) one from several years ago. I haven't bothered to renew it. The doctor said to jab it in my leg and call 911.


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## George Fergusson (May 19, 2005)

>i figure, if someone's in my yard going into anaphylactic shock, then i'm qualified to use it. 

Right. I think for liability reasons you're only supposed to administer it to yourself, an act for which you need no certification- perhaps because they figure it's just very unlikey you'll sue yourself. I wouldn't be surprised to find that you need to be certified to administer it to someone else.

Before administering the Epi-Pen to someone in anaphylactic shock, it would be both appropriate AND prudent to obtain their signature on a waiver indemnifying you of all liability in the event of a problem resulting from improper use of the Epi-Pen.

I have an epipen and a gun and I'm not certified or licensed for either. I wouldn't hesitate to use either of them- each for the appropriate scenario of course.


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## honeyman46408 (Feb 14, 2003)

""I have an epipen and a gun and I'm not certified or licensed for either. I wouldn't hesitate to use either of them- each for the appropriate scenario of course""

Dito


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## clear creek apiary (Jan 16, 2006)

i keep two because i live a ways out from civilization and one shot really only covers about 15 minutes of shock so we'd need a second shot to get us all the way to the hospital (driving fast). i must admit, though, that my epipens are expired by a few months right now. does anyone know how long they last past their expiration? i know pharmaceutical companies put dates that are way before the meds stop working.


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## BjornBee (Feb 7, 2003)

The main thing with the pen is that it is temperature sensitive. I have one originally for keeping in the truck. But keeping it all summer in the glove box is not good. So it sits at home in the closet.

I give advice to others for a bottle of benydril(sp) to be available but have none in the truck myself. It will give you some time if you down the whole bottle.

Some of my yards are way out, and I work alone alot. Does make me wonder...


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## BjornBee (Feb 7, 2003)

I better clarify, since this discussion is with beekeepers. "Down the whole bottle" means the contents within, not the actual bottle!


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## cphilip (May 25, 2006)

I doubt that Bjorn. Aniphylaxis is not a histamine reaction. 

I would doubt your going to have time to negotiate a waver with a person gasping for his/her last breath. A tricky situation but I would rather be sued than accused of standing by and not attempting to help while I had the only thing that might help in my hand. Probably get sued for that too!


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## cphilip (May 25, 2006)

I doubt that Bjorn. I Doubt it would work fast enough and in enough force to prevent a death. But hey... what the heck! Anaphylaxis is not a histamine reaction so its going to need epinephrine fast. And perhaps antihistamines later for other symptoms. But perhaps if you did actualy DOWN the bottle and it stuck in your throat just below the tracheal opening it might wedge it open! Hey! Your onto something I think!









but more importantly... I would doubt your going to have time to negotiate a waver with a person gasping for his/her last breath. A tricky situation but I would rather be sued than accused of standing by and not attempting to help while I had the only thing that might help in my hand. Probably get sued for that too!


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## BjornBee (Feb 7, 2003)

Cphilip,
Are you doubting me or are you making a statement 100% against what I have stated?

I am no doctor. I am just relaying what others have mentioned to me concerning bees stings. It was stated that although it will not stop anaphylactic shock, it will buy you a window of oportunity to get to the hospital. Something along the lines of 15 or 20 additional minutes, as compared to doing nothing at all.

Now that you say this is bunk, I'll have to go on the mission of proving it one way or the other. Without wasting too much time on the matter, are there any qualified professional doctors or others well versed on this now supposed urban legend wothin beekeeping?


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## BjornBee (Feb 7, 2003)

I never said anything about waivers...

As for Benadryl, I'll use Dewey Caron's book " Honey Bee Biology and Beekeeping" Page 12.169

This section talks about "systemic allergic reaction" and "large local reactions".

It states that without an epipen, systemic reaction is immediately and usually includes loss of consciousness. May be fatal.

The other type reaction is the "large local reaction", which is different from the systemic reaction, and although less life threatening, may include excessive swelling of the throat. Dewey's book specifically mentions benadryl.

I guess not knowing whats happening and your experiencing a hard time breathing after a bee sting, and no epipen is on-hand, I guess my opinion or suggestion of taking some benadryl does not sound like bad advice afterall.

Glad to be of assistance.... 

[ September 23, 2006, 08:53 PM: Message edited by: BjornBee ]


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## balhanapi (Aug 22, 2006)

Anaphylaxis is a hypersensitivity reaction and it does involve histamine as one of the chemical mediators. Respiratory distress(difficulty in breathing), pruritus(itching), urticaria, mucous membrane swelling, gastrointestinal disturbances(nausea, vomoting,pain and diarrhea) and vascular collapse(tachycardia & hypotension) are the clinical manifestations. Basically disturbances away from the bite site if you know what I mean. Mild symptoms can be controled by Subcutaneous injection of epinephrine(the shot in the leg you are talking about) repeated at 20min intervals. For serious reactions an I/V drip should be initiated. Other agents that can be used are Dopamine(for hypotension) anti histamine(eg diphenhydramine the active agent in Benadryl), aminophylline(to open up the lungs) oxygen(as expected) and glucocorticoids( may help in persistent hypotension and bronchospasm). Hope this helps.. I am a physician so hopefully I dont have to get a seperate licence for that.. I will go and give the person the shot if I have one and bother about being sued by him when he recovers







The nature of the job you see..

[ September 23, 2006, 08:48 PM: Message edited by: balhanapi ]


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## cphilip (May 25, 2006)

No bjorn, What I doubt is the effectiveness of an oral dose of benedril tablets or capsules at that time being effective in that situation. I doubt the availabilty of enough of it in the time needed to avoid death. For one the time it takes the stomach to break it down and get it into the blood stream in enough dose to work, I would suspect, would be longer than the circulatory colapse and breathing could wait on. And if circulatory colapse occurs then delivery of that would be nil at that point. Thats more of less what I am saying. 

Now... a liquid form... perhaps better. I just know that getting it into the blood stream needs to be fast to work. And oral normaly is not fast enough. Now there are ways to give something oraly or directly throught the mucous membranes that would be faster than a bottle of benedril capsules.... but if your preparing, why not prepare with the best thing, the epinephrine? But... eveyone is different I guess.. but wouldn't it be a bit better to perhaps get a bottle of that kids liquid benedril? Perhaps?

[ September 23, 2006, 09:11 PM: Message edited by: cphilip ]


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## Hillside (Jul 12, 2004)

Three years ago, I had two wonderful episodes with aniphylaxis. Both times, the emergency room docs treated my with an intravenous ****tail that they told me contained, along with other ingredients, a large dose of Benedryl. I think they also gave me epi when I first came in the emergency room, but I don't really remember much about that time period.

I hadn't been stung and we never determined what caused the reactions. I have been stung since with no severe reaction. It must have been something else. Whatever IT is, I suppose the day could come when I am exposed to IT again.

I spent two years seeing allergists to try to figure out what might have happened. They did a lot of testing, but never were able to determine what caused the reaction.

The docs tell me my best course of action is to always know where the nearest hospital is and always carry an epipen. One recommended that I no longer take canoe trips into the boundary waters, but instead stay close to civilization.

They also told me that I could live out the rest of my years and never have another reaction. That's the scenario I'm hoping for.


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## balhanapi (Aug 22, 2006)

The severity of the reaction may come down and go up in individuals. A person with a severe reaction may not get it later on and a person with a mild reaction may get a severe reaction later on, it goes either way. But the probability of this happening is low. So yes it is a good idea to keep epipen handy and stay close to civilisation.


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## BjornBee (Feb 7, 2003)

cphilip,
I never said tablets or capsules. But if you want to further the breakdown between tablets and capsules and liquid, fine. For the record, when I said "bottle", I was referring to the liquid form.

I recommend to all the farmers that I pollinate for, and particularly those with kids, to have a bottle handy. I know that they are not likely to get a prescription for a epi-pen, but perhaps having the benadryl handy could be of some use one day. 

I never said anything about it being 100 percent effective in the worst case scenario of someone keeling over and dying within seconds of a sting. I do think it is sound advice that for those experiencing effects of a bee stings, with hard breathing and tightness of the chest, which is common for extreme reactions, that benadryl (Liquid form) is something to consider. It may not stop the body from shutting down from anaphylactic shock, but it may keep your air way open long enough to get to a hospital without dying of not being able to breathe.

I do prepare for the best. But as I said, and if you read your epipen yourself, you will notice that there is storage issues involved with carrying it 24 hours a day. It can not take storage in a glove compartment of a truch for instance, with excessive heat. I have one at home, but for on the road everyday, its less than optimal. A bottle of benadryl may not help for the worst case scenario, but for the much more common, lesser reaction to stings, it may allow you to breathe awhile longer till help arrives or you drive to the hospital.

You can nitpick this all day long. Telling people that benadryl will not help is outright wrong. Besides me, a doctor, and a first hand account of actually using benadryl for bee sting allergic reactions has been stated. And I have also referenced a book. What more do you want?


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## Aram (May 9, 2006)

Is epinephrine that easily availabile to beekeepers? What about abuse?
I know in NY only in the past two years or so we are allowed to carry it on ambulances again. Before that the patient had to have a valid one prescribed and show the signs of anaphylaxis before we were allowed to "help them" with their epipen. (There are side effects to epinephrine that can also kill you.) If one was allergic and just swelled and itched I'd still just give Benadryl and rush to the hospital. If someone experienced difficulty breathing it's a different story.. I hope I'd have an epipen handy but, again, I would not jab someone with the epipen just because their sting site swelled.


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## magnet-man (Jul 10, 2004)

My wife insisted on getting one. I had to make sure she understood that it was only if the person was starting to have real trouble breathing or was about to pass out. She thought she should use it if she got stung and started swelling real bad. 

An epi-pen is a last ditch treatment.

Here is real good summary of anaphylactic shock. I did not know until reading this that you should be monitored for four hours. I had always thought if you didn't drop dead in the first few minutes you were fine. All these year I thought I knew everything.  
http://en.wikipedia.org/wiki/Anaphylaxis

[ September 23, 2006, 10:08 PM: Message edited by: magnet-man ]


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## BjornBee (Feb 7, 2003)

I don't want to turn this into a choice of epipen or benadryl. One is more effective thats for sure.

I mention benadryl for those who can not afford, (a prescription, a possible doctors visit and cost and about 40 paying for the epipen), and those who do not carry one around or for whatever reason...that benadryl is an option and has its usefullness. I know not many beekeepers will get an epipen, but perhaps a bottle of benadryl is more easily obtainable and prectical to have around.

I know if my epipen is not around, and I have a reaction to a sting that is beyond normal, I'll take the benadryl. If the next beekeeper feels its of no use, thats fine. Its of no use if you believe it wont help and have none handy. I have a bottle just in case. I would rather help someone drink some benadryl than hitting them with my epipen, but thats just me.


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## Jeffrey Todd (Mar 17, 2006)

If I had no more Epi, or was a long way from getting help (in which case I would have several doses of Epi, but for arguments sake . . .) I would immediately down some oral Benadryl as well. Epipens only last about 15 minutes, but that may be enough to head off the worst of the reaction.
I certainly WOULD NOT down the whole bottle - that would just be a slower way to die, or if you were fortunate enough to not die from it, you would be so sedated that you would be unable to drive yourself or get further help. Perhaps something more reasonable like 100 mg orally, although please remember, I am in no way giving medical advice, (I am a nurse, not a doctor) just my version of what I would do for myself. I am not advising anyone to do or not to do anything (gotta stay out of legal hot water!) I will leave that to those with a license to practice medicine and the malpractice insurance to cover themselves. OK Balhanapi and SantaCruzBee?


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## Edward G (Aug 26, 2006)

Forget the epi pen. What you need to do is smoke a banana peel like those guys out in California.

Took 'em 2 years to get the taste out of their mouths.


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## magnet-man (Jul 10, 2004)

When my wife had her first bad swelling episode with bees the doctor gave her 100 mg of Benadryl and 300 mg of Zantac.

[ September 23, 2006, 10:30 PM: Message edited by: magnet-man ]


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## cphilip (May 25, 2006)

"cphilip,
I never said tablets or capsules. But if you want to further the breakdown between tablets and capsules and liquid, fine. For the record, when I said "bottle", I was referring to the liquid form."

Ok... 


"You can nitpick this all day long. Telling people that benadryl will not help is outright wrong. Besides me, a doctor, and a first hand account of actually using benadryl for bee sting allergic reactions has been stated. And I have also referenced a book. What more do you want?"

Now Bjorn... you just practicaly pulled that whole thing out your [edit]. I never said don't. I said I had some doubts of its effectiveness and assumed you were refering to tablets or capsules. You didn't specify so I assumed you would not normaly have childrens liquid on hand. My bad. In fact up until now I thought we were just dicussing effective alternatives and having a nice disussion about it. I sort of sensed your defensiveness there but wasn't sure you just did not want me to clarify what I ment. Which admittedly, was left up to some interpretation, now that I reread it so I appologize for being so brief. I though my follow up would explain my "doubt" which by no means is defined as complete and utter contradiction. Which you now seem to be trying to put in to my mouth. So please don't try and do that will ya? Seems now though that your spoiling for a argument rather than having an open discussion? So just forget it. I made what points I intended to make. And hopefully you see what that was. I suggest you go back and re-read what I was saying with out the animosity you seem to think I intended. I certainly did not intend them that way. We shall just leave it at that my friend.

Oh and go look at the complicated role of Immunoglobulin E in this whole thing. You'll find Histamine treatment to be related and important. But only one part of a complex thing going on there. Not that I intended to get into all that. Been a long time since I have read up on immunology. Boring stuff but facinating in a sort of finger nail on chalk board sort of way! 

[ September 24, 2006, 09:09 AM: Message edited by: The Honey House ]


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## snoopybee (Dec 21, 2005)

Had a reaction to a too large alergy shot, which i think is the same reaction. Had to walk a about hundred yards to the hospital. They loaded me up first with adrenalyn(sp) then benadryl. Was in serious need when i got to hospital, The medications cleard me in abt 30-40 min. would advise the epipen because you don't have but a few minutes otherwise and you don't know when it's comong until it happens. it's a bit scary!

ray


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## magnet-man (Jul 10, 2004)

As Jack Nicholson said in Mars Attacks!, "Can't we all just get along??"

Balhanapi as a physician are you used to nobody paying attention to what you have said?

[ September 23, 2006, 11:32 PM: Message edited by: magnet-man ]


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## sierrabees (Jul 7, 2006)

On the serious side, as a veterinarian for over twenty years I have had to use epinephrine hundreds of times, but only as a treatment of last resort. We are talking about a drug that if givin to a person who's heart is acting normal can push it into abnormal activity. I do keep an epipen in my tool kit when I work my bees. I would use it only if I was certain my life was in imediate danger. When I feel I have had too many stings, or if I feel that I am reacting more severely to a sting than usual, I pop a couple of benadryl and go on about my business. The only time I felt serious systemic (body wide) symptoms after getting a large number of stings I went to the local clinic and let them administer epinephrine under controled conditions. 

This aint no recreational drug unless you think Russian Roulette is your sport of choice.


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## George Fergusson (May 19, 2005)

>I mention benadryl for those who can not afford, (a prescription, a possible doctors visit and cost and about 40 paying for the epipen)

I hear you Bjorn. When I started beekeeping my wife thought it would be a good idea to have an epi-pen around, if not for us then for visitors to our apiary in the event of emergency. so I called my doctor, told her I kept bees and wanted an epi-pen and she called in a prescription for me.

It cost $22 for what I thought was 2 pens which I thought was expensive, but not out of line but the pharmacist explained that the other one was "for practice". I then had a rather inane discussion with the pharmacist about the need to practice, how often I should practice, what would happen if I accidentally practiced with the wrong pen, what would happen if I accidentally practiced with the wrong pen on someone else, etc. He was glad when I left I think.

I almost didn't buy it. Now, I'm not what I consider cheap, and shelling out a yuppie foodstamp and change for something that might someday save my life, or the life of someone I love or even the life of a perfect stranger seemed like a good idea but still, 20 bucks is 20 bucks and I was kinda broke at the time being out of work and having just taken up beekeeping and well.. the $$ hadn't started to roll in yet, know what I mean?

So I bought one. Haven't had to use it. Still have it. When it expires I will NOT renew the prescription. I'll just get me a few bottles of liquid benadryl instead.

And oh yeah, in my previous message in this thread I accidentally left out a smilie or two, so I guess some people took me seriously when I was really joking. Sorry about that! I wouldn't really expect someone in anaphylactic shock to be in any position to sign a waiver before I administered the epi-pen. Obviously, I'd give them the waiver to sign after they recovered, along with a bill for $20.










George-


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## George Fergusson (May 19, 2005)

>Balhanapi as a physician are you used to nobody paying attention to what you have said?

I take anyone seriously who can spell diaraehea.. diharreha.. dieorea... whatever.


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## Andrew Dewey (Aug 23, 2005)

A few years ago I took a Advanced Wilderness Medicine course. My certification from that has run out, but as best I remember benadryl was the post epi-pen recommendation to allieviate rebound reactions. There are devices on the market now that will deliver multiple doses of epinephrene.

Again relying on distant memory, the main reason for checking with the victim before administering the pen was to learn about potential allergies to epinephrene. Some people should not take it.


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## balhanapi (Aug 22, 2006)

Now c'mon Jeffrey don't scare me!!  
Regarding your question Magnet-man sadly yes. Sadly because sometimes I know that this guy is not going to keep so-so things in mind and will come back here another day, which I don't want.(partly because I want him to not need me again and partly beacuse I don't like him  ) 
Mostly people are sane so as to say they do listen to us poor guys lol some can't help it and some are outright stubborn. But we do gotta help them as much as we can so I try to tell them whats best for them each time I see them regardless of their track record.. 

and to the lighter side of it when I tell somebody 'see ya later' - I dred the reply- I am perfectly fine doc why should I see you??  

Oh It does feel great to see your name on the board just like Santacruzbee said in another post.

George I did go back and check the spelling of 'diarrhea' in my last post so you see I do want people to listen to me


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## Beemaninsa (Jun 9, 2004)

I recently saw a benadryl TV advertisement promoting a fast acting paper like tab that you just place on your tounge. It looked promising to me. Has anyone investigated this as a prefered application method for benadryl?


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## Aspera (Aug 1, 2005)

A safe, stable and effective option is a bottle of fast acting corticosteroid such as dexamethasone. It is not as fast as epi unless given IV, but it will probably save your life if given IM. Injectable benadryl is safer than both of the above and WILL prevent many of the problems associated with anaphlaxis.


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## Judy Bee (Jul 4, 2006)

Here's another question: How many of you keep a bottle of epinepherine and a syringe for any dog or cat who may have an adverse reaction to beestings? 

My vet advised that I keep a bottle of epinepherine and syringe for just that purpose because I know that at least one of my cats got at least one sting a couple of years ago. Hopefully I'll be around watching if one of my pets gets an adverse reaction.


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## RonS (Dec 28, 2004)

During our association meeting last week, we were blessed with a presentation from a local board-certified allergy physician. As to the epipen, he said that a prescription is required, but that any GP would give one to a beekeeper. He said that all beekeepers should have one set for adults, and the special set for kids. As to the danger, he said that the epipen contains adrenylin and could be dangerous to people with heart conditions, but that if that person was experiencing a systemic reaction, the worst kind, it might be worth the risk. He also said that the pen would have no effect on people using beta blockers as the blockers counteract the adrenylin. 

Said that bee stings were the most dangerous from a reaction standpoint, but not in other ways. Yellow jacket stings took that prize (infections, etc). Evidently, about 50 deaths a year occur in the US from bee stings. So, use of the epipen is up to you. If you have a systemic reaction (swelling of trachea), you might be one of the 50 this year. 

Oh, if you have one, check the expiration date. Said if expired or is yellow, replace it.


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## Romahawk (Jul 11, 2005)

> He also said that the pen would have no effect on people using beta blockers as the blockers counteract the adrenylin.


I take a 50 MG dose of Atenelol and was told basically the same thing by an allergist when I went to him for an Epi pen. I then talked to my cardiologist who said that although my allergist was considered to be quite good in his field he needed to be educated about Beta Blockers. My cardiologist told me that with a 50 MG dose of Atenelol the Epi pen would be about 85 percent effective. As the dosage of the Beta Blocker is increased the Epi pens effectiveness decreases and at some point it would render the Epi pen useless. With that said he wrote me a prescription for two Epi pens and told me I could safely work with my bees.


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## SilverFox (Apr 25, 2003)

I wounder if the "GOOD SAMARITAN" laws would protect you??


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## Aspera (Aug 1, 2005)

I can honestly say that for animals, epinephrine was my least favorite drug for allegic reactions. I would only consider using it in full-blown, your horse will die in seconds type of hypersensitivity reactions. Even then, it would be in combination with another drug.


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## GaSteve (Apr 28, 2004)

Administering an epi-pen to someone else is a really tough call. There is a person at work who is severely allergic to certain types of food. Some nurses came in to brief all of us on the basic biology of allergies and what to do if he has an attack. First, obviously call 911. The pen is really meant to be self administered. The victim should be able to recognize the symptoms and have time to give himself the shot before becoming unconscious.

There are several risks with giving someone the shot. Apparently it can be fatal if injected straight into an artery or vein. Also, it could be fatal if the victim has another problem that only resembles anaphylactic shock. For instance if you administer an epi-pen to someone who is having a heat stroke or a heart problem, it could very well kill him. Could you tell the difference?

Also, because you have administered prescription medicine, the Good Samaritan laws may not legally protect you.


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## Aram (May 9, 2006)

No lawyer here (but I am an EMT) the way I understand it the "Good Samaritan" Laws protect you if you can prove you tried to help and didn't know any better. If you were trained and supposed to know better (EMS, nurses, doctors) you bettter have a good malpractice insurance. I guess all "prescription medicine" should come with some sort of training. And I don't mean: "Hey Doc, I just bought me a package of bees, can I have an Epi-Pen?" "OK, I'll call the drug store, go pick it up."  From what I'm gathering that is how much training many beekeepers get before being handed one. (Or that is all they remember  )


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## rache (Jun 22, 2006)

nope, that's about how it went for me - i asked for one to have on hand because i have bees and kids, and she handed me an rx. i was careful to read the directions - good thing because there are separate, half-dose epipens for kids - and i review them occasionally, so it's alwasy fresh in my mind how to use it. basically, my concern is for my family, who i'm assuming won't sue me if i ever have to use it on one of them (they know i don't have any money, so why waste their time, ha!)


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## Jack Johnson (Jun 3, 2005)

I myself carry two epi-pens when I venture out to my Bee Yard. At 70 years old and can feel a little slowing down when it comes to doing physical labour and such I feel an Epi-pen is a requirement in my Bee tool box. Fortunatelly I have not had to use the pen but will always carry it even when we go camping in the bush country of Northern Ontario, you never know when you might run into something that could cause you problems. 

For those who are unfamiliar with a Epi-pen I would suggest two things: 

#1. Talk to your family doctor as he knows your history and whether you can safely use the pen. He will also explain what to look for and how to use it. 

#2. Follow this link to all the Epin-pen information about symptoms,what it is used for, how to use it and when. 

http://www.epipen.com/ 

NOTE: These pens are temperature sensitive and should not be left in a car or location where the temp can go high and ruin the Pen. I keep mine at the back door on the kitchen counter where the temp is fairly constant and it is the first thing into my pocket on the way out to the Bee yard, 

I say carry one "It is better to be safe than sorry" 

Jack


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## Judy Bee (Jul 4, 2006)

When I carried one my doctor showed me how to use it, told me what to expect (imagine drinking 4 cups of coffee at once), to call 911 after using it, and to carry it with me at all times. 

Finally, after it was expired for 2 years, I tossed it this spring. The discussion re. benedryl is interesting because I'm recently retired and don't want to shell out the 65-plus bucks for another epi-pen. 

So how much benedryl does one have to chew in order to reduce the swelling in one's throat? Do you put it under your tongue if you can't swallow? I doubt my physician would let me inject myself with benedryl.

Interesting, I hardly swell at all after a sting; yet, I know an adverse reaction could occur at any time.


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## SilverFox (Apr 25, 2003)

For some that have been in the service an epi-pen is administered no differently that an atropine injector (used against nerve agents) and is also designed to be given through clothing in the thigh.
Some military training still prevails.


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## SantaCruzBee (Apr 23, 2004)

Hi, this thread was just brought to my attention by Jeffrey.

I do have an opinion as an ER doc. I can't say that all docs would agree with me.

However, number one, although I have nothing against the use of Benadryl in the event of an allergic reaction/early stage of anaphylaxis, I do caution against "downing the whole bottle" as it is toxic in high doses and we don't need to add that to the patient's list of problems.

If a patient can easily swallow, taking two or three 25mg capsules might help and probably won't hurt. However, I do caution that a patient in anaphylaxis, as I think someone noted above, often is unable to swallow and any attempt to force them to do so is ill advised. They will likely get it and any associated liquids into their lungs as a result of their difficult and labored breathing. That will complicate things.

Epipens. I own an adult and a pediatric one which I keep at my house for visitors should they have a severe reaction to beestings.

Is this necessary? No! They are rather expensive and I don't think that beekeepers are obliged to put out that expense. The most important thing is to call 911. Next, it is a good idea to learn CPR. Unfortunately, severe anaphylaxis really does not respond that well to CPR alone, but if you can help someone breathe and give chest compressions if necessary, that's a great thing.

Are Epipens safe? Yes! Although everyone worries about the cardiac patient who receives an Epipen injection and then goes on to have a heart attack as a result, the literature does not support this. Actually, the cardiac patient having an anaphylactic reaction will probably have a heart attack in the course of that reaction and not as a result of the relatively small dose of epinephrine in an Epipen.

Sometime in the last year or so there was an article in Emergency Medicine News which talked about this concern and reviewed the literature. I will try to look it up and reference it in the future. Feel free to remind me as I'm at the end of a shift and may well space it out.

Also noted by others above, there is a difference between moderate allergic reactions and full-blown anaphylaxis. In either case, Epipens may help, but they are unnecessary in simple allergic reactions.

Should one have an Epipen if one owns bees?

As I said before, I don't think it's your responsibility, but the downsides are minimal to non-existent in regards to adverse reactions. They may save a person's life. They are expensive. I don't remember how long a shelf life they have, but they can be stored at "room temperature." They will be less effective in the extreme cold I believe, but am not certain. If you have one and are thinking about using it, it's better to "just do it." In any case, call 911 as soon as possible.

-Doug


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## magnet-man (Jul 10, 2004)

> For some that have been in the service an epi-pen is administered no differently that an atropine injector (used against nerve agents) and is also designed to be given through clothing in the thigh.


The commercial epi-pen is a direct spin off from the military looking for a solution for self administration of atropine on the battle field. Military research does pay in many ways.









Silverfox what branch of the service were you in?

[ September 26, 2006, 08:37 AM: Message edited by: magnet-man ]


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## Jeffrey Todd (Mar 17, 2006)

Thanks, SCB, for your informed opinion. Too many of us (and I include myself) have only bits and pieces of info, and, as we all know, a little knowledge can be a dangerous thing.


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## brent.roberts (Dec 31, 2005)

For those of you how have access to Epipens, and have not read the instructions, you should be aware that in some people epinepherine can cause a significant/dangerous drop in blood pressure. 

I was cleaning up vegitation debris in the Florida Keys after Hurricane George and got bit by something. Went to the hospital when my tongue and lips got hard and throat started swelling. Scary.
Got a shot of epi and they put me on a blood pressure monitor for an hour. My blood pressure went down a fair bit, but did not become a problem.

When they say, take the shot and call 911 ... do not omit the second half, make the call even if your symptoms are reduced. You can't call 911 when you're unconcious.


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## Jeffrey Todd (Mar 17, 2006)

Brent,
It is likely that your reaction to the allergen from the bite caused your drop in blood pressure. Epinephrine does just the opposite; it speeds up heart rate and raises blood pressure.

Jeffrey

[ September 26, 2006, 01:08 PM: Message edited by: Jeffrey Todd ]


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## SilverFox (Apr 25, 2003)

Magnet=Man; Army 1972-1979, was stationed in Korea 
with 21st Trans, then to Fort Carson with the 4th engineer Bat., then went into the National Guard and volunteered for Desert Storm with a unit out of Red Oak Iowa-1168th Trans., after returning to the states moved out here to help my father and have since "inherited" his property. Nam era, Desert Storm vet. 
Left the service in late 91, E-5 over 8.

[ September 26, 2006, 01:10 PM: Message edited by: SilverFox ]


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## Ruben (Feb 11, 2006)

When I got into beekeeping this year I went to my chilrens doctor and got an Epi-Pen Jr for them. I live in the country 30 minuites from medical help. I got the pens just as a precaution, I would rather waste the $30 for the Jr Epi-Pens than to have a dead 5 year old because of my new hobby and know that an Epi-Pen may have saved thier live. That said I would only use it as a last resort.


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## SantaCruzBee (Apr 23, 2004)

Yeah, Jeffrey's right. Brent, hypotension, the drop in your blood pressure, associated with your allergic reaction/anaphylaxis and subsequent epinephrine injection was undoubtedly an aspect of your anaphylaxis and not the epi. The epi no doubt saved your life.

You make a good point there, Ruben.

Jeffrey, you're clearly very well informed yourself. I know you're an RN and as I remember an ER RN. We usually have some travellers here at Watsonville and the pay is good here, should you be looking for a traveller assignment...

I have been very lucky for approximately the last four years with a very stable and outstanding nightshift RN staff. Unfortunately tensions between the evening and night RNs have led to a change in the scheduling and I'm losing some of my best nurses either to dayshift or in one case pregnancy leave. From the point of view of the ER doc it's    
-Two of my best nurses are Bush supporters, one a Memphis transplant and the other a native of Santa Cruz Co., so it's not like we don't have republicans here.  

-Doug


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## gingerbee (Jul 22, 2006)

I have, I think, what is called large local reactions, hives and swelling around some sting locations. Anyway, I am enrolling in a course scheduled for November to become Epipen certified. It could save my own, or someone else's life. Are you teaching the course Ron?


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## Jeffrey Todd (Mar 17, 2006)

You know, SantaCruzBee, I would love to travel to your area except for 2 things: 1) My wife, child, and extended family would be always on my mind, and 2) I wouldn't be in Texas, and I don't know how long I could stand that.
Thanks for the good words. I have some knowledge, but nowhere near what you do, and it is good to have an authority around to confirm the facts to people.
Oh, and I really like the comment by Ruben. What is $30 for an Epipen compared to the potential loss of life without it?


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## Ruben (Feb 11, 2006)

>Oh, and I really like the comment by Ruben. What is $30 for an Epipen compared to the potential loss of life without it?


It's sort of like several years back I bought my first motorcycle and on the wall of the dealership they had five rows of helmets that ranged from 50$ to 350$. I asked the salesman what was the difference in all of these with different prices. He said if you have a 50$ head you buy the 50$ helmet. I bought the 350$ one! I guess I would just rather be safe than sorry.


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## buz (Dec 8, 2005)

Reading these lines makes me suspect that epipen I got in '94 probably has expired. That's okay--I haven't seen it in quite awhile. Next time I visit the doc--that'll be some good while--I can ask for another.

In Az. you can be charged for not giving aide. Must be something about the vast expanses between towns--the harsh climate--or what not. It's kinda the good samaritan law on epipen.
Lol


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## SilverFox (Apr 25, 2003)

I know when I lived in Colorado if someone was in trouble and you didn't stop to render aid and some thing happened to the person you passed, you could be held responsible, at least that was the way it was in the 'high country'. Especially during bad weather. For the basic reasons as AZ remote areas and long distance between town and houses.

[ September 28, 2006, 09:47 PM: Message edited by: SilverFox ]


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## sierrabees (Jul 7, 2006)

SantaCruzBee

When I was in veterinary practice in Half Moon Bay the local Med Clinic used to try to lure my staff away as soon as I had them well trained. Fortunately only one of them absconded over the years. Wish I could say the same for my bees.


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## Kevin M (Aug 11, 2006)

I always kept benadryl in the house and truck before i got my bees. I use to get these weird itch/hive attacks. Never did figure out the cause of them. I twice ate beef and had very bad reaction, my throat was starting to close up, i gulped down liquid benadryl and just lay still, i was okay in about 20-30 minutes. I'm sure that benadryl saved my butt...!!!


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## brent.roberts (Dec 31, 2005)

Thanks for clarifying the blood pressure drop. I guess I was not totally "dialed in" at the moment.

I support Ruben's postion. Keep the pen handy. I'm a private pilot and do offshore fishing and other crazy things. Keep a lot of safety stuff that I have not needed. .. yet.

Consider how you are going to feel when they zip up the body bag and you're standing there thinking... 
"For $30 bucks this wouldn't have happened."

How could you live with that ?


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## Michael Bush (Aug 2, 2002)

I think y'all need to get stung more often....


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## Laurence Hope (Aug 24, 2005)

A recent article in either ABJ or Bee Culture really explained different reactions to bee stings and who should get immunization therapy, etc. I still suffer from what the author calls "large local reactions" These have gone from a four day reaction to about a two day or so reaction. The authors stats suggest the future sting reaction probabilites and was the most encompassing of the situation I have yet seen. I don't think I need to run out and replace the epipen that I lost somewhere last season. Lightning probably will hit before I need it.


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## Judy Bee (Jul 4, 2006)

Michael,

I'd love a definitive answer to "how do you know you're not ever going to have a bad reaction even though you DO get stung often enough?"

I get stung often enough that I don't swell up any more - even when I purposely leave the stinger in until I'm finished working the bees. Is that enough desensitivity???

I bet an allergist or EM doc would say no.

-Judy


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## sierrabees (Jul 7, 2006)

Judy

Last year I was confident that I wasn't allergic. I got stung several times a week and five minutes after a sting I couldn't remember what part of my body got stung. In the late fall I opened up one of my hives with only a viel for protection and a short sleeved shirt. By the time I had the lid half off I had about twenty bees stinging my arm and dozens more looking for a place to sting. About six hours later I started having systemic reactions and spent most of that night at the clinic getting my blood preasure and pulse stabilized.

To answer your question, it's a lot like riding a motercycle. When you get good enough to think you will never have an accident it's time to sell the motercycle.


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## clear creek apiary (Jan 16, 2006)

Love all this discussion. I asked a question real early that never really got addressed and now that there are docs listening, I want to know:

How long after the posted expiration date can the Epi-pen still be relied upon????


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## Michael Bush (Aug 2, 2002)

>I'd love a definitive answer to "how do you know you're not ever going to have a bad reaction even though you DO get stung often enough?"

How do you know you won't get hit by a semi truck tomorrow? It's always a real possiblilty. I don't lose a lot of sleep over it.


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## Hobie (Jun 1, 2006)

MB, I like the way you think.

I assume one needs a prescription from a doc to get an epi-pen? I had considered getting one just in case a neighbor or guest has a reaction.


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## SantaCruzBee (Apr 23, 2004)

Lots of interesting discussion here since I last logged into this thread.

1) Jeffrey, bring your family out here for a summer vacation sometime. The travelling companies generally put people up. It's nice to see another part of the country even if your heart is in Texas. Mine is in California, but I lived in NY for ten years.









2) When is an EpiPen too old to use? Who knows? I wouldn't stake my professional reputation on it, but probably quite a while. Just have to decide on your comfort level with that one.

3) California too, at least on the roads. If you're the first on the scene of an accident, you're supposed to stop and give aid.

4) sierrabees: Yeah, people are always trying to steal staff from each other. My partners pay our physician assistants very well, because whenever they want a raise they go to the hospital in Santa Cruz and ask for jobs. They then come back to us and let us know they're worth more than what we've been paying. Oh well, generally they are excellent staff and it's much better to have a stable workforce than to be training new people who've never worked in an ER before constantly.

5) I have to agree with sierrabees that it is unpredictable how you'll respond to a bee sting any given time in your life no matter your level of regular exposure. Typically if you're not having escalating responses you have de-escalating responses, but no one can ever say for sure what a sting will do.

6) Ultimately, I tend to agree with Michael. You never know when you're going to be hit by that Mack truck. Part of enjoying life more is coming to accept that. As an ER doc you definitely begin to accept that 'cause bad things happen to good people all the time no matter what or how you plan differently.

Still, that is a matter of comfort level for each individual. I only got Epipens when I had 150 people over last year for my 50th birthday. -I hadn't planned to celebrate, just the opposite in fact, but my sister announced a few months before that she was flying from England with her family for the "party."

No one got stung, one of my RN's even had his 5 year old son hanging out literally at the entrance of my orneriest hive. Who knows why they were in a good mood that day? My Epipens will probably rot in the closet, at least I hope so. 

[ October 03, 2006, 07:54 AM: Message edited by: SantaCruzBee ]


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## sierrabees (Jul 7, 2006)

MB

RIGHT! You never know when you will get hit by a pickup truck, but it doesn't hurt to look before you step into the street.


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