# EpiPen



## sampa (Mar 14, 2005)

I'd like to get a few of these to have on hand at home. As far as I know, neither I or anyone in the house is allergic, but I'd like to be prepared just in case. 

Where would I get them? 
Do I need to get a prescription? 
And, do they work on dogs or is there something else I should use?

Thanks,
sam


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## Steve_in_NC (Apr 9, 2000)

Unless among the 1% of the population that have true anaphylactoid reactions to hymenoptera stings, you do not need an Epipen. (The rate of schizophrenia in the population is also 1%). Just have some Benadryl on hand if have a significant reaction to stings. Until you are used to getting a few stings, you can even take the Benadryl 1 hour prior to working the bees.

And yes, Benadryl is also used in animals.


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## James Burke (Feb 4, 2002)

You will need a prescription. They're around $50.00+ or so. 

I try to time it so I get one in the winter. Usually I'm at the Dr.s office once or twice and I just ask for a prescription then. 

Insurance will usually pay for them if you have a good plan.

I wouldn't use one on the dog...better check with your vet.


Regards,

Jim


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## Jim Fischer (Jan 5, 2001)

EpiPens do require a prescription, are expensive,
and have fairly short shelf lives.

A point that is not well-known among beekeepers
is that a victim might need more than one EpiPen
injection in the time it would take to get
professional medical attention. See:
http://www.epipen.com/user.aspx

What I do is keep bottles of liquid benadrill
antihistamine all over the place. In glove
compartments, in equipment kits, even in each
yard's hidden "cache" of tools.

Someone who is really allergic can swig the
liquid even though their breathing and swallowing
is likely getting more difficult by the second,
so the trick is to get as much of the stuff into
them as possible, while ignoring traffic laws
on the way to the nearest medical professional
or emergency room. Drinking some should buy
the victim at least 20 mins of extra breathing
time, but not much more, so one must know where
the closest help is located.

Dialing 911 might help, but waiting around for
the rescue squad might not be as good a strategy
as heading towards help yourself. Trying to dial
911 while driving at top speed is not suggested.









To assure your victim of prompt attention,
several techniques are suggested below that
are anything but "polite". If you have a
true allergic reaction on your hands, you 
may be well advised to use all of them. 
Seconds count.

You park the car, leaving the keys in it,
right in front of the door. Yes, the space
is reserved for ambulances, but that's what
your car is today, isn't it? If anyone yells
at you, you don't even break stride, you just
yell "the keys are in it - please move it".
You carry the victim from the car. (More on
this below.)

Upon entering the emergency room, you do not
go to the window to "sign in". You walk straight
through the "do not enter" doors with the victim
in your arms, and yell "This man has an
anaphylactic reaction!" at the top of your lungs.

Carrying the victim in your arms is suggested even
if the victim is able to walk, as this prompts the
medical types in the room to focus on the victim
and do a quick triage. Not being able to breathe
is right up there with hemmoraging at the top of
the priority list, and a victim that is being
carried is given quicker attention than one that
is walking.

If the door does not open, and has one of those
keycard or punch-the-code locks, you kick it open
with the flat bottom of your foot. The latches
are magnetic, and even a badly-placed kick will
open the door. You won't break it, you simply
overpower the magnet's hold on the door.

The cops that tend to always hang around hospitals
may give you some grief about your behavior, but
you can always play dumb, and claim that you were
so concerned for the victim, you did not even see
the signs.

Unethical? Yes, but you don't want to take the
chance of not getting your victim instant
attention. Don't worry, if they have a gunshot
victim being stabilized, the people working on
the gunshot victim will not even look up.
Your task is to attract the attention of those
dealing with less-than life-threatening cases.


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## Karl (Jun 18, 2002)

Sounds as if you want to deliver a corpse to the hospital. Ambulances across the country carry multiple epipens and can assist a patient having trouble breathing. These attendants have the right equipment and training to safely transport the patient. A driver who is upset and excited is just as likely to cause an accident as get to a hospital safely. I do agree that a very small portion of our society will have a true reaction. I spent 20 years as an E.M.T. in rural Wisconsin and never witnessed a severe reaction.


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## honeyman46408 (Feb 14, 2003)

If I took Benadryl 1 hour before time to work the bees I would bee asleep before time to work them.


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## Sundance (Sep 9, 2004)

I agree with Karl and Jim....... I am 20 minutes from town. If it were a severe case with obsructed airway I would do the liquid benadryl and hop in the car calling 911 to have ambulance meet me in route.

Would an emergency trach open the airway?


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## Mabe (Mar 22, 2005)

Does anyone know if asthma inhalers would help at all...albuterol?


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## dickm (May 19, 2002)

An excellent question and one I never thought of. The inhalers are epinephrin and I think the epipens are the same. Any medicos out there?

dickm


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## Michael Bush (Aug 2, 2002)

Not all asthma inhalers are epinephrine. Some are. Some are albuterol or some other bronchodilator (usually a Beta Blocker of some kind). Some are just slow working anti-inflammatory drugs of one kind or another (usually steroids) and are useful for prevention but not emergency treatment. They do not all have the same effect nor do they all have an immediate effect.


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## Butterchurn (Jan 13, 2005)

I agree with Michael. Asthma inhalers are often NOT epinephrine. Check the label. I would prefer the epi-pen in any case. I just a script from my MD for one.

Ron


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## Beemaninsa (Jun 9, 2004)

I believe Primeatine Mist has epinephrine. I cannot find any solid information, but I have heard that epinephrine inhalers do not work on the triggers of anaphylactic shock as well as epi pens. That said, I believe that about 20 puffs = the same amount of epinephrine in 1 epi pen. 
A double dead dog mean hive was doing its best to induce anaphylatic shock on me today so that I could conduct a field test on the primeatine mist. Unfortunatley, I had little reaction but I did manage to create several new colorful words. I also carry benadryl, but will take Mr Fischers advise and start bringing the liquid.

Bob

A hive got a new queen today. By the way, bee suits/veils work much, much better when zipped up.


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## Sundance (Sep 9, 2004)

Inhalers are predominently albuterol sulfate.

But here is a interesting article on this subject.

http://www.wemsi.org/epinephrine.html


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## Beemaninsa (Jun 9, 2004)

Thanks sundance. Great article. Primatine Mist, active ingredient epinephrine 5.5 mg/ml.


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## Ben Brewcat (Oct 27, 2004)

That's a really good article. I use an inhaler for asthma (well, I use exercise but the meds help too), and can tell you that 20 inhalations, during a frightening anaphylactic reaction, is asking a lot. To get the aerosolized medicine into the lungs for maximum effect you really need to exhale fully, actuate the inhaler while inhaling, and then hold your breath. Rapid, shallow breathing such as one typically encounters in a respiratory emergency will often barely even clear the "dead space" of air in the mouth and trachea before getting into the zone where gas exchange really starts happening (and where the aerosol gets absorbed).

For someone in anaphylaxis, especially if they might be alone, the "idiot's guide" to sub-Q epinephrine injections is I think the way to go. My mother has had worrisome, escalating reactions in the past so she carries a pen. Though to be fair my parents travel prepared to do minor surgery or treat any illness you might conceivable encounter everywhere they go (both retired medicos)  .


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## Jim Fischer (Jan 5, 2001)

Hold on, folks...

While an inhaler might seem like a good idea,
let's look at the symptoms of a typical case
of an anaphylactic reaction that "needs attention".

What happens is that the victim has
trouble breathing. The victim is thereby
highly unlikely to be able to get a good "dose"
from an inhaler. The victim may panic, and
not know how to even use an inhaler. Worse
yet, the symptoms include "fuzzy thinking".
Not a good time to try and teach them how
to use an inhaler for the first time. The
victim may even be a small child, unable to
focus on what you want to tell them.

That's why I like liquid. You can toss them
a bottle, and say "drink this now". For kids,
you can just pour it in their mouth, and they
KNOW what to do. No chance of confusion about
what to do. Even someone who has real problems
breathing can still swallow a liquid.

I've had this happen to a guest who was so
stupid as to pop the cover off a hive in the
barnyard beeyard, just because he had "seen me
do it, and wanted to take a peek". Needless to
say, he lacked style and panache, he lacked
any protective gear, and he lacked the common
sense to ASK for a veil or even mention that
he wanted to see inside a hive. He got stung,
no surprise. He had a reaction, big surprise.
It took him a while to realize that he was in
trouble, and convince other party-goers that
he had not simply had too much to drink.
Lucky for him, we are only 5 minutes away from
the hospital.


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## Sundance (Sep 9, 2004)

There are no interactions with diphenhydramine and epinephrine to my knowledge. In fact they are administered by injection in combination frequently. They potentiate each others brohchial dialation efects.

Having an inhaler at hand makes sence due to its relative low cost. I think taking a swig of liquid benadryl (diphenhydramine) with as many inhalations as you can muster (up to 10 or 20) while waiting for transport is not a bad idea. Bottom line........ get to the hospital.

That said.......... If you know you are that allergic, have an epipen by all means. No question. If you are not sure you are allergic and intend on handling bees........ Get tested first.

For having on hand for a potential emergency it makes sence to me.

P.S. I was a pharmacy technician in a major hospital for 5 years. No expert, but gained a bit of knowledge on drugs.


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## dickm (May 19, 2002)

I think it merits saying that there is some danger from epipens. It's a big shot of adrenalin. If some conditions restrict activity because of heart problem a dose of adrenalin would be a stressor. Use them only when you need to. The other danger is that the poerson stung may feel better (after the pen is used) and you delay going to the hospital. The pen only gives you 20 minutes. Get there. The worst you can do is make a trip for nothing.

dickm


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## JohnJ4 (Nov 4, 2003)

Hi Folks,

This is my second season of beekeeping. I had several stings last year (no big deal) and was not too worried about a serious anaphylactic reaction. Then one day, I was alone just standing near the hives and got nailed. Within minutes I knew something was wrong. I drove myself to the ER and if traffic had been worse, I would have died. By the time I arrived, my blood pressure had gone down to almost nothing (60/40), and it was very touch and go. I ended up spending a night in our local hospital. If people want to know what I've done medically since then (and how I can still keep bees), I'm happy to tell, but it's not my point here.

Besides having this fun event, I'm a medical-guy, so have really researched this. Here's my recommendations:

1. Serious allergic reactions are thankfully rare. But they can happen - even to people who have been stung in the past without any problem. In fact, hobby beekeepers who get stung only rarely may be the folks who are at greatest risk. You should always be prepared to deal with anaphylaxis in yourself or someone else if you're around bees.

2. Know the symptoms. Most symptoms will happen within 5-20 minutes of being stung. Itching on the palms of your hands or soles of your feet is common. Many people (but not all) experience wheezing or tightness in their throat or chest; you may also have symptoms of a severe drop in blood pressure: nausea, trouble thinking, trouble talking, or dizziness - if you experience difficulty breathing or any of these symptoms, call for help and administer an Epi-Pen. 

3. Real basic stuff: If you're at the hives, always carry a cell phone and make sure someone knows where you are.

4. Epi-pens are an absolute must. Depending on your insurance, they can cost $50, but they can save a life. There is no substitute for an Epi-Pen. Benadryl may help a little and is great for longer-term local reactions. But, Benadryl takes 20 minutes to get into your bloodstream and it cannot deal with all of nearly instantaneous life-threatening consequences of anaphylaxis (like severe loss of blood pressure). If you don't have an Epi-Pen, please talk to your doctor about getting one and how to use it.

5. Anaphylaxis can lead to death within 15 minutes. Some unlucky folks survive but with severe brain damage due to the loss of oxygen. Why risk it? 

Best wishes and safe beekeeping.

John


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## Mabe (Mar 22, 2005)

One reason that I have bees now (one week and counting) is because my 83-year-old father developed a severe allergy to their sting after many happy years of beekeeping and he gave me his equipment. He probably would have continued with his hives anyway had the farm next door not become a neighborhood of McMansions with nervous owners and he decided that he couldn't afford the potential liability. Since I have asthma (no symptoms, thanks to a daily puff of Advair), this is a really interesting thread and I definitely think I'll have an over-the-counter epinephrine inhaler handy in addition to an epi-pen which I'll request from my doctor posthaste. Hopefully they will never be used, but I think all of us should consider the insurance this simple protocol may provide. The cel phone is another great idea. My place just happens to be on the one half mile of our road that seems to be blind to the tower!

Thanks to all of you for the great info.


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## dickm (May 19, 2002)

If you are going for the inhaler, why not go for something made for the problem...an Epipen. I suspect the medihaler would have too small a dose to rely on.

JohnJ,
Great post. May I excerpt it for our club newsletter?
Isn't the liquid Benadryl faster to get into the bloodstream. My son got nailed by a wasp and went to the ER in an ambulance. In the process he found a couple of dusty antihistamine tablets in the medicine cabinet. Doc said they could have saved him. I carry a bottle of the liquid...made for children.

dickm


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## Sundance (Sep 9, 2004)

If you are in a situation where you have no Benadryl (diphenhydramine)liquid, open the capsule or bite it open before swallowing. It tastes horrible but will be absorbed much more quickly. And take 2 capsules for a total of 50 mg.


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## SantaCruzBee (Apr 23, 2004)

I am an MD and a board certified ER doc and I have to agree with those in this forum who have recommended epipens. That is the fastest most effective treatment that can be given at home and for that matter in the ER. If we have an established IV, which takes time occasionally, we can give epinephrine intravenously and of course the effect is more rapid still. It is true that a person with heart disease may problems with epinephrine, but to breathe is important, it actually comes number one (airway and breathing) in our internationally recognized emergency medicine protocols for treating any patient in distress before circulation and bleeding.

Primatene mist may help if nothing else is available, but using an inhaler in an emergency is difficult and sometimes impossible for even experienced asthmatics during a severe attack. Primatene mist may be absorbed somewhat by the oral mucosae somewhat, so it may be at least of some benefit all the same. It is a crappy asthma medication, however, for any of you asthmatics who may be using it and for asthma you should really be using albuterol during asthma attacks.

Benadryl is a good medicine, but swallowing during an anaphylactic attack may lead to aspiration which will worsen the problem. It's onset is also slower than epinephrine and so it is more of a second line drug. If a person is able to swallow, however, it will help in the long run and so should be considered a very beneficial maneuver.

An emergency tracheostomy is not to be done by the untrained. Nice large blood vessels in the area of the neck and the likely result would be to quicken the afflicted person's demise.

Driving oneself or another to the hospital during an anaphylactic attack is also usually unwise for the reasons noted above by someone else. Paramedics do have the supplies and training to treat anaphylaxis well. However, there are undoubtedly times when driving oneself or another is necessary and must be done. I do agree with Jim that the best approach in such an emergency is to barge into the ER proper as it does tend to get our attention. If the situation doesn't actually warrant it we'll just throw you back out into the waiting room to wait your turn with everyone else.


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## Sharkey (May 27, 2004)

Hmmmmm

Well, as a Firefighter/first responder and former EMT, I also want to remind folks of the possible legal ramifications.

Since an Epipen _IS_ by prescription only, then "LEGALLY", the only person that it can be used on is the person for whom it was prescribed.

Yes, I have one. No, I am not allergic to stings. It is for the exact purpose we have all been talking about. For emergency use on someone ELSE who gets stung and experiences an anaphylactic reaction.

All I am trying to do is remind all of us that the possibility exsists for touble if you do choose to inject someone.


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## Sundance (Sep 9, 2004)

Here's my scenerio.........

No health insurance.

Live alone.

15 miles from town.

Love to have an Epipen but til' then I have to use best possible secondary solution.

Not allergic but seems like Primatine Mist and liquid benadryl make sence to have on hand.


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## power napper (Apr 2, 2005)

Real good information here everybody, thanks.


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