# Anaphylactic Shock



## mtlad (Apr 12, 2010)

This is a survival issue that I have not seen discussed on this forum and should be of grave concern. I have been intensively researching this issue looking for ways to deal with this. Anaphylactic Shock can occur at anytime with any person, with almost any myriad of causes, this is of grave concern to me and others, I know many people that carry and epipen. I used to be a hunting guide and the hunters were instructed to carry and epipen for this if they knew that they were susceptible... I am in the mountains, many times 16 miles (usually uphill) from the nearest ANYTHING.

I would like to know if you can work a person in shock out of this if you open (forcefully) the airways and provide CPR in the case of heart failure?

Also:
I do have Benadryl and Dramamine in my first aid kit (not always there) will this help in true anaphylactic shock? With additional care?
I am going to raise these concerns with my doctor and see if he will prescribe an epipen for such cases - but I don't always have these things with me.
Will an epinephrine inhaler help?


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## Elinor0987 (May 28, 2010)

mtlad said:


> Will an epinephrine inhaler help?


From what I've read about them it could help. I wouldn't rely solely on the inhalers because if a person's airways are completely constricted, it won't do any good. It would be good to carry an alternative with them.


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## NaeKid (Oct 17, 2008)

My other-half carries an EpiPen in her purse and I carry antihistimines in pill-form due to my allergies (to just about every plant known in North America plus a few animals) ... 

I haven't heard of the inhaler system, but, it makes sense as my grandson needs one for his asthma.


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## CulexPipiens (Nov 17, 2010)

They might be able to work themselves out of it.

My wife has severe chocolate allergies. Eat some and her throat closes. The 2 times it happened she, obviously panicing, slammed walls and doors, punched the floor, etc. everything to get her body to pump as much adrenalin into her system as possible which helped to open the throat muscles enough so she could start breathing again. It's very difficult to watch knowing there is nothing I can do (911 had already been called). 

Usually it takes about 2-3 minutes from start to the point she's able to breathe a bit again... with paramedics usually arriving in 4-5 minutes. Both times they checked her over, confirmed that it was Anaphylactic Shock and recoomended hospital visit for a check over but she declined as the experience is exhausting (she says) and she just wants to go rest afterwards. 

We now have an Epipen for her once she finally saw her doctor about it. The incidents were 10 years apart. The second time was after a series of allergy tests all confirmed that she does not have a chocolate allergy. We're not believing those results.


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## CulexPipiens (Nov 17, 2010)

It brings up another issue. If SHTF happens and society collapses, you won't be able to replace the Epipen when it goes bad... and they do have a fairly short life... plus I believe they shouldn't be exposed to temperature extremes and such either.


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## TNmedicman (Nov 8, 2009)

I can tell you from field expierence that no amount of force will open an airway that has closed off caused by anaphylactic shock.Without Epi the only option is a tracheostomy and manual ventilation until medications can be administered. My suggestion is if you have an allergy, lay your hands on as many of the EpiPens as you can. Doctors will usually let you have scripts for as many of these as you want as they want them in convienent locations so they are readilly accessable. 

If its not truly anaphylasis then Benadryl will offset the body's respones to the allergen. I have seen many home remedies and none of the work for any amount of time. When the TSHTF stay away from what you are allergic to thats all I can say. Good luck.


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## tired-medic (Dec 16, 2008)

TNmedicman said:


> I can tell you from field experience that no amount of force will open an airway that has closed off caused by anaphylactic shock.Without Epi the only option is a tracheotomy and manual ventilation until medications can be administered.
> 
> If its not truly anaphylaxis then Benadryl will offset the body's respones to the allergen. I have seen many home remedies and none of the work for any amount of time. When the TSHTF stay away from what you are allergic to thats all I can say. Good luck.


I concur.You would need epi, benadryl, solumedrol, decadron and IV fluids, just as a start. A tracheotomy if you are slow, an endotracheal tube and BVM if you begin treatment quickly. Anaphylaxis IS NOT a treat and stay at home. Comparing Anaphylaxis and an allergic reaction is like comparing a hangnail to an amputation. Yes it is that serious.
I base this on my experience. Hope YMMV in a good way.


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## mtlad (Apr 12, 2010)

*tracheotomy*

Wow, I was wondering if a tracheotomy would get someone out of the mountains alive. I have no problem doing this especially if they would be dead without it... So do you suppose one should wait until the person looses consciences before performing this?


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## tired-medic (Dec 16, 2008)

There are many things going on during anaphylaxis.pulmonary edema(lungs filling with fluid), cell walls leak fluid pretty much all over ,vessels dilate. All these can cause dangerously low blood pressure. 
Now the good part. Anyphylaxis is kinda rare. I have had one occasion that the reaction continued despite a lot of epi,benadryl,and steroids. That patient was intubated and flown to a level 1 Trauma center, today he would have gotten a scene flight.
Guys the only thing I can really say is I would recommend that you learn all you can about first aid and wilderness emergency care. There are many things we take for granted today that have been and will be deadly without the advanced health care we have today.
Sorry to be so long and full of doom and gloom. I do not intend my statements to cause anyone to consider treating these conditions on their own without proper education and training, just to illustrate how dangerous this can be.


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## semperscott (Nov 7, 2010)

Good info! I continue to learn and expand my knowledge each and every time I visit the Forum. Thank you to all who take the time and effort to post info.


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## mtlad (Apr 12, 2010)

tired-medic said:


> There are many things going on during anaphylaxis.pulmonary edema(lungs filling with fluid), cell walls leak fluid pretty much all over ,vessels dilate. All these can cause dangerously low blood pressure.
> Now the good part. Anyphylaxis is kinda rare. I have had one occasion that the reaction continued despite a lot of epi,benadryl,and steroids. That patient was intubated and flown to a level 1 Trauma center, today he would have gotten a scene flight.
> Guys the only thing I can really say is I would recommend that you learn all you can about first aid and wilderness emergency care. There are many things we take for granted today that have been and will be deadly without the advanced health care we have today.
> Sorry to be so long and full of doom and gloom. I do not intend my statements to cause anyone to consider treating these conditions on their own without proper education and training, just to illustrate how dangerous this can be.


Thank you, doom and gloom is what I need, I can handle it... I am doing all I can do for education and training, any recomendations?


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## tired-medic (Dec 16, 2008)

I recommend an EMT Basic class as a starting point. It is the building block to start with. There are wilderness classes and such after that. The Paramedic class is the gold standard if you will but requires a medical control agreement or physician sponsorship. You would really need to at least find a place to volunteer to maintain certification for any EMT level.Talk to some of the local 
Emits and firemen, they usually will point you in the right direction. If these don't appeal to you get a first aid course.


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## TNmedicman (Nov 8, 2009)

tired-medic said:


> I recommend an EMT Basic class as a starting point. It is the building block to start with. There are wilderness classes and such after that. The Paramedic class is the gold standard if you will but requires a medical control agreement or physician sponsorship. You would really need to at least find a place to volunteer to maintain certification for any EMT level.Talk to some of the local
> Emits and firemen, they usually will point you in the right direction. If these don't appeal to you get a first aid course.


I will agree with that 100%. If you are not ready to dive into the EMT idea get with your local fire or EMS station and become a first responder. Its just a step below EMT basic and gives some very useful knowledge. You can also get some information on basic first aid from your local red cross chapter though I would strongly recommend going further in depth than just first aid. 
As always good luck and God bless


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## mtlad (Apr 12, 2010)

*Emergency trachiotomy*

How to Perform an Emergency Tracheotomy

I have taken quite a bit of training already, (I used to be a hunting guide AND spent the majority of my time in the wilderness) in addition, I research as much as I can, to be prepared as possible... where I live "wtshtf" can happen every day and you must be prepared for many things.

The tracheotomy is basic knowledge that every 10 year old should know, It is as basic as knowing how to stop bleeding using pressure points. An acquaintance of mine died simply because neither he, nor anyone else knew how to stop the bleeding of his femoral artery.


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## baarf (Jun 11, 2011)

No, an inhaler will not work. Anaphylactic shock is systemic. You need to administer a lot of epi fast, and of a particular dosage too. If this is a serious concern for you, then you need to have your doctor give you a script for an epipen, and show you how to use it. There is no substitute.

Benadryl is for after the initial episode wears off, and you will need further medical care.

If they are to the point you are doing compressions/ventilating you are too late.

CPR (in spite of what you see on TV) cannot bring you back from the dead.



mtlad said:


> This is a survival issue that I have not seen discussed on this forum and should be of grave concern. I have been intensively researching this issue looking for ways to deal with this. Anaphylactic Shock can occur at anytime with any person, with almost any myriad of causes, this is of grave concern to me and others, I know many people that carry and epipen. I used to be a hunting guide and the hunters were instructed to carry and epipen for this if they knew that they were susceptible... I am in the mountains, many times 16 miles (usually uphill) from the nearest ANYTHING.
> 
> I would like to know if you can work a person in shock out of this if you open (forcefully) the airways and provide CPR in the case of heart failure?
> 
> ...


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## baarf (Jun 11, 2011)

Well, again, in spite of what you see on TV, it is not as easy as it looks. There are many arteries in your neck that you can nick and then you also have your patient bleeding out. Sorry Macgyver, if you do anything, look into cricothyroid stick, and if you don't have the right training, leave this alone too.

You can take a paramedic course, and volunteer to work in many small ambulance companies, and you will probabaly get more experience than you ever want.
There is no replacement for displacement, or proper training



mtlad said:


> Wow, I was wondering if a tracheotomy would get someone out of the mountains alive. I have no problem doing this especially if they would be dead without it... So do you suppose one should wait until the person looses consciences before performing this?


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## mtlad (Apr 12, 2010)

*worst case*

Do you propose that I do nothing? you know, I have a lot of experience killing all kinds of animals by cutting their jugular vein - I know exactly where it is... trust me, if you miss the jugular vein -they live (except for rabbits - sometimes they just scare to death). SO### do you cut or not???


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## Momturtle (Nov 2, 2009)

This is an issue I have been researching lately since I had an anaphylactic shock reaction several weeks ago to an insect sting. Did not have an epipen - never had that kind of reaction before. Did have an epinephrine inhaler which I used immediately and multiple times, took benedryl (5) before my throat began swelling. Fortunately EMTs arrived with injectible epinephrine and saved the day. Talked about it later with several herbalist friends - hey, what herbs for anaphylactic shock guys? Closest they came was Foxglove extract - adrenalin precursors, very toxic and easily overdosed but just might do the trick and if you had a choice between that and dead . . . I am going to try growing some and making extract to have on hand. However, real world, real now I'm carrying an epipen everywhere and scanning around for stinging insects like a total freak. But I will not stay inside, I will garden and will continue to spend a great deal of time camping and doing various woods work. Not going to quit but I sure am more careful. We put up yellow jacket/eurasian fruit hornet traps - remove part of the problem anyway. I am looking into desensitizing shots - sounds like a prep thing to me.


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## rhrobert (Apr 27, 2009)

I am allergic to bee stings. I took desensitizing shots for 8 years...yes, 8 years, starting weekly, then going monthly, until finally the doctor said it wasn't going to help, and if I ever got stung, I better be within 15 minutes of a hospital. this was 35 years ago.

Used to carry the little red kit with the shot and pills, then carried the epi-pen for the last few years. Went to renew my pens, and even with my insurance, they are now over $200...I said forget it, when it's my time, it's my time I guess.

*EDIT*: After posting I took a look on the web for a way to get reduced cost epi pens and came across this:
http://www.freemedicine.com/medlist/EpiPen 2-Pak.shtml

Does anyone know anything about them? 80% off a 2 pack, or free after a $10 application fee. Seems too good to be true


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## SARSpecialist (May 31, 2012)

Did you mean tracheostomy or cricothyrodomy... there is a differance and Tracheostomy is very dangerous in the hands of a novice, chricothyrodomy is not mush better but the best of two evils.. .



mtlad said:


> How to Perform an Emergency Tracheotomy
> 
> I have taken quite a bit of training already, (I used to be a hunting guide AND spent the majority of my time in the wilderness) in addition, I research as much as I can, to be prepared as possible... where I live "wtshtf" can happen every day and you must be prepared for many things.
> 
> The tracheotomy is basic knowledge that every 10 year old should know, It is as basic as knowing how to stop bleeding using pressure points. An acquaintance of mine died simply because neither he, nor anyone else knew how to stop the bleeding of his femoral artery.


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## goatlady (Nov 7, 2011)

Momturtle, Be VERY careful when working with foxglove - it is the source for digitalis which is a potent heart medication. Very easy to go into arrythymia with that/extreme tachycardia and then into heart attack/failure. Based on my herbal knowledge/training only a VERY experienced knowledgable herbalist will suggest foxglove for usage.


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## stayingthegame (Mar 22, 2011)

CulexPipiens said:


> They might be able to work themselves out of it.
> 
> My wife has severe chocolate allergies. Eat some and her throat closes. The 2 times it happened she, obviously panicing, slammed walls and doors, punched the floor, etc. everything to get her body to pump as much adrenalin into her system as possible which helped to open the throat muscles enough so she could start breathing again. It's very difficult to watch knowing there is nothing I can do (911 had already been called).
> 
> ...


she may not be allergic to cocoa but to something else in the chocolate she ate that they did not test for. still best to stay away from it.


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## SARSpecialist (May 31, 2012)

There is a nation wide shortage on EPI.. that is driving the price WAY up.. our supplier said it may be next year before the manufacture get back on track.. so excpect Epi pens to stay over 100 dollars for a while.


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## JayJay (Nov 23, 2010)

SARSpecialist said:


> There is a nation wide shortage on EPI.. that is driving the price WAY up.. our supplier said it may be next year before the manufacture get back on track.. so excpect Epi pens to stay over 100 dollars for a while.


Tried Canada????


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## mtlad (Apr 12, 2010)

foxglove? Cricothyrotomy? Tracheotomy? ... Don't do it or you could kill them, don't bother they 'might' die anyway??? !!! Come on you guys, get real! Place yourself into this scenario, you are out of cell phone service, you are 20 miles from anywhere - your best friend gets stung by a bee and informs you that she left her epipen at home! *? ? ? What do you do ? ? ?*you have three minutes after her airways close...I think that I can do a tracheotomy...


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## jumper13 (Aug 13, 2011)

mtlad said:


> foxglove? Cricothyrotomy? Tracheotomy? ... Don't do it or you could kill them, don't bother they 'might' die anyway??? !!! Come on you guys, get real! Place yourself into this scenario, you are out of cell phone service, you are 20 miles from anywhere - your best friend gets stung by a bee and informs you that she left her epipen at home! *? ? ? What do you do ? ? ?*you have three minutes after her airways close...I think that I can do a tracheotomy...


Hi, Mtlad.

I have pretty extensive experience with both allergic reactions (which are mild) and anaphylactic shock (deadly without advanced medical life support). For an allergic reaction, you could treat it effectively with multiple doses of benadryl over a few hours. In the case of anaphylactic shock, a field tracheotomy or cricothyrotomy, in the hands of a novice, will simply *not* keep the patient alive, and when it is discovered that you were sawing on the patient's throat with a hunting knife, you will have a very interesting conversation with law enforcement. For a patient in actual anaphylactic shock, they will die unless they get epinephrine within a few minutes. There are numerous other problems going on besides and airway problem. Internal organs and vessels will begin to leak, fluid will start filling up the lungs, and vital organs will start shutting down. A cricothyrotomy will not stop any of this. Anaphylactic shock symptoms last for several days, and in the real world, the patient would only survive in the ICU with a constant flow of steroids, airway control, fluids, and multiple doses of epi. A cric will only buy you a couple of minutes for the required drugs to start flowing. Unless you have immediate access to epinephrine within 15 minutes, do not even think about cric-ing someone. Go get help!


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## mtlad (Apr 12, 2010)

jumper13 said:


> Hi, Mtlad.
> 
> I have pretty extensive experience with both allergic reactions (which are mild) and anaphylactic shock (deadly without advanced medical life support). For an allergic reaction, you could treat it effectively with multiple doses of benadryl over a few hours. In the case of anaphylactic shock, a field tracheotomy or cricothyrotomy, in the hands of a novice, will simply *not* keep the patient alive, and when it is discovered that you were sawing on the patient's throat with a hunting knife, you will have a very interesting conversation with law enforcement. For a patient in actual anaphylactic shock, they will die unless they get epinephrine within a few minutes. There are numerous other problems going on besides and airway problem. Internal organs and vessels will begin to leak, fluid will start filling up the lungs, and vital organs will start shutting down. A cricothyrotomy will not stop any of this. Anaphylactic shock symptoms last for several days, and in the real world, the patient would only survive in the ICU with a constant flow of steroids, airway control, fluids, and multiple doses of epi. A cric will only buy you a couple of minutes for the required drugs to start flowing. Unless you have immediate access to epinephrine within 15 minutes, do not even think about cric-ing someone. Go get help!


so, dont do anything...


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## SARSpecialist (May 31, 2012)

Do what you can.. however TRUE severe anaphylactic shock is not going to be corrected without immediate use of proper drugs, airway control, I have been a Medic for 21 years, I have seen 4 cases in 21 years that were IDLH.. Immediatly Dangerous to life and Health.. the other type I cant count the number of local reactions I have treated with shortness of breath, wheezing, swollen extremities, large rash.. Epi, Benadryl, and Steroids from the ER corrected the issue in a short time and the majority of those folks "thought they were going to die" when in fact it was systemic in nature and would have passed in time on its own.

If you have not seen someone who is conscious with a swollen and closed airway, I can promise you that you will not be able to hold them still to do any surgical manuver... UNTIL they loose consciuosness and then you have about 6 min until brain death.. not to mention Pulmonary edema, and all those issues listed in the previous discussion.. it is SHOCK.. the bodies cells are dying.. a trach or cric will not correct the underlying issues of a TRUE severe anaphylactic shock. 

In a SHTF scenario the person with a SEVERE anaphylactic shock would be left to die... this is called triage.. I cannot waste my limited equipment and supplies on someone who is beyond my care and has a very small change of survival if I have 10 others who I can care for appropriatly and have a chance to survive then they get my attention. I have had to do this in my real job and it sucks... use your equipment and talent for those who can survive.


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## Momturtle (Nov 2, 2009)

Am totally aware of foxglove dangers - especially in the hands of someone who is unaware of its potential. Actually, I expect in a total SHTF situation, the best I can hope for is, as my doctor says, not to get stung. I do have epi pens, which, in a true anaphylactic shock situation, is merely a stop gap until emergency aid can be reached so how much good that would do if there was no emergency room available . . . 

Allergist also recommended taking Claritin(Loratadine) which MAY lessen the allergic reaction enough to make it survivable along with the Benedryl. 

It is true that there is more than airway involvement going on, a month later, still having problems with circulation in my lower legs, kidneys recovering but suffering. My airway was only minimally impaired. It was not so bad once I lost conciousness -- just kind of faded out. Truly can't see it as a survivable event post-SHTF. Sigh.


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## jumper13 (Aug 13, 2011)

Momturtle said:


> Am totally aware of foxglove dangers - especially in the hands of someone who is unaware of its potential. Actually, I expect in a total SHTF situation, the best I can hope for is, as my doctor says, not to get stung. I do have epi pens, which, in a true anaphylactic shock situation, is merely a stop gap until emergency aid can be reached so how much good that would do if there was no emergency room available . . .
> 
> Allergist also recommended taking Claritin(Loratadine) which MAY lessen the allergic reaction enough to make it survivable along with the Benedryl.
> 
> It is true that there is more than airway involvement going on, a month later, still having problems with circulation in my lower legs, kidneys recovering but suffering. My airway was only minimally impaired. It was not so bad once I lost conciousness -- just kind of faded out. Truly can't see it as a survivable event post-SHTF. Sigh.


Hi, Momturtle.

For you, and everyone else out there with the possibility of having a severe allergic reaction or even anaphylactic shock, stock up on epi pens! If you have a physician that will prescribe injectible epi 1/1000 in multi-dose vials, that is even better (you have to draw it up and inject it yourself, but it is 1/10 the price). If you do get some injectable epi 1/1000, you must make sure that it is the correct concentration (1/1000, NOT 1/10,000), and follow the instructions from your physician. The normal injectible dose of epi 1/1000 is 0.3mg. Inject this wherever you would use an epipen.

Other meds that will help are benadryl in large doses (50mg for an adult, repeat in 1 hour as needed) and Pepsid AC (famotidine). Pepsid is not just for acid reflux! Get the fast-acting kind, not the extended release. Benadryl and Pepsid are histamine blockers, but they are different and attack the body's histamine response from two different angles. In the hospital, we use them both at the same time. Be careful, because it is possible to overdose on these drugs, so take them per the directions. Both are available over-the-counter.

Lastly, oral prednisone is also very valuable. Besides having numerous uses for other diseases, this steroid helps to reduce the massive inflamation caused by a severe allergic reaction and keep it from becoming anaphylactic shock. Your physician should be happy to prescribe you some, especially if you tell him/her that you are going on a "safari." However, be aware that prednisone is a fairly dangerous drug if misused, so follow your physician's directions.

If you see someone start to get itchy or start breaking out in a rash as a result of exposure to an allergen, then immediately give then the max dose of benadryl and pepsid, ang get your epipen ready. The benadryl and pepsid will most often cause the allergic reaction to subside. If they worsen, or you find them already having a raspy voice and trouble breathing, hit them with your epipen immediately and get ready to give a followup dose of epi. I hope you have enough epi to keep giving doses every 15 minutes unless the patient is getting significantly better. For benadryl and pepsid, repeat every hour or so while someone goes for help or the patient really improves. If you act fast enough, you can generally prevent an allergic reaction from becoming anaphyactic shock.

Here's a good Allergy Medical Kit for remote country or after SHTF: 
-4 Epi pens OR multi-dose injectible epi 1/1000 (keep away from light!)
-1 1cc tuberculin or insulin syrringes (at least 4)
-at least 12 benadryl (diphenhydramine) 25mg tablets. Consider a bottle of liquid benadryl. 
-at least 12 Pepsid AC (famotidine) tablets 
-prednisone, as prescribed for allergic reaction by your physician

Be prepared!


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## mtlad (Apr 12, 2010)

jumper13 said:


> Hi, Momturtle.
> 
> For you, and everyone else out there with the possibility of having a severe allergic reaction or even anaphylactic shock, stock up on epi pens! If you have a physician that will prescribe injectible epi 1/1000 in multi-dose vials, that is even better (you have to draw it up and inject it yourself, but it is 1/10 the price). If you do get some injectable epi 1/1000, you must make sure that it is the correct concentration (1/1000, NOT 1/10,000), and follow the instructions from your physician. The normal injectible dose of epi 1/1000 is 0.3mg. Inject this wherever you would use an epipen.
> 
> ...


Excellent Post, Thank you


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## ldmaster (Oct 10, 2008)

Folks, remember that epinephrine isn't a "one dose fixes everything" in most cases it's only a temporary fix, once it metabolises you'll need to re-dose until the substance that was injected is filtered out of your system. 

VERY hard to overdose on epi, btw. I don't worry about child doses, for instance, I've administered to young children using an adult pen - doesn't kill them. an adult epi pen delivers .3 milligrams and a child pen delivers .15. To get toxic a child would have to get much more than that. It's not very important, considering the clinical response is .30 milligrams for anybody over 30 kilograms and .15 for anybody under it. Don't go crazy, but dont go crazy worrying if you have to use an adult epi pen on a kid.

In some cases of severe reaction, you'll need to inject again in as little as 15 minutes. That's why you have to get someone to the hospital, as long as the substance they reacted to is still present, as soon as the Epinephrine wears off, they need re-dosing. The way they show it on TV is wrong, very wrong - epi-pen is used FIRST followed by rapid driving to the hospital.


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