Anaphylactic shock

13742 Views 43 Replies 25 Participants Last post by Michael Bush, Apr 28, 2014

sjbees

Discussion Starter · Apr 25, 2014

I was recently told about a backyard get-together where a child was stung by a bee or wasp and had a severe reaction. The host had an Epipen on hand for his own use, and administered it. The visit to Emergency spoiled the day, but the medic told the parents it was fortunate the child was given the injection.

Until a few years there were always a couple of Primatene Mist inhalers in my shed to cover such a contingency but it was banned, and no OTC substitute has appeared on the market. The Primatene tablets have to be digested, which would take way too long to help. A severe case requires epinephrine within 5 minutes to prevent death.

There is a bottle of children's liquid Benadryl on the shelf, but Benadryl is not much help in the case of a severe reaction. The dissolvable Benadryl strips were a far better alternative, but they have been removed from the market too.

For the last couple of years I've been playing ostrich and ignoring the possibility of an anaphylactic event. That's foolish, so am curious about what other beeks are doing to provide effective first aid in case of an incident.

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PA Pete

· #2 · Apr 25, 2014

I have a beek backpack I keep stuffed with stuff I might need in the field or on removals. It contains two epi-pens prescribed prophylactically by my doctor. I also carry a small bottle of liquid Benadryl (I think it's for children) and a pill bottle of other stuff I might need like Ibuprofen, Naproxen, my allergy meds (Allegra), aspirin. I also have a spare flashlight, some bandaids, a change of clothes, some water, and a knife in there.

I have never had a serious reaction and I hope I never do, but having this kit (especially the epi-pens) gives me at least some peace of mind that if I'm in the middle of a field somewhere and have a reaction, I at least have a chance of making it to a hospital. Anyone with me in my bee yard gets a tour of my pack (especially the epi-pens) and a lesson on how and when to use them.

As I mentioned, I also do removals. The homeowner also gets an epi-pen lesson along with an explanation of why I have them (just in case!) - which they have without fail appreciated.

Talk to your doctor and get a prescription for a pair (they come in a two-pack). The biggest pain of having them is that they expire within a year, so you have to buy them annually.

HTH

-Pete

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muusu

· #3 · Apr 25, 2014

You keep a fire extinguisher in your kitchen with the hopes of never using it but its still there.

I had never considered having an epi-pen as a precautionary measure but will now. An injury to myself I can live with (or not depending on severity), someone else getting hurt on my farm would be devastating.

BeeMoose

· #4 · Apr 25, 2014

I am a totally new bee keeper (only had them a little over a week). Even before I received my bees, I went to my doctor and asked for and received an RX for an epipen. If you look
on line you can find a manufacture's coupon that will leave you spending $10 or less for a two-pack. Do not think I am allergic, but pays to be ready.

JWChesnut

· #5 · Apr 25, 2014

Since the story is second hand, I suspect some details have been lost.

Anaphylactic shock from bees in children is vanishingly rare. (Check the epidemologic statistics yourself).

This is because Anaphylaxis must be "primed". The requisite antigens must be created and built up. Children are very, very unlikely to have experienced the exposure to create the antigens. The antigens are not present in the bloodstream in requisite numbers to induce a threatening condition until there has been some exposure.

Children are at risk for anaphylaxis from a host of other allergens (e.g. peanuts), where the exposure is repeated and frequent. Asthma is a co-factor in anaphylaxis, so the scenario of a naive bee-sting is not impossible, just very, very infrequent.

That said, I have personal experience with a child with an autistic condition being stung and going into a panic reaction that was difficult to "talk" the child down from despite no symptoms beyond a mild local reaction. It possible that this is the situation in this case -- a panic-induced asthma attack.

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Tenbears

· #6 · Apr 25, 2014

What I want to know Is How many Joules in an Anaphylactic shock?

peterloringborst

· #7 · Apr 25, 2014

Anaphylactic shock from bees in children is vanishingly rare. (Check the epidemologic statistics yourself).

Agreed. Also, I have made it a policy to never carry an Epipen (even though I am allergic to peanuts and could get one any day). If you have one, you have to keep it up to date, even if you never use it. If you use it on a stranger, you are practicing medicine without a license, and if something goes wrong you could be held accountable. Keep benadryl close to hand, and call 911 in a real emergency.

Just my $.02

MsBeHaven

· #8 · Apr 25, 2014

I too have an epi-pen and an epi-pen jr for emergencies. As a registered nurse, I want to be prepared for emergencies rather than work one.

And as for administration, when someone can't breathe, it's an emergency and the good sAmaritin laws will protect you if given in good faith.

WBVC

· #9 · Apr 25, 2014

JWChesnut said:
Since the story is second hand, I suspect some details have been lost.

Anaphylactic shock from bees in children is vanishingly rare. (Check the epidemologic statistics yourself).

This is because Anaphylaxis must be "primed". The requisite antigens must be created and built up. Children are very, very unlikely to have experienced the exposure to create the antigens. The antigens are not present in the bloodstream in requisite numbers to induce a threatening condition until there has been some exposure.

Children are at risk for anaphylaxis from a host of other allergens (e.g. peanuts), where the exposure is repeated and frequent. Asthma is a co-factor in anaphylaxis, so the scenario of a naive bee-sting is not impossible, just very, very infrequent.

That said, I have personal experience with a child with an autistic condition being stung and going into a panic reaction that was difficult to "talk" the child down from despite no symptoms beyond a mild local reaction. It possible that this is the situation in this case -- a panic-induced asthma attack.

Anaphylaxis may be rare but when it occurs it is 100% in that person. There are various types of immune response where one produces antibodies to an allergen. The mechanisms for anaphylaxis are not the same as for normal immune responses. As leukotrines are major players when one gets stung by a bee antihistamines such as diphenhydramine are of limited value.

PA Pete

· #10 · Apr 25, 2014

Tenbears said:
What I want to know Is How many Joules in an Anaphylactic shock?

42 (millijoules)

PA Pete

· #11 · Apr 25, 2014

It is truly unfortunate we live in such a litigious society - thank you MsBeHaven for the info on Good Samaritan laws - I hope they do help should I ever need to use my pen on someone else.

Note that the Benadryl I carry is liquid, which may or may not be faster-acting than a pill, but I like to think it is. Pretty sure it's also expired - need to pick up a new bottle!

-Pete

peterloringborst

· #12 · Apr 25, 2014

thank you MsBeHaven for the info on Good Samaritan laws

What info? As it happens these laws are different in different states. They apply primarily to para-medics and other trained volunteers. They do not prevent someone from suing you if your improvised medical assistance goes bad. They do not authorize you to buy an epipen for use on other people. An epipen requires a prescription and it is only authorized to be used on that person. If is expired and you poison someone, you could be held accountable. Frankly, I would not want someone to die in my hands, after doing the wrong thing. I always warn Newbees to get their own epipens if they are unsure. Administering an epipen for someone else to whom it belongs is a whole other matter.

tacomabees

· #13 · Apr 25, 2014

BeeMoose said:
I am a totally new bee keeper (only had them a little over a week). Even before I received my bees, I went to my doctor and asked for and received an RX for an epipen. If you look
on line you can find a manufacture's coupon that will leave you spending $10 or less for a two-pack. Do not think I am allergic, but pays to be ready.

A couple of things I think I know..

When I first started keeping bee's, I thought that I needed to have some epi's around, and talked to my Doc, who happily prescribed them "just in case"... I didn't think I was allergic, but also didn't know about my grandkids, etc.....but when I went to pick them up, they were going to cost me a couple of hundred bucks (others have found them for less), but that got me doing some reading.... Unless you know for sure that you are allergic to bee stings to the point of AS, you don't need them, everyone reacts to a sting....Locally (swelling at site), regionally (whole hand swells up), and systemically (AS)...Many people that I've talked to about bee's have said some version of "Oh, I'm allergic to bee stings!", but are mostly just confused to what that means when you ask a few more questions... "have you ever been stung?" "why, no", "Then how do you know you're allergic"? or, "yes, I have" "Then, did you have to go to the hospital?) "well, no, but I really swelled up and it hurt a lot!"

.....I'm not sure I would agree on the Good Samaritan rule for cover either, there are some differences on that family of laws from state to state. You might read up on those for your location. I don't know if I would administer a prescription drug (mine) to another person, or just get it out, ready to use and hand it to them and say "do this". Going into AS in not like a heart attack, it's generally progressive and keeping in mind, it's not a solution to the sting, just a little time in the bank to get somewhere else (ER). They do have a shelf life and a "best use by" date, but in the directions it also says there is a color change when they are no longer good. Stored properly, they appear to be able to exceed the "use by date"...After my first few stings, my reactions were less not worse...I also understand that the base of the poison for honey bee stings and wasp stings are very different, but don't know if that has anything to do on the efficacy of the dose in the Epi... I haven't been stung hundreds of time like others here, but I'm workin' on it.....02cnts

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PA Pete

· #14 · Apr 25, 2014

peterloringborst said:
What info?

Ummm... the suggestion that Good Samaritan laws might protect a good samaritan. I then used Google to research the law in my state. Wow. Really?

Santa Caras

· #15 · Apr 25, 2014

Tenbears said:
What I want to know Is How many Joules in an Anaphylactic shock?

LMAO! so were back to that again? Did ya spell it right??
Electricity baffles me so that whole other thread was more amusing than informing. lol

jbeshearse

· #16 · Apr 25, 2014

peterloringborst said:
What info? As it happens these laws are different in different states. They apply primarily to para-medics and other trained volunteers. They do not prevent someone from suing you if your improvised medical assistance goes bad. They do not authorize you to buy an epipen for use on other people. An epipen requires a prescription and it is only authorized to be used on that person. If is expired and you poison someone, you could be held accountable. Frankly, I would not want someone to die in my hands, after doing the wrong thing. I always warn Newbees to get their own epipens if they are unsure. Administering an epipen for someone else to whom it belongs is a whole other matter.

And with that response of completely wrong information any shred of credibility you may have had with me is gone Peter.

Good Samaritan laws apply only to non medical Samaritans. Professional medical personnel are not protected and are required to apply their knowledge in a medically sound way.

I guess some people they would rather watch someone die secure in the knowledge they won't get sued for trying to save someone. For me a life is more important than possible litigation. I just hope if I ever need emergency medical attention and a medical professional is not around that some Good Samaritan is there to help me and you are far away.

You need to stick to replying to those things you might actually actually know something about and quit spreading false information with possible life threatining implications.

Michael Bush

· #17 · Apr 25, 2014

I saw a picture of an epipen once...

What will you do if someone gets run over by a car in front of your house? Do you have tourniquets on hand? Large bandages? This happens to about 60,000 people a year in the US. About 4,100 of them die. In one year 15,517 people are murdered, 20,000 die from the flu, 90 people die from lightning strikes and 54 people die from stings of some insect or another (probably most are hornets or wasps).

jbeshearse

· #18 · Apr 25, 2014

Michael Bush said:
I saw a picture of an epipen once...

What will you do if someone gets run over by a car in front of your house? Do you have tourniquets on hand? Large bandages? This happens to about 60,000 people a year in the US. About 4,100 of them die. In one year 15,517 people are murdered, 20,000 die from the flu, 90 people die from lightning strikes and 54 people die from stings of some insect or another (probably most are hornets or wasps).

Michael, you make a good point about the overhype of the likelihood of death be beesting. BUT, most everyone does have a tourniquet and large bandages (belt and a shirt). Or we can use our finger to staunch blood flow, apply pressure etc. we do not have a comparable item that can be used I place of an epipen.

Also for Peter, I was wrong Most if not all the Good Samaritan laws also cover medical professionals when they are rendering emergency aid in an unpaid capacity.

I would encourage anyone who is interested or concerned to google "good Samaritan law" and your state name.

Tallykat

· #19 · Apr 25, 2014

For those considering an "epi-pen:" I do have one--the brand is Auvi-Q and it actually talks you through the injection. It was prescribed for me after I tested non-allergic to bees. Yes, I am one of those who always thought they were allergic to bees because I jumped off of a dog house when I was 7 into a "bees' nest" and was stung dozens of times. Then in college i was stung by an unknown insect and had a severe (but localized) reaction. The ER doc told me I was allergic to bees and wasps and I should have an epi-pen, but I only ever carried Benadryl because of the cost factor.

When I decided to become a beekeeper, I went to an allergist, who nearly laughed at me when I told him about my allergy. First of all, since honeybees do not nest in the ground, I was more likely stung by yellow jackets. Second, localized swelling, no matter how much, is not an "allergy" or in the same class as a systemic anaphylactic response. He did however recommend an epi-pen, not just for me, because you can convert at any time to an allergic response, but because my mom lives with me (and her 75 lb labrador). He did not tell me that the injectible was for me alone.

My allergist told me to keep it on hand, keep it up to date, and NEVER ADMINISTER IT unless specifically directed to by medical personnel. In other words, people do not get stung and drop to the ground clutching their throats--although I'm sure one person knows one person that it happened that way. You WILL have time to call 911. You WILL have time to give the details to a knowlegable person who can instruct you on whether you should give an injection or not. Epinephrine has its own risks and side effects. Any one given epinephrine will have to be taken to the hospital and observed--as much for the reaction to the shot as to the sting. Following the instructions of emergency medical personnel is not practicing medicine without a license.

I think it gives my mom comfort to know the epi-pen is on-site in case something happens. And yes, my vet told me that if the dog seems to be reacting to a sting, we can call a vet receive instructions on whether we need to use it. It helps that we had a coupon so it was no cost to us.

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shinbone

· #20 · Apr 25, 2014

I feel sorry for the soul of the person who would rather watch someone die in front of them for fear of litigation than take a few simple steps to save their life.

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