RumiDude
Trail Wise!
Marmota olympus
Posts: 2,361
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Post by RumiDude on Apr 29, 2016 9:14:50 GMT -8
I have had two patients over the 22 years I have worked as a medic that presented with anaphylaxis. I would note that as a working medic for over 22 years, immadman has only had two people presented with anaphylaxis. Just two! One of them was a man who already knew he had a history of this reaction to stings and the other was an infant with initial onset to peanuts. In that light, carrying an epipen with no prior history of anaphylaxis seems like overkill as well as wasted money, weight, and bulk. The same applies to carrying nitroglycerin with having no prior history of heart problems. If you are worried about heart attack, then have all the tests done to check your heart out. You are more likely to have your heart attack at home rather than out in the backcountry. I still don't know how a person gets a prescription for nitroglycerin without ever having a heart issue. If a person has a known health issue, then they should take precautions, whatever that may involve. My SO has a bleeding disorder, so we take extra precautions to stop bleeding in case of an accident. The precautions we take would be overkill for most people. Certain activities might require special precautions. Doing trail work, we always carry a full FAK with special attention to caring for severe cuts as well as carrying radios to call for help. The most common unexpected needs in the backcountry are extra food and extra clothes. Following those would be a way to signal help, shelter, and fire building skills. A PLB or SPOT device might be the way to go if one is worried about "possible/maybe" situations. Taking a course in Wilderness First Aid might help as well. Rumi
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sarbar
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After being here since 2001...I couldn't say goodbye yet!
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Post by sarbar on Apr 29, 2016 11:22:58 GMT -8
Btw, the reason why Doctors prescribe Epi Pens so much now is that you never know how a reaction will occur.
For example, while my son has been ana twice, he hasn't (knock on wood) since he was 16 months old (he is 4 now). And I live within 1/4 mile of a fire station with full level EMT services. However, I won't take that chance!!
His first time the ana wasn't severe - it was bad, but not OMG!!!! The second time was really, really bad (a different allergen). They have no way to predict how he will react if it ever happens again. It could be minor. It could be very, very bad. So they prescribe. Because that one tube might save a life.
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Post by Lonewolf on Apr 29, 2016 12:32:16 GMT -8
is that you never know how a reaction will occur. Or when. When I had my first reaction and was given the script, the doc told me that while rare, anyone can have a reaction at any time even from something they've been exposed to for years without any reaction at all. For those who have never used an epipen, I had to once and never want to do it again. Using the pen was damn near as scary as the anaphlaxis. No, not the needle. The massive adrenaline boost.
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daveg
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Michigan
Posts: 565
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Post by daveg on Apr 29, 2016 16:31:10 GMT -8
I would also strongly suggest, if you do not already do so, carry aspirin with you in addition to the NTG. If you should experience any chest pain, take 325 mg of aspirin. If you are already taking low dose aspirin, go ahead and take 4 each (comes up to 324 mg). Apologies for getting too medical. I also did not mean to insult anyone's intelligence... Madman
I've been taking low dose aspirin for years. I take both that and full dose aspirin when I go backpacking. It seems quite a few of the older hikers I've met on the trail also carry aspirin. The nitro is a fairly recent addition to my first aid kit. No apology necessary. Always good to revisit this stuff on occasion.
If a person has a known health issue, then they should take precautions, whatever that may involve. A PLB or SPOT device might be the way to go if one is worried about "possible/maybe" situations. Taking a course in Wilderness First Aid might help as well. Rumi
A person can have a high 10-year risk of cardiovascular disease even though s/he has never evidenced any issues. My doctor has determined I am in that category and has advised me and prescribed medications accordingly. To my thinking, that means I have a known health issue and having aspirin and nitro in my first aid kit is a reasonable precaution when I go on a long distance hike. If I do have a cardiac event, a SPOT or PLB is not likely to provide the IMMEDIATE help I need. And I have taken a Wilderness First Aid course.
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Post by immadman on Apr 30, 2016 9:50:01 GMT -8
I would note that as a working medic for over 22 years, immadman has only had two people presented with anaphylaxis. However, I have seen several allergic reactions that required intervention. They were not anaphylaxis, which is a true life threatening emergency, but they could eventually go that way without the appropriate medications. Allergies can manifest themselves at anytime during one's lifetime. Just because one was not allergic beforehand, does not mean one will not be allergic now. My brother is an example, he used to be able to eat seafood with impunity and did so for many years. One day, after a meal, he started having difficulty breathing, broke out in hives, etc. Turns out he developed an allergy to seafood. I think that whatever makes one comfortable in the backcountry or even on a day hike, that is what one should take along. HYOH as we say.
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Post by cloudwalker on Apr 30, 2016 16:29:21 GMT -8
Thankfully I've never had a bad reaction to bees, wasps, hornets or other stinging insects other than mild pain and swelling. Last week I got stung by the pectoral fin of a catfish. Although I've been pierced dozens of times from these spiny fish I've never had a reaction like I did recently. The fin stuck in the heel of my hand near my wrist. Apparently, the venom was close to a vein and I experienced pain in my left arm for 2 days. I was actually concerned that I may have been having a heart attack as I didn't relate the sting to the arm pain but I didn't have any other symptoms that accompany a heart attack. Three days after the first incident I got stabbed again in my middle finger and realized it was the same pain.
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RumiDude
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Post by RumiDude on May 1, 2016 0:10:13 GMT -8
I have seen several allergic reactions that required intervention. They were not anaphylaxis, which is a true life threatening emergency, but they could eventually go that way without the appropriate medications. Anaphylaxis almost always presents fairly quickly within the first few hours. I have had several reactions to foods that were short of a full blown anaphylactic reaction but indicative of systemic reaction. They were all to do with food allergies. Hives is the most common indication of systemic reaction. Anytime a person gets hives they should be attentive to any further reactions. But again, local swelling from an insect bite or sting is just that, a localized reaction and not anaphylaxis. If a person gets stung on the leg and the leg swells up, that is a local reaction to the venom. If the back and chest break out in hives, they have difficulty swallowing, they start to wheeze, they vomit - that is anaphylaxis. Allergies can manifest themselves at anytime during one's lifetime. Just because one was not allergic beforehand, does not mean one will not be allergic now. My brother is an example, he used to be able to eat seafood with impunity and did so for many years. One day, after a meal, he started having difficulty breathing, broke out in hives, etc. Turns out he developed an allergy to seafood. If you read back at the top of page two in this thread, I related how my older brother also developed an allergic reaction to shell fish. He could have trouble breathing even if the knife which had been used to chop his salad had previously been used to cut up shell fish and not cleaned between the two uses. I completely understand that concept and don't deny it. But I don't carry an epipen just in case I eat shell fish and suddenly have an anaphylactic reaction. For the same reason I don't carry one in case I suddenly develop anaphylactic reaction to stings. I think that whatever makes one comfortable in the backcountry or even on a day hike, that is what one should take along. HYOH as we say. I am a STRONG advocate of HYOH. I realize sometimes we carry things out into the backcountry simply because they soothe our comfort level. But public discussion of taking epipens, nitroglycerin tablets, etc demands that we also consider them carefully. Sometimes peoples fears are unfounded and taking powerful medications which can produce powerful negative reactions needs to be balanced with sober reflection on the real dangers. Here are the ASCIA Guidelines for anaphylaxis emergency medication (adrenaline [epinephrine] autoinjector) prescription. I have known several individuals who carry epipens who do not meet these guidelines. Through conversation with them, I realized they simply had an unreasonable fear rather than a real need. By far the greatest danger in the backcountry is injury from falls. That is where most people should concentrate their energy in both prevention and possible treatment options in case of injury. Rumi
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Post by Lonewolf on May 1, 2016 3:52:09 GMT -8
I realized they simply had an unreasonable fear rather than a real need That would apply to my not leaving an itinerary because I'm confident in my abilities and am willing to accept the consequences if I'm wrong. "Unreasonable fear" is different for everyone.
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RumiDude
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Marmota olympus
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Post by RumiDude on May 1, 2016 8:11:18 GMT -8
That would apply to my not leaving an itinerary because I'm confident in my abilities and am willing to accept the consequences if I'm wrong. "Unreasonable fear" is different for everyone. I find it curious you don't leave an itinerary because you are confident of your abilities yet carry an epipen. Anaphylaxis can take more than one dosage of epinephrine to stem a reaction, so a person needs to carry two. Additionally, there is such a thing as biphasic or rebound anaphylaxis. The recurrence rate is up to 20%. That means you have 20% chance of anaphylaxis reoccurring within 8-12 hours after the initial anaphylaxis episode. That is why I say a person with a history of anaphylaxis should carry two or more epipens if out in the backcountry. 20% or 1 in 5 chance of biphasic anaphylaxis is a serious and not unreasonable fear. Steroids and antihistamines are generally given in addition to the initial epinephrine. Something is either reasonable or unreasonable. Only an individual's perception of the risk entailed is different for different people. Rumi
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Woodsie
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Colorado
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Post by Woodsie on May 2, 2016 17:43:52 GMT -8
Why I carry epipens... This happened a couple of years ago. I have no idea what bit me. My doctor thinks it was a spider bite. The bite What it did to me. I had some swelling around my neck and large red, itchy splotches all over my body The normal me
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