Medical Question (Anaphylaxis and Diphenhydramine)

[boogerhook]

Apparently, there is recently another OTC product, containing epinephrine, that is now safe for the ozone layer.

According to a press release from Nephron, its product, Asthmanefrin, was available in retail outlets beginning in late August. The inhaler contains 11.25 mg racepinephrine per 0.5 ml puff as an active ingredient. The solution is not made with CFCs or preservatives. It is available as a 10-vial starter kid that includes an atomizer and as a 30-vial refill kit. - See more at: http://www.pharmacytimes.com/news/New-OTC-Inhaler-on-Store-Shelves#sthash.PsQrHPUL.dpuf


WAYNO.

An adult epi pen delivers 0.3mg - this one has 40 times that amount per MD. It's probably an indication for how much more effective the uptake is when delivered IM.

 

[bolus]

Thanks, I dont really recommend the epi inhalers for asthma so I havent tracked any of the OTC meds.

Personally, I would not stock an emergency med kit with inhaled epi. If someone had asthma they should have their regular albuterol rescue inhalers. If they had severe allergies, they should have an Epi pen. I would not to even try experimenting in the field trying to get inhaled epi into someone having anaphylaxis. Better use of my time would be getting emergency personnel to our location.

 

[WAYNO]

My intention was not to replace an epi-pen with an inhaled product.

I have spent many years in the woods, far from medicine, and I know surprises happen. The one and only anaphylaxis episode I ever had, caused me to be prescribed an epi-pen. I can't imagine most folks who've never had such an episode would have access to an epi-pen, so my question continues to be, in an emergency, during an anaphylactic episode, if there's no epi-pen available, and there's always an additional chance someone just might have asthma medicine, would the OTC epi-inhaler be better than nothing, or an absolute waste?

In combat first aid, I was taught to use whatever I brung.

WAYNO.

 

[bolus]

I honestly dont know the efficacy of using an epi inhaler in the setting of anaphylaxis. Im thinking that the chance of it working is near zero. You have to absorb it systemically at a level to get enough into the blood stream. I just dont think you could get enough in that way. The person going through anaphylaxis is already going to have their respiratory system compromised.

Again, so much better to plan ahead and have the Epipen than be in any situation where you have no access to emergency services and only have a epi inhaler with you.

 

[CoastRange57]

The person going through anaphylaxis is already going to have their respiratory system compromised.

Again, so much better to plan ahead and have the Epipen than be in any situation where you have no access to emergency services and only have a epi inhaler with you.

Exactly. Anaphylaxis brings its own unique set of problems. Your previous comments about using the energy to find emergency services is right on. You are already in deep shot with the respiratory distress, and without suitable emergency interventions, i.e. proper equipment and med's, the chances of the respiratory distress is going to bring on cardiac issues, with the epi increasing this. The low O2 sats you will have would pretty much eliminate any effective delivery that way. There are a bunch of ways this situation can go bad on you real fast.

A person in anaphylaxis is going to need minimum of 2 and preferably 4 experienced EMS persons who have the right tools. Managing an airway takes 1 to 2 people, at least 1 more for IV access, 1 to ready meds, one to get high flow O2 going.....we used to run 2 to 3 people on the Rescue unit, and on anaphylaxis or similar calls, we would send an Engine company along with 3 to 5 more people.

Epi pen will be a life saver if you are more than 10 minutes way from SUITABLE EMS services.

 

[AMProducts]

So my wife has had some serious allergy problems in the past, up to and including anaphylaxis, she has an epi-pen that lives in the FAK, usually we keep them on a 3-year cycle, with the newest being first, the second oldest next and so-on. This is mostly so that there's always going to be a pen available, no matter what, even if it's an old pen, it's better than no pen.

Diphenhydramine has worked in the past to mitigate mild symptoms (where there was minimal distress) usually oral solution was the preferred route. These are similar to what I keep on hand:

http://www.drugstore.com/walgreens-...icine-single-dose-sugar-free-cherry/qxp523705

I think the ones I have I bought at walmart, or through one of the many EMT catalogs I get.

As for what I can remember from EMT training, the general rules are: Epi if available, O2, airway management, and rapid TX. While you may want to consider OP or NP airways, these won't do much good if the airway swells shut, as you're going to need either an ET or Combi-tube. Both of which require some skill to use.

For people with allergies, there really is no substitute for EPI, and either a cell/sat phone or a amateur radio that's going to let you call for help. (GPS to give locations also help) Carrying O2 Bottles, ET tubes, etc are really not practical.

However to deal with the OP's exact question: Carry Diphenhydramine, it's one of the 4 most important medicines in your kit. It may not help with the worst case of anaphylaxis but there are many not so bad conditions it can help with.

 

[Surf Rat]

Like others have pointed out, epinephrine is the treatment for anaphylaxis. Benedryl will not reverse a true anaphylactic reaction. If you have a history of severe allergic reaction, you must take seriously the need to have epinephrine on hand.

In my 30 years as a licensed and practicing paramedic, I have found true anaphylaxis lass common than other less severe forms of allergic reaction. Benedryl and bronchodialators such as albuterol have a proven place in treating allergic reaction below the threshold of anaphylaxis but for the patient near circulatory and respiratory collapse, there is no substitute for epinephrine.

 

[Riot]

Thank you all for the replies...

 

[Riot]

Update...I just wanted to let you all know that I followed through with everyone's advice and acquired an epi pen.

I value everyone's opinion and felt it necessary to follow through with an updated post.

Thank you all, epi pens will be further included with my preps

 

[Surf Rat]

Good job and nice follow through! Do your best to protect that Epinephrine Auto-injector from light and temperature extremes.

If you put it in your car during a family outing, keep it in a small cooler to protect it from temperature extremes. Carry some Benadryl along with the Epi. The adult dose for Benadryl is 50mg. or for pediatrics, 1mg per kilogram up to 50 mg. but you don't have to worry about being precise. Benadryl is fairly safe if you dose it on the high side. You can put the Benadryl in a small zip lock bag and tape it to the auto injector so you always have the two together.

 

[Sgt Nambu]

A handy rig to keep small items cool is an insulin carrier. Insulin must be kept cool so these things have a freezer pack in them. Easily keep your meds cool all day+. Theyre about the size of a long wallet.