Creating protocols for administering epinephrine in vials and things to consider.

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Q: Can a group of field researchers, certified in basic first aid, be allowed to have an epipen in a first aid kit at the location. There are no individuals with known allergies or prescription for epipen, but they will be in a remote location (2-6 hrs from emergency medical services.

Be direct and honest. Outline your training and your intentions. If your doctor has any questions direct her/him to the resources section our website for the Wilderness Medicine Field Protocols.

Q:  I went to the pharmacy looking for ampules of epinephrine, but they do not sell it. Instead, they sold me Xylocaina EV – HCl Lidocaine and epinephrine.. Each ml has Lidocaine HCl monohydrate equal to 20mg of HCl of Lidocaine and ‘bitartrato of epinephrine equal to 0.005mg of epinepherine. In an emergency situation, where…

Prednisone is an important adjunct in the management of anaphylaxis, especially where an evacuation is many hours away. For a dose or 2 in a person not allergic to them (yes, people can be allergic to prednisone), prednisone offers an excellent insurance policy. For most programs I would consider it to be optional.

Q: It seems counter intuitive that in anaphylaxis, the systemic capillaries dilate and the bronchial constrict. Histamine signals dilation (relaxation of the smooth muscles) of blood vessels, and increased permeability of capillaries, causing edema / inflammation. The bronchial tree also has smooth muscle around it, why would it constrict and the other relax?  Can the…

Q: With respiratory distress in anaphylaxis, if no epinephrine is available could an albuterol inhaler be used until the benedryl takes effect? It isn’t mentioned in the study materials or in the recent WAFA course I attended. Seems to me that inhalers are a lot more common than epi pens.

The allergen in shellfish is a protein, not iodine. Some people with iodine allergies really have a topical sensitivity to iodine (e.g., povidone iodine; Betadine), usually a much different kind of reaction than the immediate reaction found with anaphylaxis.

If there was nothing else available, would ingestion of a steroid cream be a suitable and effective alternative for prednisone?

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