Posts Categorized: Ask the Expert

Wilderness Medical Associates Experts answer your questions about wilderness medicine. Learn everything from when to use a tourniquet, what to do in the event of an avalanche, advice on giving CPR, and even how to locate a medical director.

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Q: Is Xylocaina EV – HCl Lidocaine and epinephrine a sufficient replacement of epinephrine ampules in a case of anaphylaxis?

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… Read more »

Q: What do you think about using prednisone in place of benadryl after epinephrine administration to treat anaphylaxis?

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: How can I use my RN degree to become an expedition medic?

Getting EMS training (Basic good; Paramedic much better) is still a good idea though, because you will get a level of practical training not provided in most RN programs. Becoming a nurse practitioner would be a great additional upgrade because on top of everything else you would have prescription writing capabilities.

Q: In anaphylaxis, why does the bronchial constrict and capillaries dilate?

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… Read more »

Q: If there is no epinephrine available, could an albuterol inhaler be used until benedryl takes effect in anaphylaxis with respiratory distress?

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.