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…


The legal system is the final arbiter of what abandonment is and when it has occurred. CPR, even good CPR, cannot sustain a person’s viability indefinitely. From published reports and studies, 30 minutes seems to be a reasonable time frame. Regardless of time, do not put yourselves or others at risk.

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.

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: 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…

We have steered away from silver sulfadiazine (e.g., Silvadene) at work for years. We have found that products like a vasoline-type gauze, e.g., Xeroform, is more comfortable and easier to maintain requiring fewer banadage changes.

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.

Jack, a Wilderness First Responder from Ohio, sent us this amazing story. “Hi there. Just wanted thank Wilderness Medical Associates (especially Phil, Robin, and Stephen) for their great instruction in last January’s Wilderness First Responder course at the University of Alabama. This summer, I utilized my skills in the backcountry to treat many routine issues,…

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.

Where’s the Man?: Belize Here is the man (with me) in front of and inside Actun Tunichil Muknal, a 3.5 mile long Mayan Cave in Belize in the San Ignacio Cayo. The ATM is a national archeological site and considered a “living museum” with over 1500 Mayan artifacts inside including 14 skeletons from sacrafices. 2nd…