Anaphylactic shock

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hedgerow pete 

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Ok people,

Here’s another hedgerow lecture coming up and one that I think every single one of you should read twice and get it printed out and either given to EVERY ONE at or near your hives and the lecture is:

Anaphylaxis
Anaphylactic reaction or known to most as Anaphylactic shock

( god I love spell checkers cause I keep calling it Annie shock, and at the bee shed, easier when you have to control a speech impediment)

In England, mortality rates for anaphylaxis have been reported as up to 0.05 per 100,000 population, or around 10-20 a year.[5] Anaphylactic reactions requiring hospital treatment appear to be increasing, with authorities in England reporting a threefold increase between 1994 and 2004

So lets start with the general cut and paste stuff off the internet and the technical jargon and I will try to break it down to hairy brummie speak.

Ps. Don’t be reading this whilst someone is on the floor going blue!!! Remember the seven P’s

Anaphylaxis is a severe, whole-body allergic reaction to a chemical that has become an allergen. After being exposed to a substance such as bee sting venom, the person's immune system becomes sensitized to it. On a later exposure to that allergen, an allergic reaction may occur. This reaction happens quickly after the exposure, is severe, and involves the whole body.

Tissues in different parts of the body release histamine and other substances. This causes the airways to tighten and leads to other symptoms.
Pollens and other inhaled allergens rarely cause anaphylaxis. Some people have an anaphylactic reaction with no known cause
.
Anaphylaxis is life-threatening and can occur at any time. Risks include a history of any type of allergic reaction.


Symptoms
Symptoms develop rapidly, often within seconds or minutes. They may include the following:
• Abdominal pain or cramping
• Abnormal (high-pitched) breathing sounds
• Anxiety
• Confusion
• Cough
• Diarrhea
• Difficulty breathing
• Difficulty swallowing
• Fainting, light-headedness, dizziness
• Hives, itchiness
• Nasal congestion
• Nausea, vomiting
• Palpitations
• Skin redness
• Slurred speech
• Wheezing

Signs and tests
Signs include:
• Abnormal heart rhythm (arrhythmia)
• Fluid in the lungs (pulmonary edema)
• Hives
• Low blood pressure
• Mental confusion
• Rapid pulse
• Skin that is blue from lack of oxygen or pale from shock
• Swelling (angioedema) in the throat that may be severe enough to block the airway
• Swelling of the eyes or face
• Weakness
• Wheezing

Treatment

Anaphylaxis is an emergency condition requiring immediate professional medical attention. Call 999. In europe that number is actual 112 and cause we brits are so nice to our lesser European underlings did you know that if you dialed 112 in Blighty or on you mobile you will get connected to our emergency services operator. Aren’t we nice!!

Check the person's airway, breathing, and circulation (the ABC's of Basic Life Support). A warning sign of dangerous throat swelling is a very hoarse or whispered voice, or coarse sounds when the person is breathing in air. If necessary, begin rescue breathing and CPR.

1. Call 999
.
2. Calm and reassure the person.

3. If the allergic reaction is from a bee sting, scrape the stinger off the skin with something firm (such as a fingernail or plastic credit card). Do not use tweezers -- squeezing the stinger will release more venom.

4. If the person has emergency allergy medication on hand, help the person take or inject the medication. Avoid oral medication if the person is having difficulty breathing.

5. Take steps to prevent shock. Have the person lie flat, raise the person's feet about 12 inches, and cover him or her with a coat or blanket. Do NOT place the person in this position if a head, neck, back, or leg injury is suspected, or if it causes discomfort.

DO NOT:
• Do NOT assume that any allergy injections the person has already received will provide complete protection.

• Do NOT place a pillow under the person's head if he or she is having trouble breathing. This can block the airways.

• Do NOT give the person anything by mouth if the person is having trouble breathing.

Paramedics may place a tube through the nose or mouth into the airways (endotracheal intubation) or perform emergency surgery to place a tube directly into the trachea (tracheostomy or cricothyrotomy) it is not recommended that we try with 2 foot of dusty half inch hose pipe from the water butt

There are several different sorts of Annie shock which I never knew so I have pasted them here

Biphasic anaphylaxis
Biphasic anaphylaxis is the recurrence of symptoms within 72 hours with no further exposure to the allergen. It occurs in between 1–20% of cases depending on the study examined. It is managed in the same manner as anaphylaxis.

Anaphylactic shock
Anaphylactic shock is anaphylaxis associated with systemic vasodilation that results in low blood pressure. It is also associated with severe bronchoconstriction to the point where the individual is unable to breathe.

Pseudoanaphylaxis
Main article: Pseudoanaphylaxis
The presentation and treatment of pseudoanaphylaxis is similar to that of anaphylaxis. However, it does not involve an allergic reaction but is due to direct mast cell degranulation. This can result from morphine, radiocontrast, aspirin and muscle relaxants.

Active anaphylaxis
Active anaphylaxis is what is naturally observed. Two weeks or so after an animal, including humans, is exposed to certain allergens, active anaphylaxis (which is simply called "anaphylaxis") would be elicited upon exposure to the same allergens.

Passive anaphylaxis
Passive anaphylaxis is induced in native animals that receive transfer of the serum experimentally from sensitized animals with certain allergens. Passive anaphylaxis would be provoked in the recipient animals after exposure to the same allergens

Signs and symptoms of shock

Anaphylaxis can present with many different symptoms due to the systemic effects of histamine releaseThese usually develop over minutes to hours. The most common areas affected include: skin (80% to 90%), respiratory (70%), gastrointestinal (30% to 45%), heart and vasculature (10% to 45%), and central nervous system (10% to 15%)..

This means ladies that if you just happen to have brad pitt walking past when one of your bees stings him, you have for medical reasons only of course, remove all his clothes whilst looking for a skin reaction as a way of preventing Annie shock!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Heres the medical talking bit I dont understand as my brain cells heat up whilst trying to read it

Pathophysiology
Anaphylaxis is a severe, whole-body allergic reaction. After an initial exposure "sensitizing dose" to a substance like bee sting toxin, the person's immune system becomes sensitized to that allergen. On a subsequent exposure "shocking dose", an allergic reaction occurs. This reaction is sudden, severe, and involves the whole body.
Classified as a type I hypersensitivity, anaphylaxis is triggered when an antigen binds to IgE antibodies on mast cells based in connective tissue throughout the body, which leads to degranulation of the mast cells (the release of inflammatory mediators). These immune mediators cause many symptoms, including common symptoms of allergic reactions, such as itching, hives, and swelling. Anaphylactic shock is an allergic reaction to an antigen that causes circulatory collapse and suffocation due to bronchial and tracheal swelling.
Different classes of antibodies are produced by B cells to bind and destroy substances that the immune system has identified as potentially dangerous pathogens. Each B cell produces thousands of identical antibodies that can attack a single, small part of a pathogen. In susceptible individuals, antibodies may be produced against innocuous antigens or allergens, such as components of common foods or plants. One class, the IgE antibodies, can trigger anaphylaxis. Production of IgE antibodies may persist for months, even in the complete absence of the allergen. These IgE antibodies associate with a receptor on the surface of mast cells. If the antibody binds to its specific antigen, then the antibody triggers degranulation of the mast cell.
Mast cells become the major effector cells for immediate hypersensitivity and chronic allergic reactions
Mast cells are large cells found in particularly high concentrations in vascularized connective tissues just beneath epithelial surfaces, including the submucosal tissues of the gastrointestinal and respiratory tracts, and the dermis that lies just below the surface of the skin, They contain large granules that store a variety of mediator molecules including the vasoactive amine histamine. Histamine causes dilation of local blood vessels and smooth-muscle contraction. Other molecules in the mast cell granules include lipid inflammatory mediators such as prostaglandin D2¬ and leukotriene C4 as well as tumor necrosis factor-α (TNF-α), a cytokine. The importance of TNF-α is most noted in the activation of the endothelium. TNF-α, the prototype of the TNF family cytokines, can induce endothelial cells to present E-selectin and ICAM-1, both of which are cell adhesion molecules (CAM) that mediate the “roll and stick” mechanism of leukocyte extravasation, termed diapedesis. While this process is essential for the recruit of leukocytes to a localized area during an inflammatory response, it can be catastrophic in cases of systemic infection. Point in case, the presence of said infection in the bloodstream, or sepsis, is accompanied by the release of TNF-α by macrophages in liver, spleen, and other systemic sites. The systemic release of TNF-α causes vasodilatation, which leads to a loss of blood pressure and increased vascular permeability, leading to a loss of plasma volume and eventually to shock.
TNF-α, along with the other aforementioned mast cell granule contents become exocytosed upon activation of the mast cell. Activation is achieved only when IgE, bound to the high-affinity Fcε receptors (FcεR1), are cross-linked by multivalent antigen. The FcεR1 is a tetrameric receptor composed of a single α chain, responsible for binding the IgE, associated with a single β chain and a disulfide linked homodimer of γ chains that initiate the cell signal pathway. Once the FcεR1 are aggregated by the cross-linking process, the immunoreceptor tryrosine-based activation motifs (ITAMs) in both the β and γ chains are phosphorylated by LYN, a protein tryrosine kinase (PTK) belonging to the Src family. The ITAM domain is simply conserved sequence motif generally composed of two YXXL/I sequences separated by about six to nine amino acids, where Y is tyrosine, L is leucine, I isoleucine, and X any amino acid. Their phosphorylation in the β and γ chains provide high-affinity docking sites for the SH2 domains of additional LYN and the SYK (spleen tyrosine kinase), respectively. These SH2 domains (Src homology 2 domian) are found in a numerous cell-signaling proteins and bind to phosphotyrosine through a very specific sequence. As the signal continues to propagate through the pathway, the membrane-bound molecule, named linker for activation of T cells (LAT), is phosphoyraleted by the LYN and SYK and acts as a scaffold protein, organizing other molecules that complete the degranulation of mast cells, as well as promote further cytokine production, The most notable of these LAT affected molecules is Phospholipase C (PLC). As in many cell signaling pathways PLC hydrolyzes the phosphodiester bond in phosphoatidylinositol-4,5-bisphosphate [PI(4,5)P¬¬2] to yield diacylglycerol (DAG) and inositol-1,4,5-triphosphate (IP¬¬3)¬. A well-characterized second messenger, IP¬3¬, signals the release of calcium from the endoplasmic reticulum. The influx of cytosolic Ca2+ and phosphoatidylserine further active Phosphokinase C (PKC) bound to DAG. Together, it is the cytosolic Ca2+ and PKC signal the degranulation of the mast cell.4
Although less well-mapped, similarly prevailing cell signaling molecules, such as Ras, a monomeric G protein, SOS (son of sevenless homologue) and MAPK (mitogen-activated protein kinase) lead to the upregulation of cytokines and the previously mentioned eicosanoids, prostaglandin D2¬, and leukotriene C4.
While this cell single pathway is sufficient to induce degranulation, it is not the only effective mechanism. Studies with LYK-deficient mice have shown that degranulation is still inducible. Consequently, several alternative pathways leading to mast cell degranulation have been mapped. The first of which, dubbed the “complementary” pathway, determined that the crosstalk between LYK and another Src family PTK, called FYN, is an essential interaction to degranulation, along with the preferential activity of Phosphoatidylinositol 3-kinase (PI-3K) over PLC. Studies have also elucidated subsequent pathways that utilize the integration of G-protein-coupled receptors to mediate the degranulation and cytokine production mechanism of activated mast cells.
IgE binding to FcεR1 in the absence of a specific antigen still induces the up-regulation of FcεR1 surface expression in mast cells through autocrine signaling of cytokines. However, not all IgE are equally capable of inducing such as secretion. Therefore, researchers have divided all invariant IgEs into two major categories: highly cytokinergic(HC), where the production and secretion of various cytokines and other activation events including degranulation is inducible, and poorly cytokinergic (PC) in which no autocrine signaling is observed. The former, HC IgE, brings forward a reaction in which cytokines are exocytosed and act as autocrine and paracrine signaling molecules. As such, mast cells with bound HC IgE attract other mast cells even in the absence of antigen crosslinking. While the exact structural features that account for the function differences between HC and PC IgE has yet to be determined, their effects are thought to be the result of intracellular cell signaling. IgE binding to FcεR1 leads to a greater stability of the mast cell and increased production of surface receptors. The newly expressed FcεR1 then aggregate on the surface, independent of antigen binding. The cell signaling pathway then initiates and appears to involve components used in the alternative mechanisms. Mast cell migration is dependent on soluble factors such as adenosine, leukotriene B¬4, and other chemokines, whose secretion is dependent upon the activity of LYN and SYK. The degranulation of mast cells in the absence of antigen can then be initiated by G-protein-coupled receptors (GPCR) stimulated by soluble factors agonists and completed by downstream activity of PI3K.


Now if there is someone on the forum that can understand that lot and it does make sense, PLEASE DONT EVER TRY TO EXPLAIN IT TO ME, my brain would melt. To me that was Vogon poetry.


Anaphylactic shock explained in hairy brummie

Anaphylactic shock is a severe allergic reaction that may occur following an insect sting or after eating certain foods, such as peanuts.
The reaction can be fast, developing within seconds or minutes of contact with the trigger. Triggers include nuts, shellfish, eggs, wasp and bee stings, latex and certain medications.

During an anaphylactic reaction, chemicals are released into the blood that widen (dilate) blood vessels and cause blood pressure to fall. Air passages then narrow (constrict), resulting in breathing difficulties. In addition, the tongue and throat can swell, obstructing the airway.

A casualty with anaphylactic shock will need urgent medical help as this can be fatal.

Signs and symptoms
• Anxiety
• Breathing difficulties and wheezing
• Blotchy, red skin or itchy rash
• Swollen face, neck, hands or feet
• Swelling of tongue and throat with puffiness around the eyes
• Fast pulse
• Abdominal pain, vomiting and diarrhoea

If you suspect a casualty is suffering from anaphylactic shock follow the steps below:

1. Call 999 (or 112)

2. Check if the casualty is carrying any medication. Some people know they suffer from this condition and carry epinephrine (adrenaline) with them, often in the form of a pre-loaded syringe called an auto-injector. You can help the casualty to administer the medication or, if you are trained to do so, administer it yourself.

3. Help the casualty into a sitting position to relieve any breathing problems.
Shock

Signs of shock
Early signs of shock include:
• shallow, fast breathing
• rapid pulse becoming weaker
• pale, cold and sweaty skin – tinged with grey.

As it develops you will notice:

• restlessness
• severe thirst
• yawning and sighing.

Treating shock
1. Treat any obvious injuries.
2. Lay the person down on a blanket or rug to keep them warm. Reassure them.
3. Raise and support their legs above the level of their heart.
©Info
4. Loosen any tight clothing.
5. Call an ambulance.
6. Do not give them anything to eat or drink because they may later need a general anaesthetic in hospital.

Types of shock

Do not confuse shock with being psychologically shocked. The first is a physical response associated with an injury or condition (which can be life threatening if not appropriately treated); the second is an emotional response.

Or basicly ,
Get them away from your bees
Lie them down so they are comfortable and feet slighty raised or in to the recover position.
I have found with some people with difficulties breathing sitting on the floor is better for them to breath in.
Epi pen or not.
well or not.
I would MAKE THEM GO TO HOSPITAL or call for a ambalance for them.
NEVER NEVER EVER BELIVE THEM WHEN THEY SAY ITS OK I FEEL FINE,
If they were, you would not be dealing with a shock patient or rubbing fresh honey into Brad Pitts chest to help his shock!!
Down girls



So we have now the epi pen cut and paste bit

EpiPen® and EpiPen Jr® Auto-Injectors (0.3 and 0.15 mg epinephrine) are for the emergency treatment of severe allergic reactions (anaphylaxis) caused by allergens, exercise, or unknown triggers; and for patients who are at increased risk for these reactions.

EpiPen and EpiPen Jr Auto-Injectors are designed for you to use immediately in an emergency, to treat an allergic reaction fast and give you time to get to a hospital or medical center.

Important Safety Information

Each EpiPen Auto-Injector contains a single dose of a medicine called epinephrine, which you inject into your outer thigh. DO NOT INJECT INTRAVENOUSLY. DO NOT INJECT INTO YOUR BUTTOCK, as this may not be effective for a severe allergic reaction. In case of accidental injection, please seek immediate medical treatment.

Epinephrine should be used with caution if you have heart disease or are taking certain medicines that can cause heart-related (cardiac) symptoms.
Side effects may include an increase in heart rate, a stronger or irregular heartbeat, sweating, nausea and vomiting, difficulty breathing, paleness, dizziness, weakness or shakiness, headache, apprehension, nervousness, or anxiety. These side effects usually go away quickly, especially if you rest. If you have high blood pressure or an overactive thyroid, these side effects may be more severe or longer lasting. If you have heart disease, you could experience chest pain (angina). If you have diabetes, your blood sugar levels may increase after use. If you have Parkinson's disease, your symptoms may temporarily get worse.

I have attached several videos to this and the library section.
But in hairy brummie speak.

Stick the epi pen into the front or just to the front off side of the persons leg
DO NOT JAB THEM IN THE BUM AS IT DELAYS THE CHEMICALS GETTING TO THE VEIN AND ARTERY ON THE INSIDE OF THE THIGHS
It is better if they can stick them selves. Instead even if you have to help steady their hands doing it.


Ladies try to remeber that your only supposed to massage Brad’s the injection point after the injection not before and your not supposed to do that for hours either!!


In all the first aid I have been given and trained in.

The one big thing you must always remeber with epi pens and shock.

Is that the epi pen is only designed to keep them alive long enough for the ambalence to arrive or for them to get to hospital, epi pens do not cure annie shock at all, it just delays it!!!!!

There are many training centres or such as the red cross, St Johns etc that do a specific epi pen day course and for about £125 they are well worth going on, even if its only once.


and now the video links for you to watch..
[ame]http://www.youtube.com/watch?v=ZR5c5VP2rOs[/ame]

I have never seen this version of the epi pen but i have linked it just incase

[ame]http://www.youtube.com/watch?v=Vv11P88J03Y[/ame]

and these are the red cross links

http://www.youtube.com/user/BritishRedCross#p/u/30/uCDa-AhrjHo

http://www.youtube.com/user/BritishRedCross#p/u/30/uCDa-AhrjHo
 
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interuption of Ca2++ pathway and annie shock

Adder venom also uses this pathway....... I have no idea how I know that!

however another venomous beast to keep at arms length.....................
 

Wraith 

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Can I also add, using 112 on a mobile phone will allow the services to trace your phones location.
 

nelletap 

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It is certainly a worry when working with bees that someone might react badly. It would be interesting to know whether the increase in annie shock (you are so right Pete, what a mouthful for the proper word) has been broken down into causes. are there any medics on here who are in a position to comment from experience? Most of those who I have come across react to peanuts or other nuts. (I was a teacher not a medic so we all had to be trained with an epipen and told which children were most at risk) I read somewhere there was an increase which they thought could be due to an increased number of children being given peanut butter too early and that now they suggest very young children - even those on normal food up to a few years of age - should not have peanut butter. In one child I knew the reaction was very severe and fast. He could not even be in a room where normal chocolate assortment was being handed around.
Tricia
 

victor meldrew 

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Anybody see the film on5 yesterday ,where I kid knocked a wasp nest out of a tree, got chased and jumped into a lake, returned a few days later , kicked the nest (Now on the floor ) took his eye off the ball and was killed by (yellow jackets no!) Bees .
You gotta give it to these film makers, makes you wonder where they get their ideas from, certainly not the real world :)

John Wilkinson
 

Mandeville 

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II read somewhere there was an increase which they thought could be due to an increased number of children being given peanut butter too early and that now they suggest very young children - even those on normal food up to a few years of age - should not have peanut butter. In one child I knew the reaction was very severe and fast. He could not even be in a room where normal chocolate assortment was being handed around.
Tricia
I think I read somewhere that allergies in children were also related to peanut consuption during pregnancy.
 

Jim Lavie 

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I read somewhere, where? Most days I have hearsay presented as fact so I am sorry but please present evidence as anaphylaxis is serious, allergies can be too. Frightening people about when the can consume penuts or peanut butter just gives me more work!
regards Jim
 

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Hombre 

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dont wish to be rude , but what the heck has peanuts to do with bee stings and annie shock. when was the last time you saw a flying peanut or got stung by one
You did ask Pete, remember - Peanut traces can cause immediate reactions such as hives on the face, blotching around the mouth, choking and wheezing.

You save four people by giving them a jab with an epi pen and the fifth one dies before the ambulance gets there, what's the compllications that are likely to ensue?

Without a qualification to do so, I thought that administering an epi pen to another person was a legal black hole. What is the official thinking on this, from those that know?
 

Nomadickarl 

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allegies

My eldest has a peanut allergy and is under the specialist allergy clinic at the local hospital. The honest answer from the consultants is they don't know why children are developing allegies, peanut or otherwise. This is also the case for the increasing levels of adults suffering allergies. How many friends, family members or colleagues do you know that have developed adult asthma or hayfever? Both are immune responses. We had children when the advice was DO NOT eat nuts and now, which is to eat nuts. The clinical answers is no one knows. They are now having some good success with trying to cure peanut allergies in children, but it is a long process and not 100% successful. If things carry on at there present rate 1 in 20 children will have a noticable allergy. Some even say that by 2050 everyone in the UK will have an allergy or food intolerance.

Yes we have to take epi-pens with us everywhere. The reason you need to go to hospital after administering the epi-pen is NOT the allergic reaction, it is the adreniline that the pen administers - this can kill you.

In my opinion the causes are many, and I have had to do a lot of reading on this. A redundant immune system that has become bored and now picks on anything it can find to entertain itself. We are vaccinated against so much and live relatively clean lives. Dietary change that has happened too quickly. Did you grandparents eat peanuts? Kiwi's? Sesame seeds? These are all increasingly common allergens. Interestingly I know of several people that can eat nuts traditionally found in Europe (Hazel and Walnut) but not more tropical ones (Brazil and Kashew). Environmental change.

I have read some interesting material into gut worms. Apparently if people have gut worms their allergies improve or disappear. It is to do with the gut worm living symbiotically with its host i.e it needs to feed enough to surive and create an environment where it can thrive but does not want the host to die. Host dies, the worm dies. So the gut worm releases a chemical that suppresses the immmune system, hence the reduced reaction to allegens.

I'm sure one day modern science will find an answer, though acupuncturists and herbalists have had some good results (apparently).
 

hedgerow pete 

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hombre this is straight off the british red cross web site .

2. Check if the casualty is carrying any medication. Some people know they suffer from this condition and carry epinephrine (adrenaline) with them, often in the form of a pre-loaded syringe called an auto-injector. You can help the casualty to administer the medication or, if you are trained to do so, administer it yourself.

they spec trained as a cover all. when you do your four day course or the one day epi pen the answer you will get is that if the person has tried to give them selves the epi pen but fail you can continue and if you were to find an epi pen on a person going down with annie shock you can use it aswell.

the first thing you are taught when you do become a first aider is the fact that " AS LONG AS YOU HAVE TRIED TO DO THE BEST YOU CAN , YOU ARE FULLY PROTECTED BY THE FLEET OF LAWERS AND BACKING FROM THE RED CROSS"
 

VEG 

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As long as you are a member of the red cross. If anything were to go wrong I dont know how anyone would stand legally. I think though that most people would just get on with trying to help the casualty.
 
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bushman1872 

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law or no law black hole or not if someone has just been stung by your bees and starts making funny noises when they are breathing or has swelling around neck or face and there is an epi pen around I would use it full stop. I would not be sat thinking what if they have a heart conditon, what if its not anaphylaxsis what if.. what if.. by that time if it is they will be screwed and then you will have your conscience to deal with the fact that your bees just put someone in a coma and you did nothing!


Call an ambulance and give the damm stuff. I get really frustrated as this stuff comes up over and over again. Don't worry about what causes anaphylaxsis just learn off by heart the signs and symptoms and remember don't worry about the heart because if they loose their airway they are DEAD!!

The more doubt put into peoples minds about whether they should do something or not is going to delay potentially life saving treatment. You can talk about the wheres and whys later, at least you can justify your actions to any court of law, even if they don't side with you which I appreciate is a nightmare situation at least you know you acted in that persons best interests.
 

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If were going into DIY medicine can I prefer to try out a tracheotomy? I carry round a biro and scalpel just in case. Also I've heard removing a kidney can help in these cases. As it's an honest belief that I'm acting in their best interests can I try that out too?
 

victor meldrew 

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law or no law black hole or not if someone has just been stung by your bees and starts making funny noises when they are breathing or has swelling around neck or face and there is an epi pen around I would use it full stop. I would not be sat thinking what if they have a heart conditon, what if its not anaphylaxsis what if.. what if.. by that time if it is they will be screwed and then you will have your conscience to deal with the fact that your bees just put someone in a coma and you did nothing!


Call an ambulance and give the damm stuff. I get really frustrated as this stuff comes up over and over again. Don't worry about what causes anaphylaxsis just learn off by heart the signs and symptoms and remember don't worry about the heart because if they loose their airway they are DEAD!!

The more doubt put into peoples minds about whether they should do something or not is going to delay potentially life saving treatment. You can talk about the wheres and whys later, at least you can justify your actions to any court of law, even if they don't side with you which I appreciate is a nightmare situation at least you know you acted in that persons best interests.
I am also tired of this topic reappearing ! The epipen instructions advise administering the stuff in a life or death situation.
People get too wrapped up in elf 'n' safety !
Let us not all descent to the level of the emergency services standing around for half an hour whilst a poor chap drowned in 3' of water.

John Wilkinson
 

Hombre 

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Now if I hadn't expressed my understanding of things, then I wouldn't have elicited the sage advice given, so my question was far from worthless and doubtless others with a similar lack of the legal certainties have learned something too from your answers. :driving:
 
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