Epi pen for personal use only!

[redpola]

Hi all,

I recently organised an epi-pen "just in case".

(for those interested: I visited my GP who was obviously trying not to look as flummoxed as he was. After some stating of the obvious and due diligence to indemnify him from any repercussions should I inject it through my skull and explode, he said he'd refer me to an allergy specialist who would explain all the stuff he'd just explained, which I'd ten minutes earlier explained to him to prove I'd read up on the subject and wasn't being reckless. It turned out that I didn't need referring and the next day he called me in to give me some pages he'd printed off from the BBKA site and some nhs.uk site and to sternly advise me of the dangers once more and to actually write me a prescription. Job done.)

Now, this is all largely what I'd expected, and is I guess par for the course, but what very much surprised me was the constant and repeated insistence that I must NOT NOT EVER EVER use an epipen on anyone else. In any circumstances. Ever.

This seemed a little harsh to me as if, for instance (and this is the most likely case) my girlfriend was laying on the floor in front of me obviously displaying symptoms of anaphylaxis, swelling up and finding breathing difficult, and I have a potentially-life-saving medicine in my pocket, it would be very very difficult for me to not use it in this instance.

It seems to me the pros are: er, save life; and the cons are: all the usual stuff from epinephrine (and from looking at the Wikipedia page for it, I can't see any side effects that compare unfavourably to death), which surely makes it no decision at all.

Right now if that situation happened I can't imagine for a minute that I would NOT use my epipen on a guest who was suffering anaphylaxis, so why was my doctor so insistent?

 

[Moggs]

Here's a bit more light reading http://www.beekeepingforum.co.uk/showthread.php?t=4547&page=2

There may be more.

 

[viridens]

Why was the doctor insistent?
Because if you inject this, even with the best of intentions, into folks with various medical conditions you may kill them.
It should not be considered as a type of aspirin or elastoplast. I am very surprised that a GP would prescribe it on this basis.

 

[redpola]

Why was the doctor insistent?
Because if you inject this, even with the best of intentions, into folks with various medical conditions you may kill them.
It should not be considered as a type of aspirin or elastoplast.

I totally understand that, and I was educated as to the conditions which cause problems.

Despite the lightness of tone of my post, I don't take the responsibility lightly, and that in part is what motivated my post in the first place.

The thing is that I specifically asked about the situation where a guest was clearly(!) dying and was still told emphatically that I shouldn't inject under ANY circumstance.

My question is specifically about the case of "if they would potentially be dead in five minutes", and I still think I would risk injecting with all the potential consequences above standing by waiting for an ambulance.

To use your own words back at you - I "may kill them". But I also may save their life.

 

[redpola]

Here's a bit more light reading http://www.beekeepingforum.co.uk/showthread.php?t=4547&page=2

There may be more.

Thanks for that - very interesting.

 

[Mike a]

I'm very surprised your doctor signed off on an epi pen for you unless you've already suffered a really bad reaction.? Localised swelling is one thing, a bad reaction through to full on anaphylactic shock is another.

June

August

*Apologies for this picture again.

On both occasions I didn't have any issues with breathing or swelling in my mouth or throat thankfully, I have an appointment next week with the doctor to see if he/she feels I need an epi pen. Both times I was stung on the forehead and within 5 mins it was obvious I was suffering badly. On the advice of a member of this forum I will also ask to be put on a desensitises program as well.

 

[itma]

... On the advice of a member of this forum I will also ask to be put on a desensitises program as well.

Hi all ...


What does a "desensitisation programme" involve?
Presumably accessible by GP's referral?

(Asked on behalf of my mentor, who needs to (and does) carry an epi pen but believes in homoeopathic remedies...)

 

[Mike a]

To be honest I have no idea other than what I've read up on. This site seemed pretty good and gives some answers.
http://www.insectstings.co.uk/immunotherapy.shtml

drstitson advised I asked my GP for a referral and as far as I know he is a Doc although not a GP.

 

[VEG]

I really cant believe your doctor gave you one without you having had some sort of reaction before. I think it irresponsible on the doctors part.

 

[BCBEE]

Right now if that situation happened I can't imagine for a minute that I would NOT use my epipen on a guest who was suffering anaphylaxis, so why was my doctor so insistent?

There are several reason for this advice.
Firstly the person may be on medication already that would react with the epi pen which is a derivatove of adrenaline (i fink). Secondly someone else may not realise that you had done it and do it again and so double dose them.
Thirdly they are indIvidually tailered to give a measures shot dependant on the person involved rather like inhalers are.-which is why a prescription is needed.
Fourthly you would have to be sure it was anaphylaxis and not a heart attack so would need to know the signs.

The rule that you should never use anyone elses medication must prevail despite how distressing it may be. You can help the patient administer the patients own but dont use your own on them. You could do more harm than good and the person could have you for assult. Worse still if the worst happened his family could . You cant be sued for not giving someone your medication even if they die.

All this seems rather complicated and selfish doesnt it ? But its the way is is and I think for more good reasons than bad.

PHILL

 

[viridens]

Mike a

I haven't seen your photos before.

Almost every swarm call I take involves someone 'allergic to bee stings', and some with epipens. On questioning, they have actually had far less reaction than shown your pictures above, and in most cases just what I would consider a normal reaction, that is swelling and itching for 24hrs or so.

Redpola, I understand that you have the best of intentions, but I would say that the probability of someone suffering previously undetected allergy and anaphalaxis to the degree where they need immediate epinephrine to survive is pretty remote. And I would suggest that those with a history of bee allergy are kept away from your apiary.

To me it is similar to asking a GP to prescribe syringes of insulin and glucose in case you come across a comatose diabetic.

 

[drstitson]

Pathologist.

My only chance to see stings professionally would be the most severe possible end of the spectrum!

However have probably seen more bee stings of varying severity than your average GP or A&E doc (especially if you are seen in august).

Epipens shouldn't be given out on just in case basis BUT only to those who have had a serious systemic reaction (and no, a swollen leg alone doesn't count, no matter how big it gets) who should also be offered the chance of desensitisation. In my book both episodes described and illustrated by mike a suggest this approach.

From what i've been told by the bods upstairs in immunology is that desensitisation for bee sting allergy is their most successful (>90% success). They do however always advise people to stop keeping bees but AFAIK no-one/few ever do.

 

[BBG]

"I must NOT NOT EVER EVER use an epipen on anyone else. In any circumstances. Ever.

This seemed a little harsh to me as if, ......"

So, now you understand why they're reluctant to give them out.

It's because we have wannabee Florence Nightingale saviours who, pen in hand, the words NEVER, EVER ... ringing in their ears and just leaving the surgery, are wondering who else they can stick it into and be a hero for the day.

So, all you have to do is work out, by diligent research, whether:

the risk of your girlfriend dying from what you THINK might be anaphylactic shock before getting to hospital or medical help

IS greater than

her dying from YOU injecting her with something you have been told to NEVER, EVER use on anyone else......

It does say on the side of the epipen:

NOT for num-nuts

I had worse reaction than pics 25 years ago but think it was due to NSAIDs - no bad reaction with recent stings though but also no NSAIDs for years.

We, use two dabs of bunny hugger Tea Tree Oil and an anti-histamine - knocks two or three stings dead

 

[drstitson]

"I would say that the probability of someone suffering previously undetected allergy and anaphalaxis to the degree where they need immediate epinephrine to survive is pretty remote"

unlikely but not that remote - remember you just need one exposure to sensitise you (with a normal reaction) and if very unlucky your second sting could be the one that causes full on anaphylaxis.

agree totally though that anyone with a KNOWN allergy should not go near your apiary.

"Almost every swarm call I take involves someone 'allergic to bee stings', and some with epipens. On questioning, they have actually had far less reaction than shown your pictures above, and in most cases just what I would consider a normal reaction, that is swelling and itching for 24hrs or so."

illustrates exactly my point that most GPs and A&E docs have absolutely no idea what bee stings may manifest themselves as normally. As is typical in UK today - the undeserving seem to get what they want and those who need a treatment are denied it.

 

[viridens]

Pathologist.

My only chance to see stings professionally would be the most severe possible end of the spectrum!

However have probably seen more bee stings of varying severity than your average GP or A&E doc (especially if you are seen in august).

As ex med physics staff myself I chuckle. But maybe this wit is lost on some readers...

I agree completely with the last paragraph in your post above.

 

[MartinL]

Hi all,

I recently organised an epi-pen "just in case".

MMMMM Had the same thought myself last year.

Expecting to have difficulty with "health and safety issues" I avoided my Doc and asked a friend who is a Pharmacist.
I was told it is DEFINITELY A NON STARTER .

 

[Cazza]

I have just had my annual mandatory NHS anaphylaxsis update.
The trainer told us that if we had an epipen and someone else was suffering anaphylactic shock we should first ring 999 and after dealing with the ambulance details we should ask if we needed to administer the epipen dose before the paramedics arrive. The dose can be given again after 5 minutes if no improvement is noted so no problem with delivering an overdose.

Cazza

 

[greatbritishhoney]

This is a very interesting debate.
On the face of it I would agree with all the sensible medical advice but, if I actually found myself in the situation, who knows how I may act. It's very difficult to pre-judge these situations.
I recently had to call an ambulance because my wife was choking. I was told by the phone operator not to slap her on the back, just to wait for the ambulance.
Living in a very rural area of Wales, the ambulance took about 20 mins to arrive. Needless to say I slapped her on the back before the ambulance arrived.

I probably did the wrong thing, but it was done out of panic and fear that she was going to choke to death.
(She was OK by the way!).

 

[Cazza]

GBH, according to my latest resuscitation update this week, you did exactly the right thing with the back slaps.I'm surprised you were advised not to do so.
Caza

 

[MartinL]

This is a very interesting debate.

I recently had to call an ambulance because my wife was choking. I was told by the phone operator not to slap her on the back, just to wait for the ambulance.

I probably did the wrong thing, but it was done out of panic and fear that she was going to choke to death.
(She was OK by the way!).

Never heard of Mr Heimlich?