Anaphalactic Shock

[Scooter]

Here's something that we talk about a lot in safety meetings: anaphalactic shock. Here's a bit of a sad article from CNN today:

http://www.cnn.com/2009/HEALTH/08/14/sk ... index.html

(CNN) -- Known for building skate parks and shaping the skateboarding scene in New York, Andy Kessler, 48, died this week after an allergic reaction to an insect sting, friends and family told news media.

Andy Kessler reportedly died this week after suffering an allergic reaction to an insect sting.

Kessler's death is a reminder that stings can be deadly for those with an allergy to certain insects, the American Academy of Allergy, Asthma & Immunology said Friday.

At least 40 people in the United States die each year as the result of insect stings, the academy said. As many as 5 percent of Americans are at risk for a severe, potentially life-threatening allergic reaction from insect stings, according to the organization.

In a typical week in the emergency room, doctors at Emory University Hospital Midtown in Atlanta, Georgia, see about six or fewer cases of people with allergic reactions to insects, said Dr. James P. Capes, director of the emergency department.

"It's common, but not incredibly common," he said.

Typically, when stung by an insect, a person will have no reaction or a mild local reaction, such as redness, swelling or itching at the site of the sting. However, some people experience a more widespread reaction, such as a drop in blood pressure, lightheadedness or hives all over.

In the most serious cases, a person can go into anaphylaxis, a condition in which he or she may have difficulty breathing. Other symptoms include swelling of the mouth or throat, itchy skin, wheezing, cough and localized pain, said Dr. Clifford Bassett, medical director of Allergy and Asthma Care of New York.

Capes advises people who experience a systemic reaction to call 911 and wait for an ambulance, because it will have medicine to treat the reaction immediately. An antihistamine such as Benadryl will be given and, in severe cases, a shot of epinephrine.

Even if the reaction is not severe, Benadryl will help with normal symptoms of insect stings, Capes said.

Those who have had allergic reactions to insects should always carry an antihistamine and an epinephrine auto-injector for emergencies, experts said.

Insect allergies may be harder to control than some food allergies because it's not always possible to predict when bees, wasps and other stinging bugs are around, Capes said.

Severe reactions don't usually happen the very first time a person gets stung, Capes said.

"The thing about allergic reactions that is interesting, or scary, is that we never know what the next allergic reaction is going to be," he said.

For those who have a history of anaphylactic reactions to insects, vaccines are available for yellow jackets, wasps, honey bees and fire ants, Bassett said. The immunization process takes three to five years, he said.

There are also blood and skin tests that people can take to determine whether they are sensitive to these insects, he said.

Besides anaphylaxis, people may experience other kinds of reactions, Bassett said. If a person is stung hundreds of times at once, he or she may need emergency care, as the venom may lead to seizures, shock and even death, he said.

There is also a rare reaction called serum sickness that includes joint pain and flu-like illness that may result from insect stings, and has allergy-like symptoms, Bassett said.

In rare cases, even mosquito bites can lead to anaphylaxis, Bassett said. There is no treatment for mosquito allergies, but there is a diagnostic test, he said.

Bassett offers the following tips to reduce the danger of insects:

• Stay away from stinging insect nests when possible.

• Consider wearing closed-toed shoes in an area where there may be many stinging insects.

• Remain calm and quiet around a stinging insect, and move slowly away from it.

• Avoid brightly colored clothing, as well as perfumes and scented hair products and lotions.

• Avoid loose-fitting clothing, which can accidentally trap the insect.

• Use caution when eating outdoors, especially when sodas or other sweetened drinks are available.

For more tips on managing insect allergies, visit the American Academy of Allergy, Asthma & Immunology Web site.

[backcountrysister]

I believe that this is why, I recommend that foreman carry an epi pen on their person - as I do- at all times. when I'm out there, I carry my camel pak which had a small kit . In that kit is an Epipen, Benadril, & antiperspirant ( the chromium acts as a anti venom for bee stings) & a couple of compression bandages.
this should a warning. I have spoken about this many times & if there is an allergy like a bee or Peanut, Make sure you get the person whom has an allergy to sign a waiver for treatment due to the grey area around procedure involving administering treatment. If this is a new allergy than @ least you can treat on the scene & hope that you can make it to the hospital on time. I also know how to preform tracheotomy- but that's worst care scenario. - Yes, I have a sterilized scalpel in my kit ,as well.

[newforest]

I have been thinking about this issue for several years now. I have kept Benadryl on hand at times, though planters with allergies have wiped out the supply. I have not kept an epi pen around. I would like to....but therein lies a tale. An American story only.

I have a question for y'all first - how much does an epi pen cost in your country?

I started working with a new hire a few days ago. Great kid, lives on a farm, recent Afghanistan veteran, loves the saw work and seed-collecting work I have going on right now. He is allergic to bee-stings, in a serious way. He knows all of the details on what to do, from his military service. An epi pen is basically a big shot of adrenaline. So if you don't have one available, adrenaline can be created in other ways, including the application of electricity, like the 12 volts from a vehicle. This is just what he tells me, I don't know these things. My First Aid class told me, get an epi pen immediately, for these situations.

I think a forestry site with 2-4 year old slash brings a higher likelihood of encountering bees. I was marking timber on a site thinned about 5 years back (Oak slash, lasts a long time), and got stung about ten times in 2 minutes several weeks ago. I was a little woozy the next day and my elbows hurt quite a bit, internally. This has happened to me about every 3 to 5 years in the woods, all my life. Walk around a lot outside, and this will happen eventually.

A few days ago I was on another such site, building a deer-proof exclosure for some rare plants. It was at the edge of a block of pine that was thinned perhaps 3 years ago. About an hour in, my new employee gets stung twice, in his wrist. Very large bumps (in area, not very tall) appear within just a few minutes. He told me there was no real worry, because of the location of the sting. An upper body sting is far more serious.

Since the Benadryl was gone from the First Aid kit again, we quit working and drove the 30 minutes to town. I re-stocked with the pills, the liquid version intended for children with a cold (fastest-acting, 2nd best thing to have after epi pen), and also the cream which works very well for the few days of itching a bee sting can create. But I did not buy an epi pen.

Because in my country, they cost $250 for us lucky un-insured types. And the shelf-life is only for one year. And in fact, I can't even walk into a pharmacy and buy one anyway, because they are a prescription item. (Is there some way to abuse the contents of an epi pen? I would've thought I would have heard of that from one of my lowlife friends by now...) Anyone who needs one can instantly renew an expired Rx. But as an employer, I can't.

Anyway, we are also about 2 weeks out from first frost and no more bees/wasps/yellowjackets/hornets this year, so I passed on the $250 expenditure. But it's a dilemma. I feel like I should have one. Or, I could require a bee-allergic employee to have one of their own, but how you can require a person too broke to even buy good work boots to buy a $250, rarely needed medical item? That's not going to happen.

The bigger issue in my mind is hiring people who don't know they are allergic. This is extremely rare I think, but as more and more people are outside less and less, not everyone is stung by a bee at some point in their childhood any more. On the other hand, I have heard that full-blown, life-endangering, Anaphalactic Shock isn't actually very likely on a very first bee sting....it is a risk that grows with each bee sting for an allergic person.

So anyhow, medical thinking in my country is beyond insane, it is criminal. Everything here costs 400% or more of what it does anywhere else. I hope an epi pen in a normal country is a routine part of a First Aid kit. ?

[Scooter]

Epi Pens aren't included in first aid kits here, because until they have a pretty high level of training, a first aid attendant cannot administer drugs to a patient. People with the weekend courses cannot. In the OFA3 course here (a BC standard, which is a higher level two week training course) I believe that the last time I took the course, we were told we were not allowed to administer an Epi to someone out of the blue, although if someone owned their own Epi pen and were semi-conscious, we were allowed to assist (ie. unpackage, put it in their hand, guide their hand in the application). Once you get into higher-level training, ie. EMT's on provincial ambulances, the administration of drugs is normal.

I think an Epi Pen costs about $130 if you were to buy it over-the-counter here in BC. One of my nieces has severe allergies to a lot of foods, and has been hospitalized a number of times due to reactions. She carries a couple Epi Pens, and her siblings have been taught to help administer them to her. I think since it's a medical issue for her, they're really cheap, something like $16 each. I'll email and ask.

I think the general practice in BC/Alberta is that if you know that you have a reaction to stings, you are told by your employer that you have to carry an Epi Pen as a condition of work.

[newforest]

Thanks Scooter. Always helpful to learn how a reasonable country handles a medical question.

One of my nephews needs an epi pen on-hand, but my sister has very good insurance, so they only cost her $30. It figures the prices in Canada would be half that; I thought they might be even less.

I feel that an employee that needs one should be required to have one, and of course as an employer, having an employee own and purchase one is a preferred option. But I also know the reality in that if a potential employee knew of this requirement, they would most likely just lie about needing one. Most people applying for the job I have are applying because they need work right away, not because they are drawn in by the glamour and excitement of physical outdoor work in remote locations. Such people are out there though, and I will assemble them eventually.

I am making progress on securing good contracts for which I can pay good wages. I recently won a brush-saw bid at double the rate it has been going for. Even better, I won the single line item I bid on. The other 3 line items weren't awarded due to rejected bids. So the brush-saw work is looking very good for the future. Planting has a few just-starting trends in the same direction. With good wages, I can be selective in hiring....and find people that would keep an epi pen around if they need one. I suspect even my current guy could get one for cheaper than $250 if he looked into insurance options through his veteran status or other low-income options that do exist, though who ever knows about these things in the Corporate States of America.

I was interested to learn that the location of a sting makes such a huge difference, but that does make sense. A sting in the throat is the biggest worry by a long way. I still have never seen an epi pen or known much about how to use one; the one course I have had spent probably 2 minutes on the topic. The Rx requirement does make sense.

[Scooter]

Sting location absolutely makes a big difference. Both of my parents are extremely allergic to bees and wasps. I've never had a reaction. However, I've never been stung in a really fleshy area with significant blood flow. I carry a box of antihistamines in my bags when planting fall coastal blocks, and carry them in my truck for the rest of the year. I've been stung many times, but always in places with very little blood flow, like the elbow, shin, tip of the ear, etc. I've actually been stung on the point of the elbow about four or five times, but never anywhere else on my arms. Very odd. I assume that if I ever got stung on the neck, where swelling could cause pressure on the windpipe, I'd want to eat about 8 antihistamines immediately and get back to a vehicle to sit for a while, just in case. Or maybe I'd be fine. Who knows? Live on the edge.

[Scooter]

From my sister:

Hi! Epi pens and the new Allerject device run about $120. With our insurance we pay only 20%. They last about nine months before expiring. Your niece carries two on her at all times. Hope that helps!

[photocopy]

Sting location absolutely makes a big difference.

Thats right! Not only where on your body you get stung but where you are geographically when you get stung... I had 2 nail biter incidents with people who were highly allergic and didnt know it getting stung. Both were ok, because we were close to PG, but for the one who got stung in the neck(met ambulance midway) the doc said he was minutes away from severe and possibly irreversible complications.

[Scooter]

This article, and the YouTube links in the comments, should initiate a few bad dreams:

http://gawker.com/this-hornet-will-be-t ... 1428724767

[Scooter]

#throwbackthursday

From my days growing up in the hood, when we didn't have tripods so we leaned our flamethrower across our planting partner's back ...

[Scooter]

Epi pen price hike controversy in the US:

http://www.cbc.ca/news/health/epipen-price-1.3734214

The 400 per cent spike in the price of EpiPen devices for those with severe allergies in the U.S. has sparked outrage among American doctors and politicians.

Epinephrine auto-injectors such as EpiPen are used as an emergency treatment by people who have a history of serious allergic reactions, called anaphylaxis, or who are at risk because of allergies to foods, insect bites and stings or medicines.

In the U.S., Mylan Pharmaceuticals has increased the price of its EpiPen injectors up to three times a year over nearly a decade, pushing the cost to more than $600 US for a pack of two.

White House spokesman Josh Earnest wouldn't comment directly on Mylan's pricing of EpiPens.

"I'm obviously not going to make specific comments to specifically second guess the pricing strategy … of one private enterprise," Earnest said at a news briefing.

"I will observe, however, that pharmaceutical companies that often try to portray themselves as the inventors of life-saving medication often do real damage to their reputation by being greedy and jacking up prices."

Earlier today, the American Medical Association and U.S. Democratic presidential nominee Hillary Clinton urged Mylan to rein in what the AMA called the "exorbitant cost" of EpiPens.

"Although the product is unchanged since 2009, the cost has skyrocketed by more than 400 per cent during that period," AMA president Dr. Andrew Gurman said in a release.

"The AMA has long urged the pharmaceutical industry to exercise reasonable restraint in drug pricing, and, with lives on the line, we urge the manufacturer to do all it can to rein in these exorbitant costs."

If someone experiences anaphylactic shock, symptoms can include wheezing, hives and skin swelling to rapid heartbeat, trouble breathing and convulsions. Without treatment, it can be deadly.

Pfizer Canada distributes EpiPens through a license from Mylan, which owns the brand.

A spokesperson for Pfizer Canada said the price has not changed and there are no plans to do so.

In Canada, drug prices are regulated by the Patent Medicine Prices Review Board.

"We can confirm that, at this time, there are no investigations or hearings ongoing with respect to EpiPen," a spokesperson for the board said in an email.

In an emergency, the syringe is jabbed against the thigh. The needle inside injects the epinephrine into muscle tissue.

Back-to-school season is a good time to check the expiry dates on epinephrine injectors, said Beatrice Povolo, director of advocacy and media relations for Food Allergy Canada. Schools often ask students with severe allergies to bring an auto-injector to school and sometimes ask for a back-up device to deliver the life-saving medication.

The devices last about 12 to 18 months.

"We feel that everyone should have access to life-saving medication and that cost shouldn't be a barrier. Thankfully we're not seeing the same issues here as we are in the U.S.," Povolo said in an interview.

In the U.S. in 2007, when Mylan took over rights to EpiPen, a pair of syringes cost $93.88 US. The price of a pack of two is now about $600 US, according to Elsevier's Gold Standard Drug Database.

In a previous statement, Mylan said the EpiPen's price "has changed over time to better reflect important product features and the value the product provides."

[fluffer]

kutv.com/news/local/slc-emergency-responders-beat-soaring-cost-of-epipens

May be of interest. Not sure what Eipen costs are like here in Canada.

[ohsnap]

A few tidbits I've learned the last few months:

Depending on province, and health coverage of the buyer, epipens are still somewhere around 90-120$ - which is the single use pen. The company in Canada that distributes the pens is pfizer, not mylan, and we have different laws regarding regulations of drugs and pricing - so the price shouldn't be changing much here.

You can go to the pharmacy and request epinephrine vials, and then buy needles. You may need a prescription, I'm pretty sure my partner bought vials from the pharmacy without a prescription, but with the reasoning of wilderness first aid credentials. Each (glass) vial comes with about 3 doses of epinephrine for adults. Cost is cheap, can't remember how much exactly (10-40$?).

Obviously this isn't an option for self administering while having an allergic reaction, this would be for someone else to inject you as a 'this is what we've got' option. I'd much prefer that while hours from any hospital or ambulance service. Keep in mind that severe allergic reactions might require more than one dose of epinephrine. So while you probably carry an epipen for whatever allergy you have, you might need a second or third one over the next few minutes/hours after initial injection. Most people would be well on their way to hospital, we aren't always so lucky in proximity while planting.

One last thing, I know the expiry says it lasts a year, but technically your epipen *should* be good until the liquid is cloudy. A bit risky, but a good option for a backup to a current pen.

[jdtesluk]

Last point is a good one. I inquired about expired epi-pens. Apparently they do lose potency over time. However, the expired contents do not pose additional risks. In other words, it's not like eating old meat.