Epinephrine for Allergic Reactions
Saturday, February 23, 2008
Paul Auerbach, M.D.
A reader posed a question in response to
my post about killer bees in New Orleans:
"I have a question regarding the proper use of epinephrine in wilderness medicine situations. In my recent wilderness first responder (WFR) recertification, we were told that if epinephrine is required, the protocol is to administer one dose, then give an oral antihistamine. Before the oral medication has time to work, another does of epinephrine will (might) be required. The point was that TWO doses (minimally) of epinephrine should be packed for each individual with severe allergies on a wilderness trip. This is NOT what I was taught in my initial certification - there, we were taught that one dose is enough. I believe in always being on the safe side in packing meds, but is a second dose of epinephrine always necessary?"
The answer is that most of the time, one dose of epinephrine injected subcutaneously or into muscle tissue (intramuscularly) will be sufficient to handle an allergic reaction. However, it is unpredictable. So, sometimes a second dose of epinephrine is necessary. My recommendation is to carry two doses, because there is absolutely no harm in being prepared.
The premise of the
Twinject product is that it provides for two doses of epinephrine in a single unit package, as opposed to the
EpiPen, which only provides for a single dose. Both products can be lifesavers.
Tags:
epinephrine,
allergic reaction,
Twinject,
wilderness medicine,
outdoor medicine,
healthlineLabels: allergic reaction, epinephrine, Twinject
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Twinject Update
Wednesday, December 12, 2007
Paul Auerbach, M.D.
The
Twinject auto-injector is designed to deliver two doses of aqueous epinephrine, USP 1:1000, and comes available for injections of 0.15 mg (each dose) or 0.30 mg (each dose). The product has been redesigned to make it easier for use. The first dose is a true autoinjection, in that the user removes the green caps at either end of the device, holds the red rounded tip against the middle of the outer thigh, then presses the pen-shaped device firmly ("hard") against the skin, which fires the auto-injector to thrust a needle through the skin. By the count of 10 (slowly), the drug is administered. If a second dose is needed (for instance, if a person is suffering a severe allergic reaction and symptoms are not improving or are worsening after 10-15 minutes), the rounded red cap is unscrewed from the device, which exposes a needle attached to a small syringe, the combination of which sits inside the barrel of the device. The needle-syringe combination is easily removed from the barrel, a small yellow collar then removed from the plunger on the syringe, and then the needle-syringe can be used to inject the second dose of epinephrine into the patient by inserting the needle and pushing the plunger all the way down.
Verus Pharmaceuticals, Inc. of San Diego, CA distributes the Twinject autoinjector, as well as an instructional DVD in both English and Spanish that also includes information on understanding and treating anaphylaxis (severe allergic reaction). A carrying case for the enhanced Twinject is available (pictured below).
Tags:
Twinject,
epinephrine,
allergic reaction,
wilderness medicine,
outdoor medicine,
healthlineLabels: allergic reaction, allergy, autoinjector, epinephrine, Twinject
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The premise of the Twinject product is that it provides for two doses of epinephrine in a single unit package, as opposed to the EpiPen, which only provides for a single dose. Both products can be lifesavers.
