Howto: Administer an Epinephrine Shot

[Kathyp]

By the way, the correct dose of Liquid Children's Benadryl for an adult having a moderate allergic reaction (i.e. severe swelling but no hives or anaphylaxis) is 8 teaspoons.  This equals 50mg of regular Benadryl.

i carry liquid benadryl also.  one of the very nice things about it is that a good swig will not OD you.  i tend to get stung doing things like cutouts and i don't remember to take a spoon, but the benadryl is in the cutout kit.   :-D

[Pillpeddler]

Ok, a little Epipen education.
1)  If you are truly having an anaphylactic reaction, as apposed to severe sting-site swelling, it is a bodywide hypersensitivity reaction.  You could be stung on the toe and have hives all over your body (bad sign), angioedema where some part of your body puffs up (really, really bad) or your throat could swell until you cannot breath (you get the idea).   Any of these last 3 are LIFE THREATENING emergencies.  The chemical processes that are in motion during anaphylaxis can last 3 or more days...   an Epipen lasts 15 to 20 minutes.   An Epipen is a crutch to get you to the hospital so that medications can be administered to hopefully contain the reaction.  You might get to go home in a couple of hours or you might spend a few days in the hospital depending on the severity of the reaction.   
2)  An Epipen is a dose of epinepherine, a drug that can have significant side effects.  It can even have life-threatening side effects under some circumstances so it isn't something to play around with.   Talk with your MD and see if he or she thinks you actually need to have an Epipen.
3)  They shouldn't be used for a routine sting (ie- you have no itching or tightness of the throat, no unusual swelling of a non-stung site) that could easily be treated with an over the counter antihistamine.

Always talk medical situations over with your physician, they are trained to take care of us and most of them do a great job.   Any time you are stung be very aware of what is happening to your body.   The degree that a person will react to a sting is never 100% predictable but normally the longer you go without a problem the less likely you are to have a problem but there are no absolutes.  Normally problems will progress in steps (ie- hives, then worse hives, then angioedema, then full blown anaphylactic shock) but, again , there are no absolutes.  I know of people who have gone from "wow, I'm a little itchy" to "call 911" in one step.

One last thing, Benadryl or any other antihistamine, will have a dose for adults on the bottle that should not be exceeded.  More will typically only increase the side effects.

Y'all be careful out there.

Pill

[hoxbar]

I'm an EMT, and I've seen several  people go into anaphalactic shock from bee stings. I strongly suggest if you get stung, take a Benadryl even if you think you do not need it. A Benadryl will really help. If you start feeling itchy, or tingly you need to start getting yourself some help. Dial 911 get your epi and give yourself an injection or have someone help you. This is a life and death situation, immediate action must be taken.
Something that I do not think anyone has mentioned about an epi-pen. DO NOT DRIVE YOURSELF TO THE HOSPITAL after an epi-pen injection. 95% of people that get an epi-injection will have the worst headache of their lives following an injection.  The headache is as bad as a migraine and most people can not function.
Also, you still should go to the emergency room after an epi-injection, even if you do not have a headache. Your blood pressure will be extremely high after an epi and those with hypertension could suffer a stroke.

[Storm]

Great info Pillpeddler & hoxbar.  As I say, better safe than dead. 

One last thing, Benadryl or any other antihistamine, will have a dose for adults on the bottle that should not be exceeded.  More will typically only increase the side effects.
Pill

The correct dose is 8 teaspoons (2 2/3 tablespoons).  It is not always marked on the bottle, since the bottle is labeled for children, not adults.

I95% of people that get an epi-injection will have the worst headache of their lives following an injection.  The headache is as bad as a migraine and most people can not function.
Also, you still should go to the emergency room after an epi-injection, even if you do not have a headache. Your blood pressure will be extremely high after an epi and those with hypertension could suffer a stroke.

So true, hoxbar.  I have cluster headaches and hypertension already, and after an epi injection, my head just about pounds open.  This is just one of the reasons why those who carry epi-pens may hesitate to use them when they really need them, FYI.

Thanks again to all who have posted here.  it's important for all beeks to know what to do in an allergic emergency, whether for themselves or for another person.  I'd like to suggest that those who are club members might make this a discussion topic for a meeting.  The more informed that we all are, the better.

[L Daxon]

I read about this earlier this spring and bought a bottle of children's liquid benedryl to have on hand instead of the eipi pen.  I got stung a few weeks ago on the hand (hadn't been stung in 20 years) and I got real flush and broke out in hives from head to toe and felt a little woosie, though I didn't have any trouble breathing. I downed about half the bottle of the children's benedryl and my nurse brother-in-law and dietitian sister just happened to be at my house and kept an eye on me.  We talked about going to the hospital, but since I was breathing OK I didn't.  In about 20 to 30 mintues the hives went away. My hand eventually puffed up like a catcher's mit and the next day a doc gave me some steriods for the swelling.
On the assumption that the next time I am stung the reaction could be worse, I went ahead and got an epi pen.  But I think my real plan of action will be in the event of a future sting to down the benedryl and drive straight to the hospital emergency room (which is about 8 minutes away).  If I start having trouble breathing, I will go in.  If after 20-30 minutes I don't seem to be having trouble, I will go back home.
My doctor son told me to be particularly careful if I get stung on the neck/throat area. Given the way I swell up, my wind pipe could swell shut if I am stung in that area. So of course I don't get into the hive now without full protection from the waist up.

[Ibeehappy]

I think the most important thing to remember about Epi is if you have to give it you should ALWAYS call 911 after you give even one injection.  The medicine will last only so long before you may begin to have problems again.  And suffocation sucks!  Also don't panic- give the shot in the thigh and wait a little bit before you take the needle out if you have to give it to your self.  I've taught this loads of times in the ER and with school nursing and people always forget that step.  Benedryl is a wonderful drug- it will help with most reactions. Liquid is better than pills because the body absorbs it better and the strips act quicker than the liquid.  However if your airway is feeling swollen or your chest feels tight and you are even slightly working to breath call 911 even if you have epi.  I say that because I've seen loads of people blow it off then show up at the er in terrible shape and we have to do a lot to keep them breathing. 

[bigbearomaha]

honestly friends,  I have read this whole thread.  if  I might bee so bold...

I will not allow anyone in my bee yards unless they have signed a release form and waiver.   I inform everyone who will be working in my bee yards that if they suspect they might bee allergic, they need to get to a doctor and get an epi-pen prescribed to them and have it with them when they come to the bee yard. 

They also need to let me know if they need and have an epi-pen.

The next piece of advice  I have for any and every beekeeper is always try to have a "bee buddy" with you on site.  Not only can the extra pair of hands and eyes bee useful working hives, but having that other person around can be critical if something requiring medical attention comes up.

I also keep benadryl on hand at all times and  I have first aid training, including the knowledge of how to administer an epi-pen shot.  I am not allergic and I will not have one prescribed to me to use on someone else.  It's not just about how litigious the recipient might or might not bee.

I always keep a cell phone charged and handy any time  I am working around bees.

I think it is not enough to think having an epi-pen on hand is the solution to potential problems.  One needs a plan, kind of like an integrated pest management plan.

I think the discussion here is an important one to have though. 

good posts everyone.

Big Bear

[Pete]

Another missing bit in the information here is, what is bee sting first aid? Just giving some one meds cant be the answer, you wont always have them?

What else can you do? Remove the stinger, immobilise, elevate, compress?

[L Daxon]

Well, it has been two months since I was stung on the hand and had a big reaction with full body hives and major swelling, so much swelling in fact that the doc gave me some steroids (I couldn't even begin to close my hand or get my watch off).  I am happy to report I have been stung six times since then (one of the stings was from a wasp/yellow jacket) and I have had virtually no reaction -- not even itching with the subsequent stings.  The next 4 times I was stung, I immediately chugged liquid benadryl, swabbed the area with AfterBite (a stick pen I got at CVS) and put ice on the sting. The last 2 times I haven't even taken any benadryl.  Just used AfterBite and some ice.  I did get a little swelling when I was stung again on the hand but nothing like the first time. 

I hope all this means I am developing an immunity to the stings.  Or at least my reactions aren't getting worse with each sting as I have heard can happen. I think part of what helps is getting something on the sting site immediately, which I can do since my hives are in my back yard.  I know some have said putting heat on the sting site helps them but the ice sure seems to work for me.

[David McLeod]

Interesting reading. I have considered the epi in the past to the point of actually getting a scrip for one with three refills. After much discussion with the missus we decided not to fill it since i have never had a bad reaction to a sting. I do not even swell at the sting site and the itching subsides within minutes. My chief concern is always those around me since I am a NWCO and do cutouts and swarm removal. It was the liability issues of adminstering a prescribed medication to others tht swayed me against. What if I had the epi available and withheld it for fear of liability or what if the epi was not needed but administered anyway. To many what ifs for my taste, so I keep benadryl on hand at all times and the cell phone ready.
I am changing some things this year in how I conduct business. I will be drafting a new waiver and establishing some hard and fast rules for my clients to sign when I do a cut out plus I will never agian do another cut out or swarm removal unassisted and my fees will reflect the second person on site. I can only do so much to protect my clients without playing superhero and will get it in writing.

[Minyassa]

Being a newcomer both to bees and this forum, I came to this thread first because the last time I was stung by an insect (yellowjacket), some 15 years ago, I had a mild anaphylactic reaction, almost like an incomplete asthma attack, that went away after I took Benadryl.  The incident frightened my husband and he took me immediately to get an Epi-pen.  I still have it, but obviously it has now expired.  Until I read this thread, I was not taking the whole "get a new epi-pen" issue seriously despite my mother and husband wanting to swat me for dragging my heels on it...someone told me that there are plenty of allergic beekeepers and do I ever read about beekeeping deaths in the newspaper?  Nope.  So I thank you all for this thread for potentially saving my life, but I have a couple of questions now:

1.  Am I legally endangering my mentor in any way?  Of course I will tell him or her (haven't met my mentor yet, just started training) about my past reaction, and I will certainly carry my new epi-pen with me to bee yard sessions, but I want to make sure that I am not going to come off as inconsiderate or stupid or a troublemaker (my best friend just told me "to me it sounds like Superman working in a Kryptonite mine").

2.  How do I now get over the mind-numbing *terror* of finding out whether I am actually allergic by risking having to punch a ginormous hole in my leg with a potentially thumb-impaling needle the thickness of a space shuttle and then suffering hours of misery and thousands of dollars of medical incapacitation?  Please give me some kind of a talk-down here, because this thread scared the heck out of me while awakening my common sense.

PS--while I have only had the one reaction to a wasp sting as far as insects go, I had the same mild respiratory reaction to a bite from a jumping spider more recently but not to stings from a venomous caterpillar a few years ago.  The spider bite was almost exactly like the yellowjacket sting; the caterpillar stings were horribly painful and itchy, but only locally around the sting site and without any breathing problem at all.  During none of these events have I experienced full body itching, just the usual pain and swelling of a sting.

[Jim134]

someone told me that there are plenty of allergic beekeepers

 I have been doing beekeeping for over 50  years and I have meet one.GO TO A DR. AND GET  A TEST  ........


          BEE HAPPY Jim 134 :)

[James M. Wagner]

You might want to check and see what the liability might be if you administered a shot to someone other than yourself. That might come under the heading of practicing medicine without a license.
[/quote]

I believe you are correct in that.

I am a licensed EMT in Alabama and I am legally able to only 'assist' a patient in administering a dose to themselves. That dose must have been prescribed to the patient AND not be expired. In other words, i cannot procure an epi pen for 'emergencies' that may crop up with someone visiting my own beeyard because the epi pen will obviously NOT have been specifically prescribed to that person.

The simplest (and best) thing to do - call 911 if someone gets stung and is having an allergic reaction. Paramedics have a lot more leeway in what they can do and often carry epi pens in their rescue vehicle or ambulance. Even then, they must get permission from medical control PRIOR to administration of the drug.

Laws to vary by state, so I would seriously consider looking into what your laws are before going to the expense of getting a prescription to buy epi pens that you intend to be used on other people. Find out what a layperson can do to administer first aid to a bee sting victim in your state. It will likely be simply an ice pack. Epinephrine is a drug and drugs do have side effects. If you administer a prescription drug to someone other than to whom it was prescribed and they have and adverse reaction then you are in deep doodoo.

My 2 centavos.

-James Wagner, NREMT

[Kathyp]

so wrap their fingers around the thing and give it.  what?  you are going to let them die because of liability? 

if your mentor is concerned, write a note for him.

[iddee]

NC has the good Samaritan law. If you suspect someone is going to die if they don't receive help, you cannot be held liable for trying to help them. Even if it doesn't work.

[Jim134]

NC has the good Samaritan law. If you suspect someone is going to die if they don't receive help, you cannot be held liable for trying to help them. Even if it doesn't work.

  It is the same law in MA.


   BEE HAPPY Jim 134

[Katharina]

An Epi pen can save lives, but it can also kill.  There are people out there that are oversensitive and I'm one of them.  This shot will kill me.  The first one who noticed that was my dentist.  Yes, I did say dentist.  Their Novocaine shots contain small amounts of epinephrine.  This makes the shot last longer and reduces bleeding.  He injected only a little bit of it and I went into trouble.  I needed an oxygen tank and was on my way to the hospital via ambulance.  This experience was not pleasant.  I was sick for 3 days, not to mention the migraine it gives you.  Now my folder is marked with a huge sticker not to use it.  They do have Novocaine without epinephrine, only the shot wears off faster.  I had my overreaction to epi confirmed later in the hospital again before I needed stomach surgery to keep me safe.  So this is my little warning, be careful because you can do harm.  Also if you use it on someone let the ambulance know so they will not administer adrenalin, which they sometimes do in these situation.  The combination of epinephrine and adrenalin is deadly, it puts the patient into full cardiac arrest.  If you get a prescription for epi ask for the child dosage.  Two children shots equal one adult shot.  You don't want to give a full dose to a child.  Sometimes it is better to give half a dose to an adult too.  As stated before you are only buying time with it.  Also the chances of being truly allergic are not that high, and the pens are only good for one year. 

[mikecva]

Great posting. One thing to add: I have received different pens over the years and have have observed great similarities between them but there are differences in the auto-injectors, so if you are assisting someone with theirs, take a few seconds to inhail twice and look at the directions so you do not break the pen pulling off the wrong end.

[Lone]

Hello,

Also if you use it on someone let the ambulance know so they will not administer adrenalin, which they sometimes do in these situation.  The combination of epinephrine and adrenalin is deadly, it puts the patient into full cardiac arrest.

That's interesting, Katharina, because adrenaline is the term we use here in Australia for what you know as epinephrine.   ;)   
Lone

[Kathyp]

here in Australia for what you know as epinephrine

might she have been talking about the natural adrenalin dump you get when agitated?  that was my thought  :-)