Epi Pens

[Rob]

In case you come across one - the new style auto injectors are now starting to make it on to the scene.

Video about them here.

Nice thing is - you don't get left with an exposed dirty sharp bit after you use it.

[Leonidas]

Greatly improved, would love to get one for the medi kit..

[whats wrong with you all]

Greatly improved, would love to get one for the medi kit..

how so? I'm just wondering, since if a person did need one, they would have it on their person.

[bikething]

how so? I'm just wondering, since if a person did need one, they would have it on their person.

Only if they knew they needed one... unless they've had a reaction before, they wouldn't know..

[Rob]

Very important not to stray in to prescribing something and administering a drug to someone that has not been prescribed by a Doc - unless you are suitably qualified to do so.

There is the obvious moral dilemma if you had one with you and someone experienced their first anaphalaxis.

[BoonDoc]

It is important to get training in order to use EpiPens. There are courses out there that can certify practitioners to use the EpiPen. In the UK the Remote Emergency Care crowd have this in their curriculum at the REC 4 level.

Nice bit of kit with the safety needle.

[rik_uk3]

Only if they knew they needed one... unless they've had a reaction before, they wouldn't know..

Are you qualified to diagnose a person in need then administer the epi pen?

[Rob]

I would hope that Bikething is qualified to recognise the condition - as he has been on one of our expedition med courses. If not - i haven't done my job properly ;-)

ECP courses cover this kind of thing at Level 2/3 - as it is pretty important.

[rik_uk3]

I would hope that Bikething is qualified to recognise the condition - as he has been on one of our expedition med courses. If not - i haven't done my job properly ;-)

ECP courses cover this kind of thing at Level 2/3 - as it is pretty important.

But should he or you be carrying epi pens? Expedition maybe, UK...no IMHO. Know how to use one and use a patient/casualties own pen but don't carry your own and 'think' you are right to give it; potentially a very dangerous thing to do.

[Rob]

To the best of my knowledge, Bikething will not be carrying an epi-pen in the UK on a routine basis. The training that he received means that he should be more than capable of identifying the problem and administering to someone with a known condition / their own stash.

I carry one in the UK on a regular basis, but that comes down to training and what i do for a living. Overseas, I don't carry autoinjectors - I use the old fashioned route.

[Adi.]

We do not teach you can carry an Edipen or any drug in the UK environment.

To carry an Epipen or any POM in the UK without a script is illegal. Whether you acquired it from a friend, abroad or stole it.
If you choose to carry a POM without a script you leave yourself open to prosecution.

On expedition abroad if you have the relevant training then you can carry and prescribe a POM. I would advise you get medical advise from the UK first and it is strongly advised that any POM's you do carry are sourced on a UK script and not bought over the counter in country. The reason being if something does go wrong there will be an investigation and possible legal tribunal.

[nigeltm]

All arguments over training, rights to carry and the rest aside there is one simple reason for not carrying an Epi Pen just in case;

cost

A pen has a usable life of around 6 months and they cost £30 plus.

Is it worth the hassle of sourcing pens and paying £60 to £100 a year for something you may never use? How many of us have come across severe anaphylaxis in a previously undiagnosed casualty, other than medical professionals and responders who go looking for this kind of thing :-) Even then, it's not exactly a day to day occurance.

Better save the cash and stock your kit with more useful bits that don't have a shelf life and high cost.

[santaman2000]

We do not teach you can carry an Edipen or any drug in the UK environment.

To carry an Epipen or any POM in the UK without a script is illegal. Whether you acquired it from a friend, abroad or stole it.
If you choose to carry a POM without a script you leave yourself open to prosecution.

On expedition abroad if you have the relevant training then you can carry and prescribe a POM...

I'd think that last statement is highly dependent on the laws of the host country.

[Adi.]

If you are in a position to lead an expedition or to do medical cover for one then I would hope you would know the law. If you don't you have no right being in a position of responsibility.

There is no country that would stop a trained expedition medic from treating a member of the expedition in country. Start treating the local population you might open yourself up to problems. It is however wise to check what drugs you wish to take with you are legal in that country as not all drugs available in the UK are legal in other countries. That also goes for drugs obtained in other countries that you may decide to bring back to the UK. Some drugs available in the states are illegal here, including some over the counter products.

An important thing to remember is 'ignorance of the law is not a valid defence'.

[Toddy]

As someone who carries an epi pen (cleg bites) and has a permanent prescription so that when one dates out I have a fresh one to hand, I can categorically state that the only ones I've ever seen are 'Auto-Injector' and leave no exposed sharp end, and that the use by date has always been at least a year.
My present prescription is dated 10/03/11 and the exp date on the pen itself is 04-2012

The thought of managing to stay cool headed enough to stab myself with this one is bad enough, the thought that I would have to manage the co-ordination to effectively fill a syringe too, is not funny, especially since the likely symptoms include, "shortness of breath, nausea, vomiting, stomach cramps and insome cases, loss of consciousness".

If it's of any help, my Doctors tell me that should I present at hospital with anaphylaxis then the epi pen is the last thing they would use. First response is anti histamine, not adrenaline. The very same anti histamines that are available in packs of seven in every poundstore in the land.

Hoping no one (me included) ever needs the pen, but it's rather reassuring (to me *and* to my family and friends) that it's available.

cheers,
Toddy

[bikething]

Are you qualified to diagnose a person in need then administer the epi pen?

Yes. I’ve had training to recognise an anaphylactic reaction, and to use an EpiPen.

But should he or you be carrying epi pens? Expedition maybe, UK...no IMHO.

There’s a reason why it’s called an “expedition” medical course. Some of us don’t restrict our travels to a 5-room tent with built in Jacuzzi on a Caravan club approved site :

Know how to use one and use a patient/casualties own pen but don't carry your own and 'think' you are right to give it; potentially a very dangerous thing to do.

At £40 a pop with a 6 month shelf life I have no intention of carrying one myself in the UK (unless a doctor prescribes that I need one).

Still it's useful knowing how to use one on a casualty who is unable to use their own

[bikething]

... the only ones I've ever seen are 'Auto-Injector' and leave no exposed sharp end..

The pointy bit isn't exposed until after you have used it ..

[Toddy]

......the pharmacist made a point of demonstrating to my husband with an out of date one, the point isn't accessible once the thumb pressure is released. It retracts.

cheers,
M

[bikething]

......the pharmacist made a point of demonstrating to my husband with an out of date one, the point isn't accessible once the thumb pressure is released. It retracts.

cheers,
M

Guess there's different types out there - is "auto-injector" the brand name / manufacturer ? I thought it was just a generic description of the pen thingy.. a bit like "hoover"

[Adi.]

If it's of any help, my Doctors tell me that should I present at hospital with anaphylaxis then the epi pen is the last thing they would use. First response is anti histamine, not adrenaline. The very same anti histamines that are available in packs of seven in every pound store in the land.
Toddy

Your doctor is correct Toddy (as one would expect). The adrenaline is used by casualties, first responders and sometime, A&E departments as the initial treatment to give time to administer anti histamine and give it time to start working. In an overseas expedition as a medic if you are going to carry adrenalin it is important to carry anti histamine too. Normally in the form of chlorpheniramine 4mg every 8 hours orally as stated in the included literature. In very bad cases it might be necessary to inject the first dose of chlorpheniramine from instructions a doctor has given you prior to your trip or much better over a sat phone whilst you are dealing with the casualty.

[Adi.]

......the pharmacist made a point of demonstrating to my husband with an out of date one, the point isn't accessible once the thumb pressure is released. It retracts.

cheers,
M

I don't know what product this was but by saying thumb pressure suggests it was not an Epipen. The old style Epipens, which are still available in the UK, once fired left the needle exposed.

[Toddy]

From the other side of things; it's damned scary when my own body starts reacting and there's nothing I can do to stop it
By the time I feel my heart fluttering like a bird trapped in my chest I reckon I need help; now! The bite on my throat that threatened my breathing though.....that was most unpleasant

I'm very glad, and grateful, that people take the time and trouble to suss out how to, why to, and when to, help, when either I can't, or someone else can't help themselves, either.

Mine is simply labelled, in the manufacturer's box...EpiPen, Auto-Injector 0.3mg, Adrenaline (Epinephrine) Solution for injection for intramuscular use. Delivers one sinle dose (0.3ml) of 0.3mg Adrenaline (Epinephrine). Injects medicine for Allergic Emergencies (Anaphylaxis)
This is my third one so it's not a new-new development, iimmc.

I live near water, lots of water, clegs are commonplace at some times of year. I do get bitten, I do react, but the antihistamines have so far been incredibly effective.

Don't underestimate a simple across the counter solution. I do find the effect is better with anti inflammatory (ibuprofen, again commonly available) too though.
I wouldn't risk foreign travel or camp without the EpiPen. My family and friends know I *always* have anti histamines with me, (spy capsule on my keyring, among other places) and those closest to me have all been shown the pen and given the instructions to read.
This wasn't just for my sake, but it helped reassure them too; that they knew what to do should there be an issue I couldn't deal with. Not fair to leave them worrying.

It's a bit of bu88er, but it's life; sod's law and all that.

The *really* scary bit is how many children are allergic to so many things nowadays not just someone like me who's been bitten so often that my body sees it coming now and over reacts.

cheers,
M

[Toddy]

I haven't used it Adi; the pharmacist said that without pressure it would be into the leg and out again and safely inside the pen and it can't be reused.
The instructions say to hold it against the outer thigh for ten seconds.
It comes in a rather robust plastic tube that we're supposed to put the pen back into, put the bung back on, and hand the whole thing into the chemist or surgery when possible.

cheers,
M

[Rob]

The kids thing is frightening indeed. As is having your body doing something crazy.

From the work that I do at schools, an epipen bumbag used to be something that you could occasionally see - nowadays, it does not surprise me to see half a dozen kids out of a group of 30-40, plus another one on a TA or other member of staff - containing spares.

I often wonder if it is something more of a "just in case" thing with some kids, who have bad allergies that may not have been prescribed for a few years ago but now carry one "just in case the next time it is worse".

For those who do have them prescribed, it is good to know that you can log your pen with the epipen website and they will send you a reminder when it is time to get a new one.

[rik_uk3]

Yes. I’ve had training to recognise an anaphylactic reaction, and to use an EpiPen.

There’s a reason why it’s called an “expedition” medical course. Some of us don’t restrict our travels to a 5-room tent with built in Jacuzzi on a Caravan club approved site :



At £40 a pop with a 6 month shelf life I have no intention of carrying one myself in the UK (unless a doctor prescribes that I need one).

Still it's useful knowing how to use one on a casualty who is unable to use their own

Good to know. Lets keep things simple, doing a course is one thing, doing it for real is a totally different world. I was involved in dozens of cardiac arrests in Nursing and no matter how many times the shout went out, you ring goes tight and you have to make yourself think. Simple as simple can be is the order of the day in first aid situations.

PS I only have four bedrooms in the family tent

PPS got a porta potti in the summer sales

[bikething]

Good to know. Lets keep things simple, doing a course is one thing, doing it for real is a totally different world.

Hopefully I'll never have to do it for real... but if i do, I think it's better to do the course, then do it for real
.. rather than the other way round

I was involved in dozens of cardiac arrests in Nursing and no matter how many times the shout went out, you ring goes tight and you have to make yourself think. Simple as simple can be is the order of the day in first aid situations.

In the absence of a plentiful supply of real casualties (I'd like to keep it that way ) I'll have to make do with the occasional course to get my practice

PS I only have four bedrooms in the family tent

that's more than I've got in the house! LOL

PPS got a porta potti in the summer sales

I ain't lugging one o' them through the jungle

[santaman2000]

If you are in a position to lead an expedition or to do medical cover for one then I would hope you would know the law. If you don't you have no right being in a position of responsibility.

There is no country that would stop a trained expedition medic from treating a member of the expedition in country. Start treating the local population you might open yourself up to problems...

It is however wise to check what drugs you wish to take with you are legal in that country as not all drugs available in the UK are legal in other countries. That also goes for drugs obtained in other countries that you may decide to bring back to the UK. Some drugs available in the states are illegal here, including some over the counter products...

On your 1st point; I agree. That was pretty much the same point I was making.

On your 2nd point; I'm not so sure. Here it's regulated by the individual states and I know of no state that has a separate standard of care for foreigners. However I suppose expeds here might be limited to less remote sites where the issue wouldn't come up.

On the 3rd point; again I agree, but I don't believe it's going to be an issue for Epi.

[Adi.]

I haven't used it Adi; the pharmacist said that without pressure it would be into the leg and out again and safely inside the pen and it can't be reused.
The instructions say to hold it against the outer thigh for ten seconds.
It comes in a rather robust plastic tube that we're supposed to put the pen back into, put the bung back on, and hand the whole thing into the chemist or surgery when possible.

cheers,
M

I would suggest when this one runs out you get yourself an orange and you use it on the orange just so you know what it feels like to use one. Like this http://www.youtube.com/watch?v=9GYruyl9_j8

[kiltedpict]

I remember as a student nurse practicing on an orange! Brings back memories

[Pict]

As someone who carries an epi pen (cleg bites) and has a permanent prescription so that when one dates out I have a fresh one to hand, I can categorically state that the only ones I've ever seen are 'Auto-Injector' and leave no exposed sharp end, and that the use by date has always been at least a year.
My present prescription is dated 10/03/11 and the exp date on the pen itself is 04-2012

The thought of managing to stay cool headed enough to stab myself with this one is bad enough, the thought that I would have to manage the co-ordination to effectively fill a syringe too, is not funny, especially since the likely symptoms include, "shortness of breath, nausea, vomiting, stomach cramps and insome cases, loss of consciousness".

If it's of any help, my Doctors tell me that should I present at hospital with anaphylaxis then the epi pen is the last thing they would use. First response is anti histamine, not adrenaline. The very same anti histamines that are available in packs of seven in every poundstore in the land.

Hoping no one (me included) ever needs the pen, but it's rather reassuring (to me *and* to my family and friends) that it's available.

cheers,
Toddy

I have had to Epi myself and it is a terrifying experience. I have had two severe reactions and to this day we have no idea what caused them. The second one I used the Epi as we live about 40 minutes form the nearest hospital and ambulance service here is a joke. Staying cool enough to stab yourself is the hard part. My reaction started when I was sound asleep of all things. I suddenly woke up with that doom feeling and knew right away what was happening. I had the presence of mind to get my wedding ring off as the first time I swelled up so bad it was killing me. It looked like the metal staple between two sausages.

I made it downstairs and the world started to fade really fast. I sat down before I fell down and stabbed myself in the side of the leg. The effect is amazing. It's not like, "Wow everything is OK!" It's more like, "Wow, I'm still here!" (and I still really feel like crap) They do buy you some time but aren't really a treatment. If you do have to use one expect a really sore leg the day after. Maybe I was just really keyed up and aggressive with it but its like getting punched in the leg with a narrow baton tipped with a needle. I sincerely hope you never need one. Mac

I would carry one still but my spare is now out of date and I can't get them here in Brazil.