Sunday, December 23, 2012

Take the Fear Out of Epinephrine - Part Two

Here's a follow-up post to my original post, to add some more points that I didn't get to make, the first time around.

Point #1: More than one dose of epinephrine might be needed to treat an allergic reaction.

Even though my daughter didn't actually need the epinephrine that she received, I did notice a couple of things.  For one, despite the fact that we live literally down the street from EMS/Fire/Police, it did take them about 10-15 minutes to arrive.  (Now, in their defense, I told the dispatcher that my daughter was breathing, not in great distress, etc., so they probably did not rush, as they would have if I had said she was without oxygen, so I'm not complaining, just explaining.)  The other thing I noticed is that the epinephrine was metabolized pretty quickly.  The rapid heartbeat she experienced subsided pretty quickly and she seemed to be "over" any of the major effects by the time EMS arrived.  So, if she had been in need of that medication, she very well may have been in need of a second dose, had there been a severe allergic reaction that did not fully respond to the first dose.  Since epinephrine can wear off so quickly, you need to keep monitoring the "patient", even though EMS has been called.  You may administer additional epinephrine within minutes of the first injection, if necessary.  This leads me to my next point...

Point #2: Always have at least TWO doses of epinephrine on hand, at all times, home or away!

Given the reasons why you may need a second dose, you should always have at least TWO doses of epinephrine on hand.  This especially applies to when you are away from home.  I think sometimes people feel like they just want to carry one (if they carry one, at all...*shudder*).  However, when you're away from home, that is when you REALLY need to have two with you.  It's like when you go on vacation and they suggest you pack extra medicine, in case your trip is delayed and you can't refill your prescription from where you are staying.  Well, if you have a reaction while you're out and about and use your single dose, there's no time to run home for your second injector!  Speaking of home, that reminds me of my third point...

Point #3:  Always keep your anaphylaxis emergency kit in a particular place, with all the components together.  Check it before you go to bed, after you brush your teeth. [or insert nightly-routine-point here.]  

Even as "together" as I think I have things, I had recently done some rearranging and did not know where my daughter's rescue inhaler was, that night.  I had the EpiPens in one place, the Benadryl and Allegra were in the kitchen, and it took me a bit to find her inhaler.  Those items had all been together, but I had taken them out for various reasons and did not put them back in their spot, so I was scrambling around, looking for them.  You don't want that in an emergency.  You want everything you need, in a single location, ready to go.

Point #4: Don't let anyone make you feel foolish for having administered "unnecessary" epinephrine.

I feel like I was met with some second-guessing by one of the pediatricians when I took my daughter in for her follow-up visit.  I got the impression that she felt I overreacted in administering epinephrine.  I can see how she might think that, in the daylight hours, with the benefit of hindsight, after seeing a steady stream of sick kids march in and out, etc.  However, given what studies are showing about how ER doctors and EMS personnel are failing to properly treat anaphylaxis (this linked article requires a free Medscape account), I did not appreciate her looking at me sideways over having made the call to administer the epinephrine to my daughter, and I don't want anyone else to be dissuaded, either.  I'm not saying we should administer it whenever we feel like, on a whim, but if we truly feel that it is warranted and there are valid symptoms from the "anaphylaxis playbook" presenting themselves, then we do not need to have disapproving people's faces in our heads, making us pause and second-guess ourselves at that critical juncture.  I would much rather have appreciated a "better safe than sorry", as we know all too often the case is usually that someone did not administer epinephrine when it was needed and not the other way around.  I'd rather there be stacks of stories of people administering epinephrine and finding out it wasn't needed, after all, than to read one more story about someone who did not administer it, with tragic consequences.  If anyone gives you any flack, send them to me!


  1. In addition to carrying two epi-pens and leaving two epi-pens with caretakers, be sure that the emergency action plan has instructions to use a second dose if needed. My son's worst reaction was while he was at camp. When they called me, I told them to use the epi-pen and call an ambulance. When I found out the whole story, I realized that he could've used at least one more shot before the ambulance got there. I knew to give him a second dose, but I didn't make sure to communicate that to others.

  2. This is a great follow-up post. I always bring just one pen with me, but now I realize I should really bring both! Thanks!