*** Asthma and Anaphylaxis Shock Treatments ***

Re: First Aid (Mike Stacey , Fri 9:36)

Judy Zachariesen wrote:
> 
> padlin (padlin@ix.netcom.com) wrote:
> : Judy Zachariesen wrote:
> : >
> : > Anaphylaxis and asthma are not the same thing. Epinephrine is the
> : > correct treatment for anaphylaxis but NOT for asthma. Don't go
> : > stabbing asthma victims with epi-pens.
> :
> : Hmmm, I was given an rx for an epi-pen by my previous Dr. for just this
> : reason, backcountry asthma emergencies. Guess I'll check it out with my
> : current Doc.
> :
> :  Bob
> :
> Well, my info comes from having a father who is severely asthmatic and
> from a wilderness first responder course and 2 anaphylaxis treatment
> classes.
> - I finished the 2nd day before yesterday. (Yes, I am now allowed to give
> people epinephrine, even if it isn't with their own epinephrine). What
> I understand is that asthma is caused by muscles spasms of the lower
> airway in response to some stress (cold, exercise, toxin e.g. pollen,
> cat hair). The spasms cause constriction of the airway which will continue
> until the muscles relax, which those inhalers help (BTW, the inhalers
> need to be used ASAP - if the airway is too constricted they won't be
> able to inhale them in -this happened to my father who needed a respirator
> tube jammed down his throat.) Anaphylaxis is a systemic allergic reaction
> to an allergen whereby the body vasodilates, blood pressure goes down,
> and the body is no longer adequately sending blood around - the person
> can actually experience volume shock from the vasodilation. Signs of
> anaphylaxis include respiratory distress, hives, etc. Epinephrine (which
> is a synthetic form of adrenaline) is a vasoconstrictor and counteracts
> the vasodilation of the anaphylaxis. If you give epi to someone who is
> not in fact experiencing anaphylaxis, you are vasoconstricting someone
> who has normal vessel volume - this draws the blood from the extremities
> to the core, and causes blood pressure to rise dramatically which can be
> very dangerous if someone is not healthy. Or so I understand it.
> 
> It may be that with some asthmatics, the toxin that generates an asthmatic
> reaction also triggers an allergic anaphylactic reaction, in which case
> epi would be appropriate. My point is simply that one needs to be very
> careful that someone is really experiencing anaphylaxis before using epi-
> you can really hurt them otherwise. Maybe I will ask around among docs.
> But remember, doctors sometimes don't know/remember everything so getting
> epi for asthma still might be wrong, even if the doc gave it. Or it
> might be right, and my info is wrong.
> 
> Judy


Judy,

I have been in EMS as both a paramedic and an instructor so let me see
if I can help.

For field treatment of either anaphylaxis or asthma, epi (we only carry
one kind in the field or the ER) is an acceptable first line drug.  It
is falling out of favor as a first line drug for asthma because of the
new inhaled bronchodilators. Epi has many undesirable side effects such
as increased cardiac oxygen demand and ectopy that are making it less
and less a first line drug expecially for adult (medically that is the
over 40 crowd) asthma.

Anaphylaxis is and IMMEDIATE life threatening condition and must be
AGGRESSIVELY treated as rapidly as possible. For anaphylaxis however
epi is THE drug of choice for initial administration. It reverses the
initial immediate life threatening bronchoconstriction and elevates the
BP. It is however temporary and must be followed immediately by
Diphenhydramine (Benadryl) in order to block the further release of
histamines and stop the reaction from proceeding. Also within a short
period of time these patients need fluid replacement to compensate for
fluid shifts, and corticosteroids such as Solumedrol or Solucortef or
Decadron, and inhaled bronchodilators, and..., well you get the idea. 
These people are HOT cargo during the recovery phase and tend to get in
a lot of trouble after the initial crisis.  Carrying an epi pen for
anaphylaxis in the field is like carrying a fire extinguisher for a
forest fire. It's a nice start but it won't fix the problem all by
itself. It buys you time and nothing more. You need to think beyond
that.

Hope this helps, feel free to e-mail me if you would like more info.

Mike Stacey EMT/P

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