BEES!

[mobey]

So at this point i'm growing more and more concearned as the miracle Epi & Benadryl is not doing the trick.

It is at this point I hop on the radio with our base hospital (Something rarely done) for guidance.

You are the base hospital, what are you gonna advise.

or

You are in my position, what are you gonna do.

SaO2 continues to drop and there was no RSI to use.

I have heard of using IV epi for severe anaphylaxis, but have no idea what dose, so i'll patch a doc and get some ideas!

[ERDoc]

Is this pt on beta blockers? Are we missing something (given that the stings occured 4 hours prior to the onset of symptoms)? IV epi can be given:

0.1 cc of 1:1000, diluted to 10cc, given over 5-10 minutes

You can also initiate a drip by mixing 1cc of 1:1000 in 250cc (4mcg/ml) start at 1mcg/min and titrate to effect with a max of 10mcg/min

That being said, follow your local protocols.

[chbare]

Yeah, need to consider beta blocker use. In addition, SC epi may not reach the central circulation in a patient who does not have peripheral perfusion. Epi gtt is a good idea. We could also consider H2 blockers. I know of a couple of cases where preservatives in 1:1,000 epi can cause a reaction, so try 0.1-0.3 mg of cardiac (1:10,000) epinephrine slow IV. Once stable, we can give a steriod such as solumedrol.

Take care,

chbare.

[ERDoc]

Yeah, need to consider beta blocker use. In addition, SC epi may not reach the central circulation in a patient who does not have peripheral perfusion. Epi gtt is a good idea. We could also consider H2 blockers. I know of a couple of cases where preservatives in 1:1,000 epi can cause a reaction, so try 0.1-0.3 mg of cardiac (1:10,000) epinephrine slow IV. Once stable, we can give a steriod such as solumedrol.

Take care,

chbare.

Just give the roids now. They're going to take a few hours to start working anyway.

[SANDMEDIC]

Exactly!!! The patient is on Tenormin also known as Atenolol.

We did not have IV Epi in our protocols, but does anyone have a guess what the order was for.

[ERDoc]

Exactly!!! The patient is on Tenormin also known as Atenolol.

We did not have IV Epi in our protocols, but does anyone have a guess what the order was for.

I know. :wink:

[SANDMEDIC]

Alright !!

The order was for Glucagon 2 mg slow IV.

of all the drugs in my toolbox it was the one everyone make fun of and always wonder why we carry it.

Well Glucagon saved the day.. literally!

After approximately 10 minutes the gentleman was asking me if he really needed to go into the E.R. as he felt completely fine now.

How it was explained to me.

The physician explained it as Biphasic/ multiphasic analphylaxis, he stated it usually happens after some initial treatments although can be completely delayed up to 8 or more hours.

The delayed reaction was simply a slower release of histamine and other chemical components of analphylaxis, although it potentiates the longer the body is allowed to continue in this state.

An alternative drug for treating anaphylaxis in patients taking beta-blockers is glucagon. Glucagon helps to produce the same chemical within the mast cells that epinephrine does, but Glucagon doesn't need the beta-receptor sites to do it. This chemical stops the release of histamine and other chemical mediators that contribute to anaphylaxis. The Glucagon dose used to treat anaphylaxis in patients taking beta-blockers who are unresponsive to epinephrine is 1-2 mg IV. Common side effects of Glucagon administration for anaphylaxis include nausea, vomiting, and hyperglycemia.

Things to remember.

1. Take your time and get a complete list of meds.

2. No more making fun of Glucagon. Those that do not carry it, it might be something to suggest.

3. When things are going bad and you are at the end of the Algorhythm, DO NOT have too big of an ego to call your base hospital and ask for guidance.

4. This is a good one to ask around the station, I found that it is such a rare occurance some have forgotten this little tool.

5. Having a little guide book on drugs comes in handy. Not all of us know what Tenormin is, if we don't see that "olol" to know it's a Beta-blocker.

Hope you all enjoyed my first little scenario.

Any further questions or points I should have made please post.

[WendyT]

I just want to make sure I'm clear on this. He was stung 4-5 hours prior and the bees are still swarming? They were taken care of by FD. He took his epipen just prior to calling? Did he take anything immediately after he was stung? Why did he take the epipen so late? What new symptoms was he having just prior to the epipen? What symptoms started after he used the epipen?

Given factor's since he was stung so many times that makes the epi-pen not nearly helpful enough and benedryl pills or liquid?

Sweating profusedly, throat closing, given the distance of him mowing the lawn from his house, running to his house only makes the venom work faster against him. So I can see why it's not working, to many bee's, had it only been one or 3 bee's it might work.

But a whole swarm is not good. I'm surprised he's NOT dead yet! :wink:

[Richard B the EMT]

Sandmedic said

As you stage a safe distance the fire department used the old dish soap in the water tank trick and has since made the scene safe.

If we end up with a Bee situation, we got a few LEOs in the ESU (Emergency Services Unit) trained as bee keepers, or have bee keepers on call. So...

Dish soap in the water tank trick?

Somebody please elaborate for this City Boy, with thanks in advance?

[Chief1C]

Send next unit due.

I am allergic. No unit available, I quit.

CO2 Extinguisher.. or.. Deck gun fed with a high density mixture of detergent foam. Two things that pisses bees off more than mowing their home. Cold and Soap.. They can't fly and they can't take in oxygen through their exoskeleton, and it breaks down the exo. through some type of chemical reaction.

We have a miracle grow garden sprayer on the brush truck. You attach it to either forestry hose; or the garden hose we carry to fill "Indian Guns".. It's filled half with Ivory liquid and half with Dawn.. Shake while spraying and those SOBee's will never know what hit them.