Outdoor Ed^SM

Allergic Reactions & Anaphylactic Shock Protocol

Anaphylactic shock is a form of neurogenic shock, which results from a serious allergic reaction. It is usually caused by insect stings (bees, wasps, hornets, yellow jackets, etc.), but it also may be triggered by other insects (flies, mosquitoes), foods, (fish, shellfish, berries, nuts), drugs (antitoxins, penicillin), and pollens.

Anaphylactic reactions may be mild to immediately life threatening. Someone may have a reaction with no prior history. Be wary of people who are allergic to shellfish, but have never been stung by a bee. Anaphylactic reaction can set in anytime from almost immediately to hours later. Allergic reactions to ingested food take longer than injected substances (like bee stings) or contact allergies. If the person has not had any reaction after 6-8 hours, they will not have a reaction.

It is essential that you evaluate the patient�s condition carefully. You need to ascertain whether the person is having a localized reaction or a systemic reaction. The allergic reaction releases histamine, which dilates blood vessels. In a local reaction blood vessels around the allergy site dilate causing localized swelling. In a systemic reaction, blood vessels all over the body dilate. This massive vasodilation causes the person to go into shock. The most dangerous aspect of a systemic reaction is the potential for airway obstruction caused by swelling from the vasodilation. An obstructed airway can lead to death in minutes. Be most careful about stings around the face, neck, and mouth since these are most likely to create swelling around the airway. In this case even a local reaction can compromise the airway. Anyone showing swelling around the face or neck should be treated as described below for Systemic Reaction. The more immediate the reaction to the sting, the more likely the reaction will be severe.

For local reactions, treat with Benadryl. Benadryl is an antihistamine, which inactivates histamine in the blood to keep the vessels from dilating. Benadryl will not constrict vessels. Epinephrine is a vasoconstrictor and reverses the vasodilation. However, Epinephrine will not deactivate histamine. That is why for a systemic reaction, you must treat with both Epinephrine and Benadryl.

Local Reaction:

This is a normal reaction to a sting (See Insect and Spider Bites/Stings).

• Local pain
• Swelling
• Redness
• Itching
  
  

Treatment:

• Monitor the person.
• If you see any sign of the local reaction spreading give Benadryl (see Medication Profile) and watch for a systemic reaction.
• If the reaction is caused by an injected substance (bee sting) you can also use the Extractor within the first 2-3 minutes of the sting to remove some of the venom and decrease the allergic response.

Systemic Reaction:

Mild

• Look for hives (red spots at other body locations away from the sting site),
• Itching and burning, especially of the face and chest,
• Discomfort, and anxiety.

Moderate-Severe

• Difficulty breathing - this can be immediately life threatening.
• Pain (generalized/abdominal)
• Constricted feeling in the chest
• Wheezing
• Nausea
• Vomiting
• Dizziness
• Weakness
• Hoarse speech

Treatment for any Type of Systemic Reaction:

1.Use the Anaguard for any patient showing any level of systemic reaction (mild to severe). The instructions are taped to the inside of the kit. Have someone read them out loud once and then again while you work. Inject into the deltoid muscle (upper arm), thigh, or butt. You want to get the dose into the person�s system before they have more severe symptoms. Once the major vasodilation has occurred, it is difficult for the injected Epinephrine to be transported through the body. Be prepared to give a second dose after the initial Epinephrine dose wears off (within 5-10 minutes). If the person shows no improvement after 5 minutes, give the second dose. You may even have to give a third dose. After administration of Epinephrine the patient may feel fine, but s/he must be evacuated, no matter how good s/he may feel (see Evacuation Protocols below).

2. Begin preparations to evacuate your patient. Anyone having a systemic allergic reaction must be seen by medical personnel. Depending on the severity of the reaction, the patient may be able to walk out on his or her own after receiving the Epinephrine. If they are unable to walk out, you will need to make arrangements for a litter evacuation (see Evacuation Protocols below).

3. Give Benadryl (see Medication Profile). Have the person continue to take Benadryl (25 - 50 mg) every 4 hours for 3 additional doses over the next twelve hours.

4. If the reaction is caused by an injected substance (bee sting) you can also use the Extractor within the first 2-3 minutes of the sting to remove some of the venom and decrease the allergic response.

Evacuation Protocols

• Anaphylaxis is a potential life-threatening illness. Any individual who has been given Epinephrine must be seen by a physician as soon as possible.
• In more severe cases of anaphylaxis the individual must not hike out.� In this case, you will need to contact local Emergency Services (Rescue Squad, ambulance) to transport the patient. Any of these signs to mean that your patient is too critical to walk out.
• Swelling around the airway, tongue, face, or throat.
• Respiratory problems such as constriction or wheezing.
• Hypotension of signs of volume shock
• In mild cases of anaphylaxis (e.g. hives are present but none of the signs above) the individual may be able to walk out under his/her own power with support. In this case, the entire group is to hike out with constant monitoring of the patient. At any point if the patient�s condition deteriorates, stabilize the patient and send for emergency medical transport.

Administering Epinephrine

Open your Anaguard before you go on a trip. Familiarize yourself with the instructions. Also, be aware that people with a history of anaphylactic reactions often carry their own Anaguards or "Epi-pens." The patient may administer the Epi-pen to herself, however, the pens only have one dose, so if a second dose is needed, you will need to use the Anaguard.