Would benadryl help anaphylaxis any?

RedBlanketRunner

Opheophagus Hannah Cuddler
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"And up is down and sideways is straight ahead" -Cord the seeker

Returning to the original OP...
Your 6 miles in the woods hiking with some buddies with no cell signal when one of your buddies gets stung by a bee, tells you he is deathly allergic and isn't carrying epi. Your other friends leave to go get help while you stay with your buddy who is showing signs of anaphylaxis. You have a basic first aid kit with a few medications that includes antihistamine pills. What do you do?
Monitor. If acute respiratory arrest occurs, not just labored breathing, perform an emergency tracheotomy. Never administering anything by mouth in the event of a respiratory crisis. From the (outdated?) AHA CPR handbook.
 
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mgr22

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Monitor. If acute respiratory arrest occurs, not just labored breathing, perform an emergency tracheotomy. Never administering anything by mouth in the event of a respiratory crisis. From the (outdated?) AHA CPR handbook.
If my buddy can talk, he's getting some of the oral antihistamine mentioned earlier. That might delay or prevent anaphylaxis, and I'm pretty sure the onset of action PO is at least as quick as IM.

As for a tracheostomy, I usually leave my kit at home right next to the umbrella, but I'm thinking I could use a tire iron and a screwdriver. The tire iron would be for sedation.
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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Grabbing the books...
Mayo: antihistamines such as diphenhydramine (Benadryl), isn't sufficient to treat anaphylaxis. These medications can help relieve allergy symptoms, but work too slowly in a severe reaction.
* Non intervention - therapeutic
* Contraindicated - may complicate further diagnosis and treatment
* Contraindicated - may cause sedation/somnolence/sleepiness, drowsiness, unsteadiness, dizziness,
headache, attention disturbance
* Contraindicated - may cause tremors or convulsions
* Contraindicated - may cause gastrointestinal disturbance, nausea, vomiting, epigastric distress
* Contraindicated - may cause palpitations, hypotension, arrhythmia, tachycardia
* Hypersensitivity - may cause angioedema, anaphylactic shock


Of course, a lay person can administer anything that comes to hand but a person trained in trauma intervention should not go here.

Respiratory crisis: Gasping for breath. Unable to speak. Respirations have become mostly ineffective.
Tracheotomy. All else fails/unavailable. Keys have been used. Soft metal easily sharpened on a rock. Two small round sticks side by side are sufficient to keep the airway open and provide an air passage.


My personal take. Going into the wilderness means always carrying a first aid kit and the $50 insurance policy:

 
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E tank

Caution: Paralyzing Agent
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Having wanted to avoid this dumpster fire, and failed, I'd just like make a point of order and say that I hope that the topic of surgical airway that is being batted about is actually referencing emergency cricothyroidotomy and not tracheostomy.
 

Summit

Critical Crazy
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Anesthesia == triggered 😂
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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The etymology of the word tracheotomy comes from two Greek words: the root tom- (from Greek τομή tomḗ) meaning "to cut", and the word trachea (from Greek τραχεία tracheía). The word tracheostomy, including the root stom- (from Greek στόμα stóma) meaning "mouth," refers to the making of a semi-permanent or permanent opening, and to the opening itself. Some sources offer different definitions of the above terms. Part of the ambiguity is due to the uncertainty of the intended permanence of the stoma (hole) at the time it is created.

(I have done tracheotomys by the book. I leave tracheostomys to physicians. )
 

CALEMT

The Other Guy/ Paramaybe?
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Time to break out Michael... this is almost as good as the helicopter thread.

giphy.gif
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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What in the actual **** has happened to this site. You have got to be kidding me.
I'm new here. Clue me.
PS Hey Hemet. I worked with you people twice. San Jac /Idylwild and Junction fires. What's your fav engine?
 
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Peak

ED/Prehospital Registered Nurse
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It's not a respiratory crisis
Talking does not preclude the presence of respiratory/ventilatory/airway crisis.

Case study:

4 YOM presents to you with barking cough, I/E audible stridor at rest, moderate to severe suprasternal/supraclavicular retractions, moderate intercostal retractions, moderate subcostal retractions, abdominal accessory breathing, nasal flaring, positional comfort in a tripod position, his respiratory rate is limited by how fast he can move air in and out of his airway, dusky appearance to lips and nail beds, cap refill 4-5 seconds.

During exam the patient cries and in a hoarse voice says "I want my mommy."

Does this patient present in extremis?
If he can still swallow secretions are oral or IV steroids preferred?
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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@Peak That's helpful. I'm still going rote by the AHA guidelines. Lots has changed, obviously. AHA was dumbed down and black and white to get the general idea across to lay persons.
BTW, you brought up a very salient point. Being aware of the entirety of the patient. Nail beds, lips, overall skin appearance. Many things easily missed if the medic goes tunnel vision.
 
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Gurby

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The etymology of the word tracheotomy comes from two Greek words: the root tom- (from Greek τομή tomḗ) meaning "to cut", and the word trachea (from Greek τραχεία tracheía). The word tracheostomy, including the root stom- (from Greek στόμα stóma) meaning "mouth," refers to the making of a semi-permanent or permanent opening, and to the opening itself. Some sources offer different definitions of the above terms. Part of the ambiguity is due to the uncertainty of the intended permanence of the stoma (hole) at the time it is created.

(I have done tracheotomys by the book. I leave tracheostomys to physicians. )

You are correct about the "ostomy" vs "otomy" thing.
The key difference is "cricothyr-" vs "trache-".

In a cricothyrotomy, you are cutting the cricothyroid membrane. This is apparently easier to do and has fewer complications. In a tracheotomy/ostomy you are cutting in between the rings of the trachea which I guess is probably more difficult.

 

RedBlanketRunner

Opheophagus Hannah Cuddler
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So what I've done was actually a crico....... Live and learn.

But really the whole point here should be you, the first responder, should not view that procedure as some esoteric surgery:
As for a tracheostomy, I usually leave my kit at home right next to the umbrella, but I'm thinking I could use a tire iron and a screwdriver. The tire iron would be for sedation.
Dead is dead. Do something or stick your thumb up your wazoo and watch bio death resolve the issue for you.

Just to drive the point home (sorry about that turn of phrase) I 'm now going to stab this person in the neck with my Buck. POKE. Went in like cutting butter. Chest instantly expands. Cyanosis recedes to gone in less than a minute.
 
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ffemt8978

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So what I've done was actually a crico....... Live and learn.

But really the whole point here should be you, the first responder, should not view that procedure as some esoteric surgery:

Dead is dead. Do something or stick your thumb up your wazoo and watch bio death resolve the issue for you.
Are you seriously advocating for a first responder to operate outside their scope practice and training?
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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Are you seriously advocating for a first responder to operate outside their scope practice and training?
ABSOLUTELY! When the alternative is death. But when I was teaching CPR we were teaching airway management inclusive of trach/circ to lay persons. Hand the responsibility over to the Reasonable Person Doctrine taking circumstances into account. And please don't get me started on how CPR has been dumbed down into idiot proof little nibbles.
 
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