Epinephrine, a hormone produced in the adrenal glands, is also a
medication. When you go to the bathroom in the middle of the night in a
very quiet house, and when your mother jumps out at you as you open the
door to leave and scares the bejeebers out of you, you experience an
adrenaline rush. The fight or flight response. It makes the heart beat
faster, widens air passages to facilitate breathing, raises blood
pressure, and dilates pupils. (Epinephrine and adrenalin are the exact
same thing; the former is derived from Greek and the latter from Latin.
Americans favor the term epinephrine, and the rest of the world uses adrenalin.)
Synthetic epinephrine acts in much the same way. It is effective
against all aspects of anaphylaxis, which is the first big reason you
may want to have it in your medical kit. And that is because anyone can have a reaction to anything at any time.
People who are allergic to nuts, bee stings, etc., already know that
they should be carrying an epi-pen at all times and that all their
family members should know how to use it as well. In a true
anaphylactic reaction, the patient's airway is being compromised or
entirely shut down. In addition, the patient's blood pressure drops,
the tongue and/or back of the mouth may swell, further compromising the
airway, the chest may become tight, and there may be hives and weakness
or confusion. These symptoms most often appear during the first hour
after the sting or eating the food. Epinephrine must be injected to act
quickly enough to save that person's life.
Without epinephrine, you may be able to help the patient with Benadryl,
oral steroids if you have them, and/or a histamine blocker like Zantac
(ranitidine) or Pepcid (famotidine). Of course, your patient's best bet
is to get to a functioning hospital where he can get intramuscular
injections of epinephrine, as well as steroids and antihistamines in a
clinical setting.
Because it is a liquid, epinephrine doesn't have great shelf life,
usually about a year. Even the EpiPens have a pretty short shelf-life,
and once they hit their date, you're supposed to throw them away. Never
mind that they are incredibly expensive in this country. However, the
dirty little secret is that they don't automatically go bad once they
hit their use-by date. Even EpiPens five years out of date may have
enough epinephrine in them to save a life. So if you have a source for
EpiPens that are out of date, get them and hang on to them. Yes, the
efficacy decreases, about ten percent each year. EpiPens five years out
of date are about 60% effective, but a lot will depend on how it was
stored. A nice, moderate temperature is critical. Do not let it freeze
under any circumstances, and do not let it get hot. Also, always
protect it from light, and always know exactly where it is in the
medical kit.
Now, one more item about EpiPens, and this is mainly for people who have
them or their family members. Those epinephrine pens actually have
five full doses in them. But you can only use one dose at a time. Yes,
it doesn't really make sense, and the manufacturers all know this, but
they still continue to put the full five doses in, even though only one
will be used. The EpiPen can be dissembled and reloaded so that it can
be used again. Please note, this should only be done when you have no
other options--no other epinephrine, no doctor, no hospital, no trained
medical personnel whatsoever. There are Youtubes and other instructions
online; click here
for one such video. Note that this requires strong hands and you and
anyone else in the room will need safety glasses. It would also be best
to do this in a small, enclosed area if possible. That spring is gonna
go flying.
A second reason that it is nice to have epinephrine is that as a
vasoconstrictor, epinephrine also helps to stop bleeding. In this case,
epinephrine is usually combined with lidocaine in a 1-2% solution. It
is not to be used on fingers, toes, noses, or ears because it may cut
off circulation entirely. It also should probably not be used in the
feet of diabetics or others with compromised circulation. It is great
when used with lidocaine on superficial wounds with significant
bleeding, especially scalp wounds.
Finally, a third reason to consider having epinephrine in your medical
kit is for treating croup. Croup is most often caused by a virus, and
most often in fall and winter. It's a little more common in boys than
in girls and usually occurs between the ages of six months and five
years, though it can occur in patients as old as fifteen years. QOTPE was nearly eight years old when she had it in the
summer. Croup causes swelling of the inside of the trachea which
results in the classic seal bark cough, stridor (high pitched breath
sound due to turbulent airflow in the larynx), and hoarse voice. The
symptoms are often worse at night and usually last only one or two
days. It afflicts about 15% of children at some point in their lives,
and 1-5% of these cases are severe enough to require hospitalization. A
single dose of steroids is usually administered in more serious cases.
Lacking steroids, epinephrine may also be used.
However, systemic epinephrine will not work in the case of croup. The
epinephrine needs to actually come into contact with the vocal cords.
So the epinephrine, if it is liquid, as most of it is, needs to be put
in a nebulizer. Dry epinephrine may be put into a pot of boiling water
for the patient to inhale the steam. In this case, 1/4 cc, or 1/4 gram,
of epinephrine should be added to one cup of water.
Epinephrine is not a controlled substance. It is not illegal to possess
it. But it is not so easy to find, either. If you've got a good
relationship with your doctor or veterinarian, you may be able to get a
vial that way. And one vial is all you should need to get you through
TEOTWAWKI.
So now, the $64,000 question. Is epinephrine a "must-have" or
"nice-to-have" for you? I asked this very question of the doctor
teaching the off-grid medicine classes I attended. I shared our family
medical history, with no one having any known allergies to anything
except stupid pollen, and my husband's brother being truly allergic to
bee stings. He said if dollars were limited, he would forgo the EpiPen
in our situation and use that money elsewhere. He'd still recommend
getting a vial of epinephrine, if at all possible. Without having tried
out the epinephrine capsules, he said he couldn't recommend it, but it
might be a good thing to have just in case.
One final note: The US FDA took Primatene Mist, a mainstay for treating
mild asthma for many years, off the market in 2011 because it didn't
like the propellant used in it. It is finally available again, as of
late last year. However, Amazon doesn't have it. Walmart, Walgreens, and CVS do carry it. It would be a really good idea
to have this in your kit for treating mild asthma, anaphylaxis, severe
wheezing and coughing, and croup. At $30 each, it's not cheap, but it
is OTC.
Links to related posts:
Lidocaine
Caffeine
Benadryl
Common and Off-Label Uses of Antihistamines
Antacids, H2-Blockers, and Proton Pump Inhibitors
For further reading:
Armageddon Medicine
The Survival Medicine Handbook, pp 249-251.
11.19.19
Epinephrine can't be taken orally. It would be denatured by stomach acid. It must be given via a needle. And should ONLY be administered by a trained professional. The wrong dose can kill....quickly.
ReplyDeleteThe epinephrine capsules are no longer available in the US. They are not taken orally, but are used like Primatene Mist once was. I gather that because Primatene was again available, demand for the dry capsules fell off.
DeleteOf course, everything we store is with the hope that there will be a trained professional available to care for our family members.
Delete