Well known Sonoma racer died from swallowing bee/bug

[buddybikes]

Sounds great to have EPI pens in their bag of tricks, but $$$ yet another life saving product kept away due to corporate greed. This isn't new technology...

[froze]

That's a sad bit of news.

I swallowed a bee once, and it stung my throat, while it hurt a bit, that's all it did. I tried to gargle some water to flush the little bugger out, but it didn't work, so I guzzled some water to flush it down. Actually, for a bug, it wasn't bad tasting, sort of sour from what I can remember. Of course, I didn't chew it up, yuk!

[litcrazy]

Originally Posted by Black Dog

Toss in some chewable aspirin 81mg I case of a potential heart attack for yourself or someone else.

I hadn’t thought of that. I will add those.

[Black Dog]

Originally Posted by rwsaunders

Yep…I had been stung countless times by ground wasps as a kid when I was a caddie and as I grew older, when I was stung the reactions seemed to intensify…swelling, itching. One Summer while trimming a tree in our back yard, a sting in the head by a paper wasp sent me into shock and I was out cold by the time paramedics arrived and revived me. Fortunately I was home and my wife called 911 when I wasn’t responding to Benadryl and my pulse was dropping.

EpiPen user after that and I’ve had to use it a few times over the years following a sting…especially from wasps…no reaction from honey bees for some reason. Being an active cyclist exposes one to more bee encounters than you think. Just using myself an as example, 5 stings while riding over the past 20 years…two were memorable and one ended with another ambulance ride.
Some people think of the EpiPen as a “cure”, but it’s supposed to be the temporary fix until a medical professional takes over. The poor gent at the race seems to have run out of luck, as you couldn’t script that story.

EpiPens buy you time to get an antihistamine on board. Anyone who carries an EpiPen should have Benadryl with the pen. Hope that an ambulance will get to you before the epinephrine wears off is not a good idea. 10-15 minutes is the window that the epinephrine gives.

[rwsaunders]

Originally Posted by Black Dog

EpiPens buy you time to get an antihistamine on board. Anyone who carries an EpiPen should have Benadryl with the pen. Hope that an ambulance will get to you before the epinephrine wears off is not a good idea. 10-15 minutes is the window that the epinephrine gives.

When I was first prescribed an EpiPen, I was issued one pen, which was the norm for 15 years or so. Then one Spring when my prescription expired, I went to the pharmacy and they issued a 2-pack. When I inquired why two pens, the pharmacist indicated sometimes than one isn’t enough. That was a bit sobering.

[thwart]

Originally Posted by Black Dog

EpiPens buy you time to get an antihistamine on board. Anyone who carries an EpiPen should have Benadryl with the pen. Hope that an ambulance will get to you before the epinephrine wears off is not a good idea. 10-15 minutes is the window that the epinephrine gives.

From a physiological perspective antihistamines don’t help very much if you’re experiencing anaphylaxis.

Epipens are used to treat anaphylactic reactions. Benadryl is not a part of initial management.

A possibility the OP didn’t die from an anaphylactic reaction, although we may never know. He may have had a severe localized reaction (lots of swelling… like when your entire hand swells up after a horsefly bite or bee sting) or angioedema (similar process, but with deeper tissue involvement) in a location where swelling is not well tolerated. At all.

Someone above mentioned the possibility of biting a Benadryl gel cap to get more immediate action of the med. There is some chance if that had been done at the first aid tent, the OP would still be with us, as Benadryl is helpful for severe localized reactions. But as somebody else posted, it would require a perceptive “medic” to make that connection and use the appropriate treatment. And then to make darn sure that person sticks around until everything clears or the paramedics arrive.

RW (and his pharmacist) is correct. Epipens buy you time until the paramedics arrive… not until the Benadryl starts to work. If you’re experiencing an anaphylactic reaction, unfortunately that med won’t save you.

[Black Dog]

Originally Posted by thwart

From a physiological perspective antihistamines don’t help very much if you’re experiencing anaphylaxis.

Epipens are used to treat anaphylactic reactions. Benadryl is not a part of initial management.

A possibility the OP didn’t die from an anaphylactic reaction, although we may never know. He may have had a severe localized reaction (lots of swelling… like when your entire hand swells up after a horsefly bite or bee sting) or angioedema (similar process, but with deeper tissue involvement) in a location where swelling is not well tolerated. At all.

Someone above mentioned the possibility of biting a Benadryl gel cap to get more immediate action of the med. There is some chance if that had been done at the first aid tent, the OP would still be with us, as Benadryl is helpful for severe localized reactions. But as somebody else posted, it would require a perceptive “medic” to make that connection and use the appropriate treatment. And then to make darn sure that person sticks around until everything clears or the paramedics arrive.

RW (and his pharmacist) is correct. Epipens buy you time until the paramedics arrive… not until the Benadryl starts to work. If you’re experiencing an anaphylactic reaction, unfortunately that med won’t save you.

I am unsure about this. I agree that an antihistamine will not reverse anaphylactic reactions, that is the role of epinephrine. The antihistamine suppresses inflammation rebound after the epinephrine has reversed the reaction. Paramedics may give oral cetirizine. It is preferred over Benadryl because it is non sedating. In remote locals where rapid intervention from paramedic's not possible the treatment is epinephrine concurrently with Cetirizine or Benadryl after the administration of epinephrine.. I am not speaking to the case in the OP. My wilderness medical first responder training is current and this is still the protocol taught. Since Benadryl is universally well tolerated it is the default go to in the field but cetirizine is preferred in a clinical setting. Assuming that an ambulance will be there before the epinephrine is metabolized is a risky bet if a refractory anaphylaxis occurs.

This is a great discussion. Thanks for your input.

[rallizes]

oh this is awful

not that it necessarily applies in this case but I often think of how when people are told something to the effect of 'you need to get to the ER, you need to get in an ambulance', their first thought might be 'can I afford to do that?'

[thwart]

Originally Posted by Black Dog

I am unsure about this. I agree that an antihistamine will not reverse anaphylactic reactions, that is the role of epinephrine. The antihistamine suppresses inflammation rebound after the epinephrine has reversed the reaction. Paramedics may give oral cetirizine. It is preferred over Benadryl because it is non sedating. In remote locals where rapid intervention from paramedic's not possible the treatment is epinephrine concurrently with Cetirizine or Benadryl after the administration of epinephrine.. I am not speaking to the case in the OP. My wilderness medical first responder training is current and this is still the protocol taught. Since Benadryl is universally well tolerated it is the default go to in the field but cetirizine is preferred in a clinical setting. Assuming that an ambulance will be there before the epinephrine is metabolized is a risky bet if a refractory anaphylaxis occurs.

This is a great discussion. Thanks for your input.

Good to know that’s current wilderness med training. Agree, good discussion. Thank you for your input.

Current ER treatment protocols are moving to larger and repeated doses of epinephrine with antihistamines (and steroids) definitely taking more of a back seat than a few years ago.

And to speak to the ER cost issues…. that’s one of the reasons some folks with early anaphylaxis wind up at an urgent care clinic. Not a good idea.