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Sea Sick: Ask for training on low-cost EpiPen alternatives

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Sea Sick: by Keith Murray

Last year I wrote a column about anaphylaxis (pronounced “ana-fi-lax-is”) and how to treat it with an EpiPen.  At the time, there were countless news stories about the high cost of this life-saving medication in the U.S. — $300 per Epipen. Since then, similar products have entered the marketplace and the prices have dropped substantially.

The EpiPen, made by the pharmaceutical company Mylan, is an auto-injector device containing epinephrine, a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives and other symptoms of an allergic reaction.

Adrenaclick, a generic FDA-approved device with the same active ingredient as EpiPen, is now offered by CVS Pharmacy at $109.99 per two-pack for those without insurance. This means the cost went from $300 per use to about $55 per use — a substantial savings for this invaluable medication.

Please note: It is recommended that anyone switching to Adrenaclick ask the pharmacy for a training session on how to use that injector, or include this training in your next onboard CPR AED First Aid training class. You can also refer to the training video on the manufacturer’s website.

Here are some more details from my column last year.

Anaphylaxis is a potentially severe or life-threatening allergic reaction that can occur very quickly — as fast as within a couple of minutes of exposure to an allergen. Some of the more common allergens are peanuts, shellfish, eggs, ant bites, bee stings, penicillin and latex (the type of rubber used to make balloons and exam gloves). Exercise-induced anaphylaxis is also possible, and sometimes there is no known cause of anaphylaxis.

Anaphylaxis can be different for everyone — sometimes it is a mild allergic reaction; sometimes it is fatal.  I have seen people accidentally eat food containing peanuts or shrimp or something else they are allergic to, yet only experience a temporary tingling in their lips and watery eyes.  Other times, in similar situations, I have seen severe and deadly reactions.

According to the American College of Allergy, Asthma & Immunology, early anaphylaxis  symptoms may be mild, such as a runny nose, a skin rash or a “strange feeling.” These symptoms can quickly lead to trouble breathing, hives or swelling, tightness of the throat, hoarse voice, nausea, vomiting, abdominal pain, diarrhea, dizziness, fainting, low blood pressure, rapid heart beat, feeling of doom and cardiac arrest. Allergists and emergency physicians have formulated the Be S.A.F.E. action guide to help you remember what to do during and after an allergic emergency.

Be S.A.F.E. steps are as follows:

S: Seek immediate medical help. Call 911 or radio for help while at sea and get to the nearest emergency facility at the first sign of anaphylaxis, even if you have already administered epinephrine.

A: Identify the allergen. Think about what you might have eaten or come in contact with – food, insect sting, medication, latex – to trigger an allergic reaction. It is very important to identify the cause because the best way to prevent anaphylaxis is to avoid its trigger.

F: Follow up with a a physician who specializes in treating asthma and allergies. Ask your doctor for a referral to an allergist/immunologist. If you have had an anaphylactic reaction in the past, you are at risk of future reactions. It is important that you consult an allergist for testing, diagnosis and ongoing management of your allergic disease.

E: Carry epinephrine for emergencies. Kits containing fast-acting, self-administered epinephrine are commonly prescribed for people who are at risk of anaphylaxis. If you have an allergy that may cause anaphylaxis, carry an epinephrine kit with you at all times and make sure that family, crew and friends know of your condition, your triggers and how to use epinephrine. Consider wearing an emergency medical bracelet or necklace identifying yourself as a person at risk of anaphylaxis.

It’s a good idea on board a yacht, especially one that charters, to have all guests fill out a medical questionnaire to see if they have any life-threatening allergies, and if they will be bringing epinephrine aboard.  Most people with these types of allergies do carry their medication with them, and when I conduct CPR classes on yachts I have found that most of them have epinephrine in the first aid kit.

Here’s how to use an EpiPen:

  1. Hold the EpiPen by the middle firmly in your fist.  Do not place your finger or any other part of your hand over either end to avoid accidentally triggering the device.  An EpiPen is a single-use device; once it is triggered it cannot be reused.
  2. Pull off the blue activation cap (opposite end from the orange tip that holds the needle).
  3. Inject into the outer thigh at the midpoint, halfway between knee and hip.
  4. Remove the EpiPen and discard.
  5. Prepare for possible side effects.
  6. Get the patient to the hospital as quickly as possible.

Trained as an emergency medical technician, Keith Murray now owns The CPR School, which provides onboard CPR, AED and first-aid training as well as AED sales and service (www.TheCPRSchool.com). Comments are welcome below.

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