Friday, November 18, 2011

Anaphylaxis and Asthmatic management in Remote Areas

   Anaphylaxis is rare enough even in civilian and city based environments but in remote areas there will not be a doctor around to administer helpful drugs. As a Remote Medic it is important to have the skills, training and kit on hand to deal with anaphylaxis and asthmatic illnesses.  

   Medical Legal requirements first......

******This blog is geared for medical professionals. If you are not qualified to use this information please refer to a doctor***********

   Anaphylaxis and Asthma are both similar in signs and symptoms. Both face a closing of the bronchioles found within the respiratory system. Asthma will not have the systemic symptoms that anaphylaxis will present with. Let's look at the definitions for both before starting our Wilderness assessment.

    Anaphylaxis is a serious allergic reaction that is rapid on onset and may cause death. It can result in a number of symptoms including occluding the upper and lower airways and the upper respiratory system. It can also cause a systemic rash and a drop in blood pressure. 

   Asthma is a common, chronic inflammatory disease of the airway and respiratory system. Symptoms are reversible airway obstruction, bronchospasm, wheezing, coughing and shortness of breath. 

   In the wilderness these are addressed with the same treatment. Basically the Remote Medic is faced with a casualty who will no longer be able to breath due to the swelling of soft tissues. With anaphylaxis there are more biological reactions to think about including the cardiovascular system leaking out fluids as well as working out what exactly is causing the allergic reaction. 

   There are four drugs that can be used for either of these issues:

   First, Epinephrine is needed immediately in order to buy the Remote Medic some time for the other drugs to take effect. Epi is administered via IM or SC injection with the most common site being the thigh or buttock. The quicker option is to administer the Epi subcutaneously in the belly fat just below the belly button. Subcutaneous injection will get into the system faster than intramuscular. 
   Epi works immediately and can last up to ten minutes. Be ready for a second dose. Keep giving Epi until the second line of medication takes effect.

   Second, Piriton if you live in the EU or Benadryl if you are in North America. Both work well. These take a minimum of twenty minutes to start taking effect. This drug will work for four to six hours. It will take over for the Epi doses that have been keeping the casualty alive up to this point.

   Third, is Prednisone which is a corticosteroid. It needs to be taken once per day until the casualty can be seen by a doctor. This is usually a tablet that can be prescribed by your local doctor. This is a longterm option that will keep the cascading effect of anaphylaxis or asthma from closing the airway of your casualty. 

   Now the wildcard, Ventilin (Salbutamol), or a normal asthma inhaler will keep your casualty breathing long enough for the Piriton and Prednisone to start working. It is a bronchodialator that reverses bronchospasm found in asthma (and anaphylaxis). 

   The Remote Medic should have all four of these options in their med kit especially if they have a client with a medical history of asthma attacks or anaphylaxis. 

An alternative treatment is to have the casualty breath in misty air from a glass filled with ice and drinking water. The cool air will help with the bronchospams. 

More information can be found at Remote Medicine Ireland.

   Again I have to mention the Medical Legal requirements......
******This blog is geared for medical professionals. If you are not qualified to use this information please refer to a doctor***********

This blog is for entertainment only and is not to be used as medical advise. 

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