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Epinephrine
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by Crotalusssp on May 9, 2008
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There was a discussion the other day about Epi-pens which I thought was somewhat interesting. I am familiar with them and their uses in terms of allergic reactions and release of histamines which cause drastic drop in blood pressure. I am not familiar with there uses in snake bites where the victim suffers a drop in blood pressure not related to histamine release but by mechanism of venom. It seems as if it would have an application. Does anyone have any more information on this topic?
In a side note--Yes I am posting this thread partially because of dislike of all the bickering going on.
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RE: Epinephrine
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by Cro on May 9, 2008
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Charles, this would be a good topic to start back up.
It has been discussed in the past some, but there is still a lot of information on this topic that we could talk about.
Best Regards JohnZ
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RE: Epinephrine
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by JoeCrotalid on May 12, 2008
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As a member who has no interest in the bickering that is going on, but rather wants to ensure appropriate info gets out-I will address this issue as I did when it was put out before from that of a snakebite treatment specialist stand point.
The use of Epi-pens has no use in the treatment of snakebites except when in the field with a long transport time to medical help and may provide some help with hypotension caused by some bites. However, Epinephrine pens are used only to treat the histamine response caused with allergic reactions in the short term similar to an adrenaline surge, but the effects are short acting. The symptoms in snakebites are not even close to those of allergic reactions, and there is no true histamine release from the venom. In addition, Epi is a powerful vasoconstrictor and local injection close to a bite can cause increased tissue necrosis similar to the effects that applying a tourniquet can promote by causing decreased blood flow to the site.
The only true use for an epi-pen in snakebites may be in helping treat the cardio toxins contained in the venom of many eladidae species that cause bradycardia or hypotension. In addition, Epinephrine in itself can cause cardiac damage when injected into a person who does not need it. The use of Epinephrine is best left out of snakebites and used only for allergic reactions and cardiac arrest.
At the Venom conference in Tucson, we started a work group to focus on preventing local tissue damage caused by crotalidae species, and a better medicine would be Regitine to be trialed. Regitine is locally injected into patients who have dopamine (Vasoconstrictor) infusions infiltrate the skin and tissue causing localized necrosis to prevent the damage.
To conclude, snakebites do not cause a histamine reactions similar to an allergic reactions and therefore an Epi-pen provides no benefit in its treatment.
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RE: Epinephrine
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by Crotalusssp on May 12, 2008
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Thank you for the answer. I was thinking that the uses were very limited at best, and only under a certain set of unlikely circumstances. In the event someone has an allergic reaction to the venom or the antivenin, possibly having been bitten before and had antivenin before, wouldn't this be an option?
Charles
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RE: Epinephrine
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by JoeCrotalid on May 12, 2008
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This would be the only exception to its use. Although you are not treating the snakebite in this instance but rather the allergic reaction or hypersensitivity to the venom or antivenom from subsequent bites. An individual with no previous bites would not have a use unless they developed an allergic reaction to the venom itself. Signs and symptoms for use would be wheezing, difficulty breathing, and the feeling that your throat was closing (Severe allergic reactions).
Again Epi is very short acting in this form, and definitive treatment would still be required. When a patient develops an allergic reaction to the venom or antivenom I generally start them on a continuous epi infusion, give solumedrol IV (corticosteroid), Tagament or Pepcid IV (Histamine blocker), and Diphenhydramine IV (Histamine blocker) in order to continue the antivenom which is the only true treatment for the envenomation. These patients are very closely monitored in an ICU setting.
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RE: Epinephrine
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by JoeCrotalid on May 12, 2008
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In addition (with regards to another comment in a different post about Epi), an Epi-pen can only be obtained legally with a prescription from a physician, and is only prescribed to patients with a known anaphylaxsis. They can not be just purchased as this person stated over the counter. Still the best first aid is knowing exactly what species you have, knowing the appropriate antivenom for that species, your cell phone with the numbers to Poison Control, Miami-Dade Venom Bank, and having an appropriate bite protocol written to give to EMS and Hospital Personnel when you arrive. It doesn't hurt to have other keepers numbers and Chris's, mine or other specialist phone numbers as well.
I don't recommend the Epi-Pen unless you have a known hyper-sensitivity.
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