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 Post subject: Emergency treatment
PostPosted: Tue Oct 02, 2007 6:52 pm 
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Joined: Mon Feb 07, 2005 6:39 pm
Posts: 2948
Location: Toronto
At the allergists' conference in Edmonton this past weekend, there was a seminar that got into how anaphylaxis is treated in Emergency Rooms.

Some of the allergists seemed to think that epinephrine was usually given as the first-line drug, while others were less certain. know that wasn't my experience on one occasion in west-end Toronto (I was given corticosteroids for the breathing), and I've heard the same from others.

Has anyone else gone to Emerg for treatment of themselves or their child? If so, what were the meds given - and do you feel they got the urgency?

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Allergic to soy, peanut, shellfish, penicillin


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 Post subject:
PostPosted: Tue Oct 02, 2007 7:52 pm 
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Joined: Sat Sep 16, 2006 6:50 pm
Posts: 205
Location: Ontario, Canada
Epinephrine both times and then benedryl and prednisone one time. We were seen immediately ( the nurse ran with us). They did not even ask for a health card until later once things settled down.

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daughter: 6 years tree nuts, peanuts


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 Post subject:
PostPosted: Tue Oct 02, 2007 8:53 pm 
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Joined: Thu Sep 22, 2005 11:39 pm
Posts: 1141
Location: saskatchewan, canada
My youngest was in emergancy 3 1/2 years ago (her first and only major reaction) with a swollen head, swatting at her head ( we assume inner ear swelling) and vomiting. She was basically unrecognizable. She was NOT given epinephrine. The doctor tried to give her liquid cortisone but she was fighting him...because he was forcably holding her down. There was NO WAY she would take it...and not spit it out. When I suggested being less forceful he gave ME the medicine and told me to do it (basically he gave up). Looking back, it was a very serious situation and epimephrine should have been given no doubt about it.

_________________
DD age 9 1/2 -peanuts, nuts,
DD age 7 1/2 - milk, eggs, chicken, peanuts, treenuts, cats, dogs,
DS age 2 1/2
Husband- asthma, eggs, treenuts, fish, shellfish environmental
Self - penicillan, eurithromiacin, mild laytex allergy.


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 Post subject:
PostPosted: Tue Oct 02, 2007 10:44 pm 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6481
Location: Ottawa
2 ER visits. Both times she was given EpiPen enroute (or just before) and recieved Benedryl during the hospital stay and prednisone just before discharge.
At the first hospital (an adult hospital) she was left to the supervision of her parent.
At the second hospital CHEO, she was hooked up to a heart/O2 monitor for the entire duration.
I felt that there was little urgency as the parent was there and could monitor. In both instances the airway was clear and heartrate was normal (as normal as to be expected on epinepherine). There was no waiting to get a room but there was minimal involvment.
I believe the staff was busy with other patients who required more hands on care.
I felt very respected by the hospitals and any questions/concerns were promptly dealt with.
My only real question was when could I offer her something to drink/eat as we were there a long time and over the dinner hour.

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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 Post subject:
PostPosted: Wed Oct 03, 2007 10:21 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
First time: epinephrine, steroid, benedryl. They definitely GOT the severity.

A few times shortly after that: they did not treat as such a severe reaction. They were right -- I was suffering anxiety, and treating it as anaphylaxis would have been the wrong thing to do. (I went to ER thinking it was another ana. reaction.)

My trips to ER were in Toronto.

*******

A few years later, we took our son to the ER in Summerside, PEI. He was having a reaction, but it was not anaphylactic. They monitored him, and gave him benedryl. I felt for the reaction he was having this was the correct way to deal with it.

I also feel they GOT how serious it COULD have been. Before we left the hospital the doctor took the time to talk to us about where we were staying, where the ambulance would come from, where we could get cell service to call the ambulance, where we could meet the ambulance. The one BIG error -- he should have given me a prescription for a jr. epi-pen, as all I had was a full-dose epi and our son was only 2.

_________________
self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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 Post subject:
PostPosted: Thu Oct 04, 2007 9:12 am 
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Joined: Tue Mar 22, 2005 6:53 pm
Posts: 1454
Location: Canada
My first experience was horrible at first---I had had a number of symptoms before going to the hospital, but what was most noticeable at the time was acute respiratory difficulty. I'm really not sure whether my face was swollen yet--by the time I got treatment, it was, but I'm not clear on whether it was swollen when I was refused treatment.

What happened (mind you, this was 17 years ago)--I was at a family gathering in Toronto and had a run in with some nut-laced caramel corn. (Nope, wasn't so careful back then.) To make a long story short, my father ended up driving me to the Toronto General. When we got to emergency, I was told that I was too young--we ought to have gone to Sick Kids just across the street. My dad started arguing, and a nurse who saw what was going on simply plunked me in a wheelchair and literally ran me to Sick Kids (with my dad keeping pace behind). I was put on oxygen, and I.V., given two doses of adrenaline (the first dose had no effect), and probably given other meds intravenously. The drs at Sick Kids were not pleased. Someone remarked that a man having a heart attack had wandered into Sick Kids the other week, and they did *not* ask him to walk across the street!

I was well taken care of at Sick Kids, but they should have given us more info. before discharging me. They considered having me stay overnight for observation which scared me because it implied that something could still go wrong. When my parents indicated that we were from out of town and had planned on going on vacation the next day, the dr. said I could stay for several more hours and then they'd make a decision from there. So when I was discharged later that night, I was still scared something could happen---all the more so because I was given benadryl to take for a few days. I asked why I needed the medication, and the dr. said to prevent another reaction. I really wasn't clear whether I was 'safe' and if not for how long I'd need to worry. And as I recall, we didn't fill the prescription for the epis right away. I was afraid to go to sleep at night! We did delay our vacation for a few days, but I really wasn't ready to travel---I ended up having a panic attack in the car. I was hyperventilating a bit, and for a short period of time was partly paralyzed (psychosomatic).

----------
My other ER story---I had taken epinephrine, and I was fine afterwards, but went to emerg just in case. They didn't seem particularly concerned because I had no symptoms when I got there--they kept me for 'observation' (i.e. stuck me in a curtained off area where I wasn't being observed at all. At first, I was by myself, but I caught a nurse's attention and asked her if the person who came with me to the hospital could wait with me as opposed to sitting in the waiting room!) I don't recall if I was given any more meds. In any case, I was fine.


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 Post subject:
PostPosted: Thu Oct 04, 2007 9:45 am 
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Joined: Mon Sep 19, 2005 6:31 pm
Posts: 61
Location: Ontario
I've always intended to "write a letter!" about the treatment we got at the local ER and have never gotten around to it. I wanted to impress upon them the potential severity of the situation because I've been told since by our allergist that it was handled wrong.

We had two visits, one when Cayley only about 5 weeks old and had a severe reaction to milk formula, but the second ER visit was the one I wanted to write a letter about. Cayley had outgrown her milk allergy at 2-1/2 years and when she was nearly three she licked a tiny bit of peanut butter from a knife during breakfast. Within 30 seconds she was screaming, clutching her stomach, projectile vomiting and covered with hives. We raced to the ER, where they immediately checked her throat and tongue for swelling and, finding none, they relaxed and gave her some Benadryl (which she promptly vomited up). They gave her more Benadryl and we stayed there a few hours while she slept and slowly recovered.

In hindsight, I shudder at what could have happened. The ER doctor told us that hives and vomiting are not signs of anaphylaxis, so she just had a "mild" peanut allergy and didn't need to carry an Epipen or see an allergist. "Just avoid peanut butter" he said. If I hadn't pursued the issue, insisting to my family doctor that we needed an appointment with an allergist, I might have believed that ER doc. Bad enough - my husband believed him and thought I was being slightly hysterical, insisting on an allergist for no good reason. However, I'd grown up with a peanut/tree nut allergic and asthmatic friend and knew it was potentially serious - what was this "mild peanut allergy" stuff?

Fast forward two months (yep, that's how long it took to get us an allergy appointment): the allergist promptly gave us a prescription for an Epipen, after seeing the huge wheal from the skin test, and told us that Cayley had indeed suffered an anaphylactic reaction and should have received epinephrine. Since then, I've read that an Epipen be given immediately when there is known ingestion with gastrointestinal involvement because the cramps, pain, etc., means the GI tract is swelling - just because an ER doctor can't see the swelling doesn't mean it isn't potentially serious. My husband was devastated at the allergist's recommendations of strict avoidance, Epipen (two, preferably) and making our house peanut-safe - he had completely trusted the diagnosis from the ER doctor and thought the allergist was just going to confirm it.

Holy mackeral that's a long post, sorry about that! I do think allergies and body system involvement are misunderstood by ER docs, who definitely need to have a surface understanding of everything medical but don't have the in-depth training that perhaps they should on severe allergy. So much is still unknown about the immune system, and allergists need to realize that new breakthroughs take ages to get to the ER level, especially small town ERs like ours. To answer your question simply - not only was an Epipen not given as a first treatment, it wasn't thought to ever be needed for follow up peanut ingestion reactions. I really should write that letter!


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 Post subject:
PostPosted: Thu Oct 04, 2007 4:22 pm 
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Joined: Thu Oct 04, 2007 4:08 pm
Posts: 1
Location: Edmonton
Hi all! I'm a new poster, but have been following the forums for a while now, and have always been thankful for all the information that everyone shares!

With regards to emergency visits, thankfully, we have only had one, in October 2004. My daughter, who was not quite 3 at the time, was having her first anaphylactic reaction. We took her to the Stollery Children's Hospital here in Edmonton where, after taking one look at her, she was seen immediately. They administered epinephrine right away, as well as other meds to help her breathing, etc. Looking back on it now, I am so impressed with how everything was handled and how the ER docs were so knowlegeable about anaphlaxis. In fact, the doctor that discharged us was quite perturbed at the lack of information we had been given about when to use our Epipen when it was initially prescribed. We have since changed allergists and are very happy with the ongoing follow-up we receive.

I'd like to think that our experience was the norm and not the exception at our hospital. You rely on having those in the ER know how to treat your child!

_________________
Daughter, 6 - allergic to peanuts
Daughter, 9 - environmental allergies, mild asthma


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 Post subject:
PostPosted: Thu Oct 04, 2007 5:30 pm 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6481
Location: Ottawa
If you call 911 they will take you to the nearest childrens hospital. Children are better off being treated in hospitals that specialize in child care. They have equipment suited to the childrens needs and they are not really able to take on the adults. I don't know if there is a funding reason but there might be.

Any hoo, after epinephrene has been given call 911 and have the EMS transport the patient. They are often able to do more on route than you could. They can navigate through the traffic better and they are less likely to become distratcted and have an accident.
:)

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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 Post subject:
PostPosted: Thu Oct 04, 2007 5:47 pm 
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Joined: Sat Sep 16, 2006 6:50 pm
Posts: 205
Location: Ontario, Canada
I have had better experience at our regular hospital. There is a room set aside for children with all the equipment required for infants and children.

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daughter: 6 years tree nuts, peanuts


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 Post subject:
PostPosted: Thu Oct 04, 2007 11:36 pm 
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Joined: Mon Feb 07, 2005 6:39 pm
Posts: 2948
Location: Toronto
Carolyn, that's a rather scary story - and that ER doc sure didn't get anaphylaxis.

I'm glad that some others have had good ER experiences. But this all kind of confirms my sense that the protocols followed for anaphylaxis aren't terribly consistent. (Though I can also understand AM's rationale in one instance of a panic attack; I can see where that might happen. with this condition.)

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Allergic to soy, peanut, shellfish, penicillin


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 Post subject:
PostPosted: Sun Dec 23, 2007 9:10 am 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6481
Location: Ottawa
Yesterday we presented at CHEO emergency by ambulance after having given the Epi-Pen. Because it was given almost immediately before symptoms progressed very far, she was looking normal (swelling and hive had vanished), she had no trouble breathing and her blood pressure was normal.
The resident Dr takes a look at her and starts ordering IV and steroids...um, excuse me? Mother over here...what are you doing? I asked him to explain to me the rationelle for each action he wanted to take. I told him that I was prepared to allow him to do whatever was necessary but that I wanted this to be as least invasive as possible. (IV's should blood pressure drop and to administer medications yes-but in this circumstance it wasn't needed) .
He agreed to forgo the IV and to get back to me about the steroid. In the end we decided against the steroid and I will do some research into that before I say more because I don't recall the exact wording and I don't want to mislead.
Excellent care for the 6 1/2 hours we were there. Nurses asked food services for a safe meal given her allergies and they sent up roast turkey, corn, rice, banana, apple juice and fruit cocktail all on a plastic plate on a pressed paper tray with plastic cutlery.

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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 Post subject:
PostPosted: Sun Dec 23, 2007 9:47 am 
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Joined: Thu Dec 21, 2006 5:25 pm
Posts: 83
Location: Orleans, Ontario
Hi Susan,

Sorry to hear about your ordeal. I hope your daughter is ok and that you are as well. I know how stressful these experiences can be.

My thoughts are with you over the holidays. May Santa bring you everything on your list and then some!!!

Denise

_________________
Oldest son 9: allergic to fish and shellfish, pollens, pets, mould and dustmites
Youngest son, 5: allergic to peanuts, nuts, dairy, eggs, sesame, kiwi, asthma, pollens, pets, mould and dustmites


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 Post subject:
PostPosted: Sun Dec 23, 2007 11:42 pm 
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Joined: Tue Sep 12, 2006 8:25 pm
Posts: 233
Location: Winnipeg
Susan, I hope your daughter is feeling better, and glad to hear your treatment at the ER was good.

_________________
1 son allergic to eggs, peanuts, green peas, chick peas, lentils and tomatoes
(avoiding tree nuts and most other legumes too)
1 son allergic to eggs, and has outgrown peanuts
Both with many environmental allergies, asthma and eczema


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 Post subject:
PostPosted: Mon Dec 24, 2007 3:33 am 
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Joined: Fri Dec 22, 2006 12:52 am
Posts: 214
I had an ana reaction while studying abroad and basically had no clue what was happening and just waited it out (nearly passed out in a school bathroom, but went right back to class after the dizziness passed about 20 minutes later). So scary! I went to student health services the next day, and if there is anyone worse than an ER, it's a student health service! I told them I thought I had a food reaction and wanted to get tested, and they pretty much told me that a) it was unlikely because those are really rare and not very serious and b) that you can't really test for them anyway. Thus began a myth that endured for two years, that all I had was eczema and that the one serious reaction I had was a fluke! It took two years for ME to finally figure out via food diary what the trigger was for the skin stuff, which convinced them to test me, which confirmed the corn allergy THAT I HAD FIGURED OUT ON MY OWN and pinned the ana reaction to a tree nut allergy. My second ana reaction was to a raw apple, and a doctor relative of mine was quite orrified when she heard that my allergist had never warned me about the potential for tree nut/tree fruit cross-reactions.

So, yeah. Not really impressed with any of the 'treatment' I have gotten so far :)

_________________
Asthma and eczema
Drug allergy (succinylcholine)
Food (corn, raw apples, green beans, tree nuts, flax)
Misc (pollen, grass, mold, dogs, cats)


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