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PostPosted: Sat Oct 03, 2009 2:35 pm 
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Joined: Fri Oct 02, 2009 8:06 pm
Posts: 217
Location: Terrebonne, Quebec
My daughter is very young, (10 months) so her reactions are very hard to judge, because the only thing she does is cry and rub her face when she has a reaction. She had her first reaction at 4 months, and being a first aid/CPR instructor, I know how to recognise the signs of an allergic reaction, and knew what it was (this one was to dairy). I thought it was minor, popped her in the car and drove off to the closest ER (10 minutes away). By the time I got there, her lips were huge, her eye was swollen shut and her ears looked like ballons, I was visibly shaken taking her out of the car, ruched in and luckily the nurse that I saw was very good, quick to recognise the reaction. She fell unconscious just as I got into the ER and turned grey (blood pressure). Well, after handing her over to the doctor, and hearing them call a code over the intercom I was about to pass out from worry. They were great, they got me a chair, explained everything that was happening and let me hold her as soon as she was tubed and stable, then we went to observation for 8 hours. They prescribed an epi-pen but they mentioned she had a very odd reaction, because she showed NO respiratory symptoms before losing consciousness.

So I had a baseline to base her reaction on. The second time (at 9 months) giving her egg yolk for the first time, she started getting a little bit red around her lips, and I wasn`t sure it was the egg, because they dog sometimes gives her kisses which cause the same redness, so I gave her the emergency dose on benadryl and everything was fine.. for the next 4 hours (which brought us past bedtime). She wakes up crying, and my husband gives her a bottle, which seems to calm her down, an hour later she is screaming from her crib, I bounded out of bed, not knowing what to expect, I go in her room and turn on the light because I can sense there is something wrong. She looks at me, rolls over and projectile vomits all over the wall next to her crib. I grab her quickly, strip off her clothes and she is red from head to toe. (Here I should really have given her the epi-pen of course, but I didn't and will know better for next time). We gave her a quick dose of benadryl and off the the hospital (same one as last time), by the time we get there, she isn't vomiting anymore but she is still very red, but not crying. I say I need to see the nurse right away, and she comes out, I explain quickly the history and she listens to her lungs, says she doesn't hear wheezing, so she's fine and makes me sit down and wait. 5 minutes later, she projectile vomits again (6 feet for a 9 month old is pretty surprising to see). Still, the nurse says vomiting doesn't make her a priority. I wanted to slap her so she'd wake up. She was looking at me like "oh it's just another paranoid mother". 10 minutes later, finally get to see her, and she yet again listens to the lungs, says there is no wheezing, I explain the history again, and she doens't even ask me to take off her shirt to see her skin, just says she must be a bit red because it's cold out. She sends us to a glorified waiting room, where my fed up husband finds some other nurse to come in, who immediately runs to grab to doctor after hearing her history, after some fun injections and long observation, we are sent home.

I probably should have taken out the epi-pen right there in the ER and given it to her after she vommited again, and then they would have had to take her to put her on a monitor at least, and I could have seen someone competent.

I would have gone to the childrens hospital, but it's 30 minutes from home, and my daughter wouldn't have survived that long, i'm sure of it! Next time I know, Epi-pen and 9-1-1 right away (her pediatrician gave me heck for not having done that in the first place, she said an ambulance will be faster and they wont make you wait that way, which makes sense).

How do you deal with the frayed nerves and/or stupid hospital staff? Yelling wont help, they'll just call security.

_________________
Daughter 3.5 years) - Dairy, Eggs, Peanuts, Sesame, Beef; asthma and eczema
Daughter (2 years) - Peanuts Eczema
Son (7 months) - Contact allergy to something food undetermined


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PostPosted: Sat Oct 03, 2009 3:43 pm 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6479
Location: Ottawa
Yikes how scary! First of all, you are right, block airway is not always present. It is a huge indicator and a very serious syptom as if you can't breathe, all sorts of other things can happen but if the pressure drops and the veins collapse, the medicine won't leave the area. Hives over a large area of the bdy can draw fluid/blood away from vital organs so, give your Epipen. It doesn't matter what the professionals think. You won't harm her if it isn't anaphylaxis and you may just save her life if it is.

Give her the Epipen before you leave home. Call 911 if you have the service in your area. You will have medical help from the moment the ambulance arrives and depending on the serivce in your area, they can intubate her and host of medicines in their arsenal. They won't use your Epipen but will give the dose required for her weight. they will also monitor her oxygen levels and heart so you won't be dealing with someone who is looking for wheezing.

Wheezing isn't even present in all asthma episodes...would that nurse not treat for that either?

Best of all, the ambulance will take you to the childrens hospital and they see more anaphylaxis so they'll be better trained (I hope).

You may want to follow up with a letter to the hospital regarding the treatment your daughter received but you may also just wish to conserve your energy.

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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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PostPosted: Sun Oct 04, 2009 10:58 am 
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Joined: Fri Nov 23, 2007 12:27 am
Posts: 81
Location: Ontario, Canada
Sorry to hear about your experience. We had an almost identical hospital experience last summer where DS had a reaction, had to have th epi and I took him to hospital myselft (small town, 5 mins away). The nurse did not check any of his vitals, just looked at him and said wait for the doctor. At that time he was still red, but the coughing and chocking had stopped and hives had went away, and he really looked OK, although I really wanted to see a doctor. Within 45 mins DS started to wheeze and the hives came back full body. He was miserable but still when I asked the nurse when we would see the doctor all she said was she couldn't tell me that (I don't think there was even a doctor there as no one ahead of me was getting called either). All the nurse kept doing was taking MY benedryl from me and giving him double doses out in the emergency room. Finally the receptionist who has seen us a few times there with reactions came and asked if he was OK, took a look at him and went and got someone from administration and within about 15 mins we were in a room. It took us from the time we walked in about 1-1/2 hr to see a doctor. I was pretty mad. Of all the times we've had him there with reactions, this was easily the worst yet it was the worst they treated us. I asked his allergist about it at his next visit and he said with his symptoms we should have given him another epi right there in the waiting room. I have learned that I will not trust the nurses to know how serious it is and if I think he needs another epi then I will give it to him myself. I have to say though, I had him in a couple weeks ago and the nurse I had that day was awesome so I think it's a kind of hit and miss.

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DS Sept 2006 - peanuts, tree nuts, dairy, eggs, coconut; contact reactions. Asthma. Many animal and environmental allergies.
DS Oct 1990 - Environmental allergies


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PostPosted: Sun Oct 04, 2009 2:32 pm 
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Joined: Sat Oct 01, 2005 8:55 pm
Posts: 412
Location: Vancouver, BC
At one of the Allergist's Conventions a few years ago, they discussed how the wording of how direct people as to when to give the Epipen should be. It is kind of a difficult thing - do you give it after 2 symptoms, or 3, or wait for serious ones (breathing or blood pressure issues). One definintion I liked the best was "If you know or SUSPECT that a person with a prior history of anaphylaxis has ingested the allergen, give the Epipen." If you google Emergency Plans from different countries (FAAN vs AC, for instance) you can see that different areas have developed different criteria. What would work best, is to think it out beforehand, maybe with your doctor or allergist, about what your criteria is going to be. They could help you with working out what would be appropriate cut off.

There is no harm in giving the Epipen by accident. The danger is the waiting.

The Emergency Plan from www.allergysafe.ca (which all 5 major allergy groups in Canada developed) is the gold standard for care:

1. Give Epinephrine (auto-injector)
2. Call 911
3. Transport to hospital

Lots of times, it is really hard to think of giving the auto-injector. If you feel that way, get a trainer and practice, then when the ones you have expire, try them out to see what it's like. Lots of people have needle phobias, but if you rely on an auto-injector, you need to de-sensitize yourself by handling it a lot.

I have thought about this a lot: The auto-injectors are easy and relatively painless (usually the kids are screaming their heads off in distress, but calm down AFTER receiving the Epinephrine), so why do we hesitate? The best reason I could come up with is that giving the auto-injector moves a the reaction from a reaction to a life-threatening event, and it is difficult to mentally cross that hurdle.

Do you think that's it or do you think it's something else?

There was a study a couple of years ago of emergency room treatment and a really low number of people (I think it was about 25% or so) got epinephrine in Emergency Rooms (it was a US study), and my allergist told me that he sees a lot of people who go to emergency and don't get epinephrine, and then he sees them a couple of days later and they are having protracted anaphylaxis because the steroids do not stop the Mast cells from releasing anaphylaxis causing chemicals, only the epinephrine does that. Based on that, I would always bring my own supply to the hospital and hope for appropriate care, but be prepared to take things into my own hands or phone my allergist if things were not being handled according to best practices for anaphylaxis management.



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PostPosted: Sun Oct 04, 2009 10:30 pm 
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Joined: Fri Oct 10, 2008 9:40 pm
Posts: 2034
Location: ottawa
Cauger, how scary for you. I understand how difficult it is to read the reactions of a young child. When our son was 6 months old, after I kissed him after eating peanut butter, we went to children's and were told he was too young for allergies. His entire body was covered in rash and hives, his eyes had been bloodshot but now were totally swollen shut. He was grunting. I was told they wouldn't test a baby so young and it was highly unlikely to be peanut butter. After 2 more such reactions we were sent for an emergency appt. to an allergist who confirmed his allergies as well as requesting my permission to talk to the attending doctors about my son's case. We know when something is wrong with our children. I hope your little one has recovered.

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What would work best, is to think it out beforehand, maybe with your doctor or allergist, about what your criteria is going to be. They could help you with working out what would be appropriate cut off.

Our family dr. did exactly that and it really took my guess work away. This was of course after my lecture on not using the epipen a few times when I should have. Our son always ( to date) gets rash and hives with every reaction, the rash and hives can be mild to very extreem. Because this is such a normal reaction for him to have during a reaction we discussed what would be the criteria for me to use the epipen. For our son anything more than rash and hives it was decided I should use the epipen. He has (with his rash and hives) had one or more than one of the following, vomiting, bloodshot eyes/teary eyes, he's sneezed and coughed, he's had induced asthma, he's had facial swelling, he's pulled at his tongue and made choking sounds. So my rule of thumb is now - any system effected besides skin (rash/hives), means use the epipen.

_________________
DD 12 yrs -no allergies
4 yr old DS - asthma/eczema Anaphylactic to Peanuts, all tree nuts, sesame , all pea/lentil legumes, gelatin.
Allergic to trees, grass,ragweed, feathers, dander, mold and dust.
Outgrew eggs, fish, shellfish


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