ALLERGIES - Medicine for Mountaineering and Other Wilderness Activities - page 329

has begun. Individuals who are carrying auto-injectors should also carry an antihistam-
ine—diphenhydramine (Benadryl®, Dramamine®, and others) is the standard—and pred-
nisone (described below).
Treatmentmustbeinstitutedwithoutdelayandconsistsofintramuscularinjectionof0.3
ml of a 1:1000 aqueous solution of epinephrine (adrenaline).
Epinephrine in 1:1000 dilutions is available in several forms in the United States.
EpiPen® is a preloaded syringe that can be injected almost instantaneously with only one
hand. The needle can be jabbed into the thigh or any other convenient location, through
clothing if necessary. Although the syringe contains 2 ml of solution, only a single 0.3 ml
dose can be delivered with each syringe. EpiPen Jr.® is intended for children and delivers
one-half the adult dose.
The manufacturer's directions state that the user should do the following:
◆ Grasp the auto-injector with the black tip pointing down.
◆ Pull off the gray safety release.
◆ Jab the needle, which is in the black tip, firmly into the midportion of the outer thigh
perpendicular to the skin until it clicks.
◆ Hold the auto-injector firmly against the thigh for ten seconds.
◆ Remove the auto-injector and massage the area for ten seconds.
The manufacturer warns that no one should touch the black tip, the gray safety release
should not be removed until the unit is to be used, no button is present under the safety
release, and the autoinjector should not be used if the expiration date has passed, the solu-
tion is discolored, or a red flag appears in the clear window in the auto-injector body. (If
nothing else is available, the auto-injector can be used if the expiration date has passed or
the solution is discolored.)
The Twinject® auto-injector is a second device that can deliver two epinephrine injec-
tions, a distinct advantage because a second injection is often needed, although this device
is more expensive. The Twinject 0.3® delivers an adult dose; the Twinject 0.15® delivers
a pediatric dose.
The manufacturer's directions for the first injection are as follows:
◆ Remove the green tip labeled “1” to expose a red, rounded tip; do not touch the tip.
◆ Remove the green tip labeled “2” on the opposite end of the auto-injector.
◆ Jab the needle, which is in the red tip, firmly into the midportion of the outer thigh
perpendicular to the skin.
◆ Hold the auto-injector firmly against the thigh for ten seconds.
◆ Remove the auto-injector and examine the red tip; if the needle is exposed the epi-
nephrine has been injected.
To make a second injection the manufacturer directs:
◆ Unscrew and remove the red, rounded tip; avoid the needle.
◆ Grab the blue plastic and pull the syringe out of the barrel; avoid touching the needle.