About the use of an Epi-pen – mightier than the sword?

yourerdoc — Mon, 20 Oct 2008 17:31:39 +0000

My child has been diagnosed with severe allergic reactions to a number of foods including peanuts. We were told that we must keep something called an “Epi-Pen” on hand at all times in case she has a sudden reaction. What does this device do exactly and will it “cure” the reaction or just buy us some time to get her to medical attention like an emergency room?

Epi-pens are commonly prescribed to patients with a history of serious allergic reactions known as anaphylaxis. With anaphylaxis, patients may have trouble breathing, swelling, rash, dizziness, and it can get rapidly worse, and in some cases be fatal. These reactions usually occur after a patient is exposed to something they are allergic to, such as a bee sting, certain foods such as peanuts, or latex. ER doctors often prescribe the “Epi-pen” after seeing patients with anaphylaxis, because it is a very effective way to reduce these symptoms and allow patients time to get in to see a doctor or come to the emergency room.

The Epi-pen is given by the patient to themsevles, as a shot, and it releases a medicine called epinephrine. This decreases the allergic reaction, but beware, epinephrine does not “cure” it. The allergic reaction can come back after the epinephrine wears off. Therefore, it is important to seek medical care immediately with any serious allergic reaction, even if you have used an Epi-pen.

Allergy doctors prescribe quite a few Epi-pens, because they have been shown to reduce the chance of death from anaphylaxis, and it’s important to have these readily available, especially when immediate medical attention may be difficult to obtain. Anyone with a history of serious allergic reactions should see their primary physician as well, and consider follow up with an allergy specialist.

When to stitch

yourerdoc — Sat, 04 Oct 2008 15:36:44 +0000

When to Stitch a Wound?

Dear ER Doc

Is there a general rule to when a cut needs to be stitched up?

With major cuts that are long and/or deep – it is pretty obvious that a trip to the hospital in needed. And for everyday minor cuts – it is equally obvious to wash it and slap on a band aid.

But sometimes there’s an “in between” cut in my family. Be it me with a
kitchen knife or my son getting a cut from some glass on the playground.
These are not “minor” but I am not sure if it really makes sense to go
through the time and expense of getting stitches. Any thoughts?

Briefly, the first thing you want to do is take a look at the wound and determine if the skin edges are lined up well. Then, see if the skin stays together when the area is moved. You will find that in highly mobile areas, such as fingers, wounds often open up when there is movement. In this circumstance I will usually put in stitches to keep the skin edges together and healing.

Also, you want to be sure that there is no deep structural injury to the tendons, blood vessels, nerves, etc. This often requires evaluation, and “exploration” of the wound by a doctor. It is especially important to make sure there is no foreign material in the wound itself, and that the wound has been thoroughly cleaned.

This may not be a satisfying answer, but I usually tell people that if there is any doubt, have the wound checked out by a physician, so that proper wound care can be done.

Be sure and look at my upcoming entry on “when you cut yourself” as well.

Your ER Doc » Emergency Room

About the use of an Epi-pen – mightier than the sword?

When to stitch