Threshold for using epipen?

[Weta]

Went back to the hospital for more emergency kit training after DS1's allergic reaction just before Easter, and the nurse said we could (I think she really meant should!) have used the epipen after all. In fact I was opening it up and trying to decide whether we needed it when the ambulance arrived, so I left it up to them to figure out.

So for those who have used it before, how did you know you needed to? was there one particular sign (or combination of signs) that made you decide to go ahead?

I have not had to use my son's epipen. I would suggest contacting the hospital that gave you the epipens and request a management plan for your child. They should then go over the plan, practice use of the epipens and ensure you are comfortable with the instructions. This plan should be reviewed after each appt and/or at least every 6 months.

IN my management plan, they said that if you have to think about it then you should give it as it will not harm and could save his life. The signs to watch for are difficulty in swallowing, wheeziness, coughing, paleness to the skin, confusion, collapse, difficulty in breathing and swelling of the throat.

if you see any of these signs, then you give the epipen, call 999 and if needed give second dose 5minutes later.

I hope this helps.

We don't actually have an epipen for ds1 but I have had epi-pen training. We were told to use it for:
-any reaction that compromises (or seems to be compromising) the breathing - ie wheezing, swollen tongue, change in voice (indicates larynx swelling)
-any reaction where child goes floppy and/or sleepy (indicates low blood pressure leading to loss of conciousness)
-more minor reactions that keep on getting worse despite giving antihistamines eg hives that just keep spreading and spreading even after Piriton.

Hth

We do have a management plan, but somehow in the heat of the moment and reading the list of symptoms and treatments to give it was harder to work out whether it was necessary than I expected.

He has never done the floppiness/sleepiness thing, more the breathing difficulties and a systemic reaction involving digestive system, skin and respiratory system.

It was helpful talking to the nurse and realising that we shouldn't hesitate so much - as you say jwpetal it won't do any harm, whereas I always felt like it was really heavy medication to be avoided if possible.

Vomiting has always been the first symptom before, but this time (probably because causes were a bit different) he didn't vomit at all but kept spitting as he had lots of saliva. The nurse said this probably means his throat was swollen and it was difficult to swallow, hence causing excess saliva. I hadn't realised at all that this could be a serious sign.

Thanks again for all your thoughts...

I'm not sure - never used DS'.

The severe reaction he had which prompted Cons to give epi-pens had the following symptoms:

Feeling very cold/ freezing (not to touch but in himself iyswim)
sudden nasal congestion
swollen bottom lip/ cheeks
angry red spots in cheeks
shallow/ noisy but rapid breathing (30 bpm)
seemed confused/ sudden tiredness
tummy pains
shaking.

In this case 15ml puriton over 3 doses worked. I have been told an epi-pen would have worked quicker. I don't know but would think I would use epi-pen if he had any of the above symptoms - I'm terrified I'll hesitate.

"Vomiting has always been the first symptom before, but this time (probably because causes were a bit different) he didn't vomit at all but kept spitting as he had lots of saliva. The nurse said this probably means his throat was swollen and it was difficult to swallow, hence causing excess saliva. I hadn't realised at all that this could be a serious sign."

I thought producing lots of saliva was a reaction in itself. DS throat never closed up but one of his reactions along with vomiting and facial swelling is lots of saliva within minutes. When he opened his mouth there was a pool of saliva in his mouth far more than would normally produced and swallowed. We never had an epipen as he never showed any problems with breathing.

That's interesting bruffin - we are seeing the specialist again on Friday so I will ask her about it.

And I didn't realise the adrenaline might not work if used too late. Will definitely be more trigger-happy next time :)

Reading this thread has made me realise there has been 3 not 1 occassions where I could of /should of used an epi-pen. (altho in my defense DS didn't have one then)

When his care plan was drawn up at school the school community nurse was very much for him having at it any of the above symptoms (from my earlier post). TBH I thought she was being extra cautious as it protects the school.

Seems I would actually wait too long as he has got over other reactions - albeit with a tub of puriton.

I agree with being trigger-happy.

A tricky question as everyone's reactions will be different.

We've used ours about 8 times now - The first three big reactions I managed to avoid doing it myself (first time - we didn't have it, second was driving kids to tennis and could see/ hear the reaction starting so passed the measured piriton to Ds to drink while I drove to the local GPs, third time was v. close to A&E).

The first time I used it - like BB was a bit too trigger happy. I think I'd made the decision we needed to do this for ourselves. I BROKE the needle of the epi-pen on first hit (good job we had two!) and the second was fine. Magic wand - all good.
After that we've just watched him - DS' anaphylaxis is a throat closer so when his wheezing gets too hoarse we use the epi-pen. I've also learned to slow down his reactions. This may not work on everyone. As long as I catch a reaction early enough (a blotchy face and hives on body are a teller) I give him maximum piriton and 10 puffs of salbutamol (ventolin - the blue rescue inhaler - which in itself creates an adrenalin reaction - DS is not diagnosed asthmatic). We work together to slow his breathing, calm him down and 90% of the time this is working for us.
I agree with BB and Helium, you should go early, I avoided this as DS became petrified of needles. We've worked on this and he's getting better.

I don't think there is a right or wrong here, it's one of those situations where your instincts count for a lot.
AND the critical thing is to have it with you - I now see my epi-pens as magic wands as they really do pull my boy back from the brink - amazing medicine!