Medic alert recommendation

[Vinca]

This past weekend I had to go to the ER for anaphylaxis. This happened once previously due to my milk allergy when I was a kid, and I went once on college for an asthma attack I couldn't get under control. I normally carry an Epipen but forgot it (which I've been repeatedly scolded for by many people!). This time I wasn't wheezing much but my bp tanked. The paramedic told me it was below 60 initially and I was like "it's always around there," and he said no, it was something like 58/36. (My normal is ~100/60.) They did spend what seemed like an excessive amount of time asking how much I'd had to drink, since I was at a wedding reception. I'm thinking I should get a medic alert bracelet in case I actually pass out and my husband isn't there to vouch I'm not falling over drunk so less time will be wasted. I'm sure it wasn't actually wasted in this case because they were doing other stuff, it was just frustrating to be asked three times how much I'd had to drink while sitting with my head between my knees trying to stay conscious.

So, I was wondering what would be best to put on the ID? I was initially going to put "Anaphylaxis/Asthma/Allergy: milk", but it seems anaphylaxis is not normally suggested? Do you think it should be there? Or is milk allergy enough? Should I include no drug allergies?

[Just Plain Ruff]

No, if you have an anaphylactic reaction to milk you need to put that. If I read MIlk allergy, I'd think oh you were allergic to milk and not think too much of it that you just get a stomach upset or you just cannot drink milk.

Put anaphyllaxis-Milk and I'm surely going to NEVER EVER give you milk to drink.

NKDA just means you have NO Known DRUG allergies. But you can have other non-drug allergies.

If I were you I would put "Allergy to Milk - Anaphylaxis"

[scubanurse]

I have several allergies/conditions and this is what I have:

Anaphylaxis: Latex, Pineapple, Morphine

Med Hx: Hypothydroidism, Ehlers-Danlos Sydrome, SVT

xxx-xxx-xxxx (my emergency contacts phone #)

It's on two sides and silver so I wear it all of the time and just looks like another bracelet.

[Vinca]

Thanks, sounds like I need to include all three. I'm thinking about maybe getting a necklace instead. Part if my job is doing inspections in low-income, often high-crime areas, so I don't like to wear visible jewelry, even my wedding ring. Do you check under clothes for necklaces?

What tips you off that jewelry is medic alert? Does it need to have a red or blue cross? I'm thinking about getting something like this: http://www.etsy.com/listing/69169100/medic-alert-necklace-sterling-silver?ref=cat_gallery_2

Is the caduceus something you'd look for or is that too nondescript?

Unfortunately I'm stuck with sterling silver or titanium, nickel gives me a rash and even stainless steel seems to have too much.

[scubanurse]

That looks good. Something like this would work too http://www.americanmedical-id.com/marketplace/category.php?sel_pullid=46.

Everyone is trained to look at them but not everyone does. If you're in anaphylaxis though they'll treat that and it won't really matter what you're allergic to at the time. It helps if you're unconscious though and they're trying to get medical info which is why I have my emergency contact on the bracelet so they can call and gather more information and notify them of what happened.

[ClutzyEMT]

If I don't find a medical alert bracelet/necklace on an unknown medical patient I will also check their wallet/pocketbook for a medical ID card as well. I try to have my partner or a bystander aware of what I am doing and 'watching' me so that it doesn't look like I'm grabbing cash tho.....

[Just Plain Ruff]

I'm sorry Vinca, but anything that doesn't stand out to me that you have a allergy, and that thing from Etsy doesn't truly stand out to me that it's an allergy alert but it makes me think that it's a necklace saying your in EMS or a you are a EMS groupie or lover of EMS.

Stick with the commercially available allergy alert bracelets and necklaces as they are immediately recognizable by EMS personnel. This is something you don't want someone to miss on you. Consider your personal well being on this.

[DwayneEMTP]

Katie, you really get an anaphylaxis reaction to latex? Does this come from simply being touched by a providers latex gloves?

I'd not heard of such a sever reaction before...

And is a, significant in this case though not huge, drop in blood pressure without other factors involved really an anaphylaxis reaction? Certainly not claiming that it's not, but I can easily imagine that drop in B/P with an uncomplicated, simple (?) alergic reaction creating symptoms based on the Vinca's normally low B/P without it being an actual anaphylaxis reaction?

Does it matter really?

Just curious. It sounds like a person categorizing their issue into the most extreme category that they've heard of instead of it being completely accurate. I would think in this patient, altered/unresponsive with a systolic near 60, no n/v, clear lungs/airway, lack of erythema, that I'm going to try a fluid challenge long before Epi. Certainly anaphylaxis isn't going to be at the top of my list of differentials early on. Sort of like everyone that gets a bad headache now has a migraine. It's not accurate necessarily, but just the most extreme thing that they've heard of so they use that instead.

[scubanurse]

For me the only time I've had an anaphylaxis reaction to latex was during school back when latex was EVERYWHERE and we were in a very small classroom with lots of latex gloves and tourniquets. After about 30 minutes I got hives and wheezing, next thing I knew I was in the elevator on a gurney with an IV and my instructor jabbing an epi-pen in my thigh. Pineapple closes my airway for some hairbrained reason and morphine gives me systemic hives. When I ingested pineapple I would get the whole angioedema wheezing dying experience so I stay far away. There has been little research and only anecdotal stories about Ehlers-Danlos patients having more reactions to a variety of foods and things. Not sure if it's real or not though, just anecdotal.

Would you try a fluid challenge if there were hives/angioedema present though, as usually the case with anaphylaxis?

[mobey]

Would you try a fluid challenge if there were hives/angioedema present though, as usually the case with anaphylaxis?

I know you didn't ask me, but I'm going to chime in anyway.

A fluid bolus would be concurrent with Epi in the above patient, as would ventolin and steroids with Benadryl.

None of the above treatments outside the fluid bolus would be administered for a patient experiencing primary hypotension with no other symptoms. I have a sneaking suspicion this never was an allergic reaction at all.......

Some will remember the scenario I once posted with the attached research regarding atypical anaphylaxis.

Do remember the definition of anaphylaxis is "Allergic reaction affecting 2 or more body systems"

Oh BTW Kate: I am having a real difficult time staying away from smart ass latex remarks right now....

Edited April 13, 2013 by mobey