Northwest Dive Club

Hi,

I read through the thread with interest about "when" to apply an epi, but I really already know that. I have epi's and I keep them with me all the time. What I've been told will kill me is wasps and hornets. However, I'm sure there are all sorts of things that could sting me underwater and I'm guessing that it would be wisdom to have one underwater. If I'm thinking this through, a logical place would be at the wrist. Myself or my buddy could get it out and I'd get my jab and then start working my way to the top.

However, does anyone even know in Epi will go through a suit?

Thanks!!

I wonder if you would have the same reaction to anything underwater? I'm extremely allergic to honeybee stings but wasps and hornets just hurt.

I doubt that your Epi-Pen would handle repeated salt water immersion. You really need to inject an Epi-Pen into a large muscle which is why the thigh is a recommended site. The wrist is problematic because it has veins, arteries, nerves, and tendons all running near the surface. It shouldn't be that big of a deal to snip a patch (that could be easily repaired) out of your wetsuit if you need a dose, odds are you are going to wind up naked in the back of an ambulance with what used to be your wetsuit outside on the ground any way.

You and your buddies should carry trauma shears and having a back up set in your car with your Epi-Pen isn't a bad idea. Part of your pre-dive briefing needs to include disclosing your allergies, where your rescue meds are, and how to get in to your car.

But the interesting question is whether a stinging Jelly (Lions Mane for example) would trigger a reaction?

I don't know what the cross-reactivity between Hymenoptera venom and jellyfish toxin is -- I doubt there is much, but you would need to talk to a toxicologist to be sure. I also don't know what the needle length on an epi-pen is, which is the determinant of whether it will get through neoprene. (The needle will go through the suit -- the question is whether it can then go deep enough into the limb to deliver the dose properly.)

LCF wrote:I don't know what the cross-reactivity between Hymenoptera venom and jellyfish toxin is -- I doubt there is much, but you would need to talk to a toxicologist to be sure. I also don't know what the needle length on an epi-pen is, which is the determinant of whether it will get through neoprene. (The needle will go through the suit -- the question is whether it can then go deep enough into the limb to deliver the dose properly.)

Apparently this question has been asked before...
http://www.aaaai.org/ask-the-expert/cro ... venom.aspx

Other than your lip, I don't see a whole lot of places you could get stung by anything underwater while in a wetsuit with hood. Unfortunately your lip is a rather sensitive spot. If you smear Vaseline on your exposed skin around your mask and lips you can help avoid the worst of the stings if you are particularly sensitive to them. It wouldn't totally preclude them however.

I don't think an epi-pen would survive more than about 2 dives. If nothing else the needle would be totally contaminated with all sorts of marine bacteria. I don't think you want to be carrying those deep into your muscle via a needle stick (tetanus anyone?). For reliable (mostly clean) use I'd either get a small canister to keep it dry or leave it in the car. You wouldn't be able to open the canister underwater due to the pressure, but you could at the surface. If you really are having a reaction, then cut up the sleeve of your suit and inject into your upper arm. No its not the proper location in your thigh, but its a IM injection, almost any muscle will do. Better than suffocating.

Assuming the OP was stung while on a dive, how long does it take for a life-threatening reaction to occur?

I'm wondering if there would always be enough time to get to the surface and take care of the problem there, keeping the epi-pen in the car.

60south wrote:Assuming the OP was stung while on a dive, how long does it take for a life-threatening reaction to occur?

I'm wondering if there would always be enough time to get to the surface and take care of the problem there, keeping the epi-pen in the car.

If it were like a bee sting on someone who was really allergic, they wouldn't make shore. My bet is that you won't have a really bad allergic reaction to anything down there until you have been exposed more than once.

I'm certainly not an immunologist or something-stung-me expert, but when I was younger I was deathly allergic to bee stings, yet got stung by jellyfish on numerous occasions with no major problems.

Fascinating conversation.

I'm guessing that folks in Australia or places that have more dangerous jellies have dealt with this on some level? Of course the worst of the worst will kill just about anyone, whether or not you have a bee sting allergy.

Anaphylaxis can kill in minutes.

To the OP: I'd consult with my allergist. Perhaps desensitization treatments might be useful.

Thanks for all the advice everyone. I've got a few key summary takeaways from this discussion so far.

1. Most important. Tell the DM about the fact that I use and EPI Pen and where it is.
2. I hadn't considered the pen would be compromised at depth. Makes perfect sense and I'm not taking it down with me.
3. Make sure it is in my kit, easy to find, on the boat or on the shore where my dive buddy can quickly find it.

All very timely. It is now 10pm. I'm heading to bed and waking up at 3:30am to catch my flight to Cozumel.
In the water Sunday morning.

Thanks All!

Good luck and have a safe and enjoyable trip!

Just my two cents but for the importance of having the epi pen ASAP and in the heat of the moment of your buddy needing to do a rescue type scenario. Could you have your epi pen inside a water proof depth proof container, that keeps it sterile and usable while on a dive? I just imagine in worst case scenario with gear and all getting to shore and then having to run to the car to garb the epi pen then run back kills alot of important time. Having it attached to your gear in some kind of water proof/depth proof case would make it instantly accessible once on shore. I dont know the size of an epi pen but I am thinking an old straight dive light housing would be a great place to store it. Just make sure to label it so that people would know what was inside.

I wonder if EPI PENS have ever been tested at depth pressures? I personally doubt it, and i doubt the manufacture would ever take any position other than don't do it, simply because they have not done the research for their own protection . I think you might want to take any expired epi pens on a test dive. Having it in a Housing of sorts would allow it to be there with you but would it function at depth when you attempted to inject it? I wonder if the auto injector would be able to fire or would prematurely fire with the increased pressure. If you need your epi at 90 feet by the time you get to the surface and on the boat or beach you are going to be in trouble. I would really be interested in hearing about your experiments with any expired pens. may you could take a pen in a water proof case of your choosing to depth and then try to inject into a orange and see how it went.

Please post what you find out
thanks
Herb

There's a lot of supposition here that jellys are cross reaction with hymenoptera (bees, wasps etc). They are completely different classes of organisms. They might or might not have ANY cross reactivity at all. Perhaps the best approach would be discuss this with your allergist and possibly look into personalized sensitivity testing if you remain concerned.

I would not be using any needles contaminated with salt water at all, salt water is loaded with billions of bacteria and viruses and carrying those deep into your muscle might actually be a worse way to go than anaphylaxis.

CaptnJack wrote:There's a lot of supposition here that jellys are cross reaction with hymenoptera (bees, wasps etc). They are completely different classes of organisms. They might or might not have ANY cross reactivity at all. Perhaps the best approach would be discuss this with your allergist and possibly look into personalized sensitivity testing if you remain concerned.

I would not be using any needles contaminated with salt water at all, salt water is loaded with billions of bacteria and viruses and carrying those deep into your muscle might actually be a worse way to go than anaphylaxis.

Good points. Another thought: I have never once heard of a diver suffering a life-threatening allergic reaction to anything while underwater. Has anyone here? It must be incredibly rare, because many of us study dive accidents/deaths like they were holy scripture or something. Not saying it's impossible, just saying it's gotta be up there with 2 headed goats or honest politicians.

ggthatcher wrote:Thanks for all the advice everyone. I've got a few key summary takeaways from this discussion so far.

1. Most important. Tell the DM about the fact that I use and EPI Pen and where it is.
2. I hadn't considered the pen would be compromised at depth. Makes perfect sense and I'm not taking it down with me.
3. Make sure it is in my kit, easy to find, on the boat or on the shore where my dive buddy can quickly find it.
...

4. Include a set of trauma shears with your Epi Pen (use a rubber band to attach the trauma shears to the Epi Pen).

Just a suggestion

Hi all,
Here is what I did.

The pen was stored in my camera bag. I also took along my test pen which shows how easy it is to pop the top and how to stab me. We talked about the fact that if I were in some sort of distress, what signal I would use, and how restrained breathing was. We had a signal that was "enough, up NOW". it was essentially a 2 handed strangleation followed up with a "double thumb up". THis was where the thumb of one hands touches the other hand which is also thumbs up.

Never did need it, but interestingly, it appears we did get into some possible Jelly Fish Larva which appears to be pretty common in the Cozumel area. Both my son and I came home with hives.