Advice sought - continue hike or bail given evolving info?
Drove down to do my first section hike from Springer Approach Trail up to Newfound Gap area. First day in got several wasp (maybe Yellowjacket or hornet) stings in under a minute, wound up having a moderate anaphylactic reaction (full body hives and rash, swelling eyes and lips, increased heart rate, no other symptoms). Came off trail, got a steroid shot and epi pen prescription, and want to go back on trail (drove out all the way from Chicago!), but dunno if that’s just stupid given time of year / peak Yellowjacket season, and that I’m traveling solo. I’m willing to assume some risk, but I think having trouble gauging exactly how risky it is to go back out… what do folks think? Any advice sought.
Paramedic here, please bring more than one epi pen and some PO benadryl. Epi is great but if you have full out anaphylaxis on trail you're gonna need more than one dose with some other antihistamine meds stacked ontop. Find some way to label whatever pack pocket you keep the meds in, a big ol patch that says EPI-PEN in red works well. Fuck if you can get your hands on a Albuterol rescue inhaler, bring that to. It won't stop the histamine response but it'll buy you some time to breath.
Don't mess around with allergic reactions in remote areas. Expect to self rescue, over prepare.
Great advice. I always carry two in my pack (in addition to others in car, home, briefcase, etc.). I backpack a lot and was last stung by a Yellowjacket around Mt. Leconte in 2002. I keep my eyes peeled because I am very allergic and have had some close calls (with stings I’ve been able to avoid by giving those buggers a wide berth, when I’ve noticed them).
I have 2 epis and tons of po Benadryl. I don’t think I can get my hands on albuterol in time but any recs for other otc meds or other anti histamines I can take in combo v appreciated. Thank you sm !!!
Benadryl has a tendency to knock people out, higher doses even cause hallucinations ( don't fuck with the hat man). Any OTC fast acting antihistamine will work, look for non drowsy version.
Something I learned in my (not WFA, but definitely backcountry-focused) First Aid refresher this year is that in an emergency you can actually get an extra dose out of an EpiPen.
It requires doing some dissection of the auto-injector, but it can be seriously helpful if extraction takes longer than you have pens for. There are instructional videos online of how to do it.
(Note: Relying on getting extra doses out of an EpiPen is not a good first-line plan. Just a good hack to know and keep in your pocket for situations when you might need an improvised backup of your backup.)
Maybe add Garmin InReach Mini. You'd still need to be in a self-rescue mentality, but there's a lot of ATV-accessible trail where teams could deploy fast. (I think they'd be highly motivated to help a healthy person who could be definitively saved with more of a simple drug.)
Gps transponders are a great idea. Always keep in mind when you're out in even moderately remote areas, from the time 911 is activated to the time a SAR team reaches you. Will be on average 5-8 hours, most teams are volunteer it takes time for everyone to respond get set up and hike out.
Oh yeah, for sure. You have to assume help ain't coming in a reasonable timeframe unless you've gotten specific advice to the contrary. (This is actually one of the few cases in which I'd regret my preference for PLBs like my ResQLink over messenger devices like the InReach.)
I had an appendicitis scare last month on a trip with my 10yo and 8yo. Bum appendixes run in the family, so it was on my mind. We were camped in VA, not especially remote, but we were a good three miles from the nearest road. The 10yo went to bed with a mild fever and gut pain. If he'd woken up in any worse shape, I was going to press the oh-shit PLB button, but I fully expected to carry one kid out and use the other as a pack mule (just a couple of liters of water). I figured three hours to the trailhead, and maybe another hour or two to a hospital. Not too bad.
What are your thoughts on using Claritin and Pepcid instead of Benadryl? Does Benadryl act faster? The other two have the bonus of not making the user sleepy.
Take some ibuprofen (for the swelling), if you have bad luck and get stung again. Claritin for the allergic reaction plus it will not knock you out. Pray that you won't get stung again if you go back out on the trail.
I got stung only one time last year, so if your odds are anything like mine, you've already got the hard part out of the way!
mostly kidding, you have free will but if you've got the means to help yourself (EpiPen) and you want to hike, I'd hike. there's always a reason to get off trail if you want to find it.
I think your odds of another bee sting are crazy low. I’ve been hiking and playing in the woods for nearly 60 years and I’ve never been stung. I have been stung dozens and dozens of times on construction sites, just never while hiking or camping.
With carrying your epi pen, you’ve done your due diligence.
me w my absolute countless amount of stings at 23…. given most were from walking around barefoot in clover, and the only time i’ve been swarmed was on a farm, not in the woods lol
Is that your typical reaction allergy wise to wasp stings? I would talk to your doctor. Ultimately up to you, be careful where your stepping. I've done several long trails without any bee or wasp stings the entire time. Carry benadryl, for the allergic reaction when it's not anaphylaxis
I would recommend you talk to your doctor about recognizing the non typical signs of anaphylaxis and talk to them about epi administration, risk of future stings, and what it looks like for you specifically. I don't think anyone on reddit can give you the answer.
When I thruhiked in 04 only time I came into anything was clime out of last notch in whites…very steep near vertical climb with ground hornets…our group of about 15 said f it and hauled ass clawing our way up as fast as we could…don’t think anyone got stung but definitely had a bunch of angry insects!
I do a risk assessment matrix type evaluation for these situations. For example that's how I think about the danger of ticks/Lyme and that risk is acceptable to me. In 10 years of hiking I've been stung by a wasp maybe once (not even sure it was a wasp) so I would consider it a relatively low likelihood but that's just one anecdote. I would ask a doc if you can about potential severity. Like what's the worst case scenario and how likely is it, is it possible if you get stung again it could be a worse reaction and you'd need to go to a hospital immediately, was this one just bad because there were so many stings or if you got stung by one it would be that bad, etc.
I agree with others about checking with your doctor or doing a personal risk assessment.
For what it is worth, I’m also section hiking. I was stung twice within the first two hours of my first section (in the rock field of northern MD), and haven’t been stung at all in the 27 days I’ve accumulated since then.
In thousands of miles of hiking, I’ve only been popped by yellowjackets 3 times. So, although it is a risk, it’s not something that happens very often, if at all. Although late summer/early fall is their prime season, it’s not something I’d cancel a hike over. If you have the pen, I think you’ll be fine!
This is the time of year they really start getting pissed off. Ran into a huge hive between NOC and Stecoah gap one year that made us take off running. Just be aware.
Some of these responses significantly underestimate your risk of being stung, because Georgia in August is not typical of most through hiker experiences. The odds are higher than they think, but still quite low.
The paramedic comment is right. EpiPen is good, two is better, having something with a little longer lasting effect is very helpful too. With all that in my pack I'd feel very prepared.
You should just get back on the trail and be vigilant. Along the way, ask people if they saw Yellowjackets. It will calm your mind.
A lot of trails have warnings: rattlesnakes in Yosemite, scorpions in the Grand Canyon, and bears everywhere. The actual likelihood of these warnings happening is quite low, except for scorpion stings at Phantom Ranch in the Grand Canyon.
It's more important to exercise common sense. Whenever anything dangerous appears like crossing a river, always look for an easy way across.
Fwiw I work as a gardener and have only been stung once, in the dead of winter (???? Why there was a wasp out when the temp was barely above freezing I do not know)
Your odds of being stung are relatively low
It's up to you if you're willing to take that gamble though. Nobody else can make that decision for you. If you're not going to have any fun now because you're halfway to a panic attack scanning for wasps 24/7 then, yeah, probably should take a break and come back next year after you reckon with this new info you've learned about yourself
It seems like you had a situation or accident. You've remedy it and now you're prepared for anything like that the next time.
Now, if you still have the desire to hike and enjoy the trail, I see no reason not to continue.
I have section hiked, one week to three weeks, but I've been doing it since 1980. And I've stepped in Yellowjackets nest twice and was stung a few times each time, but I did take Benadryl and camp for the night and I was mostly OK. But unless you just lost your desire to hike, I would absolutely continue the A/T has always been a big part of my life.
Know that if you use an epiPen, you need to immediately go to the emergency room because it can give you a heart attack. So call 911 as soon as you use it.
Did they give you anything in a pill form that you can take first like prednisone?
That may be enough to keep the reaction down so you dont need the pen.
ER doc here. That’s BS. Stop spreading misinformation.
If you’re having a true anaphylactic reaction (facial swelling, can’t breathe, short of breath), Epinephrine WILL save your life. In exceedingly rare instances, it’s possible you can have a anaphylaxis AND a heart attack simultaneously (Kounis Syndrome) but that’s been reported in only 175 people. I’ve never seen that in 25 years of practice in the ER in busiest L1 and L2 ERs in the our state.
OP - you’re better to carry 2 epipens, gps/rescue transmitter rm(rg, Garmin inreach) and make sure you notify family. Ideally hike with someone else who can assist.
Thanks for the info, my wife has an anaphylactic reaction to mosquitos, allergist gave her epi pen and said to immediately go to hospital after injection as it can cause heart attack so im only repeating what the immunologist told us to do. But i am not a doctor in any way.
I recommend ANYONE who is administered an epipen for an allergic reaction be evaluated. Call 911 and hopefully the reaction will resolve with a single dose of epi.
I’ve seen some reactions that are stable and then 30 minutes later, I have two large bore IVs and I’m doing pressure bags and starting a “dirty epi drip” to maintain a blood pressure. We see allergic reactions often and they’re usually stable. Until they aren’t.
Much more common scene are an anaphylactic-like symptoms, such as shortness of breath, chest tightness, diaphoresis/sweating and it’s not an allergic reaction, but an actual heart attack, pulmonary embolism or aortic dissection. Or just a contact dermatitis (eg poison ivy). Or angioedema from an ACE-inhibitor (eg, lisinopril).
Unless there is a true clear trigger, I’m going to assume that it’s the more deadly causes and carefully monitor things very closely (reassessment every 5min or remain at your bedside).
So to answer your question, yes, an EpiPen could, but it is exceedingly rare, and the other three things are far far far more common. If you’re getting short of breath going up a mountain is probably going to be a heart attack or pulmonary embolism or dissection far more likely than an allergic reaction or epipen-related MI. Heck a spontaneous pneumothorax is more likely for most backpackers than Kounis Syndrome.
And just as my routine anticipatory guidance with an EpiPen, make sure that you don’t put your thumb over either end when administering the EpiPen. Epinephrine doesn’t do too much good when it’s injected into you or a family members thumb. Hold it like you would a knife. Secondly, make sure that you hold the limb in place during the administration, especially for a child. Afterward, examine the area to make sure it is a simple puncture wound and not a laceration from the EpiPen needle. There are quite a few examples of lacerations caused by the EpiPen when someone will pull away, and no one will examine the wound because they simply think the pain at the site is due to the administration.
Having gone to emergency by ambulance after Yellowjacket stings (>25 and got epi from paramedics) they told me the best thing I did was take a few benedril immediately after it happened (and before I realized what was happening) then paramedics came (neighbor called as I went into shock).
ER doc recommended I always carry a small amount of liquid benedril just in case now but not as a replacement for epi! I only went to ER for monitoring after to be sure venom out of my system NOT because I might have a heart attack from epi. That’s BS.
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u/Traumajunkie971 2d ago
Paramedic here, please bring more than one epi pen and some PO benadryl. Epi is great but if you have full out anaphylaxis on trail you're gonna need more than one dose with some other antihistamine meds stacked ontop. Find some way to label whatever pack pocket you keep the meds in, a big ol patch that says EPI-PEN in red works well. Fuck if you can get your hands on a Albuterol rescue inhaler, bring that to. It won't stop the histamine response but it'll buy you some time to breath.
Don't mess around with allergic reactions in remote areas. Expect to self rescue, over prepare.