Epinephrine Error

[Shishkabob]

Wouldn't be the first time something was taken wrongly on the internet ^_^

 

[medic_texas]

Wouldn't be the first time something was taken wrongly on the internet ^_^

lol - very true.

 

[Crepitus]

Wouldn't be the first time something was taken wrongly on the internet ^_^

Looks like I may have created part of the issue as well and should retract the 'oil based' comment. Years ago we carried two vials of 1:1000 epi. One was clearly marked for SC use only, the other did not carry that descriptor. Our service required that we mix up our high dose epi/epi drips from the second vial, never the first.

I remember having the conversation asking what the difference was between the two vials of 1:1000 and was told the base was different between the two. Evidently that might not be true.

Though that was 15 years ago or so I remember the issue because around that time we ran a call where a physician suffered anaphalaxis, was given 3 injections with epi pens by a physician colleague who was with him. When my partner and I arrived we were instructed to give additional 1:1000 epi IVP by the second physician (an anesthesiologist as I recall). He repeated the order multiple times and eventually had to be separated from the call to calm him down (it was one of those calls). He and the patient complained to the medical director, they were told that even if we had wanted to comply that we did not carry epi that could given be that route. This call was run before we added the second epi vial and we added epi drips. Prior to that we only carried the small epi vials marked SC use only.

So for these years I have presumed that I was informed correctly - that epi could be consituted differently. Perhaps it was strictly matter of labelling by the manufacturer labelling it for SC use only.

I was only offering the comment as a off hand comment Usalsfyre as a potential partial explanation to his question and I hereby publically declare that folks should be skeptical of my 'oil based' comment.

But I'm with the other posters in the thread that are noting that epi is epi. It comes in different concentrations, that are typically used for specific applications and certainly could create a significant med error if concentrations are ignored. But a milligram of epi is a milligram of epi.

I would always try to avoid diluting 1:1000 epi for IV use, but I have seen it done before and believe someone with Jr. High math skills should be able to do it if necessary.

Have a great weekend everyone.

 

[MrBrown]

I read

"So if 1mg of Epi is... 1mg of Epi.. why the hell do we have 2 different concentrations? "

Because it depends on the route of administration

IV in cardiac arrest we use 1:1000
IV we use 1:1000 diluted in 1,000mls to make 1:100,000 (0.01mg)
IM we use 1:1000 diluted in 10mls to make 1:10,000 (0.3-0.5mg)
Neb we use 5mg

Now technically with an arrest we do dilute up to 10ml so it could be classed as 1:10,000 but I have generally seen 1mg drawn up into a 1cc syringe and given undiluted followed by a 10-20ml flush.

 

[Smash]

Because it depends on the route of administration

IV in cardiac arrest we use 1:1000
IV we use 1:1000 diluted in 1,000mls to make 1:100,000 (0.01mg)
IM we use 1:1000 diluted in 10mls to make 1:10,000 (0.3-0.5mg)
Neb we use 5mg

Now technically with an arrest we do dilute up to 10ml so it could be classed as 1:10,000 but I have generally seen 1mg drawn up into a 1cc syringe and given undiluted followed by a 10-20ml flush.

What is the rationale behind diluting epinepherine in cardiac arrest?

I'm also curious as to why you would dilute it to give IM? Giving 0.3 - 0.5ml (0.3 - 0.5mg) is far kinder than ramming home 5ml of solution IM.

Oh, and 1mg in 1 liter is 0.001mg/ml (1mcg/ml)

 

[EMTinNEPA]

What do your 1:1000 Epinephrine vials look like and what do the containers carrying 1:10,000 look like?

1:10,000 is in a pre-filled syringe (you know, the ones that Emergency! fans like to prepare by "Johnny Gage-ing" it) and the 1:1,000 is in an ampule and needs to be drawn up.

EDIT: We also carry epinephrine auto-injectors.

 

[MrBrown]

What is the rationale behind diluting epinepherine in cardiac arrest?

I'm also curious as to why you would dilute it to give IM? Giving 0.3 - 0.5ml (0.3 - 0.5mg) is far kinder than ramming home 5ml of solution IM.

Oh, and 1mg in 1 liter is 0.001mg/ml (1mcg/ml)

Hang on I've totally got that round the wrong way!

IM is 1:1,000 so 1mg:1ml
IV is 1mg in 1 litre - 0.01mg in 10ml

We do not "dilute" in a cardiac arrest; my preference is 1mg in a 1cc syringe (1:1000) that you push then follow with a flush. Lazy medics here I've seen draw up 1:10,000 ie 1mg in 10mls and push that with no flush.

1:10,000 is in a pre-filled syringe (you know, the ones that Emergency! fans like to prepare by "Johnny Gage-ing" it) and the 1:1,000 is in an ampule and needs to be drawn up.

EDIT: We also carry epinephrine auto-injectors.

We looked at pre-filled but they are very expensive (7-10x more so as a 1mg amp of adrenaline is like a dollar) so we carry brown ampoules of adrenaline.

Tell me, I've never seen a pre-filled in real life (coz we don't have them) you pop the yellow caps and what, screw the two parts of the syringe together, how does that work? :unsure:

 

[EMTinNEPA]

Tell me, I've never seen a pre-filled in real life (coz we don't have them) you pop the yellow caps and what, screw the two parts of the syringe together, how does that work? :unsure:

Pretty much, yeah. There's the glass tube with the medication in it, which screws into the part with the needle. Expensive? I just looked them up on www.boundtree.com and a pre-filled syringe of 1:10,000 epi was $5.70...

We carry epi, atropine, bicarb, D50, calcium chloride, nalaxone, and adenosine in pre-filled syringes.

 

[MrBrown]

Pretty much, yeah. There's the glass tube with the medication in it, which screws into the part with the needle. Expensive? I just looked them up on www.boundtree.com and a pre-filled syringe of 1:10,000 epi was $5.70...

We carry epi, atropine, bicarb, D50, calcium chloride, nalaxone, and adenosine in pre-filled syringes.

If you take adrenaline;1mg ampoule of adrenaline costs us a dollar; a 10ml plastic ampoule of saline, a 10ml syringe and an aspican needle about fifty cents each.

That's about .... $2.50 compared to $5.70 for a pre-filled model which is easier than having to manually draw it up; but it is also a lot more expensive