akflightmedic
Forum Deputy Chief
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But paramedics don't administer Insulin.
We carried and administered insulin in Alaska...as Paramedics.
But paramedics don't administer Insulin.
SubQ Epi is in almost everyone's Anaphylaxis protocol because it's an emergency that needs immediately intervention, and taking the time to get an IV probably isn't the wisest idea. While the onset for most SubQ injections is long, the Epi works very fast when administered this way.
What other drugs do you inject SubQ? Insulin, for instance.
Duh on the Insulin, I should have thought about that one...............
But, I have never had a guidline or protocol that called for Epi SQ in an anaphylactic patient, its always been IV........................
Different strokes for different folks I guess...........
We had a pt resist a Bristoject of D50 into the antcubital vein and spent about $50,000 in plastic surgery, hospitalization, and therapy to rehab his wiped out bicep. Saved his life, though.
Not to steal the question from above but this is very intersting and new to me (still only a basic :glare
So what is the depth (a few MM difference probably), angle of injection & location difference between SubQ and intradermal?
Thanks everyone for your great responses!
our protocol just changed for anaphlyaxis, its now (for adults) 0.3mg of 1:1000 IM, used to be Sub-q.
Well, since you're a CCP/FPM, you probably have the luxury of always having an IV established. However, for the first responding Paramedic, most protocols call for SubQ Epi before IV Epi because:
1. It's quick.
2. It doesn't require an IV.
3. It works.
If the SubQ Epi doesn't work, or tissue perfusion is obviously not adequate, you can jump right to IV Epi.
Pretty much same idea as the SubQ one. It was those claiming that the protocol called for IV Epi that I found hard to believe.
Find it as hard to believe as you want, but the reality is that patients suffering circulatory compromise will not metabolize Epi when administered SQ. IM maybe, but it is still too slow. If you have a pt. with circulatory collapse, i.e. immediate life threatening symptoms, IV Epi is the recommended course of treatment..........
http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-143
http://emj.bmj.com/cgi/content/abst...63c7f018aecc535e7bac47e2&keytype2=tf_ipsecsha
http://www.mchd-tx.org/clinical/documents/MCHDSDOApril2008.pdf (Page 178)
http://www.atcomd.org/downloads/PATIENT CARE GUIDELINES ONLY v06.01.08 ALL PROVIDER LEVELS.pdf (Page 2)
I don't think you're getting what I'm saying.
First of all, I made it clear in my previous post that while SubQ Epi is the primary protocol, if there is inadequate tissue perfusion, then you need to do IV Epi. However, SubQ Epi is the primary protocol because it can be administered immediately without the establishment of an IV, thus avoiding the situation getting bad enough where tissue perfusion is an issue and IV Epi IS necessary.
Someone can require immediate intervention while not being in such a dire state where their tissues aren't being perfused. SubQ Epi is the choice in such a case. The majority of cases. I'm sorry, but it's true.
Yeah, its called an allergic reaction, not anaphylaxis.....................
Obviously you failed to actually read the links. They directly contradict that very statement. My original posting was to state a personal experience, not get into a pissing match with you. Think what you wish, treat as you wish. You apparently allow zero flexibility to considering any other thought process than your own. So why you continue posting multiple pages in these threads I guess will continue to perplex me.................
My preferred site is on the cheek it they let me since i tell them that it won't hurt as bad. plus you know every patient almost has adipose tissue on their cheeks.B)Actually not true.. remember, anywhere there is fat... there is sub-q. Now, there is preferred sites.. as well, one would not want to have 50 (1 ml) injections...