# Epi 1:1000 into Epi 1:10,000



## RanchoEMT (Apr 28, 2012)

Is this right...



RanchoEMT said:


> on a side note. My medic has drawn a 1:1000 epi vial(1ml), pushed it into a 100ml NS bag and withdrew 10ml of fluid for a 1:10,000 epi solution in a 10ml push. Among other possible variences. Fun stuff.


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## Aidey (Apr 29, 2012)

No.

You have 1 shot of rum. You add it to 1 shot of coke. You now have a 1:1 solution. 
You have 1 shot of rum. You add it to 10 shots of coke. You now have a 1:10 solution. 
You have 1 shot of rum. You add it to 100 shots of coke. You now have a 1:100 solution. 
You have 1 shot of rum. You add it to 1000 shots of coke. You now have a 1:1000 solution.

In each case in order to get the whole shot of rum you have to drink the entire solution. Adding more coke doesn't make the rum stronger. So, if you only drink 10% of the 1:1000 solution you won't get the whole shot of rum. 

So, if you medic wanted to give 1mg of epi, he would have had to give all 100cc of the normal saline.


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## Handsome Robb (Apr 29, 2012)

No, it's not. 

That gives you 1 mg in 100 mL or 0.01 mg/mL. 1:10,000 is 1 mg in 10 mL or 0.1 mg/mL

I've always been taught waste 1 mL out of a 10 mL flush and draw 1 mL of 1:1000 epi into that flush to get 1:10,000


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## Anjel (Apr 29, 2012)

Did someone say rum?????

Why is the.rum.gone? An the 1:10000 epi?


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## DrankTheKoolaid (Apr 29, 2012)

If the math is confusing on this the best way to look at it is just what is says.  Epi 1 - 10000 = 1gram in 10L aka 10000mL and epi 1 - 1000 = 1 gram in 1L aka 1000mL.  And reconvert from there as needed


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## Handsome Robb (Apr 29, 2012)

Corky said:


> If the math is confusing on this the best way to look at it is just what is says.  Epi 1 - 10000 = 1gram in 10L aka 10000mL and epi 1 - 1000 = 1 gram in 1L aka 1000mL.  And reconvert from there as needed



I don't know about that one but everyone has their own system.

Easy way for me is just Epi 1:1 or 1:10. drop the zeros.


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## RanchoEMT (Apr 29, 2012)

NVRob said:


> That gives you 1 mg in 100 mL or 0.01 mg/mL. 1:10,000 is 1 mg in 10 mL or 0.1 mg/mL
> 
> I've always been taught waste 1 mL out of a 10 mL flush and draw 1 mL of 1:1000 epi into that flush to get 1:10,000



This all makes sense, thank you, but what the hell was he doing with a 100ml bag.... Can any of you come up with a way to do it with a 100ml bag... The point of it I remember was lets say for a cardiac arrest you could just keep drawing from the bag whenever epi was up...


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## RanchoEMT (Apr 29, 2012)

Corky said:


> If the math is confusing on this the best way to look at it is just what is says.  Epi 1 - 10000 = 1gram in 10L aka 10000mL and epi 1 - 1000 = 1 gram in 1L aka 1000mL.  And reconvert from there as needed



What the..... Lol


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## Handsome Robb (Apr 29, 2012)

RanchoEMT said:


> This all makes sense, thank you, but what the hell was he doing with a 100ml bag.... Can any of you come up with a way to do it with a 100ml bag... The point of it I remember was lets say for a cardiac arrest you could just keep drawing from the bag whenever epi was up...



Sure you could. If you pulled 10 mL out of the bag (to make space so you dont end up with 10 mg in 110 mL) and drew up 10 mL of 1:1000 epi out of a multi-dose vial and put it into the 100 mL bag. Then you would have 10 mg in 100 mL which gets you to 1 mg/10 mL.

With that said, I don't foresee any reason to be giving someone that much epi. 10 rounds is excessive and by that time you should either be transporting or calling for termination orders.  Most I've ever personally seen is 5 rounds and then pronounced on scene. I'm sure there are cases where providers much smarter than myself have gone upwards of 10 rounds but I don't see any *good* reason why you should be going that deep the field.


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## RanchoEMT (Apr 29, 2012)

You know what I think what might be confusing people is the wording on this part right here.





RanchoEMT said:


> on a side note. My medic has drawn a 1:1000 epi vial(1ml), pushed it into a 100ml NS bag and withdrew 10ml of fluid for a 1:10,000 epi solution* in a 10ml push.* Among other possible variences. Fun stuff.



Epi 1:10,000 is 1/10 the epi concentraction of a Epi 1:1000 solution correct??? Ok so if we put that Epi 1:1000 in 100ml of NS the entire bag has just One 1:1000 Epi vial in it.(Now 1:100,000 per ml) But I want only 1/10 of it. By drawing 10ml or 1/10 of the contense out of the bag. im extracting 1/10 of that Epi. And if i push it All * in a 10ml push.* i will get 1/10 the original concentration of the 1:1000 Epi which is 1:10,000 or 1/10 of the now 1:100,000. This isnt correct?


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## Handsome Robb (Apr 29, 2012)

No. 

The concentration doesn't change by how much you draw up..

If you put 1 mg of epi into 100 mL then draw 10 mL back you don't get the whole 1 mg back... 

I don't really know how else to explain it to you. You are getting caught up in all the zeros. Forget about the zeros! lol

I don't understand your math, sorry to say.


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## Medic Tim (Apr 29, 2012)

RanchoEMT said:


> You know what I think what might be confusing people is the wording on this part right here.
> 
> Epi 1:10,000 is 1/10 the epi concentraction of a Epi 1:1000 solution correct??? Ok so if we put that Epi 1:1000 in 100ml of NS the entire bag has just One 1:1000 Epi vial in it.(Now 1:100,000 per ml) But I want only 1/10 of it. By drawing 10ml or 1/10 of the contense out of the bag. im extracting 1/10 of that that Epi. And if i push it All * in a 10ml push.* i will get 1/10 the original 1:1000 Epi which is 1:10,000 or 1/10 of the now 1:100,000. This isnt correct?


If you put the 1 mg/ 1ml epi (1:1000 )in 100 ml. You would have to give the whole 100ml to get 1 mg of Epi into the Pt. If you only give 10 ml the Pt is only getting 0.1 mg of Epi. To get 1:10,000 you add the 1mg/ml Epi in 9 ml of ns making it 1 mg in 10 ml. MakIng it 1:10,000 

The 1:1000 means 1 gram of Epi in 1000 ml ns. It is a 1:1 Ratio as 1 g = 1000mg.  I believe this was explained in an earlier post.


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## RanchoEMT (Apr 29, 2012)

http://s1146.photobucket.com/albums/o535/RanchoEMT/?action=view&current=1335684150.jpg
This will be my last attempt with the 100ml bag, them im calling it a day...


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## RanchoEMT (Apr 29, 2012)

NVRob said:


> The concentration doesn't change by how much you draw up..
> 
> If you put 1 mg of epi into 100 mL then draw 10 mL back you don't get the whole 1 mg back...



Im not trying to get the whole 1mg of epi back right, isnt the idea to get 1/10 of it isolated making it 1:10,000? As the original 1:1000 has spread out in the fluid, from which i can draw back only a fraction of both the contense and therefore a fraction of the concentration, that being 1/10???


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## Medic Tim (Apr 29, 2012)

RanchoEMT said:


> http://s1146.photobucket.com/albums/o535/RanchoEMT/?action=view&current=1335684150.jpg
> This will be my last attempt with the 100ml bag, them im calling it a day...



Forget the 100 ml bag.

I can not think of a reason to put Epi in 100 ml. If you put 1 ml of Epi 1:1000 in 250 ns yOu get 4 mcg/ ml. Which is used for an Epi drip.

The goal is to get the rIght amount of drug to the pt. the order is fOr 1 mg of Epi. So you need to get it into your pt in a safe and practical way. The 1 mg/ ml is too strong to give iv so it needs to be diluted down to a safe cOncentratiOn. Adding 9 ml to it makes it a 1 mg in 10 ml which is the same as a 1:10,000 . The 1:10,000 is = to 1 g in 10L


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## Medic Tim (Apr 29, 2012)

RanchoEMT said:


> Im not trying to get the whole 1mg of epi back right, isnt the idea to get 1/10 of it isolated making it 1:10,000? As the original 1:1000 has spread out in the fluid, from which i can draw back only a fraction of both the contense and therefore a fraction of the concentration, that being 1/10???



No . To have a 1:10,000 you still need the 1 mg of Epi not just a fraction of it.

. In a code the dose is 1 mg of Epi . So the pt needs to get the 1 mg. if you put the 1 mg in 100 ns you have to give all 100 ml to get the 1 mg of Epi into your pt. Or you can Put the 1 mg Epi into 9 ml ns to give your rapid bolus. Much more practical


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## Smash (Apr 29, 2012)

Or just give 1:1000 neat like the rest of the world does


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## SliceOfLife (Apr 29, 2012)

Also, if you put 1mg 1:1000 or 1mg 1:10,000 into a 100 bag you would have the same concentration, 10mcg/ml (assuming you removed whatever volume your putting into the bag)

So if you draw up 10ml it would be 100mcg or .1mg


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## Farmer2DO (Apr 29, 2012)

RanchoEMT said:


> http://s1146.photobucket.com/albums/o535/RanchoEMT/?action=view&current=1335684150.jpg
> This will be my last attempt with the 100ml bag, them im calling it a day...



The problem with your drawing is that when you break down your bag into 10 little portions, the base concentration doesn't change.  100 ml of 1:100,000 when broken into 10 blocks becomes 10 ml X 10 of 1:100,000.  You were changing the base concentration.  In order to do that, you need to increase the drug amount 10 fold.

Think about it this way:  if you put 1 mg into a bag, and draw out 1/10 th of the bag, you will only get 1/10 th of a mg.


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## Handsome Robb (Apr 29, 2012)

RanchoEMT said:


> Im not trying to get the whole 1mg of epi back right, isnt the idea to get 1/10 of it isolated making it 1:10,000? As the original 1:1000 has spread out in the fluid, from which i can draw back only a fraction of both the contense and therefore a fraction of the concentration, that being 1/10???



Yes you are trying to get the whole milligram back. The only difference between 1:1000 and 1:10,000 is how much fluid the 1 mg of epi is in. That's it.


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## phideux (Apr 29, 2012)

My head hurts. :wacko::unsure::huh::huh:


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## Veneficus (Apr 29, 2012)

Not to get off topic, but does it really matter?

We know there is no evidence showing epi helps. 

We know there is some showing it actually hurts.

We also know this pharm concept called volume of distribution, and cpr creates basically a bellows effect, not actual circulation. 

Since the deletorious effects are in central circulation, perhaps it might be beneficial that the 10cc of flush might not be enough to get to central circulation?

just a thought...


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## Handsome Robb (Apr 29, 2012)

phideux said:


> My head hurts. :wacko::unsure::huh::huh:



Seconded.

There has to be a language barrier or something. I don't know how else to spell it out. It's low level high school math. 

Vene he can't get the concentrations why'd you have to go put that nonsense in his head hahaha


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## Sandog (Apr 29, 2012)

Veneficus said:


> Not to get off topic, but does it really matter?
> 
> We know there is no evidence showing epi helps.
> 
> ...



When I was a kid, I had bad asthma, at the time EPI was the only help. I can speak from experience that EPI brought me back from near suffocation many times. Sure the side affects were unpleasant, but breathing again was worth it.


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## usalsfyre (Apr 29, 2012)

Veneficus said:


> Not to get off topic, but does it really matter?
> 
> We know there is no evidence showing epi helps.
> 
> ...



I actually had the thought that while his partner made a med error, he actually gave what probably in reality was a far more appropriate dose....

The reason it matters is that while it was likely no harm, no foul in this case, what other med errors are being made because of lack of understanding.


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## Aidey (Apr 29, 2012)

Sandog said:


> When I was a kid, I had bad asthma, at the time EPI was the only help. I can speak from experience that EPI brought me back from near suffocation many times. Sure the side affects were unpleasant, but breathing again was worth it.



He was talking about epi in cardiac arrest. It definitely can be beneficial in asthma, anaphylaxis and as a pressor.


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## Aidey (Apr 29, 2012)

Aidey said:


> No.
> 
> You have 1 shot of rum. You add it to 1 shot of coke. You now have a 1:1 solution.
> You have 1 shot of rum. You add it to 10 shots of coke. You now have a 1:10 solution.
> ...




Ok, lets try again. 

When describing the concentration of a medication there are two numbers. The first number is the medication, the second number is the diluent. So in this case, 1:1000 means 1 part rum for 1000 parts coke. 

In my above explication, the amount of rum never changes. There is always only one shot of rum. All I am doing is adding additional coke. If I take my mix of 1:1000 and pour it into 10 glasses, each glass has 1/10th of a shot of rum, and 100 shots of coke. 

So, when your partner put 1mg of 1:1000 epi in 100cc, he created a solution that was 1mg of 1:100,000 epi. 10cc of that equals 1/10th of a mg of epi.


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## Veneficus (Apr 29, 2012)

usalsfyre said:


> I actually had the thought that while his partner made a med error, he actually gave what probably in reality was a far more appropriate dose....
> 
> The reason it matters is that while it was likely no harm, no foul in this case, what other med errors are being made because of lack of understanding.



Overtreatment and administering an unindicated treatment is an error, we never get broken up over those. (especially where lack of understanding come in, like backboards.)

Why is it more of an issue when it is a medication?


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## Melclin (Apr 29, 2012)

RanchoEMT said:


> This all makes sense, thank you, but what the hell was he doing with a 100ml bag.... Can any of you come up with a way to do it with a 100ml bag... The point of it I remember was lets say for a cardiac arrest you could just keep drawing from the bag whenever epi was up...




On a side note, why does it have to be given as 10mls of 1:10,000? Why can't you take the 1mg/1ml neat and run it into a free flowing line from the bag you presumably have up?  

Honestly, just forget the 100ml bag.


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## RanchoEMT (Apr 29, 2012)

Aidey said:


> Ok, lets try again.
> 
> When describing the concentration of a medication there are two numbers. The first number is the medication, the second number is the diluent. So in this case, 1:1000 means 1 part rum for 1000 parts coke.
> 
> ...



Ahh, the point has been explained wrong to me by my medic, He stated that you only needed to deliver 1/10 of the existing Epi in the vial, not dilute it. Hmm wonder if that was an error in explanation or an error all together.... :mellow:


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## Melclin (Apr 29, 2012)

RanchoEMT said:


> Ahh, the point has been explained wrong to me by my medic, He stated that you only needed to deliver 1/10 of the existing Epi in the vial, not dilute it. Hmm wonder if that was an error in explanation or an error all together.... :mellow:



Yeah that makes sense. Its not a bad way to get the right dilution for your small adrenaline boluses in severe anaphylaxis/asthma/shock etc.


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## usalsfyre (Apr 29, 2012)

RanchoEMT said:


> Ahh, the point has been explained wrong to me by my medic, He stated that you only needed to deliver 1/10 of the existing Epi in the vial, not dilute it. Hmm wonder if that was an error in explanation or an error all together.... :mellow:



Your medic has fallen victim to on of the classic blunders. The most famous of which is never get involved in a land war in Asia. Only slightly less well known is don't mix up milliliters and milligrams when discussing epinephrine doses.


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## Aidey (Apr 29, 2012)

Does it count for anything in this discussion that I am mostly Sicilian?


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## phideux (Apr 29, 2012)

Aidey said:


> Does it count for anything in this discussion that I am mostly Sicilian?



Hey Waddaumean???? When it comes to being Sicilian you are, or you ain't. Ain't no mostly allowed.:rofl::rofl:


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## Handsome Robb (Apr 29, 2012)

Melclin said:


> Why can't you take the 1mg/1ml neat and run it into a free flowing line from the bag you presumably have up?



This is how I was taught to do it if I use my three prefills out of my bag and go onto more rounds h34r:

Push 1:1000 through the top port a tid bit slower, like 5 seconds vs slamming it.


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## Akulahawk (Apr 29, 2012)

usalsfyre said:


> Your medic has fallen victim to on of the classic blunders. The most famous of which is never get involved in a land war in Asia. Only slightly less well known is don't mix up milliliters and milligrams when discussing epinephrine doses.


What you do not smell is called iocane powder. It is odorless, tasteless, dissolves instantly in liquid, and is among the more deadlier poisons known to man...


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## abckidsmom (Apr 29, 2012)

Akulahawk said:


> What you do not smell is called iocane powder. It is odorless, tasteless, dissolves instantly in liquid, and is among the more deadlier poisons known to man...



I have spent he last several years developing an immunity to iocaine. 

He didn't stand a chance.


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## TYMEDIC (Apr 30, 2012)

NVRob said:


> No, it's not.
> 
> That gives you 1 mg in 100 mL or 0.01 mg/mL. 1:10,000 is 1 mg in 10 mL or 0.1 mg/mL
> 
> I've always been taught waste 1 mL out of a 10 mL flush and draw 1 mL of 1:1000 epi into that flush to get 1:10,000




Second that!


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## Tigger (Apr 30, 2012)

abckidsmom said:


> I have spent he last several years developing an immunity to iocaine.
> 
> He didn't stand a chance.



This thread has taken a turn straight for awesome!


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## usalsfyre (Apr 30, 2012)

Tigger said:


> This thread has taken a turn straight for awesome!


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