# Question Epi pen



## MassEMT-B (Sep 5, 2010)

I am using the website www.emt-national-training.com to prepare for my NREMT test coming up. One of the questions was a scenario where the partner you have is using an Epi pen for the first time. After he uses it he asks you why there’s some still left in the pen. Then you tell him how much Epi is actually injected which is the question. Now I chose the answer which says 80-90% of the Epi is actually injected but it said the correct answer is only 10-20% is actually injected. Now am I really wrong here or is the question messed up? The rationale is Very little of the adrenaline actually leaves the auto injector approximately 80-90% stays IN the injector.


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## Shishkabob (Sep 5, 2010)

Question is messed up.


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## angels.girl84 (Sep 5, 2010)

I used that website as well & found alot of the questions to be backwards as well! really annoying!



MassEMT-B said:


> I am using the website www.emt-national-training.com to prepare for my NREMT test coming up. One of the questions was a scenario where the partner you have is using an Epi pen for the first time. After he uses it he asks you why there’s some still left in the pen. Then you tell him how much Epi is actually injected which is the question. Now I chose the answer which says 80-90% of the Epi is actually injected but it said the correct answer is only 10-20% is actually injected. Now am I really wrong here or is the question messed up? The rationale is Very little of the adrenaline actually leaves the auto injector approximately 80-90% stays IN the injector.


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## MassEMT-B (Sep 5, 2010)

Alright thank you. I thought I was right but you never know. Again thank you and stay safe.


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## Lifeguards For Life (Sep 5, 2010)

Linuss said:


> Question is messed up.



No it's not. There is a total of 2ml inside the Epipen. There is a one time dose of .3mg which is .3 ml of fluid. After an injection there is 1.7ml remaining in the auto injector. This is 85% of the initial volume.

As to why they would care if you know this, I have no idea.

This can be verified in any Physicians Desk Reference. Mine is the 2009 edition.


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## rhan101277 (Sep 5, 2010)

Lifeguards For Life said:


> No it's not. There is a total of 2ml inside the Epipen. There is a one time dose of .3mg which is .3 ml of fluid. After an injection there is 1.7ml remaining in the auto injector. This is 85% of the initial volume.
> 
> As to why they would care if you know this, I have no idea.
> 
> This can be verified in any Physicians Desk Reference. Mine is the 2009 edition.



Yeah I wonder why they would care.  Its one thing to ask how much medicine is being injected but to ask the volume that remains is kind of silly.

That like asking how much volume remains in a nitro spray after 15 uses.


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## Lifeguards For Life (Sep 5, 2010)

rhan101277 said:


> Yeah I wonder why they would care.  Its one thing to ask how much medicine is being injected but to ask the volume that remains is kind of silly.
> 
> That like asking how much volume remains in a nitro spray after 15 uses.



Exactly. I would strongly urge the OP and any others who are using that site to find a better way to study and I  advise others against paying for that site's service in the future.


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## JPINFV (Sep 5, 2010)

Actually, it is important in a sense. If you use an EpiPen and are expecting the majority of the medication to be injected, then you could end up giving additional doses from additional pens because you believe that the pens are malfunctioning. Outside of the understanding that "the majority will stay inside the pen" I agree that it's not important.

Edit: Using nitro is a bad example. EpiPens are, for the most part (there's at least one multi-dose autoinjector, but the name escapes me at the moment) a one and done dose. However nitro sprays will continue delivering doses until it runs out of nitro.


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## Shishkabob (Sep 5, 2010)

After reading the Epi-pen prescribing info, seems as though I was wrong.



Oh well, I have SQ/IM/IV epi anyhow that allows me to vary the dose instead of having to deal with an Epi-pen.


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## CAOX3 (Sep 5, 2010)

I also think its important understanding the medications and delivery systems you have at your disposal.

Why is this a knock on the website?  All their doing is providing the information.


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## Oiball (Sep 5, 2010)

> EpiPens are, for the most part (there's at least one multi-dose autoinjector, but the name escapes me at the moment) a one and done dose.



Twinject


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## lightsandsirens5 (Sep 5, 2010)

Here's what I want to know. Say you use all the epi on your truck and you are still 30 mins out and the pt is going back into anaphlaxis. Can you IO the epi pen, draw up the epi (thru the IO) and give it IM?

Jk. Lol! :-D


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## Shishkabob (Sep 5, 2010)

Shoot, I just use more SQ/IV epi.


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## lightsandsirens5 (Sep 5, 2010)

Linuss said:


> Shoot, I just use more SQ/IV epi.



We don't carry any of that, yet. The only epi we have on the truck is locked up in those stupid epi pens.


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## Lifeguards For Life (Sep 5, 2010)

JPINFV said:


> Actually, it is important in a sense. If you use an EpiPen and are expecting the majority of the medication to be injected, then you could end up giving additional doses from additional pens because you believe that the pens are malfunctioning. Outside of the understanding that "the majority will stay inside the pen" I agree that it's not important.



Good point. I didn't think of it this way. I have never used an epi pen either (We don't carry them). I don't think the majority of EMT's or medic's know this, and doubt it will be on the NRMET


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## Lifeguards For Life (Sep 5, 2010)

Can anyone explain why there is extra epi in the injector? All my books just say it is for "stability purposes." Can someone who has taken more chemistry than me explain this or provide a link?


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## piranah (Sep 5, 2010)

This could be on the NREMT..I was taught this in medic school mainly so when you get on-scene post epi pen you don't think it malfunctioned..as pre-hospital providers it is your responsibility to know specifics on common tools used by the public as to attempt first aide so in turn you can appropriately identify the pt status...


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## Lifeguards For Life (Sep 5, 2010)

piranah said:


> This could be on the NREMT..I was taught this in medic school mainly so when you get on-scene post epi pen you don't think it malfunctioned..as pre-hospital providers it is your responsibility to know specifics on common tools used by the public as to attempt first aide so in turn you can appropriately identify the pt status...



Maybe my PM school wasn't so hot. the only reason i knew this is i stumbled upon it when reading my PDR.


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## jjesusfreak01 (Sep 5, 2010)

CAOX3 said:


> I also think its important understanding the medications and delivery systems you have at your disposal.
> 
> Why is this a knock on the website?  All their doing is providing the information.



Just doesn't seem like useful information. IIRC, the epipens say on the side that not all of the medication will be injected, so the EMT just has to trust that their epipen worked correctly and gave the 0.3mg that it was supposed to. 

Even if you had a paranoid EMT that believed the first pen didn't work and gave a second, thats still only 0.6mg of Epi, whereas our medic protocol calls for 0.5mg, so I don't think you are putting the patient in extreme danger either way. There are no contraindications for epinephrine in the case of acute severe anaphylaxis


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## MassEMT-B (Sep 5, 2010)

Thanks all. In my class they just said not all of it is injected. So I wasn't sure on how much was really left in the pen.


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## Lifeguards For Life (Sep 5, 2010)

jjesusfreak01 said:


> Just doesn't seem like useful information. IIRC, the epipens say on the side that not all of the medication will be injected, so the EMT just has to trust that their epipen worked correctly and gave the 0.3mg that it was supposed to.
> 
> Even if you had a paranoid EMT that believed the first pen didn't work and gave a second, thats still only 0.6mg of Epi, whereas our medic protocol calls for 0.5mg, so I don't think you are putting the patient in extreme danger either way. There are no contraindications for epinephrine in the case of acute severe anaphylaxis



As you can't visualize the epi, I don't think anyone would be able to quantify the residual amount. The pen would feel the same in your hand. If you can hear the epi by holding it to your ear and shaking it it would sound the same.


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## rhan101277 (Sep 5, 2010)

MassEMT-B said:


> I am using the website www.emt-national-training.com to prepare for my NREMT test coming up. One of the questions was a scenario where the partner you have is using an Epi pen for the first time. After he uses it he asks you why there’s some still left in the pen. Then you tell him how much Epi is actually injected which is the question. Now I chose the answer which says 80-90% of the Epi is actually injected but it said the correct answer is only 10-20% is actually injected. Now am I really wrong here or is the question messed up? The rationale is Very little of the adrenaline actually leaves the auto injector approximately 80-90% stays IN the injector.



While there may be some silly questions, this site is a good preparation tool for the registry.  I used it and I passed.  It also gives rationale behind every answer.


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## Lifeguards For Life (Sep 5, 2010)

rhan101277 said:


> While there may be some silly questions, this site is a good preparation tool for the registry.  I used it and I passed.  It also gives rationale behind every answer.



Do you think you would not have passed, had you not used this site?


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## Shishkabob (Sep 5, 2010)

> as pre-hospital providers it is your responsibility to know specifics on common tools used by the public as to attempt first aide so in turn you can appropriately identify the pt status...



Id rather rely on my assessment of the patient and decide if they do or do not need epi. That's just me.


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## Wild_Weasel (Sep 5, 2010)

I have also started using emt-national-training as part of my review in preparation for the NREMT-B exam, and stumbled over the same question.  I have noticed that many of the questions/answers are not in the textbook we used in class, _Emergency Care and Transportation of the Sick and Injured, Ninth Edition_.  Digging around in the book and other sources looking for answers to questions I got wrong only serves to increase the depth of my knowledge and understanding, as I see it.  Also, using this site made it clear that I needed to thoroughly review my NR Skill Sheets and CPR Training.  While not stand alone I recommend this site as an adjunct to preparation for the NREMT exam.

Cheers,
W-W


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## Lifeguards For Life (Sep 5, 2010)

Wild_Weasel said:


> I have also started using emt-national-training as part of my review in preparation for the NREMT-B exam, and stumbled over the same question.  I have noticed that many of the questions/answers are not in the textbook we used in class, _Emergency Care and Transportation of the Sick and Injured, Ninth Edition_.  Digging around in the book and other sources looking for answers to questions I got wrong only serves to increase the depth of my knowledge and understanding, as I see it.  Also, using this site made it clear that I needed to thoroughly review my NR Skill Sheets and CPR Training.  While not stand alone I recommend this site as an adjunct to preparation for the NREMT exam.
> 
> Cheers,
> W-W



How can you recognize this site as good prep for the NREMT if you have not taken the NREMT?

If you like going on wild goose chases for (ultimately) useless information that will most likely not be on the test, than this is the site for you.


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