# need help to answer a question from class.



## john76 (Sep 26, 2009)

my instructer told to try and find out which dose of epinephrine to use for allergies and wich is forcardiac  1/1000 or 1/10,000 she did not say where we could look for the answer she just said if we could not find it then she would tell us next class.can anyone help me out and tell me the answer.


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## Aidey (Sep 26, 2009)

What level of class are you in? Do you have a book you use for class? What about a pharmacology guide? If you were on a call where would you look for information?


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## Mountain Res-Q (Sep 26, 2009)

Aidey said:


> What level of class are you in? Do you have a book you use for class? What about a pharmacology guide? If you were on a call where would you look for information?



He's in Basic Class, Aidey.

It sounds like an "extra credit" question...  and while I would not expect this information to be part of your typical EMT class, I too would _kindly _encourage John76 to try a littl research on your own...  A simple google search (not always the best choice, but it will do for this) will reveal the information, provide an explination of why a certain concentration might be contraindicated for cardiac use, as well as some good extra info that might expand your knowledge beyond what is required at the basic level...  Good Hunting...


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## Aidey (Sep 26, 2009)

I hope I didn't sound rude in my post, I was just trying to find out what resources he had before I said anything else. I didn't want to just give the answer away either.

While google will get you the answer, I think it's better to use a resource you would have at your disposal in real life. You can't really google in the back of the ambulance.


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## Mountain Res-Q (Sep 26, 2009)

Aidey said:


> I hope I didn't sound rude in my post, I was just trying to find out what resources he had before I said anything else. I didn't want to just give the answer away either.
> 
> While google will get you the answer, I think it's better to use a resource you would have at your disposal in real life. You can't really google in the back of the ambulance.



Actually, with todays technology... you can...  ^_^  But, I agree...  I'd be more than happy to provide he answer or even list a few links to review... but what fun is there in that...  I would prefer to leave john76 with the feeling of accomplishment and personal satisfaction...


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## Aidey (Sep 26, 2009)

Well, yeah, but would you really? 

Also, while Epi isn't anywhere near the EMT B protocols, I think it's important for EMT Bs to know the difference between the two, because they may be assisting with getting medications ready and such. That could be why your instructor wants you to know the difference.


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## tcripp (Sep 26, 2009)

John76 - I like to use www.epocrates.com when looking up information on drugs.  That should give you a good starting point.  And, it is very clear as to which concentration you use for anaphylaxis vs. cardiac.

I hope you find this helpful.


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## medic417 (Sep 26, 2009)

Aidey said:


> Well, yeah, but would you really?
> 
> Also, while Epi isn't anywhere near the EMT B protocols, I think it's important for EMT Bs to know the difference between the two, because they may be assisting with getting medications ready and such. That could be why your instructor wants you to know the difference.



Actually epi in the proper concentration is either a basic drug (actually required in many states) or allowed to use patients depending where you are.  Every basic should know which one is the right level and how, why, what about it.


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## MrBrown (Sep 26, 2009)

Aidey said:


> ...While google will get you the answer, I think it's better to use a resource you would have at your disposal in real life...



I told you this "internet" was not real! :lol: :lol:


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## mycrofft (Sep 26, 2009)

*Google "Merck Manual" then the subject.*


I guess EMTLIFE is sort of a search engine, no?

Epi for anaphylaxis is one of those funny deals where sometimes a pt can do it with a Dr Rx and teaching, but unless you have it in your protocols, you probably can't. (If I found an epi pen on the pt and he was anaphylactoid I might put it in hs hand, pull the safety cap and let it fall onto his thigh....) 

Why not start a thread about good versus not so good internet resopurces? (Your turn, I'm littering the site with dead threads).


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## medichopeful (Sep 26, 2009)

I always remember which is which because it is the reverse of what you might expect, if that helps at all...


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## rescue99 (Sep 26, 2009)

medic417 said:


> Actually epi in the proper concentration is either a basic drug (actually required in many states) or allowed to use patients depending where you are.  Every basic should know which one is the right level and how, why, what about it.



Yep..this is a typical Basic EMT drug. EMT and MFR students need the basic information on what, when, why and how right along with the R's. If they can assist or give it, they need to know something more about epi than simply _when_ to give it.


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## Mountain Res-Q (Sep 26, 2009)

Aidey said:


> Well, yeah, but would you really?
> 
> Also, while Epi isn't anywhere near the EMT B protocols, I think it's important for EMT Bs to know the difference between the two, because they may be assisting with getting medications ready and such. That could be why your instructor wants you to know the difference.



Epi (as in an EpiPen) is the the EMT protocols...  However, it wouldn't matter... I said that knowong the difference in concentrations is probably not required knowledge at the EMT level, but that doesn;t mean that EMTs shouldn't know the difference.  Like many things in the curriculum for EMTs, I believe that that basic pharm is inadequate... everyone should at least be taught basic drug recognition; if you find drug X in the bathroom, it is for condition X and the like.  Like Rescue99 said... more is needed than to know when to give Drug X...


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## rescue99 (Sep 26, 2009)

Mountain Res-Q said:


> Epi (as in an EpiPen) is the the EMT protocols...  However, it wouldn't matter... I said that knowong the difference in concentrations is probably not required knowledge at the EMT level, but that doesn;t mean that EMTs shouldn't know the difference.  Like many things in the curriculum for EMTs, I believe that that basic pharm is inadequate... everyone should at least be taught basic drug recognition; if you find drug X in the bathroom, it is for condition X and the like.  Like Rescue99 said... more is needed than to know when to give Drug X...



Ahhhh...but alas, there are now 3 different packagings. 2 pens and a vial. Mine used to come in a multi-dose (red box) kit with oral benadryl. Anyone else have this one? I see it's making a come back.


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## Dominion (Sep 26, 2009)

Mountain Res-Q said:


> Epi (as in an EpiPen) is the the EMT protocols...  However, it wouldn't matter... I said that knowong the difference in concentrations is probably not required knowledge at the EMT level, but that doesn;t mean that EMTs shouldn't know the difference.  Like many things in the curriculum for EMTs, I believe that that basic pharm is inadequate... everyone should at least be taught basic drug recognition; if you find drug X in the bathroom, it is for condition X and the like.  Like Rescue99 said... more is needed than to know when to give Drug X...



Epi is in the <condition removed so OP can't cheat > protocol in Ky.  Here basics are allowed to either give it from a pre-filled or get it in a 1ml solution of 1:1000 ampule.  EMT's (if your service follows the protocol) are trained when and why and how to draw up the dose and give it SQ.  It's standing orders for 1 dose, call in for 2, if you think you need a third you should almost be at the hospital or have a medic already enroute.  Just saying OP might get into a service or state that has orders for Epi 1:1000 and should probably know why.


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## Aidey (Sep 26, 2009)

In the 5 or so different sets of protocols I've worked under Bs were allowed to "assist" a patient in using their own Epi Pen. They were not allowed to draw up the medication from a vial, or administer it to anyone who did not have an current prescription for an Epi Pen, and have it with them. That is what I was referring to, sorry I wasn't clear. 

Technically under those protocols, the EMTB would need to know about Epi and its affects, and about the different Epi pens (peds vs adults vs multi dose etc) but not necessarily about the Epi Paramedics use. Hopefully that makes sense. And I know not just Paramedics use it, I'm just trying to avoid talking about the concentrations.


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## Dominion (Sep 26, 2009)

Aidey said:


> In the 5 or so different sets of protocols I've worked under Bs were allowed to "assist" a patient in using their own Epi Pen. They were not allowed to draw up the medication from a vial, or administer it to anyone who did not have an current prescription for an Epi Pen, and have it with them. That is what I was referring to, sorry I wasn't clear.
> 
> Technically under those protocols, the EMTB would need to know about Epi and its affects, and about the different Epi pens (peds vs adults vs multi dose etc) but not necessarily about the Epi Paramedics use. Hopefully that makes sense. And I know not just Paramedics use it, I'm just trying to avoid talking about the concentrations.



Hehe understood.  We are taught I a rudimentary run down of Epi.  Like I said our protocol is designed to be pre-filled however many services use ampules and the Basics are required to know how to draw up the meds.  With that said, I felt more confident in the epi 'class' than I feel the other basics did only because I have been in paramedic class for the last year.  According to our protocols, a severe pt has no contraindications for epi admin.  The protocol is designed also more for a basic gets on scene, turns out to be what it is, starts a medic and then gives one dose SQ.


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## john76 (Sep 27, 2009)

i found some sources online and they all say that 1/1000 is the dosage for allergic reaction can anyone please confirm this for me


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## EMTinNEPA (Sep 27, 2009)

1:1,000 is the concentration commonly given subcutaneously for anaphylaxis.  1:10,000 is the concentration used for intravenous administration.


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## SurgeWSE (Sep 27, 2009)

EMTinNEPA said:


> 1:1,000 is the concentration commonly given subcutaneously for anaphylaxis.  1:10,000 is the concentration used for intravenous administration.



Quoted for emphasis.  There is no cardiac concentration or anaphylaxis concentration.  

1:1000 for IM/SQ and 1:10,000 for IV. At the EMT-B level you'll likely be giving it IM (Epi-Pen) so the dosage will be 300 mcg IM of 1:1000 (which would be 0.3 mL).  If you were administering it IV (in an ALS setting), it might be 300 mcg IV of 1:10,000 (which would be 3 mL).

This is where understanding drug dosages, unit conversions, and concentrations is crucial.  You're dosage range should not change (300-500 mcg for Anaphylaxis, 1 mg in cardiac arrest), but your concentration will change and the actual, physical amount of medication (as in mL) will change.  Be very careful not to screw this up--3 mL of 1:10,000 epi and 3 mL of 1:1000 epi is a veeeeery different dose.


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## mycrofft (Sep 27, 2009)

*Winner winner chicken dinner.*

Need to be familiar just to help a pt do it.
What if the pt is about to shoot it into the chest or antecubitus?
Also, if the pen is still in the box, know that at least one manufacturer packs a trainer with the real one. Like any drug, read the drug's pkg before giving it, *in accordance with local protocols*.


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## cm4short (Sep 28, 2009)

In addition to which to use. It is also good to know the effect on what's the difference in administration sites, meaning... how does epi effect the body if given SQ, IM or IV. that also is a good to know. I'll give you a hint. it has to do with the B1 B2 receptors.


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