# Using EpiPen during Cardiac Arrest



## Hockey (Jun 3, 2009)

Not a question asked by me, but someone that works for another neighboring agency and it somewhat made me go hmm never heard of this before


Lets say you're on a Full Arrest as a BLS only truck and ALS is either not available or a LONG ways away.  Hospital isn't 5 minutes from you either.


Hit the patient with a EpiPen.  I mean its the same stuff pretty much as the ALS is going to give.  

So explain why or why not?  


I really don't have a reason why or why not so thats why I'd like to hear everyone elses responses.  I understand an EpiPen can be bad somewhat for someone with Cardiac history but its not going to kill someone anymore who is arresting...I think...


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## Vizior (Jun 3, 2009)

an Epi-Pen is a different concentration of the drug, and is also going sub-cutaneously instead of directly into the vascular system.  The drug isn't going to circulate at all.


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## Shishkabob (Jun 3, 2009)

1:1,000 as opposed to 1:10,000

IM vs IV


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## 46Young (Jun 3, 2009)

Vizior said:


> an Epi-Pen is a different concentration of the drug, and is also going sub-cutaneously instead of directly into the vascular system.  The drug isn't going to circulate at all.



Correct, except that the Epi-Pen delivers the med IM, not SQ. The adult pen delivers 0.3 mg, arrest protocols call for 1mg. Arrest meds don't work well without adequate oxygenation and CPR, generally via an advanced airway. About one month ago, we had a 60 y.o. male drop dead at the gym at about 0630. An off duty FBI agent immediately provided good CPR. All we had to do was drop an OPA, shock V-Fib once, and we had a 190/110 BP, 6 resps/min, spO2 99%, and he gagged when I tried to pass a tube. So, basically, it was a BLS save. Trust in BLS. Administering epi IM via autoinjector, even with OLMC authorization, may be acting outside your scope of practice. You'll lose your card, and possibly be sued. The best example I can think of is the time two NJ medics performed a C-section in the ambulance under direction of a physician, an OB GYN, I think. Things went well, but the medics still lost their cards. I just don't want to see anyone lose their livelihood while they believe they are acting in the best interest of the pt.


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## johnrsemt (Jun 3, 2009)

Also when Epi is pushed via IV, there is fluid pushing behind it to help it circulate, along with the compressions helping the meds to circulate and hit the heart.
  I don't care how good of CPR you are doing,  you will never circulate blood to the musculature (sp?) that the Epi IM is sitting at.


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## Jon (Jun 3, 2009)

Best reason - it isn't in your protocol.


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## lightsandsirens5 (Jun 4, 2009)

Jon said:


> Best reason - it isn't in your protocol.



I like that one the best so far. Really all BLS can do is try to keep blood going around (mebby shock in some states, or is that in all states?) and consequently O2 going to the brain untill the pt can get ACLS care.


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## daedalus (Jun 4, 2009)

Do not do it. Its a different dose, different concentration, and different route. It will not be effective and will get you into trouble. Did I mention it will not be effective?


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## zappa26 (Jun 4, 2009)

lightsandsirens5 said:


> Really all BLS can do is (mebby shock in some states, or is that in all states?)



AED in all states; manual defib is rare for BLS, but possible per protocols.


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## lightsandsirens5 (Jun 4, 2009)

zappa26 said:


> AED in all states; manual defib is rare for BLS, but possible per protocols.



Ok. We do Man. Defib. but I wasn't sure if other states/countys even AED shocks.


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## Sasha (Jun 4, 2009)

daedalus said:


> Do not do it. Its a different dose, different concentration, and different route. It will not be effective and will get you into trouble. Did I mention it will not be effective?



But what if while you're squeezing the heart with an gloved hand you slam the epi pen directly into the heart? Would it work then???


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## medicdan (Jun 4, 2009)

Sasha said:


> But what if while you're squeezing the heart with an gloved hand you slam the epi pen directly into the heart? Would it work then???



I saw it once on ER. It must be true, so I will do it in the field. I'll cut open their chest with a pocket knife, do a bic pen trach, and do internal cardiac massage.


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## mikie (Jun 4, 2009)

lightsandsirens5 said:


> Ok. We do Man. Defib. but I wasn't sure if other states/countys even AED shocks.



When you say Manual Defib...are basics performing it?  Is it like a LP-12 on 'AED' mode where it analyzes and you still need to "Press to Shock"?


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## WolfmanHarris (Jun 6, 2009)

mikie said:


> When you say Manual Defib...are basics performing it?  Is it like a LP-12 on 'AED' mode where it analyzes and you still need to "Press to Shock"?



That's SAED. Manual Defib involves setting a charge and delivering it based on your own interpretation of the rhythm. Adult charge settings are the same though and I've known Advanced Care Paramedics to leave the monitor in SAED unless they want to override it so they can focus on getting the advanced airway, establishing a line, etc.

As for the epi, it's been covered fairly well above. Case of knowing just enough to be dangerous.


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