# EPI Pen



## chri1017 (Aug 10, 2013)

Who has administered an EPI pen before and what was the scenario?


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## DesertMedic66 (Aug 11, 2013)

Guy was stung by a bee. Assisted him with his Epi pen.


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## TransportJockey (Aug 11, 2013)

Given it to myself twice after bee stings. Never given it at work cause our basics draw and administer it on their own.


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## Handsome Robb (Aug 11, 2013)

TransportJockey said:


> Given it to myself twice after bee stings. Never given it at work cause our basics draw and administer it on their own.



Only in New Mexico. 

Never administered anything except a trainer.


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## TransportJockey (Aug 11, 2013)

Robb said:


> Only in New Mexico.
> 
> Never administered anything except a trainer.



Dude I know areas of Texas where basics are tubing people lol


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## NomadicMedic (Aug 11, 2013)

Multiple bee stings. Helped guy with his epi pen. Started a line, gave Benadryl. Drove to hospital. The end.


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## rwik123 (Aug 11, 2013)

transportjockey said:


> dude i know areas of texas where basics are tubing people lol



et?


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## TransportJockey (Aug 11, 2013)

rwik123 said:


> et?



Yea. Out in this area supraglottic airways are common for bls providers


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## Mariemt (Aug 11, 2013)

Iowa here, bls and we have epi pens on our truck


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## teedubbyaw (Aug 11, 2013)

TransportJockey said:


> Yea. Out in this area supraglottic airways are common for bls providers



I only know of esophagus devices (King LT's) being used by basics in this area of Texas.


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## TransportJockey (Aug 11, 2013)

teedubbyaw said:


> I only know of esophagus devices (King LT's) being used by basics in this area of Texas.



The joys of the way EMS in Texas is. Your medical director could expand your scope as they see for, as long as they 'provide proper training'. It's how I was allowed to dart chests as an intermediate when I worked in rural Texas, as well as intubate. 
The frontier areas of the state are more likely to allow large scopes for their providers. I know a buddy of mine works in a tiny town on the Mexican border with an ungodly advanced practice. Their basics can and do intubate at times.


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## EpiEMS (Aug 11, 2013)

TransportJockey said:


> Their basics can and do intubate at times.



Do you think that basics tubing adds a lot of value?


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## TransportJockey (Aug 11, 2013)

EpiEMS said:


> Do you think that basics tubing adds a lot of value?



No I don't. I think most basics have way too large of a scope of practice with the low level of educAtion that is required of the level. I was just stating that Texas is an odd state. Nm isn't too much better


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## Tigger (Aug 11, 2013)

EpiEMS said:


> Do you think that basics tubing adds a lot of value?



I can't imagine they have much opportunity to use such a skill, which makes me wonder if many can effectively intubate period. If these EMTs are working with an I or P I see no reason why they need to intubate.

And to the OP: Neither of the place I work have them, we draw it up from an amp. Though I am not allowed to give it at once place because all medications except ASA, oral glucose, and O2 have to be given by a paramedic. Apparently I am not trusted enough to give medications within my scope even with a paramedic watching.


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## Jim37F (Aug 11, 2013)

Tigger said:


> I can't imagine they have much opportunity to use such a skill, which makes me wonder if many can effectively intubate period. If these EMTs are working with an I or P I see no reason why they need to intubate.
> 
> And to the OP: Neither of the place I work have them, we draw it up from an amp. Though I am not allowed to give it at once place because all medications except ASA, oral glucose, and O2 have to be given by a paramedic. Apparently I am not trusted enough to give medications within my scope even with a paramedic watching.



What I'm imagining is a rural area with two EMT-Bs on the ambulance with an extended ALS response time


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## chaz90 (Aug 11, 2013)

Tigger said:


> Apparently I am not trusted enough to give medications within my scope even with a paramedic watching.



We need to take the next step and get you into Paramedic School...


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## Wheel (Aug 11, 2013)

chaz90 said:


> We need to take the next step and get you into Paramedic School...



This is my vote as well. If ems is where you see yourself Tig, you seem too smart and motivated not to. My two cents, and you can do what you'd like/what's best for you because only you can know what that is.


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## Tigger (Aug 11, 2013)

chaz90 said:


> We need to take the next step and get you into Paramedic School...





Wheel said:


> This is my vote as well. If ems is where you see yourself Tig, you seem too smart and motivated not to. My two cents, and you can do what you'd like/what's best for you because only you can know what that is.



It becomes more of a thought everyday.


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## unleashedfury (Aug 23, 2013)

Used Epi once on a bee sting anaphylatic patient who was legit circling the drain. 

In PA BLS can carry Epi - Pens with approval of the medical director and appropriate training. 

Your supposed to verify the signs of anaphylaxis, get a full assessment and vitals and contact medical command for approval.


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## xrsm002 (Aug 23, 2013)

My service in Texas (rural)we can abs do on several
Occasions have two basics on a truck for our backup they can give epi 1:1 IM so we don't carry epi pens.


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## xrsm002 (Aug 23, 2013)

I love Texas not having state protocols.


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## MrJones (Aug 23, 2013)

I carry an epi-pen in the back country as a just-in-case, and I've recently switched to this:







Why, you ask?



> ...the world's first and only epinephrine auto‑injector that talks you through the injection process during a severe allergic reaction.



Yes, just like an AED, the Auvi-q talks the user through the process, step-by-step. Not important for me (I know what to do), but if I can't inject myself, it's good to know that whoever grabs my epi will be able to hook me up. And, as a bonus, it's a bit smaller than a deck of cards, so it takes up less space in my kit.


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## nwhitney (Aug 23, 2013)

chri1017 said:


> Who has administered an EPI pen before and what was the scenario?



I've administered Epi before but not via a pen.  We draw our own Epi here in Oregon.


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## nwhitney (Aug 23, 2013)

teedubbyaw said:


> I only know of esophagus devices (King LT's) being used by basics in this area of Texas.



Here in Oregon EMT's can use supraglottic airways like King and Combi.


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## unleashedfury (Aug 23, 2013)

xrsm002 said:


> I love Texas not having state protocols.



From what I gather about Texas.. its up to the medical director.. he can make you be John Wayne.. Or say you don't even touch the patient. Consider it a priviledge that you get to load your patient into the buggy. 

I only spent time on Fort Sam when I was in Texas and partying amongst the San Antonio night life. Never really ran into any EMS situation which required me to get the insight.


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## STXmedic (Aug 23, 2013)

unleashedfury said:


> From what I gather about Texas.. its up to the medical director.. he can make you be John Wayne.. Or say you don't even touch the patient. Consider it a priviledge that you get to load your patient into the buggy.
> 
> I only spent time on Fort Sam when I was in Texas and partying amongst the San Antonio night life. Never really ran into any EMS situation which required me to get the insight.



You nailed it. The medical director can authorize you to do (or not do) whatever he wants. There is a tremendous disparity between systems throughout the state.

SA is where I live. I'm assuming you were down for 68W. We have a new military paramedic program, too. The specialty designation eludes me, though.


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## Bullets (Aug 23, 2013)

Ive done it twice, both were within 6 months of us being allowed to use them, one was bees, one was peanuts


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## unleashedfury (Aug 23, 2013)

STXmedic said:


> You nailed it. The medical director can authorize you to do (or not do) whatever he wants. There is a tremendous disparity between systems throughout the state.
> 
> SA is where I live. I'm assuming you were down for 68W. We have a new military paramedic program, too. The specialty designation eludes me, though.



I attended Fort Sam. I was the final 91B class before they transistioned to the 91W which is now the 68W of today. So now I'm showing my age. 

OTOH I don't exactly agree with this practice. As it hampers the idea of advancing your education to become a advanced provider. I mean whats the point of becoming a paramedic if you can perform all the skills of one if your medical director permits. If you want to perform advanced practice, Become a advanced practicioner if you want to be a EMT-B, or a AEMT. do so.


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## unleashedfury (Aug 23, 2013)

STXmedic said:


> SA is where I live. I'm assuming you were down for 68W. We have a new military paramedic program, too. The specialty designation eludes me, though.



I'm presuming, you may be referring to the 18Delta Special Forces Medical Sgt. program.


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## STXmedic (Aug 23, 2013)

unleashedfury said:


> I'm presuming, you may be referring to the 18Delta Special Forces Medical Sgt. program.



No, it's not the 18D program, though they may come through here also. The medics they are putting through are training to be flight medics.


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## mycrofft (Aug 23, 2013)

Shot an expired one into an orange once.
My cohorts kept storing the glass epi ampules under fluorescent lighting. They ought to be in amber glass, but that would confuse people (Lasix comes in amber glass too).


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## Bullets (Aug 24, 2013)

unleashedfury said:


> I attended Fort Sam. I was the final 91B class before they transistioned to the 91W which is now the 68W of today. So now I'm showing my age.
> 
> OTOH I don't exactly agree with this practice. As it hampers the idea of advancing your education to become a advanced provider. I mean whats the point of becoming a paramedic if you can perform all the skills of one if your medical director permits. If you want to perform advanced practice, Become a advanced practicioner if you want to be a EMT-B, or a AEMT. do so.


Except Epi-pens are not an advanced skill....if we can prescribe Epi-pens to children and teach them to use it, and your claiming its an advanced skill, that doesnt speak to highly of paramedics, does it?

And the flight medics are still 68W, with an F2 or F3 designation, F2 is CC, F3 is flight medic


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## unleashedfury (Aug 25, 2013)

Bullets said:


> Except Epi-pens are not an advanced skill....if we can prescribe Epi-pens to children and teach them to use it, and your claiming its an advanced skill, that doesnt speak to highly of paramedics, does it?
> 
> And the flight medics are still 68W, with an F2 or F3 designation, F2 is CC, F3 is flight medic



I wasn't referring to the Epi Pen bullets. you may have just misunderstood my post. I am referring to the way Texas has the state setup. where a Basic can perform advanced skills, IV Therapy, medications, and other advanced techniques based on their Medical Directors approval.


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## TransportJockey (Aug 26, 2013)

unleashedfury said:


> I wasn't referring to the Epi Pen bullets. you may have just misunderstood my post. I am referring to the way Texas has the state setup. where a Basic can perform advanced skills, IV Therapy, medications, and other advanced techniques based on their Medical Directors approval.



A lot of it has to do with lack of training or providers. Texas has a lot of frontier regions. I know so,e areas in Texas to get to a paramedic program would be a four hour of more drive. One way.


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## unleashedfury (Aug 27, 2013)

TransportJockey said:


> A lot of it has to do with lack of training or providers. Texas has a lot of frontier regions. I know so,e areas in Texas to get to a paramedic program would be a four hour of more drive. One way.




Ahh I see, So its more of the much rural regions that expand the scope of practice due to kinda being in the middle of no where,


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## STXmedic (Aug 27, 2013)

unleashedfury said:


> Ahh I see, So its more of the much rural regions that expand the scope of practice due to kinda being in the middle of no where,



That may be its intent, but a lot of places utilize it. The EMTs in my major city FD can start IOs and place king tubes. PD's tactical medics here (EMT-Bs) have essentially the scope of military combat medics.


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## rwik123 (Aug 27, 2013)

MrJones said:


> I carry an epi-pen in the back country as a just-in-case, and I've recently switched to this:
> 
> 
> 
> ...



Are you allergic or did you get your doc to prescribe you one just for piece of mind?


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## MrJones (Aug 27, 2013)

rwik123 said:


> Are you allergic or did you get your doc to prescribe you one just for piece of mind?



No known allergies, but the possibility of coming across - and reacting to - an allergen that I hadn't previously been exposed to while in the back country is such that my Dr. and I agreed that it would be a good idea to carry one as well as some benadryl


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## mycrofft (Aug 27, 2013)

How long would they forestall anaphylaxis? Better get a satellite phone, smoke flares too. 

Ask about "Susphrine"


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## mycrofft (Aug 27, 2013)

Bullets said:


> Except Epi-pens are not an advanced skill....if we can prescribe Epi-pens to children and teach them to use it, and your claiming its an advanced skill, that doesnt speak to highly of paramedics, does it?



I think medications are in that magic zone where they aren't advanced until you are, then they are. I call it..."The YOUSHOULDAKNOWNBETTER" ZONE". If a layperson "HELPS" gives someone their epi and they expire, it's racked up as a "good try". If you as an advanced prehospital provider shoot someone and they die and there's a detectable (take vitals, good history, look for medic alerts, and record it all) and preventable situation which  exacerbates to a mortality, it could be manslaughter.


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## STXmedic (Aug 27, 2013)

mycrofft said:


> Ask about "Susphrine"



Interesting med. From what I can gather, it's just Epi in a oil-based solution. Apparently too many asthmatics were rebounding after they had already left the hospital. Good luck finding it  Somebody's dating themselves again


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## mycrofft (Aug 27, 2013)

Yeah I am. I think I read somewhere that they are trying it again.
We stopped using it (for acute serious asthma) because the pt would be OD'ed and we didn't have the onsite materials to try to counteract it, which includes cardiac monitoring and a good patent IV.


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## imhabitformin (Sep 9, 2013)

In Michigan as EMT's we carry EPI-PENS as well as King and Combitube. Even working an only 911 truck. I've only used the EPI-PEN one time in 3 months.


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## mycrofft (Sep 9, 2013)

*Death by anaphylaxis including 3 or 4 Epipens*



imhabitformin said:


> In Michigan as EMT's we carry EPI-PENS as well as King and Combitube. Even working an only 911 truck. I've only used the EPI-PEN one time in 3 months.



AND I QUOTE:
"Her parents, Sacramento urologist Dr. L G* and his wife responded immediately. Natalie's mother tasted the treat and also detected peanuts. The girl was given a dose of Benadryl to offset an allergic reaction, Brothers said.

They monitored Natalie, who at first seemed fine, still smiling and enjoying herself, Brothers said. Twenty minutes later, she vomited and began to have trouble breathing.

Natalie's father administered an injection with an EpiPen, a device used to deliver epinephrine that is commonly carried by individuals with serious allergies.

Frequently, an EpiPen can ward off a severe allergic reaction, but the injection had no impact. Brothers said Natalie's father ended up using three EpiPens over the course of several minutes before she stopped breathing.

Paramedics arrived at the camp at 10:40 p.m. and performed CPR to no avail. She was taken by ambulance to Barton Memorial Hospital in South Lake Tahoe, where she was pronounced dead at 12:30 a.m. Saturday.

The El Dorado County Sheriff's Office said the cause of death was severe laryngeal edema – a swelling in the throat – as a result of a presumed allergic reaction.

Read more here: http://www.sacbee.com/2013/07/30/5607195/years-of-caution-about-peanut.html#storylink=cpy


*Names removed by Mycrofft


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