# EPIPen, ideas on why it's in the kit?



## will (Aug 22, 2007)

Ok, not to start a likely controversial subject again. however I got to thinking after having looked at the kit the other day, and recent discussions here.

A place where I work on occasion has a BLS kit that was put together by another person who works there such as me, that is an RN.

The kit is in a tactical medical pack, and is "supposed" to be the same equipment or kit as the dispatched fire trucks would have.  The kit has several smaller bags broken into "broke bone", "gun shot wound", "wound care/epi pen" Theres some basic tools, an Ambu-bag, etc.

What got me was the fact there is in fact an Epi Pen in the bag which says there is.

I *KNOW* EPI is an Rx only to be administered by an MD, etc, etc...

I know that people who may have severe allergic reactions are prescribed Epi-Pens in case of severe reaction, and relevant family members are trained in when and how to use them.

However I also know that the only person that works there likely to know how to use the EPI is the RN who put the kit together, who is there possibly 10% of the time, perhaps a bit closer to 25% of the time.  The next 2 people in medical training would be me, and one other who are your typical Basic Aid/Lay Rescue trained... neither of which are trained, nor qualified to administer the EPI.

So, is it logical to say the RN put the EPI in there, in case he's around, he can administer it? Seems silly given he's there considerably less than any other person (including me, and I'm not there very often), he put it there for EMS? Redundant since they should have their own, and then some... He put it there for the person having the reaction who knows when and how to use it, but then shouldn't they already have their own?

Can anyone see any reasoning on why he would have supplied the kit with this medication?  There is always a possibility an EMT/RN/or MD is at a class and could administer, but I would say odds are one in every 4-10 classes has someone trained in it's use.


Does it seem logical to anyone that an EPI pen is a good choice in the kit, or just a bit over the top?  EMS response to the location is around 15-30minutes, with likely the first responder arriving in their POV, does the response time and likely hood of the first responder showing up without supplies warrant this? or just a bit overkill?

Opinions, anyone?  I'm thinking it's in ways a useless item since no one at the facility on a regular basis could administer this in any sense (not to mention may not even know what it's for)


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## Onceamedic (Aug 22, 2007)

Its in the kit cause it can save a life.  Anaphylactic shock is scary..  and kills quick.  Now the caveats.... it can save a life IF it has not expired,  IF it has not been exposed to excess sunlight and/or heat (what color is it?) , IF it is administered correctly, IF the patient is in fact having a life threatening reaction, IF.. IF... IF

My personal opinion - it will probably never be needed, but then, I dont understand personal jump kits anyway.  Any aid I render before the arrival of the cavalry is first aid and I can do it with my hands/and or stuff that's easily around.


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## ResTech (Aug 22, 2007)

If no one is qualified to administer it then it really should'nt be in there. Not sure what state ur in but in PA we have specific guidelines and protocol for "primary use epi"... that is... epi-pens we carry on-board a BLS unit and administer to all patients with anaphylaxis regardless if they have their own or not.

Epi is a potent drug.... don't touch it unless qualified and research your states guidelines.


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## will (Aug 22, 2007)

Yeah, not sure about Oregon's guidlines on EPI... might try looking it up, unless someone knows.

As far as the reason for the kit, it's at a firearms training facility, so it's not necissarily a bad kit to have on hand... especially from a liability standpoint... if something ever happened they couldn't accuse us of not being prepared when we are equipped similarly to the first responding EMS units (who would likely be called to testify to that fact)  Hopefully it never sees use, however it's there if ever needed, people fall, and get hurt, stuff happens.

I might as the RN who put it there if he knows the local protocal/laws regarding EPI's use... maybe he feels it's worth having regardless if anyone can use it or not... I would assume an RN in Oregon is qualified to use it, but who knows.


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## BossyCow (Aug 22, 2007)

In our state (WA) there was legislation passed requiring all ambulances to carry Epi-pens because a couple of high falutin' attorneys who lived next door to a state legislator, lost their daughter to anaphylactic shock.  The original law stated that all EMT-s had to carry both adult and ped.  These things outdate and they aren't cheap.  The cost of that legislation state wide was huge, for an instance that affects around 3% of the population.  They did re-write it to be only ambulances which saved some.  Personally, I've thrown out more outdated Epi-pens than I have used.

Granted, if you need one, you need one and they are certainly nice to have.  But their effects are short term, you may need three or four for the trip to the hospital if you are in a rural area.  In the backcountry, we don't even bother.  There's no point.  We have one in the first aid kit for base camp but we don't carry Epi-pens on our packs

In our state, we are allowed to 'assist people with their medications'.  We have to make sure it is their's (not some meds they borrowed from their uncle Victor when he had the same thing).  We have to make sure it's still viable (not that bottle of nitro they've had since the heart attack in '87.) We also have to make sure that the dosage is correct.  That they are taking what they are supposed to be taking (not 4 of the oxycodone because they are really small and not that strong)

But, you need to know what the contra-indications are to giving any medication before you use it.  I know, if I had an Epi-pen right in front of me, and someone appeared to be in distress, and I don't have the proper training, it's going to be very difficult to not use it.  I say remove the temptation to use a med that you aren't trained about.  If your RN wants it, let him or her carry it in his/her personal kit.  

And besides, it's a prescription med, who's name is the prescription in?


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## Ridryder911 (Aug 22, 2007)

Okay, how hard is it to use an Epi pen? ..duh! I always wonder why states mandate "special training" to open the end and jab into thigh! C'mon, we teach common layman how to use the thing. 

More important, I would say 99.% of the time, I have never have seen a need to ever use one. Much, rather have Benadryl in the system. Most of the cases are reactions, not anaphylaxis, which there is a *huge* difference. 

I probably can count how many times, I have administered epi in the field for anaphylaxis. It just doesn't occur that often. Most know if they had a real reaction and carry epi pens with them. 

For those 1% of the time, I would say it is important to have an Epi-pen available. I know my state allows basics to administer it. 

R/r 911


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## BossyCow (Aug 22, 2007)

But Rid, this is an Epi-pen (adult or peds? Who knows?) placed into a pack that is accessed by untrained and uncertified personel.  I think its highly irresponsible to place a prescription med into a first aid kit without any precautions.  Like you say, most who need it carry it.  

Yes they are easy to use.  But that doesn't mean that you allow a layperson access to meds.


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## VentMedic (Aug 22, 2007)

We recently had a good discussion on this where it concerned Bee-Keepers and having the Epi-pen  available.

http://www.emtlife.com/showthread.php?t=4706&highlight=epi-pen


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## akflightmedic (Aug 22, 2007)

BossyCow said:


> But Rid, this is an Epi-pen (adult or peds? Who knows?) placed into a pack that is accessed by untrained and uncertified personel.  I think its highly irresponsible to place a prescription med into a first aid kit without any precautions.  Like you say, most who need it carry it.
> 
> Yes they are easy to use.  But that doesn't mean that you allow a layperson access to meds.



So put a disclaiimer tag on it that says to be used ONLY by EMTs, RNs or MDs. How many people are really going to play with something unfamiliar?

Here on our camp, we have AEDs dispersed throughout. Inside those AEDs are little baggies with ASA and NTG spray...INSIDE the AED case where any layperson can get to it!!! OMG!!! They are labeled "To be used by med personel only".

In all seriousness, I think you are making a moutain out of a molehill. As Rid stated, it is hardly ever used prehospitally, and I see no harm in having it there. 

As little time as you and the RN are there, I would say the same for the Billy Joe Bob rescue man idiot is there either..(you know, the guy you are concerned with using this device while being untrained.)

The cosmic odds of Billy Joe Bob being there at same time a true emergency develops, where IF he even remembers to get the kit as well as considering using anything inside it are dismal.

On another tangent, is there ASA,Motrin,Tylenol, Immodium, Tums, or Rolaids inside your 1st Aid Kits?
This is highly irresponsible as well. I mean dispensing medications without orders, or being a doctor is highly irresponsible.

That is unless people know where to get them and are allowed to help themselves and self medicate. Then it isnt an issue, but as an EMT you better not be handing this stuff out when people make complaints to you.


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## medman123 (Aug 22, 2007)

Call med control before you do anything that you have to question. It not a big deal to know when to use it, and useing is simple also. Trust me one day you will be happy thats it there.


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## ffemt8978 (Aug 23, 2007)

medman123 said:


> Call med control before you do anything that you have to question. It not a big deal to know when to use it, and useing is simple also. Trust me one day you will be happy thats it there.



Correct me if I'm wrong, but Med Control only applies to EMS and not the lay rescuer, which is the case Will would be in without an agency affiliation.


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## medicdan (Aug 23, 2007)

Correct me if I am wrong, but in general, doesn't the first aid service at the firing range need Medical Supervision (an overseeing MD) in order to get a script for the pen? Doesn't there need to be a protocol or a standing order for it? Who wrote the script for the pen you have? 

As others have stated, the pens expire quickly (in one year, as I recall), and once administered, the patient needs to get to a hospital quickly either for more epi or for treatment of the side effects. 

I work at a summer music venue doing first aid and during concerts, we always have one RN and two EMTs/Ski Patrol people on. We kept epi pens for a while, but we used them so infrequently, and we needed a new one every summer, it just didn't make sense financially. We always have a basic ambulance on the grounds, and they carry at least one, so we dont worry. 
Because we administer O2, bandaids, carry an AED and used to have an epi pen, we had to register with the state for what I think is the equivalent of an ambulance license, which came with requirements of its own. Do you need to do something similar? 

Good Luck!


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## will (Aug 23, 2007)

emt-student said:


> Correct me if I am wrong, but in general, doesn't the first aid service at the firing range need Medical Supervision (an overseeing MD) in order to get a script for the pen? Doesn't there need to be a protocol or a standing order for it? Who wrote the script for the pen you have?



I don't think that's the case since it was never really originally obtained by the range... in fact I may be incorrect in the RN leaving it, I always thought he left it there (which he shouldn't have a script as far as I know he has no allergies, he's a diabetic requiring insulin but not allergic) it may have been some regular student who thought we needed to have one on hand, or perhaps left us a spare so if he needed it and forgot it, we'd have one... Perhaps then when the RN put the new kit together he found the one someone had left and put it in the new kit (he didn't complete build the new kit from scratch, some of it was from an old kit they had prior.

Interesting theories and thoughts... perhaps if I remember I can ask him this week, since I'll see him... see if he did in fact put it there, or if had found it already in some of our stuff, and if he did put it there what he was thinking.

Anyone know, can an RN usually administer EPI without an MD supervising?  I'm guessing a Nurse Practitioner could, but then they are almost MD's anyways.


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## Flight-LP (Aug 23, 2007)

Will,
      It doesn't matter how or why the EPI pen is there, you cannot use it, period! To answer your question, no the nurse cannot either without MD order. Honestly, I think you need to stop and put down all of the EMS toys and take a little look at reality..............

1. You are not a certified medical provider. Dive certs don't amount to crap for emergent medical care outside of the dive realm. That means you CANNOT LEGALLY PROVIDE ANY TREATMENTS ABOVE WHAT ANY LAY PERSON CAN OFFER. That includes oxygen administration. It is a drug that you are attempting to administer without a prescription or physician order. Giving it at your family place of business (or wherever you wish give it) is not allowed. Receiving training on something is not an approval to play............Hell, I have been trained and educated on performing emergent appendectomies, but do you see me cutting open people's RLQ? No. Because I am not authorized to do so by my medical director............See how that works?

2. You need to learn a little your states civil statutes and health codes. You are asking the right questions and we are responding with the right answers. But it seems that your rebuttal gets twisted around every time. Again, what you are proposing is not legal in most states. You need to be affilitated with an EMS organization or become one through your state EMS office. Regardless, you MUST have a physician on board, or you WILL eventually sued and probably prosecuted should you screw up while treating someone.

Sorry to be harsh, but man, your just not getting what we are trying to tell you. We're in the biz, many of us for decades. Take a moment to listen, you may be surprised at what you can learn.......


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## will (Aug 23, 2007)

I'm done, thanks for playing... never once did I mention me using the EPI, I said to my knowledge no one except possibly the RN could use it, or would even know how to use it, if they could.

I was only trying to see if someone could help me understand why it may have been put in the kit in the first place, to which everyone is as stumped as I am in why it's there.

But for some reason people seem to think just because I ask a question I want approval or something, when I said from the start of this thread that NO ONE WAS TRAINED NOR ALLOWED (Legally, etc) TO USE THE DEVICE so why might it be there...  This whole thread was about why would it be there since the only people around are Lay Persons who can't use such an item...

Nothing further...


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## BossyCow (Aug 23, 2007)

akflightmedic said:


> So put a disclaiimer tag on it that says to be used ONLY by EMTs, RNs or MDs. How many people are really going to play with something unfamiliar?




Sorry, but I've seen what happens when idiots who think they are saving a life do something stupid.  In this post, we have a guy who has not yet taken his EMT who is all excited about all the new toys.  

I had a similar situation on a call where some helpful harry dosed a bee stung kid with no hx of allergies with an adult epi-pen because he panicked. Very different from a kit with limited access by those who have a system of training in place. Like Rid said, most people who have severe allergic reactions carry their own epi-pens and it's a very small percentage of people who have that severe of a reaction anyway.  It's irresponsible to have a prescription med, unprescribed, unmonitored, unchecked for expiration date etc, just hanging about just in case.


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## rgnoon (Aug 23, 2007)

It looks like he got scared off. It's too bad...it was  a point that definitely needed to be made. Well put flight-lp.


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## medman123 (Aug 23, 2007)

ffemt8978 said:


> Correct me if I'm wrong, but Med Control only applies to EMS and not the lay rescuer, which is the case Will would be in without an agency affiliation.


He does not work for a Company?


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## ffemt8978 (Aug 23, 2007)

medman123 said:


> He does not work for a Company?



Nope, he stated in another post that he was thinking about taking the EMT class for his own education.


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## ffemt8978 (Aug 23, 2007)

will said:


> I'm done, thanks for playing... never once did I mention me using the EPI, I said to my knowledge no one except possibly the RN could use it, or would even know how to use it, if they could.
> 
> I was only trying to see if someone could help me understand why it may have been put in the kit in the first place, to which everyone is as stumped as I am in why it's there.
> 
> ...



But you did ask about you carrying and administering oxygen in another thread.  Do you see where this could lead to the impression that you may end up wanting to use the Epi?

As to why the Epi pen is there, the only way to know for sure is to find the person that put it there and ask them.  Otherwise, remove it from the kit to remove the temptation of using it.


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## medman123 (Aug 23, 2007)

ffemt8978 said:


> Nope, he stated in another post that he was thinking about taking the EMT class for his own education.



disregrad my other post.


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## MedikErik (Aug 30, 2007)

Better to have it and not use it, than to not have it and need it. For every million people out there who'll never need one, there's probably a quite few who thank God that the medic had one in his bag that day. Just my $0.02.


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## Flight-LP (Aug 30, 2007)

MedikErik said:


> Better to have it and not use it, than to not have it and need it. For every million people out there who'll never need one, there's probably a quite few who thank God that the medic had one in his bag that day. Just my $0.02.




Except when the individual who carries it can't use it..................


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## MedikErik (Aug 30, 2007)

Here in MD even as low as EMT-Basic you learn how to administer an Epi-Pen.


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## Flight-LP (Aug 31, 2007)

The original poster has no formal medical training and is not covered under any medical dirsctor. He therefore cannot utilize it...............


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## MedikErik (Aug 31, 2007)

Ah, I see. While I usually frown upon untrained individuals using epi-pens, if I'm going into anaphylaxis I'd rather take my chances and have someone hit me with one as opposed to going intro respiratory arrest (and this is coming from someone who had an anaphylactic reaction that was caught early by an astute nurse... thanks mom). I thought all I had was a rash from being out in the sun... didn't really associate taking a PCN pill that morning with the rash as I'd been taking it all my life with no problems. I was 16, and it would be a few months before I joined the FD, so I had no idea what anaphylaxis was, much less why my mom nearly had an MI once she saw the rash. On the way to the hospital I could actually see the hives spreading up and down my body... let me tell you, if that happened today, I could care less if it was Elmer Fudd who was injecting me with it, so long as I was receiving treatment. 

On the flip side, I do understand that injecting a healthy person with it can have adverse and potentially fatal consequences, but I do believe it is something where if you know when it's appropriate to use one (immediate life threataning emergencies only), it doesn't hurt to have it. It was the not-too-distant-past in which we couldn't give ASA unless it was assissting the patient with theirs, for crying out loud. Heck, 40 years ago you needed to consult for an IV. *shrug*. Times change.


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## Flight-LP (Aug 31, 2007)

I can understand your train of thought, but if you have a severe allergy to something, more than likely you will already have the pen in your possession. Also, a rash does not constitute anaphylaxis and usually doesn't warrant Epinephrine. Benadryl, Decadron, and Solu-Medrol would all be more suitable options........


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## BossyCow (Aug 31, 2007)

Absolutely.  I have some pretty significant allerigies with pretty extreme reactions.  I do not carry an Epi-pen, but I do carry Benedryl in the dissolving strips.  Faster acting than swallowing pills but tasting better than chewing those nasty tablets.  

I think the main issue addressed in this thread was the lack of training, the confusion over who's Epi-pen it was, where it came from and who was able to use it.  A good med or tool in the wrong hands can create more problems than it solves.


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## rgnoon (Aug 31, 2007)

BossyCow said:


> Absolutely.  I have some pretty significant allerigies with pretty extreme reactions.  I do not carry an Epi-pen, but I do carry Benedryl in the dissolving strips.  Faster acting than swallowing pills but tasting better than chewing those nasty tablets.
> 
> I think the main issue addressed in this thread was the lack of training, the confusion over who's Epi-pen it was, where it came from and who was able to use it.  A good med or tool in the wrong hands can create more problems than it solves.



Not to hijack the thread, but as a newbie I want to clarify something for my own education. Without going back to my text, I believe our orders here for epi (good 'ole NJ and our standing orders) require two signs of systemic reaction to call it anaphylaxis, one of which must be respiratory distress. Does this sound right?


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## Ridryder911 (Aug 31, 2007)

Ironically, I carried Primatine Mist inhalers (epinephrine) for immediate treatment. Faster acting, and easier administration. Unfortunately, they are removing it from the over the counter due to the flurocarbons contained as a propellant. 

R/r 911


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## BossyCow (Aug 31, 2007)

Yep and the new generation inhalers I don't think work as well, at least not for me.  But, I gotta wonder, if the propellants are as bad as they say to the environment, how are they good for fragile lung tissue?


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## EMTinNE (Aug 31, 2007)

*Life or Death situation...yours or mine? 30 Minutes & counting down...*

In our EMT-B class, we all had the ALS class pertaining to the use/administration of the EPI-pen.  This was a very important class and that is why the instructors felt it was necessary to certify the class(rural community/volunteer EMS). Of course, we can only administer the EPI if the person has his/her own via prescription and with Medical Direction. 

However, in a "general public" setting, my actions would be much different. My mother and I are both allergic to bee stings. My mom has LITERALLY 30 minutes to have an EPI shot(after being stung) or she is D.E.A.D.  In an emergency situation where my mom didn't have her EPI readily available(forgot purse, locked in vehichle, etc) or could not administer it herself(unconscious,injured, immobilized,etc) and a bystander happened to have a current(non-expired) EPI available-I know for a fact I'd be using the EPI offered. Same goes if I was the one in need of the shot...I'd rather have someone give me Joe Blow's injection than watch me die from asphyxiation. In these severe cases, the "golden hour" has been reduced to the "golden 30 minutes". 

If this bag holding the EPI happens to be within reach, I'm going to utilize it! And I'd like to think that someone else would be willing to administer also. All of the EPI pens have the injection instructions labeled right on the syringe itself(along with pictures). That is just one of those case-by-case situations when you sometimes step outside of what the book states.


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## VentMedic (Aug 31, 2007)

BossyCow said:


> Yep and the new generation inhalers I don't think work as well, at least not for me.  But, I gotta wonder, if the propellants are as bad as they say to the environment, how are they good for fragile lung tissue?



You're not the only one seeing a difference with the HFA inhalers. Our patients have expressed their concerns. I've noticed a delivery difference also.

As for as toxic effects:
http://www.ehponline.org/members/1996/Suppl-1/dekant-full.html

And Rid, don't get me started on Primatine Mist inhalers! My name was at the top of the list for banning them long before the propellant issue.  They were too dangerously misused for breathing and other purposes (diet suppressant and "energy") by some members of the general public.

EMTinNE quote:


> If this bag holding the EPI happens to be within reach, I'm going to utilize it! And I'd like to think that someone else would be willing to administer also. All of the EPI pens have the injection instructions labeled right on the syringe itself(along with pictures). That is just one of those case-by-case situations when you sometimes step outside of what the book states.



Yes, if it was an immediate emergency and an epi-pen was within my reach, I would probably use it if I thought it would make a difference. However, I would not carry one when not on duty.


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## MedikErik (Aug 31, 2007)

Flight-LP said:


> I can understand your train of thought, but if you have a severe allergy to something, more than likely you will already have the pen in your possession. Also, a rash does not constitute anaphylaxis and usually doesn't warrant Epinephrine. Benadryl, Decadron, and Solu-Medrol would all be more suitable options........



Its the trouble breathing that comes after the rash that's the kicker lol. And no, don't have the pen in my possession... but if I'd been taking the PCN while out in the field instead of in my home, I might not be posting today... I've been places where it'll take the first responders at least an hour to get out there, if not longer. 

I view the epi-pen as being in the same vein as LTD (Long-Term Disability) Insurance. It's something you hope you never have to use, but if you do need it, it's a good thing to have.


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## babygirl2882 (Sep 1, 2007)

Hope I don't hijack the thread but I have questions 



akflightmedic said:


> Here on our camp, we have AEDs dispersed throughout. Inside those AEDs are little baggies with *ASA and NTG spray*



What are ASA and NTG spray?



MedikErik said:


> On the flip side, I do understand that injecting a healthy person with it can have adverse and potentially fatal consequences



So If someone is given an epi who is not going into anaphylactic shock then it could kill them?


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## Ridryder911 (Sep 1, 2007)

Epi or adrenalin can cause heart rate to become tachycardiac (fast) and even produce ventricular tachycardia (ventricles way too fast) and yes, even death. 

To the person that posted about their mom having 30 minutes until death, one needs to study anaphylaxis a little more. Usually true anaphylaxis will kill someone in the first thirty minutes, thus the usual determination of if someone is really allergic or those that have a reaction. As well, remember sub-q is the slowest route of adminstration of a medication. Thus it takes a l-o-n-g time to absorb. 

Vent I agree Primatine was a dangerous drug; especially for asthmatics. Several years ago I attempted to patent something simular for allergic reaction, since people are more prone to take inhaler rather than injections, and Benadryl inhaler as well. Unfortunately, patent attorneys and drug research is very costly. 

R/r 911


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## medicdan (Sep 1, 2007)

babygirl2882 said:


> What are ASA and NTG spray?




ASA is an abbreviation for acetylsalicylic acid (sp?) or Asprin. NTG is Nitroglycerin.
Both of the above meds are used in pre-hospital care (depending on standing orders and state protocols) for patients who are in suspected cardiac arrest/MI/general chest pain. The idea is that with the AED, there are other tools that may help a cardiac patient. 
Inevitably I am going to be pounced for my definition, as somebody is going to take offense with one word or another...


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## Ridryder911 (Sep 1, 2007)

Your definitions are correct other than one would not use either medication in a cardiac arrest setting. (hard to chew ASA when one is dead....lol) 

R/r 911


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## MedikErik (Sep 1, 2007)

However, they are good for "pre-arrest". 

We actually had a MD give us orders to give a patient in full arrest ASA. We asked him to repeat his order, then basically told him "HTF are we supposed to give him oral ASA" to which he replied "crush it up and put it under his tongue, he'll absorb it". *sigh*. Our EMS duty officer (equiv. to a battalion chief) told us just to ignore it and continue with what we were doing; he'd take the heat for it later.


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## Meursault (Sep 9, 2007)

We just had our BLS drugs review, and since we're talking about epi, here's a little story from the instructor:

Call comes in for allergic rxn at a nursing home. When the medics arrive, they are met by a smiling nurse, who announces "Oh, the patient's okay. I took care of it." 
"Took care of it?"
"Yeah, I gave him epinephrine."
"How much?" 
"2"
"2 _what_?"
"Milligrams."

The gentleman was a bit keyed up when the medics got to him, but he survived. The story was told to us to illustrate the therapeutic range for epinephrine, and why it's okay, although not the best idea, to give kids a single adult dose in an emergency.


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## disassociative (Sep 9, 2007)

Here in TN; where the entry level designation is NREMT-B at the national level along with EMT-IV at the state level; the EMT is allowed to adminster epi 1:1000 via SubQ or IM; as well as to do blind insertions and start IV's. I find it strange that most places put such restrictions on EMT-B. 

I remember when I got on with my first ambulance service as EMT-IV. It was all good, up until the checkoff. I had to go through all of the kits(jump kit, adult airway, peds airway, drug box, ambulance itself) and document all of it: Laryngoscope blade battery status, write down the expiration dates as well as record the nearest exp on ALL meds, LR, NS, D5W, INT Kits, IV Start Kits, you name it.)

I used to sit and wonder how anyone in ems could abuse drugs. After documenting them all day; the last thing I would want to see when I got home would be a syringe full of morphine, lol. 

Anyways, don't get me wrong.. EMT-IV IS NOT EMT-I. We were NREMT-B, EMT-IV; however, we were required to spend a little more time in class focusing on more in depth physiology, etc. 

I think epi admin in BLS form of course(not cardiac) should be employed across the span of EMS Personnel.


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## Ridryder911 (Sep 10, 2007)

So let me ask you this... what is the basic going to do, when after they adminster the Epi and the patient then goes into SVT or a rate of 160 to 180 (common after Epi administration)? 

There is a reason, why medications should only be administered by those that can correct the adverse effect and correctly monitor the patient afterwards. 

R/r 911


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## Flight-LP (Sep 10, 2007)

disassociative said:


> I think epi admin in BLS form of course(not cardiac) should be employed across the span of EMS Personnel.



It is.........its called an Epi pen. Completely EMT proof, no possible way to OD someone. perfect for EMT-B's. SQ/IM epi and EMT-B should NEVER be used in the same sentence. as Rid said, once the dose is secrewed up by an overzealous and under-educated EMT-B, the consequences will be irreversible unless immediate ALS is available. Not much an EMT-B can do about SVT, V-tach, or an acute MI...............


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## disassociative (Sep 10, 2007)

Well; consider the alternative:

Anaphylactic Shock: Throat closes, airway is compromised--patient dies.
I am by no means talking about an ACLS dose of EPI.

Also; most EMT-IV would be riding with a paramedic; and those on BLS--would have the sense to put an ALS unit on stand by in case of such an event.

As an EMT-IV we had epi-pens and the ability to dose and pull up the needed amount of epi.

0.01 mg/kg

Adult: 0.3-0.5 mg SC
Ped: 0.15 mg SC

  weight / 2.2(0.01)

As I am sure most will agree; with the skill of medication administration
comes the responsibility.

and with this responsibility; lies the realization that sometimes you simply need ALS or if you are ALS someone who is trained more in depth. There is no shame in it.  If someone's throat is closing from anaphylaxis and an EMT-IV administers epi--that buys valuable time.

I, in no way; shape or form advocate witholding ALS reponse simply because you think you can do a skill on your own. I am just saying--it is a handy thing to have around--that's all.


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## Meursault (Sep 10, 2007)

What Flight-LP said. As a basic, all I'm doing with the Epi-Pen is buying 20-30 minutes to hand the patient over to ALS or get them to an ER for definitive care. That's enough for my level.


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## BossyCow (Sep 10, 2007)

An Epi-pen is a tool.  Those of us allowed (or mandated as in my state) to carry them have training on how to use it and when it is appropriate.  I think since mandating it in our state, it is being over-used.  

The type of allergic reaction that will require the intervention of an Epi-pen is pretty rare, affecting less than 3% of the population and most of them carry their own Epi-pens.  

The original poster of this thread was an untrained, possibly future EMT-B, who had some rudimentary First Aid Training of a dubious nature.  Putting an Epi-pen, of unknown origin (he thinks it might have been put there by an RN who works with him), unknown expiration date, and unknown dosage (adult or jr?) into a first aid kit, that is accessed by the general public, is irresponsible.  

The value of this particular tool is irrelevent when you consider how it was being handled.  I mean, chain saws are also valuable tools, but I'm not going to encourage 3rd graders to play with them unsupervised.


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## Flight-LP (Sep 10, 2007)

disassociative said:


> Well; consider the alternative:
> 
> Anaphylactic Shock: Throat closes, airway is compromised--patient dies.
> I am by no means talking about an ACLS dose of EPI.
> ...



Sorry, but I completely disagree with your written logic. First off, Sub-Q Epi administration is pointless in anaphylaxis / severe allergic reaction, it absorbs too slowly. IM in the lateral thigh is preferred due to its ability to absorb an average of 300% faster than a sub-q administration. Second, Epi is given too many times to too many patients that do not need it. Epi should ONLY be given for true anaphylaxis or a severe reaction i.e. angioedema, wheezing, pharyngeal edema. Not because someone itches or has a rash all over their body. And unless they are knocking on death's door, no one over 40 should get it with a known cardiac history. Many Paramedics have issues differentiating the levels of reaction, much less try to have a basic do it. That aside, there is still the basics of pharmacokinetics, again a topic that many medics don't understand, one that basics certainly won't regardless of the time spent in the "IV" training class. Here is where the problem lies........................

If a pt. is in anaphylactic shock, neither will work. If the central organs are hypoperfused, do you really think the vastus lateralis is getting any level of perfusion. NOPE! You need IV access and IV Epi (amongst other interventions). In other words, you need an ALS responder. BLS response and attempted treatment in the severe allergic reaction or anaphylactic patient is not beneficial to a patient. These patients REQUIRE ALS, there is no reason to afford them anything less.

Sorry to rant, but we must stop trying to justify the less educated being able to perform pseudo-ALS. There is a level of education and certification to address this critical level, it is a PARAMEDIC. Watering down education is one of the major demise's of our industry.................It sickens me to see people just "go with it" falsely believing there is a benefit......................


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## disassociative (Sep 10, 2007)

Well; here is the last thing I am going to say on the topic; as I have run reports to enter in.

in TN Emt-IV is encouraged to look for epi pen on the pt. SubQ/IM epi is what is kept on our ambulances in the BLS drug line. This is how TN has set it forth for us to follow--as to the true logic of the medical directors/committee that implemente this provision into the scope of practice, I have no idea what their logic was. However, I(in my personal opinion) think it is a good thing.


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## Gbro (Sep 11, 2007)

I was going to wait and ask our medical director about EPI/Anaphylaxis/Cardiac arrest. But since there seems to be a great deal of information here, I’ll try here and also bring it up with Doc.

Over labor day weekend, I had 2 bee sting reactions where I used the Epi pen. 
Enroute to the 2nd sting, as the call came in "Bee sting and the party thinks he is having a heart attack"

21 miles to scene, and no contact with 1st Responder's for Pt. update.
We were discussing whether there would be any benefit in administering the Epi if the Pt. is in cardiac arrest upon our arrival?

We had ALS enroute, and decided to try and contact Medical control for directions in case of arrest.


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## Ridryder911 (Sep 11, 2007)

Did the bee stings present a true anaphylaxis or a reaction? There is a true difference in anaphylaxis (stridor, laryngeal edema, with severe swelling of the periorbital area, tongue, and of course shock symptoms) or reaction: uticaria, swelling, itching. 

Epi injected sub-q and muscle is worthless in severe conditions. Actually, ironically it takes sub-q Epi approximately 15-30 minutes to work, which in * true* anaphylaxis is usually too late. The reason is simple. One has to have  good circulation enable to distribute medication sub-q and muscle (shocky or poor circulation, cardiac arrest does NOT have enough circulation). This is the reason analgesics and medications should never be given I.M. or Sub-q for those in shock, burns, etc... because when and if they do begin to perfuse, the medication will then be distributed. i.e. burn patient that recieves Morphine Sulfate IM, with a poor blood pressure only later to be resucitated then the Morphine will be pumped through the body... boom..bottoms out the pressure. 

There is much more to treating patients than just adminstering a medication and hoping for the best. One needs to know  all  the circumstances and methodology of pharmodynamics and pharmokinetics of how they and where they operate. This is the reason for increased education and the opposition of us that believe only in very and very few rare circumstances should untrained (BLS) be allowed to administer medications. 

R/r 911


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## Gbro (Sep 12, 2007)

No question on Sept. 2ND Pt.
presented with O2 sat. 78%, Chest pain, Dyspnea, stated feels can't breath. 

This pt did seized, 2 min post epi administration. Medics on intercept stated that its not all that unusual. Pt in seizure 1 min(approx). 5 min (post Epi) stated, feel a lot better, feels like its only a moth in throat now.


Question Sept 4Th Pt.
Pt was unresponsive but was breathing. Looked like a lobster just removed from hot water. started to respond 3 min post Epi.
Later in ER pt. stated "funny thing, i never had any trouble breathing"?? did know what was happening, ie. epi stick but couldn't feel the stick.
Just don't know,   Looking forward to Review medical director.


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## Ridryder911 (Sep 12, 2007)

Gbro said:


> No question on Sept. 2ND Pt.
> presented with O2 sat. 78%, Chest pain, Dyspnea, stated feels can't breath.
> 
> 
> ...



Tell them to stay away from Iodine and any IV dyes. Since the shellfish is high in iodine and usually this is what they are allergic to. There is a specific reaction in the throat with swelling called angio neurotic edema. Usually, H2 blockers such as Benadryl, Pepcid, or Zantac is added as well as steroid(s) such as Decadron or Solu-Medrol, etc. 


R/r 911


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## KEVD18 (Sep 12, 2007)

Gbro said:


> ...We were discussing whether there would be any benefit in administering the Epi if the Pt. is in cardiac arrest upon our arrival...



im confused. we you discussing the use of epi in general during an arrest, or using an epi pen for a person in arrest?


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## njcoldone (Sep 12, 2007)

*epi-pen*

New Jersey has given the go ahead to carry epi on bls units with the approval of the medical director-- after proper training . In some obvious cases it very well could save a life . There are parameters that must followed for the storage of and use of same. recently I heard a dispatch for a neighboring squad to respond to a bee sting and pt. administered (pre-arrival) epi even though they did not present with signs or symptons of anaphlaxis .  In my opinion that is the downfall of having it available to bls. Of course it is no different than say nitro administration (assist) , you must have proper training and apply your skills. Do the benefits outweigh the risk ? I would have to guess that anyone with an anaphalactic reaction would answer a definite yes are there risks involved of course.  Should an R.N. be carrying epi-- I would question how they received the prescription (unless it has been prescribed to them for personal use) and if they administer it without medical approval there certainly could be serious repercussions.


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## Gbro (Sep 12, 2007)

KEVD18 said:


> im confused. we you discussing the use of epi in general during an arrest, or using an epi pen for a person in arrest?



Kev;
When we were in transit to the call, 20+ min and the call was for a Bee sting & the Pt. thinks he is having a heart attack. 
So we were discussing what to do in the event *"this"* pt. is in cardiac arrest.


We had ALS enroute, and decided to try and contact Medical control for directions in case this is an arrest.

Sorry if i confused you, Its usually me that suffers from confusion.


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## Ridryder911 (Sep 12, 2007)

Gbro said:


> Kev;
> When we were in transit to the call, 20+ min and the call was for a Bee sting & the Pt. thinks he is having a heart attack.
> So we were discussing what to do in the event *"this"* pt. is in cardiac arrest.
> 
> ...



Now, I am thoroughly confused. It does not matter if the arrest was caused by Anaphylaxis or by having an AMI, Epi sub-q would not be beneficial due to the poor circulation and distribution. IV form would be beneficial due to ability of catecholamine response. 

R/r 911


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## Gbro (Sep 12, 2007)

> It does not matter if the arrest was caused by Anaphylaxis or by having an AMI, Epi sub-q would not be beneficial due to the poor circulation and distribution.



Define beneficial,
 and the Epi-Pen is an IM injection.
I myself would define "beneficial" 2 ways. Beneficial to Pt., and beneficial to our/Us as we did everything we could do.
Wouldn't have to look at that hole being dug and think now if we would have just....., Of course that is why we don't put them up on platforms like some cultures use to do. 

Pop used to say,
A carpenter had it worse, every time he drove by that house he built, he could see his mistakes, EMT's and Doc's, mistakes are buried.


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## njcoldone (Sep 17, 2007)

The use of epi or should I say the potential possession and use of by emt's has become controversial . We have been properly trained during emt certification so the use of isn't any different (or assist with ). The problem I see is that it has become more available to UNTRAINED personnel. Because it is now carried by basics some may believe it could do no harm but only good--Wrong Wrong Wrong. The adverse effects could include a fatal reaction (A friend had this happen to pt. who used their brothers epi). Does this give a small percentage an advantage to reverse the effects of anaphlaxis of course, the same as a defib for cardiac , but please be trained  .


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## bstone (Sep 18, 2007)

Sorry for coming in late to this conversation. How about using the epi-pen for people having severe asthma attacks (unconscious). Since it dialates the lungs (is a sympathomimetic), might it be used in these cases?

Where I was trained as an Intermediate (New Hampshire) we draw up our own Epi (1:10,000 for IV, 1:1000 for IM/SC) I have protocols for using an abuterol neb for asthma, but I theorized that Epi can be used in addition for severe cases. Obviously I would never just do something and always get MedControl orders for anything outside protocol.

Thoughts?


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## Ridryder911 (Sep 18, 2007)

Gbro said:


> Define beneficial,
> and the Epi-Pen is an IM injection.
> I myself would define "beneficial" 2 ways. Beneficial to Pt., and beneficial to our/Us as we did everything we could do.
> Wouldn't have to look at that hole being dug and think now if we would have just....., Of course that is why we don't put them up on platforms like some cultures use to do.
> ...



Okay, nothing personal, but it is apparent you do not understand pharmacodynamics or physiology very well. By administering 1:1,000 Epinephrine into the subcutaneous tissue (fat)  it will be stored in such or if it even reaches the muscle (usually epi pens never reach muscle tissue), and until the time peripheral circulation is restored (if ever returns). Just because you have given the medication does not mean it will be circulated at that time. Beneficial is NOT a term for the provider, rather it is a term used for the patient. There is really a reason for them not to make such recommendations for administering in any other conditions, do you not think that has not been considered, by those that truly understand medicine? 

Remember, in shock syndromes, and poor circulation that the present conditions in the * predominant capillary circulation* is immediately shut down. Hence, the reason the skin becomes pale in shock state and the precapillary & post capillary sphincters close and the blood supply is reduced in the circulatory system due to the sympathetic (adrenergic) response. Even if by chance it does so happen reach the muscle area it still will be in poor circulatory area, again since skeletal muscle blood supply is reduced. Ever hear of lactic acid build up in post shock and post cardiac arrest? The epinephrine strength; again is 1:1000 not 1:10,000 (nine thousand times stronger than the IV form) will be in the fat cells and when & if the pressure and peripheral circulation is obtained again the epi will be released. 

Can one imagine a patient that responded to resuscitation measures, and the heart (which is already damaged) for someone to give an additional  9 boluses of Epinephrine for no reason? What effect would this have on an already damaged heart? (hint.... tachycardia = increased stress on the heart = increased oxygen demand on the heart = increase AMI size = potential death) 

So defining the term *beneficial* is not that vague in medicine. One sees it often in medical literature. So when one sees such term ..."_ beneficial_".... this means, does it really outweigh the risks or dangers involved? Not, in regards to the provider. Sometimes, the risks does not outweigh the treatment: hence the art of practicing medicine. Is those risks worth it? Hence the need to know the science and all involved in medicine before administering  any medication(s). Unless you are educated (NOT trained) in such, one should not be administering medications. Giving the form or admininstering the medication is not difficult part, knowing exactly when, how, and what is  really occurring in the body, as well as all potential consequences are.

The same analogy could be true in comparing a pharmacy tech to the pharmacist. Sure it is easy to place pills in the bottle, or to hand the dosage packet to a patient/customer, but wouldn't  you rather have the pharmacist review and be sure it is correct knowing that it is exactly the right medication strength, dosage, and does not interact or potentiate with any of your other medications?  

If you want the responsibility of making those decisions, then go to school for such. That is why there are licenses, and control ... it is not that "simple". 

R/r 911


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## rgnoon (Sep 18, 2007)

Ridryder911 said:


> Okay, nothing personal, but it is apparent you do not understand pharmacodynamics or physiology very well. By administering 1:1,000 Epinephrine into the subcutaneous tissue (fat)  it will be stored in such or if it even reaches the muscle (usually epi pens never reach muscle tissue), and until the time peripheral circulation is restored (if ever returns). Just because you have given the medication does not mean it will be circulated at that time.
> R/r 911



So what is the point of an epinephrine auto-injector at all? Why prescribe them to pts with hx of anaphylaxis for emergency use if the epi is going to be stored in sub-q fat for long periods of time? Dey (maker of the epi-pen) advertises that "EpiPen helps stop allergic reactions fast"...is this BS? I think I'm missing something here and am genuinely confused...someone please fill me in.
Thanks!,
 RG


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## Gbro (Sep 18, 2007)

rgnoon said:


> So what is the point of an epinephrine auto-injector at all? Why prescribe them to pts with hx of anaphylaxis for emergency use if the epi is going to be stored in sub-q fat for long periods of time? Dey (maker of the epi-pen) advertises that "EpiPen helps stop allergic reactions fast"...is this BS? I think I'm missing something here and am genuinely confused...someone please fill me in.
> Thanks!,
> RG




PRESCRIBING INFORMATION
EPIPEN® 0.3 mg EPINEPHRINE AUTO-INJECTOR
Auto-Injector for Intramuscular Injection of Epinephrine
For the Emergency Treatment of Allergic Reactions (Anaphylaxis)
Delivers a single 0.3 mg intramuscular dose of epinephrine from epinephrine injection, USP, 1:1000 (0.3 mL).
EPIPEN® JR 0.15 mg EPINEPHRINE AUTO-INJECTOR
Auto-Injector for Intramuscular Injection of Epinephrine
For the Emergency Treatment of Allergic Reactions (Anaphylaxis)
Delivers a single 0.15 mg intramuscular dose of epinephrine from epinephrine injection, USP, 1:2000 (0.3 mL).

I E-mailed DEY, and told them that apparently they are wrong about how the auto injector works. I told them that the guru of EMS said that all we can expect out of their auto injector is a "sub-Q" injection.

Hope they can take it.


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## rgnoon (Sep 18, 2007)

Gbro said:


> PRESCRIBING INFORMATION
> EPIPEN® 0.3 mg EPINEPHRINE AUTO-INJECTOR
> Auto-Injector for Intramuscular Injection of Epinephrine
> For the Emergency Treatment of Allergic Reactions (Anaphylaxis)
> ...



Ok, I want to make it clear that this is definitely not what *I* meant. I recognize that many here (including Rid) have many more years of experience and education in this field than I. I am genuinely confused and my post was not meant facetiously. I am truly curious and confused by this matter. It looks like Gbro went the other way...just want to make sure that my post wasn't taken the wrong way. I'm not looking to make any enemies here.


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## Flight-LP (Sep 18, 2007)

rgnoon said:


> Ok, I want to make it clear that this is definitely not what *I* meant. I recognize that many here (including Rid) have many more years of experience and education in this field than I. I am genuinely confused and my post was not meant facetiously. I am truly curious and confused by this matter. It looks like Gbro went the other way...just want to make sure that my post wasn't taken the wrong way. I'm not looking to make any enemies here.




No worries my friend, it is easy to get confused when others twist around what has been written. The Epi-Pen is an INTRAMUSCULAR injection, its not the best route, but better than nothing. It was designed off of the principle of simplicity, easy enough for the layman or EMT-B to administer. It takes around 8-15 minutes or so to take effect (give or take).

The contested aspect that people are arguing about is the SUBCUTANEOUS injection. In true anaphylaxis, the body is in a hypoperfusive state, thus the Sub-Q tissues will not be perfusing. Therefore, the Sub-Q injection is pointless. Many EMS services have Epi in the Allergic Reaction protocol for some ungodly reason. It is not indicated and is ussually more harmful than helpful. Some services even go further down the logic chain by allowing lower level EMT's administer Epi in this form without having any comprehensible clue on what they are actually doing by introducing this substance into the human body. The ONLY time Epi should be administered for an allergen / antibody situation is for true ANAPHYLAXIS. The dose should be IV AND ADMINISTERED BY A PARAMEDIC (along with several other pharmacological interventions). Again, the Epi-pen was designed to be idiot proof, the route is not preferred, but since the lay public and EMT-B's have no business attempting IV's its the next best thing. Hope this helps, feel free to PM me personally if you have any other questions, I'd be glad to help.

Hey Gbro, be sure to post the companies' response as I am sure it will be educational for all..........................


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## Flight-LP (Sep 18, 2007)

Gbro said:


> PRESCRIBING INFORMATION
> EPIPEN® 0.3 mg EPINEPHRINE AUTO-INJECTOR
> Auto-Injector for Intramuscular Injection of Epinephrine
> For the Emergency Treatment of Allergic Reactions (Anaphylaxis)
> ...



Thats not what Rid wrote. Instead of attempting cynical humor, why don't you review what was typed. Specifically, what you typed. It clearly states INTRAMUSCULAR INJECTION. Rid was referring to the SUBCUTANEOUS route. 2 very different animals.......................


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## rgnoon (Sep 18, 2007)

Thanks LP, I appreciate the re-assurance there.
 I got that we were talking subq vs. IM, but rid stated that even with the IM epipen it most often only goes subq. This is where my confusion came from. If this in fact is the case, then why bother. Or is there another factor at play here that I am missing? Are the pharmaceutical companies just unaware of this flaw, is it being administered incorrectly, or is the concept just way off (i doubt this).


Your post was very helpful LP, thanks for taking the time to lay that all out.


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## Ridryder911 (Sep 19, 2007)

As well,  what I did state..._"Even if by chance it does so happen reach the muscle area it still will be in poor circulatory area, again since skeletal muscle blood supply is reduced... if you are going to quote, then quote appropiately, Since many of the users, do inject through clothing, and as well if one studies the injection needle length, one can tell that it sometimes can be administered sub-q. Even in the muscle area, during shock syndromes, there is poor circulation. *Again,*  this is why medications is not prefered to be administered this route during poor perfusion. 

So go ahead  and E-mail, I have no problem as well, I am sure after reading your posts maybe they will able to clarify it for you.. The self injection was deliberately made for untrained and those that had no true medical education for immediate treatment of anaphylaxis, not reactions, as well it is dependent on fat tissue, clothing, site, that would make the injection either I.M. or sub-q. Mute point in profound shock... 

As well, I hope you will ask your suggestion of administering in cardiac patients as you feel it would be beneficial to you. 

Please feel free to post their response in full. 

Most epi-pens are used precariously, and not in true anaphylaxis, yet instead of wanting to receive formal education and proper training, many rather take the blanket approach and treat prophylactic. That maybe okay on a moderate healthy patient, but not on one that is already compromised and has underlying medical difficulties. 

Personally, I have never used one, only teach them to Basic EMT's and clients that have a known and documented history of anaphylaxis. In my clinical practice, I have seen very few cases that where it was ever indicated or warranted (even though I live in the Southern region). I have however; have treated more patients with catecholamine responses from the usage of Epi-pens, in inappropriate time. 

That is why physician level clinicians prefers to use other med.' s and other modalities of treatment. 

R/r 911_


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## bstone (Sep 19, 2007)

Another use of Epi-pens: treatment of severe hypo-glycemia

http://care.diabetesjournals.org/cgi/content/full/24/4/701



> Using Epipen to treat hypoglycemia may be an effective, safe, and easy-to-use alternative to glucagon.


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## Ridryder911 (Sep 19, 2007)

bstone said:


> Another use of Epi-pens: treatment of severe hypo-glycemia
> 
> http://care.diabetesjournals.org/cgi/content/full/24/4/701




Actually. the study actually concluded with this .._ "CONCLUSIONS—Epinephrine *does not seem to be an adequate substitute for glucagon in the treatment of severe hypoglycemia*. The effectiveness of glucagon in reversing hypoglycemia and its side effects of nausea and vomiting are likely related to the markedly supraphysiologic plasma levels achieved with the standard intramuscular dose..."_ 

Be sure to read the full study as well as the population, the validity, the methods, population base ratio, and sponsorship. 

R/r 911


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## Gbro (Sep 19, 2007)

QUOTE]Ridryder911;57146]As well,  *what I did state..."Even if by chance it does so happen reach the muscle area *_it still will be in poor circulatory area, again since skeletal muscle blood supply is reduced... if you are going to quote, then quote appropiately, Since many of the users, do inject through clothing, and as well if one studies the injection needle length, one can tell that it *sometimes* can be administered sub-q.[/QUOTE] .............
Interesting how the 'so happen",  can then suddenly change to sometin=mes be addministered Sub-Q.





			As well, I hope you will ask your *suggestion* of administering in cardiac patients as you feel it would be beneficial to you.
		
Click to expand...


That wasn't a sugjestion, It was somthing we (the crew i was responding to the 911 call with) were discussing enroute in the event the Pt. was in cardiac arrest.  
Note to others; 
don't bring any wonders into a discussion with Medics' (some, anyway)



. 




			Personally, I have never used one, only teach them to Basic EMT's ............
		
Click to expand...


I wonder how confident they feel with one in their hand??_


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## Ridryder911 (Sep 19, 2007)

Short & simple, it does not take a rocket scientist to perform a Epi pen. If that is the biggest tasks one has to perform in EMS then it would would be smooth sailing. Again, it is so simplistic they allow a common layperson and Basic EMT's to perform it.

With that saying, the difficulty of what I and other medical professionals have witnessed is the poor identification and determination of allergic reaction versus true anaphylaxis. As well, most medical professionals do NOT use epi pens for multiple reasons. I have yet met a physician that has ever administered a Epi pen in medical setting.. the reason is alternate routes, and alternate medications. 

IV epinephrine is much preferred in an emergency condition (true anaphylaxis) since it is faster, better controlled and can be monitored.  I also attempted to educate to other modalities that should be employed if available and if one is allowed to. H2 blockers that could prevent or eliminate the histamine response from the mast cell, that causes the reaction. Again, not just treating signs and symptoms. 

I am sorry that you feel the need to be argumentative or attempt to prove justification. I am a practitioner, and have an array of medications and modalities of treatment regime that I may elect to prescribe or choose to use/not use. Treating the patient specifically upon his/her condition, not just a protocol. This is called medicine. 

Emphasis and concerns have been made in EMS in regards of basics administering medications; because of similar reactions that you have made. Not understanding physiological responses, drug distribution methodology, or even the knowledge of differential strength levels. Again, pharmacology is not a simple black & white issue, there are many variables that has to be considered and weighed heavy before any medication is administered. 

I am all in favor of administering proper medications in the field by qualified and educated clinicians when and if appropriate.

I will await the response from the pharmacology representative, I feel multiple posts on this is a beating a dead horse. We all are in agreement that use of Epi in a true anaphylaxis is ideal, and appearantly anyone can administer an Epi Pen. 


R/r 911


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## triemal04 (Sep 19, 2007)

Gbro...gbro...why so arguementative?  Just understand this part and leave it alone:  giving a subq injection, or an IM injection of epi to someone in cardiac arrest is worthless and could very well be detrimental to them.  Is that clear?  If it was beneficial it more than likely would be in someone's protocols or scope by now, but it's not.  Stop argueing this topic, it's pointless.


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## Gbro (Sep 19, 2007)

triemal04 said:


> Gbro...gbro...why so arguementative?  Just understand this part and leave it alone:  giving a subq injection, or an IM injection of epi to someone in cardiac arrest is worthless and could very well be detrimental to them.  Is that clear?  If it was beneficial it more than likely would be in someone's protocols or scope by now, but it's not.  Stop argueing this topic, it's pointless.



T...04;

I have never argued about it in a Cardiac Arrest,  I brought it up just as a question, then the IM/Sub-Q issue got twisted and turned. 
I am realy sorry you preceived my simple question the wrong way.

The issue that causes me to respond the way i do is the way "some" ALS level posters belittle the BLS level. 


> Flight-LP said;
> but since the lay public and EMT-B's have no business attempting IV's its the next best thing.





> Rid say's;
> it is so simplistic they allow a common layperson and Basic EMT's to perform it.



Its either Jab back or sign off!
And i do back away from this forum from time to time, But then i get e-mails asking me to come back and join in. 
There is so much good on this forum, But just look at all the post that are looked at and not responded to, 
I just wonder......


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## Flight-LP (Sep 19, 2007)

Gbro said:


> T...04;
> 
> I have never argued about it in a Cardiac Arrest,  I brought it up just as a question, then the IM/Sub-Q issue got twisted and turned.
> I am realy sorry you preceived my simple question the wrong way.
> ...



Neither of those comments belittle EMT-B's. they are factual statements that are well supported by both evidence based medicine and the great majority of EMS providers nationwide. Do you honestly believe that you an individual who went through less than 200 hours of training should be performing invasive procedures on human beings? Sorry you perceive it that way. I am also sorry that you perceive that the EPI pen was designed for some EMS purpose. It wasn't, it was designed for the most simplistic layperson. EMT's have it because it is literally idiot proof. That is the truth, like it or not. Stop trying to twist it around and mold it to your liking. Sorry if you can't accept it.............................

If you'd take a moment and look around you, you would see that most of your EMT-B peers are also disagreeing with you. Just let it go man, no need to lose any sleep over this.


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## triemal04 (Sep 19, 2007)

How big is the chip on your shoulder?  Are you upset because you miss being an EMT-I?  Because medic's tell you you're wrong?  What?

Hate to tell you, but given that the lay public and basic's have never been taught how to start IV's, Flight-LP is right; they have no buisness starting them.  How is pointing out a fact belittling someone?

The second...yeah, I suppose you could see that as being a bit pious and pompous, but, it's still true.  The average person off the street needs something that is very dumbed down so in the heat of the moment they can use it accurately with no training.  Hence the epi-pen.  (unless you hold it upside down, it's really hard to misuse)  As far as Basics go...not every EMT-B get's good training, keeps their skills current, or should ever touch a pt (same goes for medics, but that's a whole 'nother topic).  In my state basic's are taught how to draw up epi and give a subq shot, but I know that isn't true nationwide; so yeah, the device should be pretty simple to use.  Like you've said, you've used one what, twice?  In how many years?  If it's a complex device that isn't good.  If it's a simple one...not as bad.

If you want to be able to perform more advanced interventions, go back to school.  If you want to be treated like a professional EMT then act like one.  Basic's often have a bad rep, and getting angry when people point out something you did wrong isn't going to help that.  Figure out why what was done was wrong, and learn from it, and then move on.


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## ffemt8978 (Sep 19, 2007)

Thread closed until everyone cools off a bit.


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