EPI-pen on code with ALS unavailible?

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njemtbvol

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A discussion I was having down at the squad building- If you were on a code and ALS was unavalible (a virtual impossibility but even so) would you use an epi pen to get epi flowing while performing CPR and AED? would there be a downside do it?
 
The short answer is no, you wouldn't. Performing ACLS is beyond the scope of practice for basics in most (all?) states.
 
Intermuscular injections, like the Epipen, have a much slower increase in blood concentration than IV or IO, and that's not counting the fact that the patient isn't circulating blood, which will slow down IM absorption even more.
 
rescue1 said:
The short answer is no, you wouldn't. Performing ACLS is beyond the scope of practice for basics in most (all?) states.
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Medical reasoning >>> legal reasoning.

The legal aspects can be much easier changed than the pharmacodynamics.
 
Also, the dosage (concentration) of epi used for allergic reactions is different than that used for anaphylaxis (1:1,0000 v 1:10,000). In fact, some states (and many services) have removed 1:1,000 ampules and replaced them with Epi-Pens to reduce confusion among medics between the two concentrations.
 
Just to note, dosage and concentration isn't the same thing.
 
JPINFV said:
Medical reasoning >>> legal reasoning.

The legal aspects can be much easier changed than the pharmacodynamics.
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Well, yes, and I agree. But at this stage, given the way protocols are, I'm not sacrificing my EMT card and risking a lawsuit for going so beyond protocol, and I wouldn't recommend anyone else try either.

But from a strictly medical standpoint, I can't imagine it would be very effective anyway, for the reasons you stated.
 
emt.dan said:
Also, the dosage (concentration) of epi used for allergic reactions is different than that used for anaphylaxis .
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Isn't anaphylaxis an allergic reaction?
 
FAIL... my brain wasn't working this morning. I meant to say "allergic reactions and and cardiac arrest (ACLS)"
 
Anaphylaxis is a hyper-immune reaction

Sneezing, tearing eyes and urticaria are allergic reactions. (Pass the histamine please).
 
njemtbvol said:
A discussion I was having down at the squad building- If you were on a code and ALS was unavalible (a virtual impossibility but even so) would you use an epi pen to get epi flowing while performing CPR and AED? would there be a downside do it?
Click to expand...

There might not be a downside per say, but it is not going to have any positive effect on the patient.

Epi is supposed to be given every three to five minutes during an arrest, that one shot from the EpiPen is not going to have any sort of lasting effect, not to mention that Epi is general given (in an arrest) at 1mg 1:10,000 instead of the EpiPen's .3mg 1:1000.
 
* Not proven to improve cardiac arrest survival in humans versus placebo = probably not worth risking your licence for.

* Plus the pharmacokinetics will suck in a low CO state.


Olasveengen TM, Wik L, Sunde K, Steen PA.Outcome when adrenaline (epinephrine) was actually given vs. not given - post hoc analysis of a randomized clinical trial. Resuscitation. 2011 Nov 22. [Epub ahead of print]

Arrich J, Sterz F, Herkner H, Testori C, Behringer W.Total epinephrine dose during asystole and pulseless electrical activity cardiac arrests is associated with unfavourable functional outcome and increased in-hospital mortality.Resuscitation. 2011 Nov 11. [Epub ahead of print]

Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL.Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation. 2011 Sep;82(9):1138-43. Epub 2011 Jul 2.

Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L. Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial.JAMA. 2009 Nov 25;302(20):2222-9.
 
Legally speaking, I believe there are basics that can do ACLS in texas. Of course, you can pretty much do anything in texas under the law if your MD ok's it... Seriously!
 
WuLabsWuTecH said:
Legally speaking, I believe there are basics that can do ACLS in texas. Of course, you can pretty much do anything in texas under the law if your MD ok's it... Seriously!
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The MD has to prove that you have adequate training if I remember correctly. But in the case of ACLS that really doesn't seem to difficult.
 
wait wait wait.... is the person just a code blue or is it due to anaphalaxis... and they're coding?


If you follow ACLS - all dead people get epi
If you follow EMT-Basic scope - May assist with administration of patients own epi-pen

....so if the patient was coding due to anaphalaxis, in theory couldn't the EMT administer the medication?
 
DV_EMT said:
wait wait wait.... is the person just a code blue or is it due to anaphalaxis... and they're coding?


If you follow ACLS - all dead people get epi
If you follow EMT-Basic scope - May assist with administration of patients own epi-pen

....so if the patient was coding due to anaphalaxis, in theory couldn't the EMT administer the medication?
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Not once they are pulseless and apneic. I'm sure you could argue it but in the end I'd suspect it'd end with your certification being yanked or some other sort of nastiness I wouldn't like to experience.

I think this thread is talking about a code with an epi pen present btw.

The effectiveness in Epi during arrest and survival to discharge is pretty widely disputed. ROSC is another thing all together but there's a running joke that you could give a rock a pulse if you gave it enough epi.

Other folks have presented the medical reasons on why there's no point with an IM injection anyways so I wont be repetitive.
 
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NVRob said:
I'm sure you could argue it but in the end I'd suspect it'd end with your certification being yanked or some other sort of nastiness I wouldn't like to experience.
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Yeah, already been there for stupid county BS here. :glare: PM if you'd like more on that rant lol
 
Use an epi-pen to replace IV epi during an arrest? No.
However, we did just get a directive in Ontario for IM epi during cardiac arrest when anaphylaxis is the likely cause of the arrest (0.01mg/kg rounded to 0.05mg to a max of 0.5mg.) and the PCP is not authorized for IV starts.
 
NVRob said:
The MD has to prove that you have adequate training if I remember correctly. But in the case of ACLS that really doesn't seem to difficult.
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Exactly.

The reason this is done (not that I agree with it) is the vast swaths of west and north Texas with minuscule populations (there's a county in west Texas with 60 people living in it). Your not likely to attract paramedics to those locations, similarly, there often 3-4 hours from a paramedic program.

Many other states with similar population densities have expanded scopes for Basics and Intermediates as well.
 
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