Epipen when Pt is child

[Carlos Danger]

I think if your pants are long enough to give a drug, it ought to be given properly then; draw up the proper dose and give it, instead of relying on an automated and invariable-dose, expensive device.

If you have the tools and training, I agree 100%.

But assuming this is BLS, and/or for some reason "all you have" is the epi-pen (i.e. no syringes), as the OP stated, then you do in fact lack either the tools or the training to give it "properly". That changes the equation.

In that case, in true anaphylaxis, the risk of NOT giving the epi is probably far higher than giving it. The chances of 1mg of epi permanently harming a healthy child is very slim. Anaphylaxis, however, is one of the top non-traumatic causes of death in otherwise healthy peds.

I would imagine most OLMD's would tell you to give it. I'd like to hear Dr. Walsh weigh in on this.

 

[jzero652]

Call Med Com

 

[Medic Tim]

Call Med Com

Ok you can't get ahold of them... What do YOU do?

 

[jzero652]

Ok you can't get ahold of them... What do YOU do?

For me that would not be an issue. I run in Nassau County NY. If I cannot get them on the Radio then we have a cell phone on the bus. I also have their # and Suffolk County Med Com's # on my personal cell, as well as our Company Chief's (who is an MD) #. If I am at someones home then they have a land line. Or call a hosp direct which I have all the local ones on my cell. Worst comes to worst call dispatcher and have them chase it down. Meanwhile Rapid transport and treat for shock. There is always a way, everything cannot be down at the same time.

 

[Medic Tim]

For me that would not be an issue. I run in Nassau County NY. If I cannot get them on the Radio then we have a cell phone on the bus. I also have their # and Suffolk County Med Com's # on my personal cell, as well as our Company Chief's (who is an MD) #. If I am at someones home then they have a land line. Or call a hosp direct which I have all the local ones on my cell. Worst comes to worst call dispatcher and have them chase it down. Meanwhile Rapid transport and treat for shock. There is always a way, everything cannot be down at the same time.

That's all fine and dandy . Not everyone is that lucky.
The question is how would you or should you treat this pt. what are the pros and cons? A good critical thinking question. What would you do.

So.... Would you give the epi.

 

[NomadicMedic]

Yes. I would give the Epi. As stated before, WITHOUT Epi, anaphylaxis is lethal.

 

[jzero652]

http://web.unife.it/utenti/giampaolo.garani/Anafilassi/05053023251210125.pdf

I would give it.

 

[Handsome Robb]

I want to hear your own reasoning.

Not something that was backpedaled for and found on Google.

In other news, my better half just texted me and apparently we'll be dynamic station posting out of the fire stations here...this could be a huge step into making this system an actual awesome place to work...

 

[mycrofft]

Can't help but agree. However….

If you have the tools and training, I agree 100%.

But assuming this is BLS, and/or for some reason "all you have" is the epi-pen (i.e. no syringes), as the OP stated, then you do in fact lack either the tools or the training to give it "properly". That changes the equation.

In that case, in true anaphylaxis, the risk of NOT giving the epi is probably far higher than giving it. The chances of 1mg of epi permanently harming a healthy child is very slim. Anaphylaxis, however, is one of the top non-traumatic causes of death in otherwise healthy peds. (Accents from mycrofft)

I would imagine most OLMD's would tell you to give it. I'd like to hear Dr. Walsh weigh in on this.

(I was unpleasantly surprised to see homicide so prominent in kids).

But I have to admit, if it was MY grandkid, I'd be running up and grabbing that epi and using it myself if you hesitated, if thats all you had (a condition of the scenario) and whether or not it was the right thing to do.

Epi is a cheap and well known drug, the big deal is to prevent its exposure to light and ensure it is not getting old or cloudy before use.

The point is to work NOW so techs and parents etc are not put in that position later. Get rid of epipens, or make it MANDATORY to stock multiple dosages of devices, or have a variable dose device if they invent one. Dumbing down medication administration isn not a good idea and opens the door to excesses (like glucagon pre fills and narcan pre fills and insulin pre fills…).

 

[jzero652]

I want to hear your own reasoning.

Not something that was backpedaled for and found on Google.

In other news, my better half just texted me and apparently we'll be dynamic station posting out of the fire stations here...this could be a huge step into making this system an actual awesome place to work...

So without Epi good chance child will die, with it odds are better for survival. Give it.

But now posed with the question we use our resources to come up with the best way to react. So that if we are ever faced with the scenario suggested we will be prepared to act. You know I will speak to friends at Med Com, Dr.'s, and medic's to get there opinions on the subject. The more informed you are the better provider you can be.

 

[Handsome Robb]

redacted

 

[Carlos Danger]

(I was unpleasantly surprised to see homicide so prominent in kids).

But I have to admit, if it was MY grandkid, I'd be running up and grabbing that epi and using it myself if you hesitated, if thats all you had (a condition of the scenario) and whether or not it was the right thing to do.

Epi is a cheap and well known drug, the big deal is to prevent its exposure to light and ensure it is not getting old or cloudy before use.

The point is to work NOW so techs and parents etc are not put in that position later. Get rid of epipens, or make it MANDATORY to stock multiple dosages of devices, or have a variable dose device if they invent one. Dumbing down medication administration isn not a good idea and opens the door to excesses (like glucagon pre fills and narcan pre fills and insulin pre fills…).

Non-traumatic cause of death, in otherwise healthy peds (i.e no cardiac anomalies).

 

[Chewy20]

As BLS we carry multiple pedi and adult epi pens. BUT if I was in that situation I would give the adult one. As stated by others a little bit more medicine may not be ideal, but more than likely the PT would be better off having a little more medicine in them rather than trying to fight off anaphylaxis shock with simple o2.

With that being said, I would try to get in touch with my medical director if I had time.

 

[Brandon O]

Ok you can't get ahold of them... What do YOU do?

Give it every day of the week and twice on Sunday.

There's an analogy here to pediatric versus adult AED pads. Worrying about injury from the extra electricity (or extra epi) when there's a cardiac arrest (or lifethreatening anaphylaxis) is like worrying about a water allergy when somebody's on fire.

 

[Handsome Robb]

Give it every day of the week and twice on Sunday.

There's an analogy here to pediatric versus adult AED pads. Worrying about injury from the extra electricity (or extra epi) when there's a cardiac arrest (or lifethreatening anaphylaxis) is like worrying about a water allergy when somebody's on fire.

:rofl:

 

[Medic Tim]

Give it every day of the week and twice on Sunday.

There's an analogy here to pediatric versus adult AED pads. Worrying about injury from the extra electricity (or extra epi) when there's a cardiac arrest (or lifethreatening anaphylaxis) is like worrying about a water allergy when somebody's on fire.

Agreed.

I like that.

 

[mycrofft]

Talking outside the thread's desert island framework ("If you only had XYZ to use…"..

I wrote and edited and timed out and rewrote one of my polemics.

Distilled:

1. The stated willingness to use a drug against the manufacturers instructions and against protocols by a technician proves to her or his superiors they are unprofessional and not to be trusted.* Even if it works sometimes, that's hipshot cowboy medicine.

2. Practitioners need to refuse to take out only EpiPEns and insist upon training and tools to use vials and syringes so the pharmacist's prinicples of "right drug, right dose, right patient" are not violated.

3. "If I didn't try they might have died" is analogous to "They'd have died anyway so I did it" as an excuse. That gate has to remain closed.


PS: I just read the NY State law allowing EpiPens to be purchased, carried and used at and by summer camps. Some lawyer is going to make his client very rich one day by ripping open how the State tried to edge around the simple procedure: if the kid doesn't bring his or her prescribed EpiPens, the kid has to stay home.

* PPS:Here is the company's info to professionals about EpiPens (from Epipen.com):

"Frequently Asked Questions

Who is EpiPen® (epinephrine) Auto-Injector indicated for?

EpiPen Auto-Injector is indicated for patients with a history of anaphylaxis as well as for patients at risk for anaphylaxis (see “Identifying At-Risk Patients” section)." (Italics mine). They indicate why they should be prescribed. But nowhere does it say for use by professionals.

 

[mycrofft]

EpiPen as pacifier.

And, the EpiPen needs to be given within five to ten minutes of exposure. How often do you get there that fast anyway?

 

[Brandon O]

Not sure what you're getting at, mycrofft. Do you think epi autoinjectors work or not?

 

[Carlos Danger]

And, the EpiPen needs to be given within five to ten minutes of exposure. How often do you get there that fast anyway?

Does the epi in the auto injectors work differently than the epi that we draw up into a syringe?

I doubt I'd get there any quicker whether I carried ampules or auto injectors.

Are you suggesting that we shouldn't give epi at all?