Does sub-q Epi work?

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ParamedicStudent

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I've heard stories of people using sub-q epi, but hoe does it work? Doesn't your skin and directly underneath it have really poor circulation, and that's why people use IV epi, because it has the best circulation and drug response. Or when people are in shock theres not any good perfusion either, thats why you give Epi IV?
 
ParamedicStudent said:
I've heard stories of people using sub-q epi, but hoe does it work? Doesn't your skin and directly underneath it have really poor circulation, and that's why people use IV epi, because it has the best circulation and drug response. Or when people are in shock theres not any good perfusion either, thats why you give Epi IV?
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Also in the movie pulp fiction the guy have Epi by a shot to the heart. Woudn't that damage the heart because youre sticking it with a needle?
 
1.) it's a movie. Movies do things to be dramatic. However a long time ago Epi was in fact given directly into the heart.

2.) SQ Epi does work. Some systems use SQ Epi for treatment of allergic reactions while other systems use IM Epi.

3.) the route of Epi is going to depend on what you are using the Epi for and also the concentration of it (1:1,000, 1:10,000, 1:100,000).
 
Have you done a lit search to see what the research says?
 
SC adrenaline has its place (such as in addition to lignocaine when suturing) but not for treating asthma or anaphylaxis. It's absorption and distribution is very prolonged so it is no longer used for this purpose. I can remember seeing this as a common practice in the 1980s.

Unless IM adrenaline has been ineffective, or your patient is near death, IM adrenaline is sufficient. For most adults 0.5 mg will do just fine.

And yes, intracardiac adrenaline with a dirty big cardiac puncture needle (about six inches long) was once a common resuscitation practice. However, "once" was fifty-odd years ago.
 
It kind of depeds on the scenerio you are in. Under the skin is much much slower to take effect than IM/IV/IO. Most protocols say anaphalaxis is 1;1000 IM and cardiac is 1;10000 IV. To answer your question yes, it does work but takes longer and might not have a strong enough effect in an emergency.
 
If I recall from my last look at the lit, the IM in the thigh route showed the best outcome for the patient...
 
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