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

[medman123]

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

disregrad my other post.

 

[MedikErik]

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.

 

[Flight-LP]

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..................

 

[MedikErik]

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

 

[Flight-LP]

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

 

[MedikErik]

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.

 

[Flight-LP]

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........

 

[BossyCow]

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.

 

[rgnoon]

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?

 

[Ridryder911]

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

 

[BossyCow]

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?

 

[EMTinNE]

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.

 

[VentMedic]

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.

 

[MedikErik]

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.

 

[babygirl2882]

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

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?

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?

 

[Ridryder911]

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

 

[medicdan]

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...

 

[Ridryder911]

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

 

[MedikErik]

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.

 

[Meursault]

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.