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

[rgnoon]

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

 

[Gbro]

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.

 

[rgnoon]

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.

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.

 

[Flight-LP]

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

 

[Flight-LP]

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.

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

 

[rgnoon]

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.

 

[Ridryder911]

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

 

[bstone]

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.

 

[Ridryder911]

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

 

[Gbro]

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.

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

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

 

[Ridryder911]

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

 

[triemal04]

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.

 

[Gbro]

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......

 

[Flight-LP]

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.




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......

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.

 

[triemal04]

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.

 

[ffemt8978]

Thread closed until everyone cools off a bit.