Route of Epi Admin

[mycrofft]

By "cheek" did she megan gluteus maximus?

 

[mycrofft]

NIH says intralingual not as effective…in dogs and monkeys.
http://www.ncbi.nlm.nih.gov/pubmed/99706

NOTHING about buccal.

 

[johnrsemt]

with a needle that is either 5//8 or 7/8 of an inch long (I don't remember which) how can you put it in the cheek? Plus how would you trigger it? you can't push hard enough against the cheek to get it to fire: and if you pushed it against the gum the patient would hit you: getting a 27g needle of novacaine to numb the mouth for dental work hurts, getting a 20 g needle in the gums would feel like a railroad spike

 

[mycrofft]

Not to mention the infarct the epi will cause.

 

[Handsome Robb]

with a needle that is either 5//8 or 7/8 of an inch long (I don't remember which) how can you put it in the cheek? Plus how would you trigger it? you can't push hard enough against the cheek to get it to fire: and if you pushed it against the gum the patient would hit you: getting a 27g needle of novacaine to numb the mouth for dental work hurts, getting a 20 g needle in the gums would feel like a railroad spike

That's a great point regarding the required pressure to trigger the auto-injector.

 

[Underoath87]

By "cheek" did she mean gluteus maximus?

That has to be it ("butt cheek"). There's no way they're supposed to jab someone in the face with epi...

 

[unleashedfury]

Is he even sure its a Epi Pen what about Sub Q?

 

[KellyBracket]

Has anyone heard of administering an Epi-Pen straight into the pt's cheek? Anyone currently do this?

There is good research about IM versus SQ epi (IM in the thigh is the way to go), and good research about the safety of IV drips of epi (Don't do boluses, lousy safety profile).

Basically no research on sublingual injections for anaphylaxis that I've ever found.

As for the cheek, no, I've not heard a thing. I wouldn't do that if I were you.

 

[unleashedfury]

There is good research about IM versus SQ epi (IM in the thigh is the way to go), and good research about the safety of IV drips of epi (Don't do boluses, lousy safety profile).

Basically no research on sublingual injections for anaphylaxis that I've ever found.

As for the cheek, no, I've not heard a thing. I wouldn't do that if I were you.

Interesting,

Now I know the SubQ Epi we carry is 1:1000 concentration The EPI Pen is a 1:2000 Concentration. Our protocol is SubQ so I guess until we catch up to the research. thats the preferred method.

What about localized reactions such as angio edema? would direct injection Sub Q to the affected site or IM to the thigh be much more beneficial?

 

[KellyBracket]

What about localized reactions such as angio edema? would direct injection Sub Q to the affected site or IM to the thigh be much more beneficial?

Epi is used locally in a few conditions. For example, epi is nebulized to treat the airway edema of croup. It is also injected into gastric mucosa under ulcers to staunch bleeding through vasoconstriction of the involved arteries.

Anaphylaxis is a systemic disease, however, so I'm not sure what role local therapy might, hypothetically, have. I've never seen any discussion of this, let alone research or evidence. Let me know if you find some!

(Sublingual injection may be in some EMS protocols, but that doesn't count as evidence!)

 

[yowzer]

We're starting to move away from autoinjectors to manually drawn up and injected epi because of cost savings, but it's still just in the thigh.

 

[unleashedfury]

Epi is used locally in a few conditions. For example, epi is nebulized to treat the airway edema of croup. It is also injected into gastric mucosa under ulcers to staunch bleeding through vasoconstriction of the involved arteries.

Anaphylaxis is a systemic disease, however, so I'm not sure what role local therapy might, hypothetically, have. I've never seen any discussion of this, let alone research or evidence. Let me know if you find some!

(Sublingual injection may be in some EMS protocols, but that doesn't count as evidence!)

Ahh the Epi Racemic.
And forgot about the epi/lido mix, I've only seen it used once in emergency medicine where a ED doc used it to slow the bleeding of a ruptured varicose vein. I've seen it plenty used in dentist's offices for teeth fillings and extractions.

I was just curious since like you said Anaphylaxis being systemic if there was any benefit of localized therapy.
In my career I think I used Epi once to treat anaphylaxis, and that was the IM injection to the thigh most allergic reactions I get can benefit from diphenhydramine, and a good bronchiodialtor neb treatment.

Sublingual epi is not part of our protocol. so this is the first I heard of the S/L route.