akflightmedic
Forum Deputy Chief
- 3,892
- 2,567
- 113
What is the absorption rate of dextrose 50% if injected subcutaneously?
- Thread starter ervin
- Start date
mycrofft
Still crazy but elsewhere
- 11,322
- 48
- 48
Epi pens...try one sometime
Take an old one and shoot it into an orange or such. Needle is relatively small gauge and only about 3/4 inches long, maybe an inch. This isn't your 2-PAM Cl or Atropen from Chem-warfare class, shorter needle. If you tip it, or the subject's really obese, you can make that a sub-q, or bore down (no pun intended) and get IM. SQ with epi, as with insulin, helps avoid dumping it all on board immediately, unlike intracardiac, where you are depending upon it shocking the system to a degree...if it can make Uma Thurman look fully awake, it'll do you, too.
We had a pt resist a Bristoject of D50 into the antcubital vein and spent about $50,000 in plastic surgery, hospitalization, and therapy to rehab his wiped out bicep. Saved his life, though.
Other drugs subQ...heroin, speedballs, etc.
Oh, you might want to throw that orange away before somone tries to eat it.:wacko:
Take an old one and shoot it into an orange or such. Needle is relatively small gauge and only about 3/4 inches long, maybe an inch. This isn't your 2-PAM Cl or Atropen from Chem-warfare class, shorter needle. If you tip it, or the subject's really obese, you can make that a sub-q, or bore down (no pun intended) and get IM. SQ with epi, as with insulin, helps avoid dumping it all on board immediately, unlike intracardiac, where you are depending upon it shocking the system to a degree...if it can make Uma Thurman look fully awake, it'll do you, too.
We had a pt resist a Bristoject of D50 into the antcubital vein and spent about $50,000 in plastic surgery, hospitalization, and therapy to rehab his wiped out bicep. Saved his life, though.
Other drugs subQ...heroin, speedballs, etc.
Oh, you might want to throw that orange away before somone tries to eat it.:wacko:
Duh on the Insulin, I should have thought about that one...............
But, I have never had a guidline or protocol that called for Epi SQ in an anaphylactic patient, its always been IV........................
Different strokes for different folks I guess...........
Well, since you're a CCP/FPM, you probably have the luxury of always having an IV established. However, for the first responding Paramedic, most protocols call for SubQ Epi before IV Epi because:
1. It's quick.
2. It doesn't require an IV.
3. It works.
If the SubQ Epi doesn't work, or tissue perfusion is obviously not adequate, you can jump right to IV Epi.
MedicPrincess
Forum Deputy Chief
- 2,021
- 3
- 0
Can you explain this? Did you loose the IV and a small amount of the D50 infiltrated? Was administration of the D50 continued even after the IV site was no longer patent, at the knowledge of the person administering? Wasn't the line checked throughout administration to ensure there was no infiltration? Was it intentionally given IM? How much "resisting" was going on? I can say I have had multiple people restrain a pt who was "resisting" in order ot administer the D50, and managed to give it.Just because you "saved his life" doesn't make it right.
What about Glucagon?
mikie
Forum Lurker
- 1,071
- 1
- 36
Not to steal the question from above but this is very intersting and new to me (still only a basic :glare
So what is the depth (a few MM difference probably), angle of injection & location difference between SubQ and intradermal?
Thanks everyone for your great responses!
So what is the depth (a few MM difference probably), angle of injection & location difference between SubQ and intradermal?
Thanks everyone for your great responses!
Not to steal the question from above but this is very intersting and new to me (still only a basic :glare
So what is the depth (a few MM difference probably), angle of injection & location difference between SubQ and intradermal?
Thanks everyone for your great responses!
Well, for an intradermal injection, you're going almost parallel to the skin, and only until the tip of the needle is under the skin. It's so superficial that a bubble is created on top of the skin when something is injected underneath the skin that way. Typically only done in the forearm.
A subcutaneous injection is into the fat, which means you have to bypass that layer of skin. You pinch the skin up, and go at a 45 degree angle. A subQ injection can be given anywhere there is fat. Popular site is the arm.
Last edited by a moderator:
fma08
Forum Asst. Chief
- 833
- 2
- 18
our protocol just changed for anaphlyaxis, its now (for adults) 0.3mg of 1:1000 IM, used to be Sub-q.
Pretty much same idea as the SubQ one. It was those claiming that the protocol called for IV Epi that I found hard to believe.
Again, regardless of being in the air or on the ground, I have NEVER had a written guidline calling for Epi SQ before IV in true anaphylaxis. Severe allergic reaction maybe, but not full blown anaphylaxis. Also FYI, I do not currently fly as a medic......................
Find it as hard to believe as you want, but the reality is that patients suffering circulatory compromise will not metabolize Epi when administered SQ. IM maybe, but it is still too slow. If you have a pt. with circulatory collapse, i.e. immediate life threatening symptoms, IV Epi is the recommended course of treatment..........
http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-143
http://emj.bmj.com/cgi/content/abst...63c7f018aecc535e7bac47e2&keytype2=tf_ipsecsha
http://www.mchd-tx.org/clinical/documents/MCHDSDOApril2008.pdf (Page 178)
http://www.atcomd.org/downloads/PATIENT CARE GUIDELINES ONLY v06.01.08 ALL PROVIDER LEVELS.pdf (Page 2)
I don't think you're getting what I'm saying.
First of all, I made it clear in my previous post that while SubQ Epi is the primary protocol, if there is inadequate tissue perfusion, then you need to do IV Epi. However, SubQ Epi is the primary protocol because it can be administered immediately without the establishment of an IV, thus avoiding the situation getting bad enough where tissue perfusion is an issue and IV Epi IS necessary.
Someone can require immediate intervention while not being in such a dire state where their tissues aren't being perfused. SubQ Epi is the choice in such a case. The majority of cases. I'm sorry, but it's true.
mycrofft
Still crazy but elsewhere
- 11,322
- 48
- 48
MedicPrincess, I needed to answer you here. Sorry to interrupt the flow.
2. The patient was attempting to thwart treatment because he was aggitated and disoriented from hypoglycemia which he purposefully induced (ate suger before he got his insulin so he would get a large sliding scale dose of Regular, then vomited up supper in his cell) to avoid being extradited to a Federal penitentiary. He wanted to go to a hospital. He got it.
3. The practitioner who did it had done it once before (Bristoject mainline without IV line patent) with good result, but the second attempt ended in this fiasco. Excellent example and it answers your questions: yes, it was boneheaded and wrong.
4. No it wasn't me, it was someone who was not experienced and not level-headed in an "emergency", thereby compounding it.
5. We did not have Glucagon available to us then. Sure do now!
2. The patient was attempting to thwart treatment because he was aggitated and disoriented from hypoglycemia which he purposefully induced (ate suger before he got his insulin so he would get a large sliding scale dose of Regular, then vomited up supper in his cell) to avoid being extradited to a Federal penitentiary. He wanted to go to a hospital. He got it.
3. The practitioner who did it had done it once before (Bristoject mainline without IV line patent) with good result, but the second attempt ended in this fiasco. Excellent example and it answers your questions: yes, it was boneheaded and wrong.
4. No it wasn't me, it was someone who was not experienced and not level-headed in an "emergency", thereby compounding it.
5. We did not have Glucagon available to us then. Sure do now!
Yeah, its called an allergic reaction, not anaphylaxis.....................
Obviously you failed to actually read the links. They directly contradict that very statement. My original posting was to state a personal experience, not get into a pissing match with you. Think what you wish, treat as you wish. You apparently allow zero flexibility to considering any other thought process than your own. So why you continue posting multiple pages in these threads I guess will continue to perplex me.................
Anaphylaxis IS an allergic reaction. What you need to do when you get on scene is assess how severe the reaction is, and whether or not SubQ Epi would even be effective. But in many cases, it will be. And if I arrive early enough before they're in a state of shock, then I'm going to go for the SubQ Epi. Why? Because it's easier. It all depends on the patient's state.
mikeylikesit
Candy Striper
- 906
- 11
- 0
My preferred site is on the cheek it they let me since i tell them that it won't hurt as bad. plus you know every patient almost has adipose tissue on their cheeks.B)Actually not true.. remember, anywhere there is fat... there is sub-q. Now, there is preferred sites.. as well, one would not want to have 50 (1 ml) injections...
after reading the posts i haven't seen the science behind not using the subq epi in a anaphalaxis reaction so i thought i would put my two cents in, in mild to moderate subq epi is the most effective because the blood has yet to been shunted from the skin, in anaphalaxis the blood is shunted back to the core and the skin looses its vascular flow so limiting the absorption of the subq epi, indicating rapid iv epi. that was how i was told to hand a mild allergic vs anaphalatic reaction.h34r:
h34r: