IM Epinephrine Administration by the EMT

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IM Epinephrine Administration by the EMT

• The Check and Inject Pilot Project for the
  Administration of IM Epinephrine by King County
  EMTs
• King County EMS Training
• 2014

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Six Rights of Drug Administration

• Right person
• Right drug
• Right dose
• Right time
• Right route
• Right documentation

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What is epinephrine?

• A synthetic reproduction of the endogenous
  hormone/neurotransmitter epinephrine
• Functions in fight or flight response of the
  sympathetic branch of the autonomic nervous system

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Epinephrine Pharmacology

• Acts directly on alpha and beta adrenergic
  receptors (alpha constricts and beta dilates)
• Vasoconstriction
• Bronchodilation
• Antagonizes histaminic effects
• Stimulates the liver to produce and raise blood
  glucose levels
• Increases heart rate, cardiac contractility and
  systemic vascular resistance
• Increases myocardial oxygen demand

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Epinephrine Pharmacokinetics

• Approximate onset/duration times
• IM 3-5 min/1-4hrs
• SQ 5-10 min/2-6hrs
• Inhaled within 5 minutes/1-3hrs

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Precautions to consider during epinephrine
administration

• BE CERTAIN you are administering the correct
  concentration! It will be 11,000, or 1mg/1mL.
• BE CERTAIN you are administering the correct
  dose!
• May precipitate ACS in those with underlying
  cardiovascular disease, so be very cautious in
  older patients.
• Store epinephrine AWAY from light keep away from
  extreme heat and danger of freezing.

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How is it supplied?
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Indications for the use of epinephrine by the EMT

• Allergic Reaction or Anaphylaxis
• One or more of the following MUST be present with
  a suspected or known trigger
• diffuse and progressive hives
• respiratory distress (or sudden onset of
  wheezing)
• hypotension

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Contraindications

• Absolute Contraindications
• There are no absolute contraindications in the
  emergency setting

• Relative Contraindications
• Hypersensitivity to epi
• Glaucoma (narrow-angle)
• Cardiovascular disease
• Use during labor/childbirth

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Side effects

• Palpitations
• Tachycardia arrhythmias
• Hypertension
• Headache

• Tremor, weakness
• Pallor, sweating
• N/V
• Nervousness/anxiety
• Angina

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Dosing for Epinephrine Administration

• Anaphylaxis and anaphylactic shock
• Adults - _____ of 11,000 via Intramuscular
  injection
• Pediatrics - ______ of 11,000 via
  Intramuscular injection

0.3mg
0.15mg
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Route of administration

• Intramuscular
• Anterolateral thigh
• allows drug to be injected into the belly of a
  muscle
• blood vessels supplying that muscle distribute
  the medication into bloodstream.

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Intramuscular Injection
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Site Preparation

• Prep the site with approved antiseptic by
  scrubbing vigorously and allowing to dry
• DO NOT TOUCH, BLOW ON OR FAN THE INJECTION
  SITE!

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Anaphylaxis

• Severe allergic reaction
• Rapid onset
• Systemic involvement
• Foods, stings/bites, medications
• Mast cells gt histamines gt reaction

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Hives/Urticaria
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Drug AdministrationIntramuscular Injection

• Insert needle bevel-up _at_ 90-degree angle
• Retract the plunger
• If there is no flash, slowly and smoothly
  depress the syringes plunger to inject the
  medication
• Remove the needle/syringe and push needle protect
  over needle
• Massage injection site
• Place syringe/needle in a sharps container
• Place an adhesive bandage over the injection site
• Document! Medication, dose, site, time, vitals
  before/after, and patient response to therapy.

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Assessment of Patient Response

• Document your findings upon assessment of patient
  condition after treatment
• This includes appearance, work of breathing, lung
  sounds, skin signs, vital signs, and any changes
  in ability to speak

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Ongoing Assessment

• Continue to monitor and document the patients
  vital signs and condition for the remainder of
  your transport
• Record the patients vital signs every 3-5 minutes

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Six Rights of Drug Administration

• Right person
• Right drug
• Right dose
• Right time
• Right route
• Right documentation

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Any questions?
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Check Inject

• KC Check Inject Epi Kits
• Adult Peds in 1 kit
• 1- 1mg epi 11,000 vial
• 2- Monoject syringes w/Safety needle
• 25ga x 1
• Alcohol wipes
• Bandaids
• Check Inject paper

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Epi Kit
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Inside

• Check Inject paper
• Syringes
• Epinephrine Vial
• Alcohols wipes
• Bandaids

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Check Inject paper
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Questions?

• THANK YOU