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 Training2014
Six Rights of Drug Administration
• Right person • Right drug • Right dose • Right time • Right route • Right documentation
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
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
Epinephrine Pharmacokinetics• Approximate onset/duration times
IM: 3-5 min/1-4hrs
SQ: 5-10 min/2-6hrsInhaled: within 5 minutes/1-3hrs
Precautions to consider during epinephrine administration
• BE CERTAIN you are administering the correct concentration! It will be 1:1,000, 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.
How is it supplied?
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
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
Side effects
• Palpitations• Tachycardia &
arrhythmias• Hypertension• Headache
• Tremor, weakness• Pallor, sweating• N/V• Nervousness/anxiety• Angina
Dosing for Epinephrine Administration
Anaphylaxis and anaphylactic shock
• Adults - _____ of 1:1,000 via Intramuscular injection
• Pediatrics - ______ of 1:1,000 via Intramuscular injection
0.3mg
0.15mg
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.
Intramuscular Injection
90º
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!
Anaphylaxis
• Severe allergic reaction
• Rapid onset
• Systemic involvement
• Foods, stings/bites, medications
• Mast cells > histamines > reaction
Hives/Urticaria
Drug AdministrationIntramuscular Injection
• Insert needle bevel-up @ 90-degree angle• Retract the plunger• If there is no ‘flash’, slowly and smoothly depress the
syringe’s 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.
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
Ongoing Assessment
• Continue to monitor and document the patient’s vital signs and condition for the remainder of your transport
• Record the patient’s vital signs every 3-5 minutes
Six Rights of Drug Administration
• Right person • Right drug • Right dose • Right time • Right route • Right documentation
Any questions?
“Check & Inject”• KC “Check & Inject” Epi Kits• Adult & Peds in 1 kit– 1- 1mg epi 1:1,000 vial– 2- Monoject syringes w/Safety needle• 25ga x 1”
– Alcohol wipes– Bandaids– Check & Inject paper
Epi Kit
Inside
• Check & Inject paper• Syringes• Epinephrine Vial
• Alcohols wipes• Bandaids
Check & Inject paper
Questions?
THANK YOU