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IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the...

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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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Page 1: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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

Page 2: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Six Rights of Drug Administration

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

Page 3: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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

Page 4: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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

Page 5: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Epinephrine Pharmacokinetics• Approximate onset/duration times

IM: 3-5 min/1-4hrs

SQ: 5-10 min/2-6hrsInhaled: within 5 minutes/1-3hrs

Page 6: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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.

Page 7: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

How is it supplied?

Page 8: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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

Page 9: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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

Page 10: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Side effects

• Palpitations• Tachycardia &

arrhythmias• Hypertension• Headache

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

Page 11: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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

Page 12: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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.

Page 13: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Intramuscular Injection

90º

Page 14: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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!

Page 15: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Anaphylaxis

• Severe allergic reaction

• Rapid onset

• Systemic involvement

• Foods, stings/bites, medications

• Mast cells > histamines > reaction

Page 16: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Hives/Urticaria

Page 17: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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.

Page 18: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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

Page 19: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

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

Page 20: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Six Rights of Drug Administration

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

Page 21: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Any questions?

Page 22: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

“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

Page 23: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Epi Kit

Page 24: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Inside

• Check & Inject paper• Syringes• Epinephrine Vial

• Alcohols wipes• Bandaids

Page 25: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Check & Inject paper

Page 26: IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County.

Questions?

THANK YOU


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