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

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/2-6hrs Inhaled: 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

Absolute Contraindications Relative 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 Administration Intramuscular 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