1. Allergic Reaction Protocol Preparing & Administering Epinephrine IM
Jessica Owen, CCRN

2. An allergic reaction is a systemic or generalized sensitivity response to an allergen including but not limited to:
medications or additive
contact with natural rubber latex
contact with a solution
environmental
stings or bites

3. Reactions may be immediate or delayed, mild or sever and potentially life threatening as in anaphylactic reaction.

4. MANAGMENT Assess for signs and symptoms of allergic reaction
Anticipate and prepare for supportive measures
Code cart with appropriate airway management equipment, O2 tank, and medications
Allergic reaction kit
Aqueous Epinephrine 1:1000
Benadryl
H2 antagonist (Famotidine)
Methylpredisone
If allergic reaction is suspected STOP infusion immediately and place patient in trendelenburg position.
Call provider immediately and call code blue or rapid response team as appropriate.

5. Aqueous Epinephrine 1:1000 Used for acute anaphylaxis
0.3 ml IM vastus lateralis or deltoid muscle if appropriate
May be repeated every minutes as ordered by MD

6. Drawing Up Epinephrine from a Single-Dose Ampule
For single-dose ampules: Wrap an alcohol pad around the ampule's neck and snap off the top, directing the force away from your body. Attach a filter needle to the syringe and withdraw the medication, keeping the needle's bevel tip below the level of the solution. Tap the syringe to clear air from it. Cover the needle with the needle sheath. Discard the filter needle and the ampule in the appropriate receptacle. Attach the 25 G x 5/8” needle to the syringe.
Note: Patients who are obese may require a longer needle, and thin or emaciated patients may require a shorter needle.
Vastus lateralis: ½" to 1"
Deltoid: ½" to 1½"

7. Vastus Lateralis
Have the patient sit or lie supine. The knee may be slightly flexed and the foot may be externally rotated to help relax the muscle. Use the lateral muscle of the quadriceps group, from a handbreadth below the greater trochanter to a handbreadth above the knee. Insert the needle into the middle third of the muscle parallel to the surface on which the patient is lying.

8. Deltoid
Have the patient sit or stand. Find the lower edge of the acromial process and the point on the lateral arm in line with the axilla. Insert the needle 1" to 2" (2.5 to 5 cm) below the acromial process, usually two or three fingerbreadths, at a 90-degree angle or angled slightly toward the process

9. TECHNIQUE
After selecting the injection site, clean the skin with an alcohol pad. Move the pad outward in a circular motion to a circumference of about 2" (5 cm) from the injection site and allow the skin to dry
Position the syringe at a 90-degree angle to the skin surface, with the needle a couple of inches from the skin. Tell the patient that he'll feel a prick as you insert the needle. Then quickly and smoothly insert the needle through the skin and subcutaneous tissue, deep into the muscle at a 90-degree angle.
Support the syringe with your non-dominant hand if desired. Pull back slightly on the plunger with your dominant hand to aspirate for blood if appropriate. If no blood appears, slowly inject the medication into the muscle. You should feel little or no resistance against the force of the injection.
After the injection, wait 10 seconds to allow the medication to begin to diffuse into the surrounding muscle tissue, then withdraw the needle slowly at a 90-degree angle.
Cover the injection site immediately with a gauze pad, and apply gentle pressure.
Discard all equipment appropriately. Don't recap needles; dispose of them in an appropriate sharps container to avoid needle-stick injuries.
Clinical alert: If blood appears in the syringe on aspiration, the needle is in a blood vessel. If this occurs, stop the injection, withdraw the needle, prepare another injection with new equipment, and inject another site. Don't inject the bloody solution.

10. Questions ?