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 EMS Training
2014

2. Six Rights of Drug Administration
Right person
Right drug
Right dose
Right time
Right route
Right documentation

3. 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

4. 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

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

6. 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.

7. How is it supplied?

8. 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

9. 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

10. Side effects Palpitations Tachycardia & arrhythmias Hypertension
Headache
Tremor, weakness
Pallor, sweating
N/V
Nervousness/anxiety
Angina

11. 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

12. 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.

13. Intramuscular Injection
90º

14. 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!

15. Anaphylaxis Severe allergic reaction Rapid onset Systemic involvement
Foods, stings/bites, medications
Mast cells > histamines > reaction

16. Hives/Urticaria

17. Drug Administration Intramuscular Injection
Insert needle 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.

18. 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

19. 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

20. Six Rights of Drug Administration
Right person
Right drug
Right dose
Right time
Right route
Right documentation

21. Any questions?

22. “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

23. Epi Kit

24. Inside Check & Inject paper Syringes Epinephrine Vial Alcohols wipes
Bandaids

25. Check & Inject paper

26. Questions?
THANK YOU