Epinephrine Administration by the EMT Training Module 2013. WVOEMS Approved Education MPCC addition of skill set and treatment options for EMT Protocol changes 02-01-2013. Learning Objectives.
WVOEMS Approved Education
MPCC addition of skill set and treatment options for EMT Protocol changes 02-01-2013
With successful completion of this training module, the EMT will be able to describe and/or correctly demonstrate …
Anaphylaxis- a life-threatening, hypersensitivity reaction of the immune system
Aseptic technique - a procedure performed under sterile conditions
Asphyxia - suffocation as a result of blockage of the airway
Dyspnea - labored or difficult breathing
Epinephrine- a hormone released from the adrenal glands that activates several tissues in the “fight-or-flight” response
Histamine - one of several chemical messages released from immune cells that promote inflammation as a defense mechanism
Intramuscular - a medication route by injection into the belly of a muscle which encourages rapid transport by the bloodstream
Shock - a severe reduction in blood pressure (by any cause) that results in inadequate blood flow (oxygen & glucose) to tissues
For Intramuscular injection of Epinephrine…
Onset of effect: 3-5 min
Duration of effect: 1-4 hours
EMTs may administer Epinephrine for:
Adults- 0.30 mg of 1:1,000
Pediatrics- 0.15 mg of 1:2,000
1. Known or suspected exposure to allergen. Sting? If unclear contact base.
2. History of allergic reactions
3. Medication use prior to arrival. AnaGuard/Epi-pen, Benadryl?
4. PMH: heart disease, stroke, hypertension?
5. Medications: Beta-blockers (atenolol, propranolol)? May block effects of epinephrine
6. Vital signs including mental status
7. Respiratory status: Airway swelling? Wheezes? Stridor?
Use epinephrine with caution in the following patients (contact base when possible but do not withhold if patient in severe distress and base contact cannot be made easily):
Over 70 years of age
History of heart disease, stroke or hypertension.
Taking a beta-blocker (example: atenolol, propranolol)
Transport Priorities: Any patient with signs or symptoms of a severe reaction requires immediate evacuation. Consider helicopter and/or rendezvous with higher level of care unless symptoms responding well to therapy.
THE SIX “RIGHTS”
Intramuscularsites allow a drug to be injected into the belly of a muscle so that the blood vessels supplying that muscle distribute the medication to its site of action via the bloodstream.
NOTE: IM Injections CANNOT be administered through clothing as the auto-injectors could.
Store epinephrine AWAY from light; leave it in its carton until ready to use. Also keep away from extreme heat and danger of freezing.
Document all information concerning the patient and medication, including:
Using a 1cc syringe, insert the needle into the ampule and draw the plunger back on the syringe until you reach the correct dosage (0.30cc).
Using a 1cc (ml) syringe, insert the needle into the vial or ampule, draw the plunger back on the syringe until you reach 0.3cc (ml) mark on the syringe.
Document patient’s response to treatment:
The body’s stress response causes the normal release of epinephrine to maintain homeostasis during vigorous activity: “fight or flight”. These same actions of epinephrine counteract e.g. the bronchoconstriction and low blood pressure of anaphylaxis when administered by medical personnel.
Because epinephrine is expected to cause widespread changes in function, it is important to frequently monitor and document vital signs:
Vastus Epinephrinelateralis (lateral thigh)is the approved site for administration
If no significant improvement within 10 Epinephrine
minutes, consider second dose
Indications: Anaphylaxis (allergic reaction with respiratory distress); Bronchospasm
Equipment: Epinephrine kit containing:1, 1 ml ampule of epinephrine 1:1000, 1 tuberculin syringe with needle, alcohol prep
1. Refer to Allergic Reactions and Respiratory Distress Protocols for detailed assessment.
2. Ask patient if they have any drug allergies.
3. Confirm medication, concentration, dose and clarity of liquid in vial
4. Tap ampule to get medicine down from top, break top off ampule with gauze 2x2, place top in sharps container.
5. Draw up 0.3cc (ml) of epinephrine 1mg/ml 1:1000, syringe approximately 1/3 full.
6. Pointing syringe up, expel all air.
7. Inform patient they are going to receive an injection, side effects may include feeling shaky or heart racing.
8. Select and cleanse area for Intramuscular injection, primary is the thigh unless directed otherwise by medical command.
9. Keeping the skin taut, insert needle at 90 degrees into administration site and draw back checking for blood return. If there is blood return, select a different site, and insert needle, again check for blood return.
10. If no blood, administer 0.3 cc (ml) of epinephrine (1/3 of syringe) for any patient.
11. Discard needle properly in sharps container.
12. Observe patient for improvement or deterioration of condition. Repeat exam and vitals after each dose.
13. Document procedure, vitals and response to treatment.
14. If an additional dose is required consult Allergic Reactions and Respiratory Distress Protocols.
15. If indicated by protocol, begin again from step 5.