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
Contraindications
Absolute Contraindications Relative Contraindications
• There are no absolute
contraindications in the
emergency setting
•
•
•
•
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
0.3mg of 1:1,000 via Intramuscular
• Adults - _____
injection
0.15mg
• Pediatrics - ______ of 1:1,000 via
Intramuscular injection
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