EpiPen
(Epinephrine) Auto-Injector
A comprehensive guide to implementing Epinephrine in
NYS as an EMT-B.
Epinephrine
A medication used in the emergency treatment of severe allergic
reactions (anaphylaxis).
Epinephrine acts quickly to improve breathing, stimulate the heart,
raise a dropping blood pressure, reverse hives, and reduce
swelling of the face, lips, and throat.
Anaphylaxis
Sudden and severe allergic reaction.
Typically occurs within minutes of exposure to the allergen and
almost always within two hours.
This reaction causes the release of chemicals in the blood and
body tissue encouraging the dilation of blood vessels, leading to a
decrease in blood pressure and fluid leaks (often resulting in hives
and swelling).
Anaphylaxis
Common Causes
•Foods, such as Peanuts
•Tree nuts, i.e. almonds, walnuts, hazel, brazil, and cashew nuts.
•Shellfish, i.e. shrimp and lobster
•Dairy Products
•Eggs
•Insect stings, i.e. wasps, bees, ants
•Latex
•Medications
•Exercise
Anaphylaxis
Signs
•Rapid, Weak pulse
•Flush or Pale Skin
•History of Anaphylaxis
•Abnormal Lung Sounds
•Loss of Consciousness
Symptoms
•Swelling
•Hives
•Itching
•Flush or pale skin
•Swelling
•Nausea, Vomiting, Diarrhea
•Dizziness, or Fainting
•Difficulty Breathing
Anaphylaxis
NYS EMT-B Basic Life Support Protocol
Anaphylaxis with Respiratory Distress
Request Advanced Life Support (ALS) if available. Do not delay
transport to the appropriate hospital.
1. Assure patient’s airway is open and that breathing and circulation
are adequate. Suction as necessary.
2. Administer high concentration oxygen.
3. Determine that the patient has a diagnosed history of
anaphylaxis, severe allergic reactions, and/or a recent exposure
to an allergen or inciting agent.
4. If cardiac and respiratory status is normal, transport the patient
while performing frequent ongoing assessments.
Anaphylaxis
NYS EMT-B Basic Life Support Protocol
Anaphylaxis with Respiratory Distress (continued)
5. If either cardiac or respiratory status is abnormal, proceed as
follows:
a) If the patient is having severe respiratory distress or
hypoperfusion and has been prescribed an epinephrine
auto injector, assist the patient in administering the
epinephrine. If the patients' auto injector is not available
or is expired, and the EMS agency carries an epinephrine
auto injector, administer the epinephrine as authorized by
the agency’s medical director.
b) If the patient has not been prescribed an epinephrine
auto-injector, begin transport and contact Medical Control
for authorization to administer epinephrine if available.
Anaphylaxis
NYS EMT-B Basic Life Support Protocol
Anaphylaxis with Respiratory Distress (continued)
6. Contact Medical Control for authorization for a second
administration of epinephrine auto injector if needed.
7. Refer immediately to any other appropriate protocol.
8. If cardiac arrest occurs, perform CPR according to AHA/ARC/NSC
standards and refer to the Cardiac Arrest Protocol.
9. Transport immediately.
10. Ongoing assessment. Obtain and record the patient’s initial vital
signs, repeat enroute as often as the situation indicated. Be alert
for changes in the patient’s level of consciousness.
Anaphylaxis
NYS EMT-B Basic Life Support Protocol
Anaphylaxis with Respiratory Distress (continued)
11. Record all patient care information, including the patient's
medical history and all treatment provided, on a PCR.
12. If Epinephrine has already been administered, continue to
reassess respiratory effort and vital signs, transport immediately.
Anaphylaxis
NYS EMT-B Basic Life Support Protocol
Transition of Care: Epinephrine Auto-Injector for Anaphylactic
Reactions with Respiratory Distress or Hypoperfusion
1. When arriving on scene of a patient experiencing an anaphylactic
reaction, if the patient is being treated by a “first responder” who
has administered epinephrine by auto-injector, the EMS Provider
should immediately confirm the patient’s status and pay close
attention for signs and symptoms of respiratory distress and
hypoperfusion
2. Request ALS if available.
Anaphylaxis
NYS EMT-B Basic Life Support Protocol
Transition of Care: Epinephrine Auto-Injector for Anaphylactic
Reactions with Respiratory Distress or Hypoperfusion (continued)
3. Gather the following information:
1. Determine the substance the patient was exposed to,
2. How long ago the exposure occurred,
3. The initial symptoms the patient reported,
4. The time and dosage of the epinephrine administered,
5. The name of the individual who administered it, and
6. The patient's response to the treatment.
Medical Control must be contacted prior to administering a second
epinephrine injection.
EpiPen and Twinject
Information
Medication Name
1. Generic: Epinephrine
2. Trade: Adrenalin
3. Delivery System: EpiPen or EpiPen Jr. or Twinject (adult or
child size)
Indications:
1. Patient exhibits signs of a severe allergic reaction, including
either respiratory distress or shock (hypoperfusion).
2. Medication is prescribed for this patient by a physician or is
carried on the ambulance.
3. Medical direction authorizes use for this patient.
Contraindications
No contraindications when used in a life-threatening situation.
Medication Form
Liquid administered by auto-injector – an automatically injectable
needle –and-syringe system.
Dosage
Adult: One Adult Auto-Injector (0.3mg)
Infant and Child: One Infant/Child Auto-Injector (0.15mg)
Actions
1. Dilates the bronchioles
2. Constricts blood vessels
Side Effects
1. Increased heart rate
2. Pallor
3. Dizziness
4. Chest pain
5. Headache
6. Nausea
7. Vomiting
8. Excitability, anxiety
Reassessment Strategies
1. Transport
2. Continue focused assessment of airway, breathing, and
circulatory status.
If patient’s condition continues to worsen (decreasing mental
status, increasing breathing difficulty, decreasing blood
pressure):
a. Obtain medical direction for an additional dose of
epinephrine
b. Treat for shock (hypoperfusion)
c. Prepare to initiate basic life support procedure
If patient's condition improves, provide supportive care:
a. Continue oxygen
b. Treat for shock (hypoperfusion)
EpiPen and Twinject
How to Administer
Twinject
EpiPen
EpiPen and Twinject
How to Administer
EpiPen & Twinject
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Obtain patient’s prescribed auto-injector Esure:
a.
Prescription is written for the patient who is experiencing the severe allergic reaction or
your protocols permit carrying the auto-injector on the ambulance.
b.
Medication is not discolored (if visible)
Obtain order from medical direction, either on-line or offline.
Remove safety cap(s) from auto-injector
Place tip of auto-injector against patient’s thigh.
a.
Lateral portion of the thigh
b.
Midway between waist and knee
Push the injector firmly against the thigh until the injector activates.
Hold the injector in place until the medication is injected (at least 10 seconds).
Record activity and time.
Dispose of a single-dose injector, such as the EpiPen, in a biohazard container. Save a two-dose
injector, such as Twinject, and transport it with the patient in case the second dose is later
required.