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 1. 2. 3. 4. 5. 6. 7. 8. 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.