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Epinephrine Auto-injector Annual Refresher

EMT-B Expanded Practice. Epinephrine Auto-injector Annual Refresher. Shock (Hypo-perfusion). Inadequate perfusion of the body’s organs Caused by three general processes. Organ failure Hypovolemia Vasodilation. Assessment based on signs & symptoms. A. LLERGIC REACTIONS.

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Epinephrine Auto-injector Annual Refresher

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  1. EMT-B Expanded Practice Epinephrine Auto-injector Annual Refresher

  2. Shock (Hypo-perfusion) • Inadequate perfusion of the body’s organs • Caused by three general processes • Organ failure • Hypovolemia • Vasodilation • Assessment based on signs & symptoms

  3. A LLERGIC REACTIONS Some substances known as allergens set off an exaggerated response in the body’s immune system. Histamine is released causing capillaries and arterioles to dilate. Fluid contained in the cells leak into the vascular spaces decreasing blood volume. Bronchioles constrict during this process. A severe allergic reaction is commonly referred to as anaphylactic shock.

  4. Common Sources of Allergens • Insect stings(Bees, wasps, hornets) • Foods(Nuts, shellfish, peanuts, eggs) • Plants(Poison ivy, ragweed, grasses) • Medications(Penicillin, “Caine derivatives, • antibiotics, aspirin) • Other causes(Dust, latex, glue, soaps, • pollen, makeup)

  5. Assessing Patients with Allergic Reaction SIGNS SYMPTOMS Skin Swelling, itching, hives, red skin Cardiovascular Increased pulse, decreased BP, signs of shock Respiratory Cough, rapid breathing, laboredbreathing, noisy breathing, hoarseness, stridor, wheezing

  6. V ITAL SIGNS • Pulse • Respirations • Blood Pressure • Mental Status • Pupils • Skin Condition

  7. Allergic Reaction…Mild Epinephrine is not indicated • Itching, tearing and swelling around eyes • Dizziness • Hives, welts localized on certain areas of the skin • Nausea, vomiting, abdominal pain

  8. Allergic Reaction…Severe Epinephrine may be indicated • Wide spread hives • Feeling of constriction in the throat or chest • Difficulty breathing, wheezing • Difficulty swallowing • Sense of impending doom • Tachycardia

  9. Allergic Reaction…Acute Epinephrine is indicated • Reduced blood pressure • Cyanosis, difficulty in breathing or absence of breathing • Vascular collapse • Incontinence • Unconsciousness or death may occur if anaphylactic shock not treated

  10. Medication Profile Epinephrine

  11. Indications Severe allergic reactions Contraindications None in life-threatening situation Actions Dilates bronchioles; constrictsblood vessels Anxiety, palpitations, chest pain(rare) irregular heart beat (dysrhythmias) Side-effects Names: Generic(brand) Epinephrine (Adrenalin; names of auto- injectors(Epi-Pen , EpiPen Jr. ) Adult: 0.3 mg injected subcutaneouslyChild: 0.15 mg injected subcutaneously Dosage Epinephrine

  12. Indications…Epinephrine • Patients is in obvious shock after an insect sting(most common) or other allergen contact. • Patients who develop signs of anaphylaxis after ingestion of food or medication. • Signs including significant lowering of blood pressure, airway compromise (stridor, tongue swelling, facial swelling and/or significant difficulty breathing. • AED or SAED must be at the patients side.

  13. Contraindications Circumstances in which you should NOT administer epinephrineto a patient Known heart disease, Epinephrine use prior to EMS arrival, Ages < 5 yrs. & >55 yrs., AED or SAED unavailable at patient’s side

  14. Actions INTENDED EFFECTS of epinephrine Example... Epinephrine Produced by the adrenal gland (Dilates Bronchioles, Constricts Blood Vessels)

  15. Side-Effects UNINTENDED EFFECTS of epinephrine Example... Epinephrine (Anxiety, Palpitations, Chest Pain)

  16. Administering Epinephrine via an Auto-injector Auto-injectors Dose Infant/child 0.15 mg. >30 lbs. <60 lbs. Adult 0.3 mg. >60 lbs.

  17. If the patient has a “Prescribed” Auto-Injector: Emergency care (off-line medical control) • Administer high-flow O2. • Verify ALS response. • Have AED at patients side. • Determine if patient has prescribed • auto-injector. • If present, check date, administer. • Document administration; transport. • Remove constricting clothing from fingers, wrists, or neck.

  18. If the patient has No “Prescribed” Auto-Injector: Emergency care (on-line medical control) • Administer high-flow O2. • Verify ALS response. • Have AED at patients side. • Obtain on-line medical control. • Provide findings and request administration of EMS service supplied epinephrine. • Administer epinephrine

  19. No “Prescribed” Auto-injector(continued) Emergency care • Transport immediately. • Remove constricting clothing from fingers, wrists, or neck. • Perform ongoing assessment. • Document changes in condition.

  20. Ongoing Assessment Emergency care • If condition worsens: • Contact medical control • Treat for hypo-perfusion (shock) • Prepare for initial life support (ventilation, CPR, application of AED for cardiac arrest) • Document changes in condition.

  21. Transition of Care Relay to Paramedic or ED Staff: • Substance patient was exposed to. • Time of exposure. • Symptoms patient reported. • Assessment & care provided. • Name of physician ordering injector. • Time & dosage(s) of epinephrine. • Response to treatment.

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