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EpiPen SubQ or IM?

Posted (edited) · Report post

OK I know this seems like an obvious answer, to me at least, but it sparked a heated debate last night.

It was time for our liscense renewal class for Epi and a question came up on the test that asked the following:

When Administering EpiPen or EpiPen Jr. You Are Giving A(n)....

A) Subcutaneous Injection

B )Intravenous Injection

C) Intramuscular Injection

D) Intraosseous Infusion

naturally I chose C. A 1 to 1 1/2 inch needle is clearly an IM injection.

Now here is where the debate started, the Medic running the class said well according to the answer key it is A. I, being the inquisitive type :devilish: , asked why would it be SQ when clearly you are injecting into the thigh muscle. You are not putting it just below the skin between the dermus and muscle but into the muscle itself.

I was told that because Epi is supposed to be administered SQ that the answer is SQ. Again I said EpiPen is pushed into the thigh muscle thus the correct answer is IM.

Well you get the drift by now... this went on for a good 15 minutes. Was I totally off base with my thinking or was the instructors thinking flawed and just blindly following the answer key?

side note: Yes I know Medic administered epi can be done a number of ways, I am not talking about drawing your own injection and administering, I am strictly talking about EpiPen Auto Injectors here.

edited to change a stupid smiley where B should have been

Edited by UGLyEMT
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Posted · Report post

According to the prescribing info, if you look under "dosage and administration," it says it is administered "intramuscularly or subcutaneously into the anterolateral aspect of the thigh."

Think about it. In most people it will be IM, but there are many people that need a much longer needle to make it IM so it will end up SQ.

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Posted · Report post

Where I work we used to give epi SQ but now we give it IM-- even when not using an autoinjector. The only answer that makes sense is IM.

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Posted · Report post

Your instructor is old school. IM is the standard for epi these days.

Your instructor is old school. IM is the standard for epi these days.

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Regions vary... Some have taken out SQ Epi for IM Epi and others have kept SQ Epi... When NYC replaced SQ with IM Epi 2-3 years ago; Hudson Valley, NY still gave Epi SQ... It's up to the Physicians on the various Medical Advisory Committees... IM is a faster route than SQ...

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Posted · Report post

I say it is IM

Here in Kiwi, we prefer IV adrenaline giving as an infusion; 1mg of adrenaline in 1 litre of NS 2gtt/s titrated

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Posted · Report post

Your instructor is old school a misinformed, undereducated idiot. Take everything he says with due scepticism.

Fixed that for ya. ;)

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Posted · Report post

Despite what his protocol may say, the auto injector is designed for IM, right? And it was an auto injector question?

It makes no difference how he defends his answer, auto injectors are designed IM, basics are trained IM, and I could be wrong, but I doubt many have a protocol for SQ.

So yeah, he was just being an idjit.

Dwayne

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I would just like to point out the obvious value of this thread in pointing out and validating the belief that EMT-B "experience" is detrimental to the educational development of the paramedic. The longer you spend cooking by the book, without the educational foundation to truly understand -- in an intelligent, informed, scientific manner -- what you are doing, the longer and harder it is for you to overcome all of those mistaken and misleading beliefs you pick up as a basic. This instructor is a poster boy.

Can I say "longer and harder" here? :unsure:

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Posted · Report post

Red flag 1: "the answer key says..."

Sure I've had to use pre-written exams for the first responder and EMR programs when I teach, but I do the test myself first, check the answer key for problems and then still allow for discussion.

Multiple choice testing is for ease of marking not necessarily because it provides a good test of a students understanding.

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Posted · Report post

Can I say "longer and harder" here? :unsure:

Sure, if we are talking about bad girls dreams :D

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Posted · Report post

If your at the point of needing epi theres probably a fairly decent amount of perephial shunting away from the skin from shock (perephial vasoconstriction). There isnt the neccessary blood flow to make SQ reliable to work quickly.

Excuse any spelling, i'm mobile...

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Red flag 1: "the answer key says..."

Yep. That's what got Dan Quayle in trouble.

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Excuse any spelling, i'm mobile...

We will excuse it, but ONLY if you were NOT driving when typing!

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Posted (edited) · Report post

Thanks for the responses guys.

Glad to see I knew what I was talking about and not just thinking out my ass. Guess this Basic knows a few things :devilish:

Edited by UGLyEMT
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