HF-EMS Posted January 31, 2006 Share Posted January 31, 2006 Hi guys, I was recently talking to my med control physician when he mentioned a study he had just read saying that in the prehospital care and tx of anaphylaxis, the initial dose of .5 epinephrine could be given IM as opposed to SQ. What have you guys seen/heard, or have any of you tried it? Link to comment Share on other sites More sharing options...
DwayneEMTP Posted January 31, 2006 Share Posted January 31, 2006 Am I missing something or isn't the Epi-pen IM? Do Medics give it subQ? Link to comment Share on other sites More sharing options...
HF-EMS Posted January 31, 2006 Author Share Posted January 31, 2006 yeah, the initial dose, atleast in my region is .5mg, SQ usually followed by IM Benadryl and IV solu-medrol(with a physicians orders for the steroid) Link to comment Share on other sites More sharing options...
DwayneEMTP Posted January 31, 2006 Share Posted January 31, 2006 Oooops....sorry....I forgot I was in the ALS forum Link to comment Share on other sites More sharing options...
Dustdevil Posted January 31, 2006 Share Posted January 31, 2006 Anaphylaxis, yes. IM because if they are already in anaphylaxis, the sub Q circulation is already compromised to the point that absorption will be seriuosly delayed, if not almost prevented. Consequently, IM or IV is the way to go. I have seen anaphylaxis patients given a couple subQ epi's with no improvement. Then when they got IM or IV epi, their circulation came back to normal, dumping a milligram or more of epi rapidly into their now normotensive system. Not good. Especially in an older patient. For that reason, SQ is strongly discouraged in anaphylaxis. Link to comment Share on other sites More sharing options...
AZCEP Posted January 31, 2006 Share Posted January 31, 2006 Sub Q epi will only work if it is given early in the process. When the patient starts to tell you that their tongue feels funny, give the epi. If you wait any, the sub Q dose will be a waste of time. Anyone over ~40 or with cardiac history, we need to contact medical control, but if things look bad, a little epi before they code, or a lot after they do. Link to comment Share on other sites More sharing options...
nsmedic393 Posted January 31, 2006 Share Posted January 31, 2006 Up until recently, our BLS providers gave their doses of epi 1:1000 sub-q and all other level providers gave it IM or IV. For the reasons dust stated everyone has been inserviced to give it IM. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted January 31, 2006 Share Posted January 31, 2006 Personally, I think I have only given epi 3 or 4 times in the field. I have found there is very rarely times, I have ever seen it needed. Most of the time I have seen an adverse effects, or mild allergic reactions. Using H2 blockers and steroid, is routinely successful. Yes, epi is exceptional in true anaphylaxis, if this is the case, I prefer IV route. Since, one should already have an access, with fluids as well. Be safe, R/R 911 Link to comment Share on other sites More sharing options...
pmedic623 Posted January 31, 2006 Share Posted January 31, 2006 Since, one should already have an access, with fluids as well. Be safe, R/R 911 Good point........... Link to comment Share on other sites More sharing options...
Airmedic999 Posted January 31, 2006 Share Posted January 31, 2006 We have always given it IM, however, we also give it IV from time to time incrementally ... Link to comment Share on other sites More sharing options...
Recommended Posts