Epinephrine Auto-injectorAnnual Refresher

Shock (Hypo-perfusion)Shock (Hypo-perfusion)

Inadequate perfusion of the body’s organs

Caused by three general processes

1. Organ failure2. Hypovolemia3. Vasodilation

Assessment based on signs & symptoms

AAAALLERGIC REACTIONSLLERGIC REACTIONSLLERGIC REACTIONSLLERGIC REACTIONS Some substances known as allergens set off an exaggerated response in the body’s immunesystem. 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.

Common Sources of AllergensCommon 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)

Patients with Allergic ReactionSIGNS 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

AssessingAssessing

VVITAL SIGNSITAL SIGNS

PulsePulse

RespirationsRespirations

Blood PressureBlood Pressure

Mental StatusMental Status

PupilsPupils

Skin ConditionSkin Condition

PulsePulse

RespirationsRespirations

Blood PressureBlood Pressure

Mental StatusMental Status

PupilsPupils

Skin ConditionSkin Condition

Allergic Reaction…MildAllergic Reaction…Mild

Itching, tearing and swelling around

eyes Dizziness Hives, welts localized on certain areas

of the skin Nausea, vomiting, abdominal pain

Epinephrine is not indicated

Allergic Reaction…SevereAllergic Reaction…Severe

Wide spread hives Feeling of constriction in the throat or

chest Difficulty breathing, wheezing Difficulty swallowing Sense of impending doom Tachycardia

Epinephrine may be indicated

Allergic Reaction…AcuteAllergic Reaction…Acute

Reduced blood pressure Cyanosis, difficulty in breathing or absence

of breathing Vascular collapse Incontinence Unconsciousness or death may occur if

anaphylactic shock not treated

Epinephrine is indicated

EpinephrineEpinephrine

Medication Profile

EpinephrineEpinephrine

Contraindications

Actions

Side-effects Anxiety, palpitations, chest pain(rare) irregular heart beat (dysrhythmias)

Names: Generic (brand) Epinephrine (Adrenalin ; names of auto-injectors (Epi-Pen , EpiPen Jr. )

None in life-threatening situation

Dilates bronchioles; constrictsblood vessels

Dosage Adult: 0.3 mg injected subcutaneouslyChild: 0.15 mg injected subcutaneously

Severe allergic reactionsIndications

Indications…EpinephrineIndications…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.

ContraindicationsContraindications

Known heart disease, Epinephrine use prior to EMS arrival, Ages < 5 yrs. & >55

yrs., AED or SAED unavailable at patient’s side

Circumstances in which you should NOT administer epinephrine

to a patient

ActionsActions

INTENDED EFFECTS of epinephrine

EpinephrineProduced by the adrenal gland

(Dilates Bronchioles, Constricts Blood Vessels)

Example...

Side-EffectsSide-Effects

UNINTENDED EFFECTS of epinephrine

Epinephrine(Anxiety, Palpitations, Chest Pain)

Example...

Administering Epinephrine via an Auto-injectorAdministering Epinephrine via an Auto-injector

Infant/child0.15 mg.

>30 lbs. <60 lbs.

Adult0.3 mg. >60 lbs.

Auto-injectorsDose

If the patient has a“Prescribed” Auto-Injector:If the patient has a“Prescribed” Auto-Injector:

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.

Emergency care (off-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

Emergency care (on-line medical control)

If the patient hasNo “Prescribed” Auto-Injector:If the patient hasNo “Prescribed” Auto-Injector:

Transport immediately. Remove constricting clothing from

fingers, wrists, or neck. Perform ongoing assessment.

Document changes in condition.

No “Prescribed” Auto-injector(continued)No “Prescribed” Auto-injector(continued)

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.

Ongoing AssessmentOngoing Assessment

Emergency care

Transition of CareTransition of Care

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.

Relay to Paramedic or ED Staff: