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Epinephrine Administration by the EMT Training Module 2013

Epinephrine Administration by the EMT Training Module 2013. WVOEMS Approved Education MPCC addition of skill set and treatment options for EMT Protocol changes 02-01-2013. Learning Objectives.

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Epinephrine Administration by the EMT Training Module 2013

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  1. EpinephrineAdministration by the EMT Training Module 2013 WVOEMS Approved Education MPCC addition of skill set and treatment options for EMT Protocol changes 02-01-2013

  2. Learning Objectives With successful completion of this training module, the EMT will be able to describe and/or correctly demonstrate … • Epinephrine identification as a medication • Identify steps in aseptic technique • Preparation Epinephrine for administration • Administer Epinephrine via the IM route • Evaluate the mechanism of action and effects of Epinephrine

  3. EMT Utilization of Epinephrine • 6501-Allergic Reaction (Anaphylaxis) • 6302-Respiratory Distress (Bronchospasm) • In both protocols Epi can be given by an EMT with Medical Command contact • Auto-injectors may be utilized in both protocols as well as IM Injection

  4. Key Terms Anaphylaxis- a life-threatening, hypersensitivity reaction of the immune system Aseptic technique - a procedure performed under sterile conditions Asphyxia - suffocation as a result of blockage of the airway Dyspnea - labored or difficult breathing Epinephrine- a hormone released from the adrenal glands that activates several tissues in the “fight-or-flight” response Histamine - one of several chemical messages released from immune cells that promote inflammation as a defense mechanism Intramuscular - a medication route by injection into the belly of a muscle which encourages rapid transport by the bloodstream Shock - a severe reduction in blood pressure (by any cause) that results in inadequate blood flow (oxygen & glucose) to tissues

  5. What is Epinephrine… • A synthetic reproduction of the naturally occurring hormone Epinephrine • Released during “fight or flight” responses • reflex stimulation of the adrenal gland • sympathetic division of the autonomic nervous system

  6. What is Epinephrine • A catacholamine, sympathomimetic • Acts on cardiovascular system • Increases the strength of heart muscle contraction • Increases heart rate • Increases systolic blood pressure • Acts on respiratory system • Bronchodilation

  7. Actions of Epinephrine • Relaxes smooth muscle in the airways • Counteracts histamine and other cytokines • Raises blood sugar level • Raises heart rate, blood pressure, and myocardial oxygen demand For Intramuscular injection of Epinephrine… Onset of effect: 3-5 min Duration of effect: 1-4 hours

  8. Epinephrine Precautions • DO NOT give epinephrine to these patients: • ONLY hives, flushing or itching • Ongoing chest pain • Use caution (contact Medical Command) when giving epinephrine to patients with a history of heart attack, angina, or stroke

  9. Epinephrine Considerations • Give epinephrine with a clear history of insect bite or sting, or history of other allergy • MUST have at least one of the below signs and symptoms of severe allergic reaction • Respiratory Tract • Wheezing, Stridor, Shortness of Breath • Skin • Facial swelling involving lips, tongue, mouth (airway involvement) • Cardiovascular • Dizziness, HR>120, BP <90, AMS

  10. Epinephrine Onset • IM/SC, 5-15 minutes • Danger: • IV onset immediate, however at the 1:1000 concentration can cause arrhythmia and death • This is the reason for drawing back on syringe prior to injection to ensure you are not in a vessel

  11. Side Effects of Epinephrine • Palpitations • Tachycardia & arrhythmias • Hypertension • Headache • Tremor, weakness • Pallor, sweating • Nausea & vomiting • Nervousness & anxiety • Pain, redness at the injection site

  12. Medication Packaging • Name of medication • Concentration (1:1,000 or 1mg/1ml) • Expiration date

  13. Indications for Use EMTs may administer Epinephrine for: • Allergic Reaction/Anaphylaxis • Respiratory Distress/Bronchospasm

  14. Dosage • Epi Pen Auto Injector • IM Injection Drawn Up Dosage: Adults- 0.30 mg of 1:1,000 Pediatrics- 0.15 mg of 1:2,000 Dosage: • Adults- 0.30 mg of 1:1,000 • Pediatrics- 0.30 mg of 1:1,000 • Is 0.3 mg of Epi ever too much? • Can you really overdose a child?

  15. Special Considerations SPECIAL CONSIDERATIONS Assessment 1. Known or suspected exposure to allergen. Sting? If unclear contact base. 2. History of allergic reactions 3. Medication use prior to arrival. AnaGuard/Epi-pen, Benadryl? 4. PMH: heart disease, stroke, hypertension? 5. Medications: Beta-blockers (atenolol, propranolol)? May block effects of epinephrine 6. Vital signs including mental status 7. Respiratory status: Airway swelling? Wheezes? Stridor? Medication Issues Use epinephrine with caution in the following patients (contact base when possible but do not withhold if patient in severe distress and base contact cannot be made easily): Over 70 years of age History of heart disease, stroke or hypertension. Taking a beta-blocker (example: atenolol, propranolol) Transport Priorities: Any patient with signs or symptoms of a severe reaction requires immediate evacuation. Consider helicopter and/or rendezvous with higher level of care unless symptoms responding well to therapy.

  16. Anaphylaxis is an over-reaction of the Immune System • Sudden, severe allergic reaction involving the whole body (systemic) • multisystem involvement, including the skin, airway, vascular system, and GI • Most common allergens: insect sting, food, medication, latex • Widespread immune system response causes itching, hives & swelling • May also cause circulatory shock; tracheal and bronchial swelling resulting in asphyxia

  17. Allergic Reactions • Range from mild to life threatening • Early symptoms may be vague • Classic skin signs are urticaria, (hives) • Red, itchy raised welts anywhere on the body • Swelling of face, lips, eyes • Symptoms can occur seconds after exposure or up to 30 minutes

  18. Mild Reactions • Itching • Hives • Redness • Treatment is close observation and watching for progression of symptoms

  19. Severe Reactions • Respiratory Tract • Skin • Cardiovascular

  20. Respiratory Tract Signs and Symptoms • Wheezing • Upper airway noisy breathing (stridor) • Chest and throat tightness • Shortness of Breath • Nasal congestion* • *alone does not indicate a severe reaction

  21. Skin – Signs and Symptoms • Facial Swelling • Involving lips, tongue, mouth (airway involvement) • Redness* • Hives* • Itching* • *alone does not indicate a severe reaction

  22. Cardiovascular Signs and Symptoms • Decreased Blood Pressure (<90) • Increased Heart Rate (>120) • Severe Dizziness • Fainting • Decreased Mental Status • confusion, lethargy, coma

  23. EMT Treatment • Ensure an open airway • Administer oxygen • History and Physical • Vital signs • Epinephrine

  24. Intramuscular Drug Administration

  25. Intramuscular Drug Administration THE SIX “RIGHTS” • Right person • Right drug • Right dose • Right time • Right route • Right documentation

  26. Intramuscular Drug Administration Intramuscularsites allow a drug to be injected into the belly of a muscle so that the blood vessels supplying that muscle distribute the medication to its site of action via the bloodstream. First steps: • Prep the site with approved antiseptic by scrubbing vigorously and allowing to dry. DO NOT TOUCH, BLOW ON OR FAN THE INJECTION SITE! • Align the syringe and needle above the injection site at a 90 degree angle, with the bevel of the needle facing up. NOTE: IM Injections CANNOT be administered through clothing as the auto-injectors could.

  27. 90º Intramuscular Drug Administration

  28. Administration Sites

  29. Deltoid Dorsogluteal Ventrogluteal Vastus lateralis

  30. Needle Handling • Minimize the tasks performed in a moving ambulance. • Immediately dispose of used sharps in a sharps container. • NEVER recap needles.

  31. Ampules and Vials Store epinephrine AWAY from light; leave it in its carton until ready to use. Also keep away from extreme heat and danger of freezing. Vials Ampules

  32. Document all information concerning the patient and medication, including: • Indication for drug administration • include appearance, work of breathing, vitals, lung sounds, skin signs, and ability to speak • Drug, dosage, and delivery site • Patient response to the medication • include appearance, work of breathing, vitals, lung sounds, skin signs, and changes in ability to speak • both positive and negative responses

  33. Obtaining Medication from a Glass Ampule

  34. Common Packaging of Epinephrine • Medication name • Dosage (1:1,000 or 1mg/1ml) • Expiration date • Not cloudy; no color or precipitate

  35. Hold the ampule upright and tap its top to dislodge any trapped solution.

  36. Place Gauze around the neck

  37. Snap off the Top

  38. Draw up the Medication Using a 1cc syringe, insert the needle into the ampule and draw the plunger back on the syringe until you reach the correct dosage (0.30cc).

  39. Consideration • WVOEMS does not require the use of a filtered needle when drawing from an ampule. • Individual squads may have policies in place that require the use of a filtered needle. Please refer to your squad training officer.

  40. Obtaining Medicationfrom a Vial

  41. Epinephrine in a Vial • Medication name • Dosage (1:1,000 or 1mg/1ml) • Expiration date • Not cloudy; no color or precipitate

  42. Prepare the syringe andhypodermic needle

  43. Clean the vial’s rubber top

  44. Insert the hypodermic needle into the rubber top and inject the air from the syringe into the vial.

  45. Withdraw the appropriate volume of medication Using a 1cc (ml) syringe, insert the needle into the vial or ampule, draw the plunger back on the syringe until you reach 0.3cc (ml) mark on the syringe.

  46. Administration • Prepare the site – • Vigorously rub an alcohol prep in a circular motion • Allow to air dry • Use your fingers to stretch skin and make it taut • Insert needle at a 90 degree angle • Draw back slightly to insure you have not cannulated a vessel. • Push slow and steady until medication is administered • Remove needle and cover puncture site • Dispose of needle properly

  47. Assessment of Medication Response Document patient’s response to treatment: • LOC, behavior, breathing effort, lung sounds, skin signs, vital signs, and changes in ability to speak • Document adverse effects, if any

  48. The body’s stress response causes the normal release of epinephrine to maintain homeostasis during vigorous activity: “fight or flight”. These same actions of epinephrine counteract e.g. the bronchoconstriction and low blood pressure of anaphylaxis when administered by medical personnel. EPINEPHRINE

  49. Document Vital Signs before and after treatment with Epinephrine Because epinephrine is expected to cause widespread changes in function, it is important to frequently monitor and document vital signs: • HR, RR, BP • include general appearance, work of breathing, lung sounds, skin signs, and ability to speak

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