Presentation on theme: "Epinephrine Administration by the EMT Training Module 2013"— Presentation transcript:
1Epinephrine Administration by the EMT Training Module 2013 WVOEMS Approved EducationMPCC addition of skill set and treatment options for EMT Protocol changes
2Learning ObjectivesWith successful completion of this training module, the EMT will be able to describe and/or correctly demonstrate …Epinephrine identification as a medicationIdentify steps in aseptic techniquePreparation Epinephrine for administrationAdminister Epinephrine via the IM routeEvaluate the mechanism of action and effects of Epinephrine
3EMT Utilization of Epinephrine 6501-Allergic Reaction (Anaphylaxis)6302-Respiratory Distress (Bronchospasm)In both protocols Epi can be given by an EMT with Medical Command contactAuto-injectors may be utilized in both protocols as well as IM Injection
4Key TermsAnaphylaxis - 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
5What is Epinephrine…A synthetic reproduction of the naturally occurring hormone EpinephrineReleased during “fight or flight” responsesreflex stimulation of the adrenal glandsympathetic division of the autonomic nervous system
6What is Epinephrine A catacholamine, sympathomimetic Acts on cardiovascular systemIncreases the strength of heart muscle contractionIncreases heart rateIncreases systolic blood pressureActs on respiratory systemBronchodilation
7Actions of Epinephrine Relaxes smooth muscle in the airwaysCounteracts histamine and other cytokinesRaises blood sugar levelRaises heart rate, blood pressure, and myocardial oxygen demandFor Intramuscular injection of Epinephrine…Onset of effect: 3-5 minDuration of effect: 1-4 hours
8Epinephrine Precautions DO NOT give epinephrine to these patients:ONLY hives, flushing or itchingOngoing chest painUse caution (contact Medical Command) when giving epinephrine to patients with a history of heart attack, angina, or stroke
9Epinephrine Considerations Give epinephrine with a clear history of insect bite or sting, or history of other allergyMUST have at least one of the below signs and symptoms of severe allergic reactionRespiratory TractWheezing, Stridor, Shortness of BreathSkinFacial swelling involving lips, tongue, mouth (airway involvement)CardiovascularDizziness, HR>120, BP <90, AMS
10Epinephrine Onset IM/SC, 5-15 minutes Danger: IV onset immediate, however at the 1:1000 concentration can cause arrhythmia and deathThis is the reason for drawing back on syringe prior to injection to ensure you are not in a vessel
11Side Effects of Epinephrine PalpitationsTachycardia & arrhythmiasHypertensionHeadacheTremor, weaknessPallor, sweatingNausea & vomitingNervousness & anxietyPain, redness at the injection site
12Medication Packaging Name of medication Concentration (1:1,000 or 1mg/1ml)Expiration date
13Indications for Use EMTs may administer Epinephrine for: Allergic Reaction/AnaphylaxisRespiratory Distress/Bronchospasm
14Dosage Epi Pen Auto Injector IM Injection Drawn Up Dosage: Adults mg of 1:1,000Pediatrics mg of 1:2,000Dosage:Adults mg of 1:1,000Pediatrics mg of 1:1,000Is 0.3 mg of Epi ever too much?Can you really overdose a child?
15Special 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.
16Anaphylaxis 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 GIMost common allergens: insect sting, food, medication, latexWidespread immune system response causes itching, hives & swellingMay also cause circulatory shock; tracheal and bronchial swelling resulting in asphyxia
18Allergic Reactions Range from mild to life threatening Early symptoms may be vagueClassic skin signs are urticaria, (hives)Red, itchy raised welts anywhere on the bodySwelling of face, lips, eyesSymptoms can occur seconds after exposure or up to 30 minutes
19Mild Reactions Itching Hives Redness Treatment is close observation and watching for progression of symptoms
26Intramuscular Drug Administration THE SIX “RIGHTS”Right personRight drugRight doseRight timeRight routeRight documentation
27Intramuscular Drug Administration Intramuscular sites 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.
31Needle Handling Minimize the tasks performed in a moving ambulance. Immediately dispose of used sharps in a sharps container.NEVER recap needles.
32Ampules and VialsStore epinephrine AWAY from light; leave it in its carton until ready to use. Also keep away from extreme heat and danger of freezing.VialsAmpules
33Document all information concerning the patient and medication, including: Indication for drug administrationinclude appearance, work of breathing, vitals, lung sounds, skin signs, and ability to speakDrug, dosage, and delivery sitePatient response to the medicationinclude appearance, work of breathing, vitals, lung sounds, skin signs, and changes in ability to speakboth positive and negative responses
39Draw up the MedicationUsing 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).
40ConsiderationWVOEMS 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.
45Insert the hypodermic needle into the rubber top and inject the air from the syringe into the vial.
46Withdraw 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.
47Administration Prepare the site – Insert needle at a 90 degree angle Vigorously rub an alcohol prep in a circular motionAllow to air dryUse your fingers to stretch skin and make it tautInsert needle at a 90 degree angleDraw back slightly to insure you have not cannulated a vessel.Push slow and steady until medication is administeredRemove needle and cover puncture siteDispose of needle properly
48Assessment of Medication Response Document patient’s response to treatment:LOC, behavior, breathing effort, lung sounds, skin signs, vital signs, and changes in ability to speakDocument adverse effects, if any
49The 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.Airway dilationBlood flow to skeletal muscles increasesPupils dilateBlood sugar level increasesHeart rate increasesBlood pressure increasesBreathing rate increasesEPINEPHRINE
50Document 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, BPinclude general appearance, work of breathing, lung sounds, skin signs, and ability to speak
51Always Wear PPEWear gloves and goggles when assessing the patient, preparing the medication, cleaning the site of injection, and administering the drug.
52Vastus lateralis (lateral thigh) is the approved site for administration
53Vastus lateralis (lateral thigh) is the approved site for administration Good site for all agesFar from major blood vessels & nervesMedical Command may authorize other sites
54If no significant improvement within 10 minutes, consider second dose If patient is wheezing consider, Albuterol nebulizer 2.5 mg with oxygen 8-10 LPM per order of MCPSecond dose of Epinephrine requires consultation and order of MCP. It is indicated if patient remains in moderate distress
55Equipment Size Syringe Needle Size - Adult Needle Size - Pediatric The EMT should chose a 1 cc (ml) syringeDO NOT select a 1cc (ml) insulin syringe with a subcutaneous injection needle attachedNeedle Size - AdultHypodermic needle 21 to 23 gauge1 to 1.5 inches longObese patients may require a 2 inch long needleNeedle Size - PediatricHypodermic needle 25 to 27 gauge1 inch long
56EMT Epinephrine Administration Scope: EMT Indications: Anaphylaxis (allergic reaction with respiratory distress); Bronchospasm Equipment: Epinephrine kit containing:1, 1 ml ampule of epinephrine 1:1000, 1 tuberculin syringe with needle, alcohol prep Procedure: 1. Refer to Allergic Reactions and Respiratory Distress Protocols for detailed assessment. 2. Ask patient if they have any drug allergies. 3. Confirm medication, concentration, dose and clarity of liquid in vial 4. Tap ampule to get medicine down from top, break top off ampule with gauze 2x2, place top in sharps container. 5. Draw up 0.3cc (ml) of epinephrine 1mg/ml 1:1000, syringe approximately 1/3 full. 6. Pointing syringe up, expel all air. 7. Inform patient they are going to receive an injection, side effects may include feeling shaky or heart racing. 8. Select and cleanse area for Intramuscular injection, primary is the thigh unless directed otherwise by medical command. 9. Keeping the skin taut, insert needle at 90 degrees into administration site and draw back checking for blood return. If there is blood return, select a different site, and insert needle, again check for blood return. 10. If no blood, administer 0.3 cc (ml) of epinephrine (1/3 of syringe) for any patient. 11. Discard needle properly in sharps container. 12. Observe patient for improvement or deterioration of condition. Repeat exam and vitals after each dose. 13. Document procedure, vitals and response to treatment. 14. If an additional dose is required consult Allergic Reactions and Respiratory Distress Protocols. 15. If indicated by protocol, begin again from step 5.
57Potential Pitfalls Dose Error Drug Error Drawing up epinephrine can potentially result in over or under dosingConcentration error – (1:10,000) vs (1:1000) since both drugs are availableAdministration error – epinephrine given IV instead of IM/SQDrug ErrorGiving the correct dose of the wrong drugWho stocks the EMT drugs?Potential to stock the wrong drug