How To Administer Epinephrine
Epinephrine auto-injectors MUST be carried by anyone who is at risk of a severe allergic reaction (anaphylaxis). Why? Because epinephrine is the only *life-saving* drug that treats the symptoms of anaphylaxis. It is essential that Food Allergic individuals and their families, friends and caregivers are trained on how to use it during an emergency.
There are several different epinephrine auto-injectors available – Mylan EpiPen and Mylan Generic (Teva), Mylan EpiPen Jr., Auvi-Q, and Adrenaclick, just to name a few. These auto-injectors have different steps for use, but they all contain a needle that administers the medicine when activated. We highly suggest you get a trainer auto-injector that allows you to practice by walking you through how to use it, step by step. Most epinephrine auto-injector prescriptions come with a trainer.
Instructions for EpiPen:
Take the epinephrine auto-injector out of its package.
Remove the blue safety cap.
Hold the auto-injector in your fist. The needle comes out of the orange end, so be careful not to hold your hand over the end. *Remember, “Blue to the sky. Orange to the thigh”
Push the end with the needle firmly against the side of the thigh, about halfway between the hip and knee. Inject the medicine into the fleshy outer portion of the thigh. Do not inject into a vein or the buttocks.
You can give the injection through clothes or on bare skin.
Hold the auto-injector in place until all the medicine is injected—usually no more than 3 seconds.
Remove the needle by pulling the pen straight out. A protective shield will cover the needle as soon as it is removed from the thigh. Put the injector back into its safety tube. Give it to EMS when they arrive.
Instructions for Auvi-Q: (The Auvi-Q has automated audio instructions)
Pull Auvi-Q out of the case.
Pull the red safety guard off – the needle will come out of the black end.
Place the black end firmly against the side of the thigh, about halfway between the hip and knee. Inject the medicine into the fleshy outer portion of the thigh. Do not inject into a vein or the buttocks. Hold the leg firmly in place before and during the injection.
You can give the injection through clothes or on bare skin.
Hold the auto-injector in place for the 2 second countdown.
Remove the needle by pulling the Auvi-Q straight out. A protective shield will cover the needle as soon as it is removed from the thigh. Put the Auvi-Q back into its case. Give it to EMS when they arrive.
Instructions for Adrenaclick:
Pull off the gray caps off both ends. The needle will come out of the red tip.
Place the red tip firmly against the side of the thigh, about halfway between the hip and knee. Inject the medicine into the fleshy outer portion of the thigh. Do not inject into a vein or the buttocks. Hold the leg firmly in place before and during the injection.
You can give the injection through clothes or on bare skin.
Hold the auto-injector in place for 10 seconds.
Remove the needle by pulling the Adrenaclick straight out. If the needle is exposed, then the dose was given. If the needle is not exposed, repeat steps 2-4.
Put the Adrenaclick back into its case. Give it to EMS when they arrive.
Where Should Epinephrine Be Injected?
Epinephrine is supposed to be administered into the outer thigh. But... why the thigh? Why not the arm like most other shots?
Per doctors, epinephrine is recommended to be given into the muscle. This is because the administration of epinephrine into the muscle will provide a more rapid increase in its concentration in the blood and tissues, compared to being administered into subcutaneous tissue. And during an anaphylactic reaction, the fast uptake of epinephrine is critical. Also, the thigh muscle is one of the body's largest muscles with good blood supply. Because of this, it allows faster absorption of the medication — epinephrine.
When dealing with a life-threatening anaphylactic reaction, time is of the essence. You need the speed because if it's too slow, a life may be lost before adequate epinephrine levels are achieved. And this is where the thigh muscle comes in. It provides the speed for the injection to do its work.
What Is the Correct Positioning of the Body During Anaphylaxis?
Correct positioning of the body is extremely important in anaphylaxis. Prevailing medical advice is that you should lie down with legs elevated when experiencing a severe reaction and administering epinephrine, AND remain lying down, especially after administering.
Case research has highlighted the potential for a change in posture (like going from sitting or lying, to standing) to trigger decompensation and a fatal event in some patients. In fact, fatality can occur within seconds if the person sits or stands suddenly. If you are having trouble breathing, you can sit with lower limbs elevated if it improves comfort. Why?
A possible mechanism suggests itself to explain a striking pattern of sudden deaths after a change to a more upright posture. During anaphylactic shock, the capacity of the veins and capillaries expands greatly. While a shocked person is lying down, sufficient blood might return to the vena cava (vein carrying blood to the heart) to maintain a reduced circulation, but on the person sitting up or standing, this venous return stops. The vena cava will then become empty within seconds.
There is then no flow through the right side of the heart, and within a few seconds more, no blood will return to the left side of the heart from the lungs. Pulseless electric activity continues, but in the absence of left ventricular filling there can be no contractions; this prevents coronary arterial flow and leads to myocardial ischemia (when the heart is not getting enough blood).
If this hypothesis is correct, once the vena cava (vein carrying blood to the heart) is empty, epinephrine—no matter where or how it is given—could not circulate and so could not reverse the shock; nor could external cardiac massage reestablish the circulation if there is no blood in the vena cava.
*** This information is based on our non-medical professional insight & research. As always, please consult your doctor and allergist with specific questions relating to your #foodallergy protocols.
Sources:
jacionline.org/article/S0091-6749(03)90000-5/pdf (See Myth 9)
firstaidforlife.org.uk/anaphylactic-shock-acute-allergic-reaction/
