Outdoor Leadership & Wilderness Medicine
EpiPen® Auto Injector
Common mistakes you should avoid
Anaphylaxis is a severe systemic allergic reaction that causes the bronchi (in the respiratory system) to constrict and blood vessels to dilate. This is a two fold assault to crucial body systems, namely the Respiratory and Circulatory systems. When a person experiences anaphylaxis it is also called an anaphylactic shock.
During an anaphylactic shock a patient is having trouble breathing which can lead to respiratory arrest (failure) as the airways start / continue to constrict allowing less air to get through for a normal breathing process. Patients start showing signs of choking as they become desperate for the air. While this is happening to the respiratory system, on the other hand blood vessels that help in transporting blood to different parts of the body & maintaining adequate blood pressure, expands in their size resulting in falling blood pressure.
This is an emergency situation which requires immediate intervention.
There is more to learn about the signs & symptoms, bodies response and treatment for anaphylaxis*. PLEASE READ DISCLAIMER.
Other signs and symptoms for anaphylaxis may also include the following but not limited to:
- – Itching
- – Hives around neck and abdomen area
- – Other complications with circulatory system
- – Persistent gastrointestinal symptoms
- – Swelling on the face
Having to manage an anaphylactic patient can add to the mental stress of leading a group especially in an outdoor setting. Once decided that a person is experiencing anaphylaxis, epinephrine is the drug that needs to be administered as soon as possible. It would be unwise to wait for symptoms to become severe. A delay in administering epinephrine may result in a fatality.
Here are some common errors people do while using an Epipen® auto injector
- – “Delay in drug administration”.
- – Very common mistakes that have been observed during administering epipen is when care providers attempt to administer without removing the safety cap.
- – Removing safety cap but not applying the pressure required to unload the spring to get the needle out of the housing.
- – Placing their thumb on the needle end. This can be lethal for the care provider also.
- – Administering the medication to someone who does not show symptoms of anaphylaxis.
- – Giving prescribed medication to someone else.
Knowing the 5 rights
Prior to administering an Epipen® auto injector. Run down a check list of five simple questions. This is a helpful medium to reduce chances of an error.
- – Right patient
- Ask yourself if this is the right patient?
- She or he is showing the right symptoms for the medication. Are they allergic to the medication?
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- Is the medication prescribed to this patient?
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- – Right drug
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- Is this the right drug for the signs & symptoms I am observing?
- Are there any granular forming or discoloration in the medication?
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- – Right time
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- Is this medication within the expiry date?
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- – Right dose
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- What is the right dose for the medication? In an auto injector epipen it is already determined.
- Is this the right dose for the patient based on symptoms?
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- – Right route
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- Which route should I use to administer this medication?
- Intra Vein, IntraMuscular, Orally, Sublingually, Topical, are some of the mediums to administer.
- Epipen auto injector is administered IntraMuscularly. Continue reading
Administering Epipen® Auto Injector
Once you have checked 5 rights, the patient’s signs and symptoms meet the criteria and it’s time to administer the drug. Most important, do not panic or withhold the medication. Epipen® auto injector is administered IntraMuscularly. Preferably on the mid outer thigh, left or right. (vastus lateralis muscle).
Caution: Please note that the Epipen is a registered brand. You or your client might have a different make and it may not have the colors mentioned above. We strongly advise that you familiarise yourself prior to having the need to use. Epinephrine can also be purchased in a vial.
Steps
- 1. Hold the Epipen® auto injector in your hand with a firm grip as shown in the picture. You may also ask the patient to hold if they are able to. Do not put your or patient’s thumb or fingers on either end of the Epipen® auto injector.
- 2. Remove the blue safety tab.
- 3. Now with the orange end facing the outer (lateral) thigh, bring theEpipen® auto injector closer. Check that there is no object e.g. key chain, mobile phone, writing pad etc in the pocket, at the administration site.
“If possible pull the pants up or cut open the fabric and administer at skin level”
- 4. Apply gentle pressure while pushing the Epipen® auto injector towards the thigh, you will hear a click sound. This means that the needle has ejected from the covering.
- 5. Now while holding the Epipen® auto injector to its position, start counting for 10 seconds. Remember each drop of this medication is crucial for reversing the adverse effect.
- 6. After 10 seconds remove the Epipen® auto injector and be careful with the needle. Pack the used Epipen® auto injector in a hard sharps container and mark it with biohazard. Dispose off the biohazard container properly.
How it works
The EpiPen® auto injector contains a drug called epinephrine. Epinephrine are hormones that help in reversing bronchoconstriction and vasodilation.the airways begin to open, raising blood pressure, stimulating the heart, reversing hives, and reducing swelling of the mucous membrane.
You should be planning to call an ambulance or take this person to a definitive medical care. The patient would experience another anaphylactic shock. In which
case you are left with less resources to respond and manage your patient.
Conclusion
Anaphylaxis or anaphylactic shock is a life threatening condition causing constriction of the airway and dilation of the blood vessels. It’s a dual assault to two of the crucial body systems. If left untreated, it may lead to a fatality, hence it requires immediate intervention.
To treat anaphylaxis, epinephrine is the go to drug. Epinephrine is available as auto injectors as well as in vials. Additional training may be required to administer an injection. Once sure that a person is experiencing anaphylaxis, administer epinephrine and start working towards taking the patient to medical care.
Author – Amit Arora, Outdoor Leadership & Wilderness Medicine Educator
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