Questions regarding epinephrine.

Specialties Emergency

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I have spent a long time online searching for the route on how to give epi. Today during my PALS class I was informed that it can only be given IM, IV, or endotracheally. But my nursing pharmacology textbook says the routes are SC, IV, or PO (which I assume is via the ETT).

Online I found some websites with conflicting info.

Basically I want to know the emergency routes for epinephrine when someone needs it in case of shock (cardiogenic, anaphylactic, etc.).

Also, is the Epipen IM or SC? I searched and it said to inject into the "fleshy" part of the thigh. Very vague!

Also, I give flu shots this season and was informed that in case of an anaphylactic reaction, we are to give epi SC behind the arm.

Someone please clarify!

Thanks.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
I have spent a long time online searching for the route on how to give epi. Today during my PALS class I was informed that it can only be given IM, IV, or endotracheally. But my nursing pharmacology textbook says the routes are SC, IV, or PO (which I assume is via the ETT).

Online I found some websites with conflicting info.

Basically I want to know the emergency routes for epinephrine when someone needs it in case of shock (cardiogenic, anaphylactic, etc.).

Also, is the Epipen IM or SC? I searched and it said to inject into the "fleshy" part of the thigh. Very vague!

Also, I give flu shots this season and was informed that in case of an anaphylactic reaction, we are to give epi SC behind the arm.

Someone please clarify!

Thanks.

Hello, Mithrah,:balloons:

Epi is given IV, ET, or IO in PALS. The epi pen is subq. Never seen it given PO (by mouth).

For the flu shot anaphylaxis, yes, given SC.

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Specializes in Burn/Trauma ED.

To elaborate:

For cardiogenic shock it is almost always given IV or down the ET. Anything else is too slow. Usual dose is 1 mg. (I don't know about PALS dosing though.)

As an aside, it can also be given IC (intra-cardiac) but I don't think people do that anymore... Except in the movies.

For anaphylaxis it is usually given SC in the field. Epi-pins are designed to be used by lay folk and thus have really short needles that won't usually get into muscle tissue. In the hospital you can give it IM or IV depending on how fast you need/want it to work and what kind of access you have. Normal dose is 0.1 to 0.5 mg and 0.3 mg is pretty popular.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

PALS epi dose: 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution IV or IO.

......or,......0.1 mg/kg (0.1 mL/kg of 1:1000 solution (high dose) by trachel route.

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Specializes in ER.
I have spent a long time online searching for the route on how to give epi. Today during my PALS class I was informed that it can only be given IM, IV, or endotracheally. But my nursing pharmacology textbook says the routes are SC, IV, or PO (which I assume is via the ETT).

Online I found some websites with conflicting info.

Basically I want to know the emergency routes for epinephrine when someone needs it in case of shock (cardiogenic, anaphylactic, etc.).

Also, is the Epipen IM or SC? I searched and it said to inject into the "fleshy" part of the thigh. Very vague!

Also, I give flu shots this season and was informed that in case of an anaphylactic reaction, we are to give epi SC behind the arm.

Someone please clarify!

Thanks.

It all depends on why you are giving the epinepherine.

You can give it IV/IO push, IV/IO drip, ET, or SQ.

IV/IO push is usually in cardiac arrest. However, allergic reaction can also be treated with Epi IV/IO push.

IV drip is usually for bradycardia.

ET is for cardiac arrest.

SQ is usually for allergic reaction, but it can also be mixed with lidocaine to maintain homeostasis when suturing (but never on the fingers and toes!).

PO is not the same as ET. I cannot think of a reason to give Epi PO, nor do I think that you can get an appropriate elixir or tablet.

The Epipen is usually SQ, but it is not a problem if it turns out to be IM.

Good luck.

Chip

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Also, with ET you need to make sure you are bagging well and providing good PEEP, positive end expiratory pressure to help facillitate transferance across the alveolar membrane and into the blood.

SQ vs. IM - Muscles are much more vascular than subcutaneous tissue. Epi pens and normal SQ injections are given with the idea that you will have a more sustained release into the system thus mitigating the potential for a short relief of symptoms that arise again. If the Epi is given IM it is taken into the blood very quickly and metabolized quickly. Remember in ACLS epi is given every 5 minutes or so.

Hope that helps.

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And dont forget racemic epi via nebulizer.

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Specializes in ER.
And dont forget racemic epi via nebulizer.

You're dating yourself!

Chip

P.S. Anyone else remember susphren?

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Still see racemic epi fairly often, esp in the peds ED. The EpiPen is meant to be IM, not SQ. Although I'm sure it ends up SQ pretty often.

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Specializes in Emergency Nursing Advanced Practice.
PALS epi dose: 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution IV or IO.

......or,......0.1 mg/kg (0.1 mL/kg of 1:1000 solution (high dose) by trachel route.

The ET dose is not really considered a "high dose" as in "high dose epi" (HDE).

True high dose epi is 0.1mg/kg of 1:1000 given IV. We use this same dose for ETT delivery because so little of it actually gets absorbed in to the vascular system.

Also, you can give an injection of epi into the sublingual tissue in case of severe angioedema of the mouth and tongue.

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