Epinephrine IV or IM in this situation.

[JuliusSeizure]

A patient comes in to the urgent care center and states that she has been stung by a bee. She complains of shortness of breath and dizziness. She is pale and loses consciousness in the waiting room. The receptionist screams for help and calls 911. The nurses recognizes that which of the following medications should be considered first?

A.) Diphenhydramine (Benadryl)

B.) Phenytoin (Dilatin)

C.) Epinephrine IV

D.) Epinephrine IM

It looks like an emergency situation to me, so naturally I would go with IV for fastest route, but the issue here is, does she have an IV site? If not I go with IM.

[guest769224]

D.) Epi IM

Muscles have adequate vasculature for a quick absorption rate.

It really depends on how quickly IV access could be established, though. If she has an existing IV, that's the answer, even considering the event of extravasation.

[Rose_Queen, BSN, MSN, RN]

This would require rescue epinephrine. How do many who have anaphylactic allergies deal with them? What are they prescribed and how is it administered?

[JustBeachyNurse, LPN]

Think EpiPen. It works rapidly. Since no IV established it would waste time starting an IV with possibly collapsing vasculature and dropping BP that can occur with anaphylaxis

[emtb2rn, BSN, RN, EMT-B]

IV epi using im concentration epi is gonna cause some problems. And chu gonna have some 'splainin' to do.

[Jolie, BSN]

Think EpiPen. It works rapidly. Since no IV established it would waste time starting an IV with possibly collapsing vasculature and dropping BP that can occur with anaphylaxis

This!

Remember that Epi is a short-acting drug, and that the duration of effect of the bee sting may out last the duration of action of the Epi-Pen. Once the Epi-Pen is given and effects are seen, you would begin IV insertion for follow-up doses of Epi, Benadryl and Steroids that will be necessary to stabilize the patient over the longer term.

This

[BeachsideRN, ASN]

IM. She's in urgent care and has no IV access established. Fastest route to prevent anaphylaxis is IM. Hence why patients with known allergies are given Rx for self administered IM epi (epi pen, auviq)

[KatieMI, BSN, MSN, RN]

In theory, IM through EpiPen. It takes exactly 5 seconds to get the drug working. Plus, excruciating pain from this injection adds stress responce (seriously, it hurts like ****, and it is right the case when pain is good). In the next 5 minutes, one can get an IV and start fluids, steroids and antihistamines.

It is true that Epi us a short acting thing, that's why it is prescribed in two syringes pack, and more experienced patients usually carry double packs.

In practice, though, the question is more interesting. I was asked more than once how epinephrine is supposed to work when there is no systemic blood pressure to speak of and therefore no circulation to bring the drug to the bloodstream. From my personal experience, in case of primary systemic reactions (the rare and extremely dangerous kind when massive surge of histamine and mediators causes critical drop of blood pressure within one or two minutes, and death from cardiac arrest within next 3 to 5 minutes, with respiratory and other symptoms just not yet developing) EpiPen is much less effective.

I would rather be careful with IV epinephrine in the field and without good monitoring of vitals. The dramatic surges of blood pressure are known to cause strokes on more aged patients, and 0.3 mg of Epipen is quite a dose to be given as a quick push.

[SoldierNurse22, BSN, RN]

Unless the patient walks in with an IV already established, you're going the IM route.

This is an emergency. You're not going to take the time to establish an IV while the patient's airway closes off, especially when you have an effective IM treatment that can be given immediately.

[KelRN215, BSN, RN]

Because this patient is in an urgent care center with no IV access, the answer is IM. An EpiPen would be the fastest way to get epinephrine into the patient. If a patient in the hospital with existing IV access starts to anaphylax, you administer the Epi IV.

[emtb2rn, BSN, RN, EMT-B]

Why is epi IV being discussed for anaphylaxis? That route as a push is reserved for the dead guy.

[BuckyBadgerRN, ASN, RN]

Well, as we know, IM is the answer. I just hope to high heaven that the patient isn't allergic to epinephrine, because you know, lots of people are!