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.
Having personally experienced this scenario, you go with IM as your first response. My husband took me to the ER door and the doctor was waiting there with the injection. I received the injection at the same time we were getting out of the car. Yes we drove, we were in a small time with a volunteer ambulance and about 10 blocks to the hospital. Hubby called Dr., called someone to watch the kids and we left speeding those few block. It would have taken longer to wait for the ambulance there.
Specializes in Adult and Pediatric Vascular Access, Paramedic.
Epi IM!
Epi 1,10,000 IV should only be given in cardiac arrest IVP or as an IV drip for those suffering from anaphylaxis refractory to repeat doses of IM Epi 1:1,000.
IVP Epi in a living person would make them feel very sick, or worse kill them!
Specializes in EMT since 92, Paramedic since 97, RN and PHRN 2021.
I have personally given IV Epi to a living person.
Basically I was the 911 medic, guy gets stung by a bee, when I get there he is walking and talking, seems ok. Get him in the truck, get an IV, gave 50 of Benadryl, 1/2 way to the hospital the guy goes south. Visible welts start popping all over. He turns white as a ghost and his extremities got cold, fast.
I called command for orders. I tell the doctor what I have and what I want to do, I wanted to give .3mg Epi IV. My reasoning was he was shunting all of his blood and I didn't want the Epi to just sit in his skin .
The doctor ok's, I give the Epi, the guy says"I don't feel good".
I then watch as the welts subside and his color comes back.
Two good things happened because I gave IV Epi, first is he survived a most severe anaphylactic reaction and second, because I gave the Epi they did a stress test on him and found underlying conditions that he wouldn't have found until it was too late.
IVP Epi in a living person would make them feel very sick, or worse kill them!
Anni
I know that it is written so in the book. It is also so that Epipens are still generally not existing for about 1/3 of the World, together with US emergency care protocols. People with allergies in these countries get Epinephrine IV first thing in the field. Yes, it causes unpleasant side effects like palpitations. Yes, it can provoke tachyarrythmias (although, according to Franc-Starling effect, simultaneous delivery of fluids partially counteracts it). Yes, it can (very much potentially) kill someone with heart and brain vessels already failing long and hard, but such patient has a flimsy chance to survive a full -blown anaphylaxis anyway.
I was living for 27 years in just such country with critically severe allergies and therefore had IV Epinephrine/adrenaline dozens of times, just like all other unfortunate fellows there. I was saved by these shots. Nobody died from the injection, although the predicted life span for those diagnosed as children in 1980 th was about a year from first anaphylaxis, because so many parents refused to learn to do IV injections on their own children and the adrenaline itself was difficult to get.
The last time I got it IV on the spot was in 2008 in Japan. I had pressure 60/20 something and Japanese paramedics shot Epi IV first, then used my own second shot IM along with Ringer running wide.
quiltynurse56, LPN, LVN
953 Posts
Having personally experienced this scenario, you go with IM as your first response. My husband took me to the ER door and the doctor was waiting there with the injection. I received the injection at the same time we were getting out of the car. Yes we drove, we were in a small time with a volunteer ambulance and about 10 blocks to the hospital. Hubby called Dr., called someone to watch the kids and we left speeding those few block. It would have taken longer to wait for the ambulance there.