How to use epi pen?

[Iwander]

This is a rather dumb question. But, for you school or pediatric office nurses, if you have to use an epi pen on a patient, I have a few questions: 

Do you go straight through their clothes like you would educate in a nonclinical setting, or do you bother to pull their pants down first?

What symptoms do they have to have to give it, like, are a couple coughs, one sneeze, etc mild enough symptoms to wait or do you still give it? 

I'm trying to figure this out so that when I am in a clinical setting, I know when to give the epi pen vs not. Also whether to undress them or to just go through the clothes. 

[MunoRN, RN]

The FDA approved instructions include that it can be used through clothing if necessary.  The length of a standard epi-pen needle is just over half-an-inch (about 15mm for pretty much the entire world except for the US).

If you have an epi-pen for use there should be ordered indications, typically some variation of anaphylaxis.  This can be hard to interpret in the moment, but generally some sort of sign that an airway might be compromised (stridor, wheezing, etc.) or signs of hypoperfusion (altered LOC, syncope, etc).