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A Mighty Pen: Epinephrine Auto-injectors

epinephrine; epipen; auto-injector; toxicology; medicine; complications; anaphylaxis; vinoo

Vinoo Dissanayake

on 19 November 2011

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Transcript of A Mighty Pen: Epinephrine Auto-injectors

A Mighty Pen:
Epinephrine Auto-injectors Vinoo Dissanayake
9/14/2011 NOT easy NOT safe NOT good Epipen
Jext Potential call questions How do I do this? What do I do after? I shot myself!
Now what? Which end goes in? When should I give it? Anaphylaxis:
rapid, deadly allergic reaction Anaphylaxis Criteria for Diagnosis* Acute skin response with end-organ effects
After allergen exposure, at least two of the following: acute skin response, respiratory compromise, cardiovascular collapse or GI symptoms
After allergen exposure, reduced blood pressure alone *only one needed Within several minutes to hours... Follow manufacturer's instructions Twinject Green cap off
Red cap off
Press gray side into thigh
Hold for 10 seconds
Pull out syringe for 2nd dose
Pull off yellow collar
Administer 2nd dose Adrenaclick
http://www.adrenaclick.com/about-adrenaclick/adrenaclick-training.aspx Epipen Remove gray safety release cap
Do not touch black tip
Jab black tip into thigh
Hold for 10 seconds Remove cap #1
Remove cap #2
Place red tip on thigh
Press red tip firmly into thigh
Hold for 10 seconds Call 911 immediately. Visit the ED regardless of symptom resolution. Majority of cases require no treatment.
21 cases since 1900 resulted in digital necrosis.
Various treatments: phentolamine injections, systemic or topical nitroglycerin, warm water immersion, terbutaline infiltration Epipen & Jext: black tip
Adrenaclick: red tip
Twinject: gray tip
Anapen: open tip
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2. Mrvos, R. Accidental injection of epinephrine from an auto-injector. S Med J 2002; 95(3): 318-320.
3. Muck AE, Bebarta VS, Borys DJ, et al. Six years of epinephrine digital injections: absence of significant local or systemic effects. Ann Emerg Med. 2010; 56:270-274.
4. Singer AJ. Accidental digital self-injection of epinephrine: debunking the myth. Ann Emerg Med. 2010;56:275-277.
5. Sinclair MD, Bailey MA, McAree BJ, et al. Rapid epinephrine 'reversal' with phentolamine following accidental auto-injector inoculation. Vascular Medicine 16(3):215–216.
6. Guerlain S, Hugine A, Wang L. A comparison of 4 epinephrine autoinjector delivery systems: usability and patient preference. Ann Allergy Asthma Immunol. 2010;104:172–177.
7. Simons FE, Edwards ES, Read EJ, et al. Voluntarily reported unintentional injections from epinephrine auto-injectors. J Allergy Clin Immunol 2010;125:419-23.
8. Gosbee L. Nuts! I can't figure out how to use my life-saving epinephrine auto-injector! Joint Commission Journal on Quality and Safety 2004; 30(4): 220-223.
9. Sicherer SH, Simons FE. Self-injectable epinephrine for first-aid management of anaphylaxis. Pediatrics 2007;119;638-646.
10. Simons KJ, Simons FE. Epinephrine and its use in anaphylaxis: current issues. Current Opinion in Allergy and Clinical Immunology 2010, 10:354–361. 10-25 kg child: 0.15 mg >25 kg child: 0.30 mg 0.01mg/kg Ouch!
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