EpiPen and Narcan Administration Notes

EpiPen (Epinephrine Auto-Injector)

• Used for severe allergic reactions (anaphylaxis), not just sniffles.
• Dosage:
  • Adults: 0.3 mg
  • Children: 0.15 mg

Scenario: Bee Sting Anaphylaxis

Initial Assessment

• Scene size-up.
• Prioritize patient with breathing difficulties.
• Oxygen administration is key.
• Check airway patency, breathing rate, and quality.
  • Breathing rate of 10/minute and shallow indicates respiratory distress.
• Check pulse rate and skin color/condition.
  • Rapid pulse is expected due to excitement/distress.
  • Pale skin color may indicate poor perfusion.
• Perform a blood sweep to assess for injuries.
• Determine chief complaint: Anaphylaxis due to bee sting.

Vitals

• Blood pressure may be elevated due to excitement.
• Pulse remains rapid.
• Respirations are shallow and decreasing.
• Oxygen saturation (SpO2) is around 80%.
• Pupils should be equal and reactive.
• Check blood glucose level (glucometer).

History (SAMPLE)

• Signs and Symptoms: Swelling and pain at the sting site.
• Allergies: Bee stings only.
• Medications: None.
• Past medical history: Appendectomy 2 years ago.
• Last oral intake: Lunch.
• Events leading up to the incident: Disturbance of a bee nest while cutting a tree branch.

Assessment

• Focused assessment on the affected area (arm).
• Check for warmth, swelling, and hives.
• Localized swelling is present.

Administering EpiPen

• Check the "Rights" of medication administration to ensure safety and accuracy.
  • Right patient: Verify the patient's name on the prescription.
  • Right medication: Ensure it is epinephrine.
  • Right dose: 0.3 mg for adults.
  • Right time: Patient is experiencing anaphylaxis.
  • Right route: Intramuscular (outer thigh).
  • Right date: Ensure the medication is not expired.
  • Right documentation: Record the time of administration.
• Technique:
  • Brace the patient's thigh.
  • Remove the blue safety cap.
  • Firmly inject the EpiPen into the outer thigh.
  • Hold for 10 seconds.
  • Massage the injection area to aid absorption.
• Dispose of the EpiPen in a sharps container.
• Transport the patient and reassess vitals.
• Provide supportive care and treat for shock.
• Reassess interventions (oxygen, EpiPen).
• Inquire if the patient has another EpiPen for transport.

Narcan/Naloxone Administration

Scenario: Opioid Overdose

Initial Assessment

• Scene safety is paramount.
  • Beware of needles and other hazards.
• PPE (Personal Protective Equipment) is essential.
• Note the nature of the illness (NOI): Suspected drug overdose.
• Assess the number of patients.
• General impression: Patient is semi-conscious and pale with shallow breathing.
• Check pulse and airway.
  • Airway should be clear of obstructions.
• Breathing rate is approximately 8 breaths/minute.
• Perform a blood sweep.
• Assess skin color and condition.

Vitals

• Blood pressure may be low.
• Pulse may be slightly rapid.
• Respirations are shallow and decreasing (approximately 6/minute).
• Oxygen saturation (SpO2) is around 70%.
• Pupils may be dilated.

History (SAMPLE)

• Signs and Symptoms: Unconsciousness.
• Allergies: Unknown.
• Medications: Unknown (suspected drugs).
• Past medical history: Unknown.
• Last oral intake: Unknown.
• Events leading up to the incident: Patient was discovered slumped over on a porch.

Assessment

• Perform a rapid head-to-toe assessment.
• Ensure adequate ventilation.
• Check breath sounds for clarity.

Administering Narcan (Naloxone)

• Check the "Rights" of medication administration.
  • Right route: Intranasal.
  • Right patient: Patient is overdosing with respiratory distress.
  • Right medication: Naloxone.
  • Right time: Patient is experiencing respiratory depression due to overdose.
  • Right dose: 2 mg (1 mg per nostril).
  • Right date: Check for expiration.
  • Right documentation: Record the time of administration.
• Technique:
  • Administer 1 mg of naloxone in each nostril.
• Dispose of the Narcan device in a sharps container.
• Continue bag-valve-mask (BVM) ventilation.

Post-Administration

• Reassess the patient to see if respirations increase.
• Titrate the dose to achieve adequate respirations without causing withdrawal.
• Transport the patient for further medical care.

Important Considerations

• Avoid over-administering Narcan to prevent violent withdrawal.
• Prioritize respiration over consciousness.
• Be prepared for potential vomiting or combativeness.

Additional Notes

• Ventilate if the patient is breathing very slowly.
• If they're breathing, then you're going to be administering oxygen.
• Always transport patients who have received EpiPen or Narcan for further evaluation.
• Be aware of body fluids and take necessary precautions.