|
Post by Brendoon on Oct 28, 2015 1:18:43 GMT
HI Team, Here is another question for you to give me an answer to.......enjoy Anaphylaxis is a life threatening condition that can often easily be treated with an intramuscular injection of adrenaline. Two questions: 1 The administration of intramuscular adrenaline was, up until recently, a Paramedic and ICP skill. Why do you think that this was changed and added to the delegated scope of practice of the EMT? What ‘safety’ factors have been implemented with this change? 2 How can you ensure that a patient with anaphylaxis in your area receives adrenaline quickly? Adrenaline is an example of a more aggressive treatment that can easily be implemented in the field by EMT. Giving better survival chances if not waiting for back up. 1. So, anaphylaxis is a life threatening condition, which can often be easily treated with an IM injection of adrenaline. I think it has been included in the EMT scope of practice as it can easily be administered, there are no contraindications, and if anaphylaxis is suspected, early administration of adrenaline is the most important aspect. I believe the dose of 0.5mg for all adults at EMT level was implemented to take the guess work out? Whereas ICP and paramedic are able to adjust the dose to the patient. 2. Early recognition of systemic involvement and having a low threshold for administration of adrenaline if anaphylaxis is suspected.
|
|
|
Post by Barry on Oct 29, 2015 19:53:51 GMT
Hi Brendan, Some good parts to your answer here but I think you should look at the contraindications of adrenaline verses side affects and the effects on the receptor sites it targets. Let me know your answer on this
|
|
kat
New Member
Posts: 8
|
Post by kat on Oct 30, 2015 19:59:54 GMT
Anaphylaxis is a time critical, life or death situation. I think because of this reason IM adrenaline has been lowered to be within the scope of practice of an EMT. IM Adrenaline at the set dose rate that we administer is safe and outweighs the reality of not giving adrenaline to an anaphylactic patient, death. In my area, rural with a time delay of an ambulance of between 20 - 45mins the first port of call is going to be me (when I get my first responders pack, hopefully with adrenaline included)to administer the adrenaline at this present time I would have to contact clinical desk. I would hope that given the time delay people who have known life threatening allergies would have an epi-pen which they can administer themselves. Prime within clinic hours could respond and bring adrenaline or if all else fails I would ring a vet. We have a couple that live locally and have adrenaline in their packs.
|
|
|
Post by Kirsty on Nov 12, 2015 9:02:49 GMT
I agree with previous posts that I.M adrenaline has been brought down to EMT level as it is a time critical treatment for Anaphylaxis. As mentioned in our CPG's its early administration is the most important aspect of treatment of anaphylaxis and the risk of death is raised in patients whose need for adrenaline, and repeat adrenaline is under recognised. As anaphylaxis is a rapid onset, multiple organ generalised hypersensitivity syndrome, adrenaline is an effective drug as it is an Alpha and Beta receptor agonist with the additional action of stabilising mast cell membrane and reducing histamine release from the mast cells. As far as safety goes, good training and a set dose rate for EMT,s to give of 0.5mg for adults, helps as this appears to be a "relatively" safe dosage. You could also consider the effect of the drug on the body as a potential safety aspect. I.M Adrenaline takes 3 to 5 minutes to take effect. Duration of effect on the Cardiovascular system lasts 2 to 15 minutes. The effects on this system are potentially the most critical as far as adverse reactions are concerned. This timeframe has both positive and negative aspects. Any adverse effects such as Tachycardia, Tachydysrhythmias and hypertension etc should resolve when the effect wears off but on the negative side repeat adrenaline may be required to continue to combat the Anaphylaxis. To ensure that a patient with Anaphylaxis receives adrenaline quickly I would check if they have an epi-pen first, Call for backup and prime doctor and phone clinical desk to ask for an out of scope administration. Back up in our area could be 20 to 30 minutes away on a good day!!
|
|