The EpiPen that cost $75 in 2001 costs over $300 today

[bcla]

This looks very old, but it does have an auto-injector, with, presumably, the correct dosage, so no fumbling around with dosages or vials, thankfully.

There would be no need for a tourniquet as one would not be injecting it intravenously. (We cannot make that mistake people!) It is given intramuscularly as a direct injection.

I read a bunch of articles last night and I think I saw just one that mentioned the possibility of a vial, but even that one acknowledged that dosing errors, as well as fumbling in an emergency, could make that method a hazard. Most calls for reform from from professional groups call for an auto injector with a measured dose.

That was the only photo I could find that actually showed the complete contents, and it has that visible watermark. However, it's filled and shows all the parts. I also found a newer kit (with a folded instruction sheet), but where the user had already used the needle and had replaced several parts with with two syringes, two ampules of epinephrine, and what looks to be Benadryl (and the original contents were chlorpheniramine). Wonder how fast and accurate he would have reacted in case of emergency - especially breaking open the ampules without cutting a finger or spilling it.

http://forums.clubtread.com/11-hiking-backpacking/22708-epipens.html

I found an online version of the instructions.

http://www.kiessig.com/drugs/druginfo.aspx?id=1207

So the "tourniquet" was meant for something like a bee sting or accidental injection (I guess it could happen) of some allergen - to slow down the flow of the blood if the exposure was on an arm or leg. The instructions were to apply it after the injection.

 

[Pea-n-Me]

That was the only photo I could find that actually showed the complete contents, and it has that visible watermark. However, it's filled and shows all the parts. I also found a newer kit (with a folded instruction sheet), but where the user had already used the needle and had replaced several parts with with two syringes, two ampules of epinephrine, and what looks to be Benadryl (and the original contents were chlorpheniramine). Wonder how fast and accurate he would have reacted in case of emergency - especially breaking open the ampules without cutting a finger or spilling it.

http://forums.clubtread.com/11-hiking-backpacking/22708-epipens.html

I found an online version of the instructions.

http://www.kiessig.com/drugs/druginfo.aspx?id=1207

So the "tourniquet" was meant for something like a bee sting or accidental injection (I guess it could happen) of some allergen - to slow down the flow of the blood if the exposure was on an arm or leg. The instructions were to apply it after the injection.

Interesting home made kit.

How much of the epinephrine would you use?

And what number on the syringe would you fill it up to?

I'll give you all the time you need to answer. No emergency here.

 

[bcla]

Interesting home made kit.

How much of the epinephrine would you use?

And what number on the syringe would you fill it up to?

I'll give you all the time you need to answer. No emergency here.

Is this a trick question?

I will say that those are the wrong needles for the job. They're obviously insulin needles, and probably have way too short a needle length for injecting into a thigh muscle. If he had the correct needles, the line should probably be marked with a Sharpie. Or better yet draw the epinephrine in advance, as some doctors are recommending.

Aren't there also errors using EpiPen? I've heard of failure to remove the cap, improper direction (getting stabbed in the hand), not holding it the 10 seconds to allow it to fully inject the drug, or even patients wincing from the needle and allowing it to spill.

 

[Pea-n-Me]

No, it wasn't a trick question.

It was an illustration in how difficult it can be to have the right equipment, the right dosage, and the proper knowledge to give a dose of epinephrine safely and correctly even when there is plenty of time to figure it all out.

Yes, you are correct, those are insulin needles. Their unit of measurement is not the same as that of a regular syringe. And not only would the needle not be long or wide enough for an intramuscular injection, a) it would also be difficult to draw up medication with it out of an ampule, b) it would be unsafe to do so, as well, as medication from an ampule needs to drawn up with a filter straw so as to filter out any tiny shards of glass after the break, and c) after you use a filter straw you need to replace it with a fresh needle, and you can't do that on that type of insulin syringe. Once you get past the problem of how to draw it up, you'd need to figure out how much to give, because the amount in those vials would be an overdose for anaphylaxis for either an adult or child. A vial would have some of the same problems.

This is why the EpiPen is so great. Everything is right there, all set to go. All you have to know is when and how to give it. Very little thinking involved. What you say is true, there can certainly be mistakes made with an EpiPen, too, but with frequent review they should be minimized.

 

[bcla]

No, it wasn't a trick question.

It was an illustration in how difficult it can be to have the right equipment, the right dosage, and the proper knowledge to give a dose of epinephrine safely and correctly even when there is plenty of time to figure it all out.

Yes, you are correct, those are insulin needles. Their unit of measurement is not the same as that of a regular syringe. And not only would the needle not be long or wide enough for an intramuscular injection, a) it would also be difficult to draw up medication with it out of an ampule, b) it would be unsafe to do so, as well, as medication from an ampule needs to drawn up with a filter straw so as to filter out any tiny shards of glass after the break, and c) after you use a filter straw you need to replace it with a fresh needle, and you can't do that on that type of insulin syringe. Once you get past the problem of how to draw it up, you'd need to figure out how much to give, because the amount in those vials would be an overdose for anaphylaxis for either an adult or child. A vial would have some of the same problems.

This is why the EpiPen is so great. Everything is right there, all set to go. All you have to know is when and how to give it. Very little thinking involved. What you say is true, there can certainly be mistakes made with an EpiPen, too, but with frequent review they should be minimized.

Somehow this guy managed to get the ampules and needles, and it sounds like some doctor signed off on it. There are ways to get this stuff though through illegal channels.

From reading about what medical professionals are using, it's typically a 1.5" 22 gauge needle, and most seem to be available in 3 ml syringes, which may be a bit on the long side for storage in small containers.

I'm pretty sure I could draw the required 0.3 ml out of a vial, but I'd freak out with the needle going in.

 

[Danman]

Makes the Disney increases look like a bargain...

 

[Pea-n-Me]

Somehow this guy managed to get the ampules and needles, and it sounds like some doctor signed off on it. There are ways to get this stuff though through illegal channels.

From reading about what medical professionals are using, it's typically a 1.5" 22 gauge needle, and most seem to be available in 3 ml syringes, which may be a bit on the long side for storage in small containers.

I'm pretty sure I could draw the required 0.3 ml out of a vial, but I'd freak out with the needle going in.

I'm sure, with some practice, you could do it.

Did anyone figure out the amounts of epi to give on those insulin syringes?

 

[bcla]

I'm sure, with some practice, you could do it.

Did anyone figure out the amounts of epi to give on those insulin syringes?

Well - isn't everything really a compromise? Reading enough literature, there are lots of variables with body types, and the size/length of the needle and preferred injection site are the best compromise. If you could get epi into an insulin syringe to a shallow depth, it will still do something. I suppose the someone with a lot of fat in the thigh might present an issue.

I was reading 0.3 to 0.5 mg (using a long enough needle to inject into the thigh muscle). Of course the ideal would be to adjust for weight, but that's kind of hard to do in a stressful situation. And anyone who is really thinking of this should discuss this with a doctor. My cousin is married to an allergist, so maybe I can ask him the next time I get a chance. He did say that one reason he chose that specialty was because for the most part his patients aren't dying from their conditions, although there must be the patients with life-threatening allergies.

 

[Pea-n-Me]

I meant what volume in the syringe as shown in the kit.

 

[bcla]

I meant what volume in the syringe as shown in the kit.

They're 1 cc syringes and 100 units should equal 1 cc. If my math is correct, the standard 0.3 ml dose should go up to the 30 unit line.

That being said, it's the wrong tool for the job.

 

[Pea-n-Me]

A couple of updates I saw:

1) Mylan CEO going up before Congress to answer for drastic price increase

http://www.bloomberg.com/politics/a...appear-before-house-oversight-panel-next-week

And 2) More on errors related to using vials of epinephrine in place of auto injectors with measured doses

http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=1145

 

[bcla]

A couple of updates I saw:

1) Mylan CEO going up before Congress to answer for drastic price increase

http://www.bloomberg.com/politics/a...appear-before-house-oversight-panel-next-week

And 2) More on errors related to using vials of epinephrine in place of auto injectors with measured doses

http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=1145

I read the latter. However, they're specifically referencing hospital errors. I'm pretty sure there are many ways for hospitals to make mistakes with hundreds of different medications and different hypodermic needles in the cabinets. I would have thought that the worst error would have been extracting the contents of a 30 vial in a hurry, although I suppose there's little chance of the entire vial being drawn.

Some of the recommendations seem to be to stock a specific anaphylaxis kit with all the vials/needles selected in advance, along with clear instructions on how much to draw and inject.

 

[Pea-n-Me]

I read the latter. However, they're specifically referencing hospital errors. I'm pretty sure there are many ways for hospitals to make mistakes with hundreds of different medications and different hypodermic needles in the cabinets. I would have thought that the worst error would have been extracting the contents of a 30 vial in a hurry, although I suppose there's little chance of the entire vial being drawn.

Some of the recommendations seem to be to stock a specific anaphylaxis kit with all the vials/needles selected in advance, along with clear instructions on how much to draw and inject.

Yes, this is a newsletter that hospitals get. The point is, that if licensed, trained, seasoned medical professionals are making these types of mistakes with epinephrine, then we can expect even more if the general public takes it on, which was much of my point in this thread.

 

[bcla]

Yes, this is a newsletter that hospitals get. The point is, that if licensed, trained, seasoned medical professionals are making these types of mistakes with epinephrine, then we can expect even more if the general public takes it on, which was much of my point in this thread.

Sure. However, you're thinking of hospitals, emergency rooms, urgent care, or paramedics that need to respond to hundreds or thousands of possible medical issues. If there is a single purpose kit set aside and the user concentrates on that one purpose, doesn't it simplify the process?

My MIL has a pretty nasty seafood allergy. She's always freaked out at restaurants. I'm pretty sure that I could administer a shot of epinephrine for her if I had to. That doesn't mean I know how to do anything else. However, a single purpose tends to simplify things a lot. I said maybe even mark the line on the syringe.

There are doctors prescribing this for their patients. I'm pretty sure they go over everything. Maybe even hand out instructions to keep with the kit.

 

[Pea-n-Me]

There are lots of people who use EpiPens, too. Not sure what the exact number is, but I'm sure over the course of each year it's in the thousands.

This is specifically talking about a vial and/or ampule.

Kits would perhaps be nice if there could be a measured dose. But then you have the problem of who will draw them up and when do they expire, where to give it, how not to stick your finger, etc.

The beauty of the EpiPen is that it's so easy to use, and it's encouraged to be used even if you're erring on the side of caution.

But I didn't post the link to re-hash this. Just wanted to point out that even pharmacy overseers are very concerned with using epinephrine in vials and ampules as well.