Epi IM vs SQ

[iMac]

I have always been told IM Epi is the most ideal because of the absorbtion rate. If anyone is willing to take a couple mins to go in further detail with this one. Are there more reasons as to why you would choose IM vs SQ? absorption, less side effects? contraindications? situations where you might prefer SQ?

Thanks everyone.

[Doug]

Think about why you would be giving Epi. The person most likely is in shock and is "shunting." The first area the body shunts from is from the skin. So a SQ injection doesn't have the circulatory support to be absorbed. Muscle, especially the larger muscle masses you would be giving the IM injection to, shunt later.

Somebody correct me if I'm wrong but shunting starts with skin, digestive,muscle, kidney, resp, heart then brain.

[spenac]

Just as a side point have you noticed how far the needle in an epi pen pops out? It is actually probably an IM injection in most people rather than SQ.

[akflightmedic]

Just as a side point have you noticed how far the needle in an epi pen pops out? It is actually probably an IM injection in most people rather than SQ.

Isn't an epi pen supposed to be IM?

[iMac]

Yes they are but that wasn't the question. Epi pens as far as I have known to be are all made to be an IM administration (family member has had them for years). I want to understand if there is more underlying reason as to the reasoning behind why one was preferred vs the other than what I already knew (Cough, which isn't much).

So other than the absorption rate, there are no other reasons as to why you might differ from IMs then?

[spenac]

Isn't an epi pen supposed to be IM?

We don't use them, even our first responders just draw up a syringe, but I was always told they were SQ. During course we fired one to see the needle length. Guess I need to do some reading on them.

[Dustdevil]

Absorption would be the primary reason. I've seen patients get two or three SQ epis with no effect. Then later, once they are stabilised and circulation restored, that SQ epi all gets suddenly dumped into the circulation and they go into a tachycardia that is so severe they think they are having an MI. If there are any signs of shock, then IM is a must.

[Doug]

My life is complete...Dust agreed with me.

[Mateo_1387]

I probably am not the best to answer this due to limited experience, but......

From Paramedic school, we were told that to decide between Epi IM vs. SQ we have to view the skin. Patients who are hemodyanamically compromised (shock) should receive the Epi IM, as the blood is shunted away from the skin. A patient who is having respiratory compromise, who has very red skin, which means no shunting, but rather vasodilation of the capillaries of the skin, should receive the Epi SQ. In this case, the Epi is absorbed through the permeable capillaries of the skin..

I hope this is right, as I hate to post inaccurate information. If anyone knows better, please let us know.

[Arizonaffcep]

This is an interesting topic here in Southern AZ...only within the last year have we gotten the "Okey-Dokey" to do IM Epi as opposed to just SQ.