#065 EPINEPHRINE (EPIPEN) INSTRUCTIONS FOR USE DURING A FOOD ALLERGY

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Last updated on May 5, 2021

 the pharmacist gave you epinephrine that the doctor had prescribed for your child?  The epinephrine came into a brown little bag.  You opened up the bag and looked at the medication.  You saw two medications in the bag - two epinephrine auto injectors in the bag. It's like you got a two-for-the-price-of-one deal.  How come?  Why did the pharmacist give you two of them?  Was one supposed to be meant for the car while another one for home? 

No!  The goal is for the child to have both auto-injectors with them at all times.   How come?  Let's look at this from a practical standpoint.  I'll give you four reasons why epinephrine medication come in sets of two auto-injections and no, one of them is not that the insurance company feels sorry for you and wants to give you a "free deal".  

First, if your child doesn't have the medication next to them, how are  they going to be able use it?   You have to bring the medication with you wherever you go.  Easier said than done especially for someone who forgets their cell phone or their car keys in random places! Easier said than done for someone who misplaces their items!  Remembering to bring the epinephrine doses with you might you to put both the medications and a key finder in the same bag.  I would recommended a well-insulated bag as the medication doesn't work as well at extreme temperatures.  Store the epinephrine at room temperature - not in your car on a hot summer day or in the cold refrigerator.   

Second, what if one of the epinephrine auto-injectors fails, and you are dealing with a life or death situation?   You better hope that you have a second epinephrine next to you that is properly functioning.

Third, you should call 911 after giving the epinephrine.  Even after giving the epinephrine, you may still be dealing with a life threatening situation.  When you call 911, an ambulance is supposed to come and take your child to the hospital, but there's a little problem with some of the ambulances.  Not all ambulances carry epinephrine.  In that case, you'll be glad that you had an extra epinephrine with you. (By the way, when you call 911, let them know that your child is having an allergic reaction, and you would like an ambulance that carries epinephrine to appear at the scene.) 

Fourth, what if the first injection of epinephrine doesn't work as well as you would like?  What if you  inject the first epinephrine and five to ten minutes later, your child still has difficulty breathing and hives that keep on spreading over the body?   There are many situations where you wind up having to give both doses of epinephrine.  Going into a reaction, you don't know how many epinephrine injections you'll have to go through.  You'll find out once the reaction is over but not before. 

All right!  Back to my story... You look at the brown bag that that has the prescription of epinephrine within it.  In which form do you think the actual epinephrine medication comes?  Is it a or b?    Does it come as a - a liquid solution - or as b - a solid pill?  If you answer a, then you're correct.  Almost all epinephrine comes as a liquid solution.  The trick is that you need to get this liquid solution into the muscles in the outer thigh.   You can't just rub the solution onto the thigh. That will put the solution on the surface of the skin, but it won't get it into muscles.  To get the solution into muscles, you need to inject it into there.  

There are a few ways that you can get this liquid epinephrine solution into the muscles.  First, you can buy a needle and a syringe. You can draw out the correct amount of epinephrine from the vial and then inject it into the muscle.  That's the old fashioned way but some families still use this method because it can be cheaper. Buying epinephrine solution in a jar along with a syringe and needles can be much cheaper than getting epinephrine that's already prepackaged and ready to be injected.    

Nowadays, most people get epinephrine inside of an autoinjector because it's easier, and many people have some kind of insurance that helps pay for it.  The autoinjector is medical device that has a needle on one end.  It holds a particular dose of epinephrine medication so there's no need to try to figure out the correct amount to give to the child.  Plus, the device can inject epinephrine directly into the muscles in your child's outer thigh even if your child is wearing stockings, jeans, or pants.  You just press hard on the device once you have it up against the outer thigh, and the device should be able to deliver the dose right into the muscles in the thigh.

Talking about auto-injectors, let's say that you go up to your friend whose child also has food allergies and ask to see their epinephrine autoinjector.  That autoinjector may look quite different from yours. The same dose of epinephrine medication comes in different auto-injector forms. These auto-injectors act to get the epinephrine into the body, and they can look cylindrical, round, or even flat-ish.  They can have needles that retract or that do not where the child is more likely to be stabbed by the needle.  You have to be careful with those!  

To learn how to inject epinephrine,  check out the next blog post (#061). 

Three "legal" things:  First, either a male or a female could consider themselves to be a mother.  My job is to serve and not to judge.  Second, although I am a family physician, I am not your doctor or therapist.   Please see your and your child's doctor.  Third, the information presented here is for educational purposes only.  It does not constitute professional medical advice. 

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