Epinephrine Autoinjector

Aka: Epinephrine Autoinjector, Epinephrine Home Injectable Devices, EpiPen, EpiPen Jr, Twinject, Adrenaclick, Ana-Guard, Ana-kit

1. Indications
   1. Indicated for history severe reaction or Anaphylaxis
   2. Patient injects at time of Allergic Reaction
2. Precautions
   1. Immediate medical attention after using injector
   2. Further Anaphylaxis management may be required
3. Technique: EpiPen (or similar device)
   1. Device will penetrate clothing
      1. Bare skin is not required for the injection
   2. Preparation
      1. Remove the cap from the carrying device (caps are yellow for adult version, and green for child's version)
      2. Remove the injector from the case and grasp in one fist with orange tip pointing downward
      3. Pull out the blue safety release pin from the top of the device with the free hand
   3. Technique
      1. Aim the orange tip toward the outer thigh
      2. Swing the arm up in abduction and then down striking the device firmly at 90 degrees at the outer thigh
      3. Expect to hear a click as the needle deploys and penetrates the skin
      4. Hold the device firmly against the thigh for at least 10 seconds so that all medication is deposited
   4. Post-Injection
      1. Remove the device and massage the injection area for 10 seconds
      2. The needle will be safely enclosed within the orange tip to prevent needle sticks (however device needs to be disposed of as biohazardous waste)
      3. Proceed to obtain immediate medical attention
4. Dosing
   1. Pearls
      1. Consider supplying more than 1 injector
      2. Place in different locations at home, work, school
      3. More than one injection may be required
   2. Prefilled Epinephrine auto-injectors
      1. Adult dose (weight >66 pounds or 30 kg): 0.30 mg
      2. Child dose (weight <66 pounds or 30 kg): 0.15 mg
5. Preparations: Epinephrine Autoinjectors
   1. EpiPen and EpiPen Jr
   2. Twinject
   3. Adrenaclick
   4. Ana-Guard
   5. Ana-kit (Epinephrine with Chlorpheniramine)
   6. Auvi-Q
      1. Talking device that walks patient through use of the injector at time of use
      2. Device is in shape of smart phone
      3. Cost is similar to EpiPen ($250 for 2 pens)
      4. (2013) Presc Lett 20(3): 18
6. Resources
   1. Meridian Medical Technologies (EpiPen)
      1. http://www.epipen.com/how-to-use-epipen/
7. References
   1. Arnold (2011) Am Fam Physician 84(10): 1111-8