Do I need to have an epinephrine auto-injector?

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Epinephrine auto-injector
Epinephrine auto-injector, image source: Vu Nguyen | Flickr.

Anaphylaxis is one of the most frightening things that can happen in your practice. It can happen at any time: immediately after an injection, when you’re taking an impression, as a result of premedication, or even to a patient that just walked into your office. If you find yourself in that situation, there’s only one way to treat it effectively. And that’s with a dose of epinephrine, delivered intramuscularly, right after the reaction starts.

It’s not as simple as that, however. You have to ask yourself a few questions: how long will it take me to grab the emergency medical kit (if I know where my staff keeps it)? How long will it take me to grab the syringe? It’s been years since I’ve done this, so how do I break open a glass ampoule without slicing my hand to pieces? How long is it going to take me to draw 1mL of epinephrine and inject one-third the drawn dosage into my patient’s outer thigh? Is that patient wearing jeans, slacks? If so, how do I make sure the needle doesn’t bend or break? Was that 1:1000 or 1:10000 that I grabbed? Oh, and don’t let me forget: how do I do this calmly, effectively in two minutes?

You could try to do all of that. Or, you could grab an epinephrine auto-injector.

Epinephrine auto-injectors come preloaded with an appropriate single dosage for a healthy adult (and for children, if it’s a pediatric pen). There’s no need to break glass, draw medication, or remove clothing just to treat your patient’s symptoms. The premeasured dose alone makes auto-injectors a clear choice for dental practices like yours, but if you remain unconvinced, we compiled a small list of other benefits you should know.

They’re color-coded for adults and children

As we’ve said, all auto-injectors come in fixed dosages for both adults and children. They’re also color-coded. This makes picking the right pen from your emergency medical kit simple, which makes the likelihood of a mistake during an emergency that much smaller.

Injection is simple and fast

Injecting a patient with an auto-injector takes roughly 30 seconds. While a seasoned E.R. doctor can break an ampoule open, load a syringe and inject a patient in the same amount of time, someone inexperienced (or who hasn’t done that since dental school) may take longer. A lot longer. Treating anaphylaxis quickly can mean the difference between life and death, so a tool that lets you speeds this up is an invaluable one.

Training is much easier

Knowing how to use an auto-injector is as simple as reading the package and following directions. In fact, the instructions are meant to be simple enough that a layman—who is in the throes of a reaction—can follow them without any help. Some auto-injector models, like the Auvi-Q®, even offer voice-guided instructions. Moreover, there are auto-injector trainers available to help you rehearse using the real thing.

A few words of caution

It’s still important to keep epinephrine in a vial on hand. It’s used to treat cardiac arrest, and it plays a crucial part in treating biphasic anaphylactic reactions, which occur 20% of the time. This means an initial treatment with the auto-injector gives you enough time to properly measure more epinephrine from the backup vial, and more effectively manage a biphasic reaction as it happens.

Dr. Stanley Malamed, author of Emergencies in the Dental Office, says that epinephrine “needs to be kept in the preloaded form, which minimizes confusion when looking for it in this near-panic situation.”  While the cost of an auto-injector may be high when you compare it to a vial, the benefit to your practice and to your patients is immeasurable.

Do you have an epinephrine auto-injector in your emergency medical kit? Have you ever used one? Share your thoughts with us.

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Dr. Donald Cohen, a trusted figure and key opinion leader, has been a licensed and practicing dentist for over 30 years. Additionally, Dr. Cohen has 20 years of teaching experience at Columbia University SDOS, and 20 years as an Attending Dentist at Columbia Presbyterian Hospital in New York City. With his many years of experience in the field and in the classroom, “Dr. Don” is an expert in the areas of dental compliance, regulations, and best practices.

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