Administer Epinephrine to stop blood loss in the field? As an EMT can I give an Epi pen to costrict blood flow
Answer:
To use Epi to control blood loss would be a bad idea. It would be much better to imediatley apply a tourniquit. It is less invasive and you wont get sued (the unfortunate reality of civillian healthcare). A tourniquiet is quick and can be easily applied and be more effective then Epi so long as you have one preped in your "go bag". The note you read in Emergency Medicine may have been refering to a clinical procedure, which EMT's don't traditionaly do.
I dont recall what civillian EMT's are being taught as of late but, treatment technics in the military are changing rapidly (as a result of the GWOT and OIF) and what is now being taught to our ground and flight medics is to tourniquit all moderate to severe bleeding. The justification is that we do not have the time, resources, or security to go through the traditional steps of direct pressure, dressing, pressure dressing, and finally tourniquit. It is much better to "T" everything of concern and go. I recomend the same to you. Stabalize what you need to on the ground, and leave quickly. A Tourniquit will not cause a pt to lose a limb. They use them in surguries everyday. Some of those surguries last for hours.
I commend you for thinking beyond your reach. It helps you to better understand the skill and to better adapt and overcome. Be careful of what you read, who's advice you take, and what you actually put into action.
... and remember, you are not the asset, the ambulance is...
You might want to consider what that epinephrine will do to the rest of the patient - it doesn't do much good to save the limb if you caused a cerebral hemorrhage or heart attack with the epi.
I'd go with the tourniquet.
Won't work. Your hands are better used on direct pressure and packaging. One of those little issues about your job is prioritization. If you're looking in Tintinalli or some such text, I suspect you may be looking at a warning about the potential of accidental injection into a digit. People don't bleed out from a cut finger. Now be a good boy and limp (you are Tamur the Lame, right?) back onto the bus for your next run.
While the epi does cause vasoconstriction, this probably will not result in less bleeding. It's true that the bleeding vessels may constrict, but so do all the other vessels in the body. The epi will jack the patient's blood pressure by a huge degree, which will probably increase bleeding. The vasoconstriction might help with very small bleeds, but if this blood loss is enough to make you think about using epi, odds are the epi won't help. High dose epi may compromise blood flow to the fingers and toes, but I'm pretty sure that if you sliced them they would still bleed quite a bit even with the epi.
The surgeons never ask us to give epi to help stop a patient from exsanguinating. If anything, they often ask us to lower the pressure a touch if bleeding is getting out of hand. The only time epi will help the bleeding patient is if the blood loss is so bad you need strong agents to support the blood pressure. But even then, it is only supportive, not curative.
And, as pangolin and others have noted, the epi can cause a lot of bad effects, including cerebral hemorrhage, myocardial infarction, etc... in conclusion, don't give epi to stop bleeding.
When in doubt, read your local protocols. Aside from being a bad idea, I'm pretty sure its not in the EMT-B scope of practice.
Check with your standing orders from your medical direction for epinephrine. I bet it will be only covering allergic reactions if you are a basic. Also if you are a basic, you are not trained to give medication to constrict blood flow in your basic training. If you were to do this. You would most likely loose your EMT certification and be charged with negligence. Id check.
Pressure, Elevation, Pressure point, Tournicate. That is what we are trained in to restrict bleeding. Stick with that.
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