Question: I have heard paramedics inquiring amongst fellow paramedics about the use of epi without a cardiac monitor applied or a full set of vitals when dealing with a patient who is suffering from anaphylaxis. My stance is that all meds (except ASA) require a full set of vitals and the cardiac monitor applied. Please clarify.
Interesting question! It boils down to the clinical picture and the manner by which you and your partner manage patients. It would be rare in our mind to arrive a patient suffering from anaphylaxis and by the time you have made the decision to deliver epi, gone to your bag and drawn the medication up and are prepared to deliver it, your partner has not been able to apply a cardiac monitor or obtain a set of vital signs.
In profound arrest situations, one would have to consider other mimics of profound shock such as dysrhythmias and as such, a cardiac monitor and vital signs would seem€¦.well€¦.vital. That being said, in clinical practice in the ED, we have seen cases where patients have presented with massive edema and appear to be imminently arresting, and in these situations while our other team members are obtaining vital signs and applying the cardiac monitor, we have on RARE occasions administered epi prior to having a complete set of vital signs.
So, bottom line€¦absolutely our preference is to have the cardiac monitor and a set of vital signs obtained prior to medications being delivered. Rare exceptions may occur and documentation as to your rationale is essential.