Question: I know that the standard practice for Epinephrine administration in the case of anaphylaxis is in the patient's deltoid. I have heard and read that the time to maximal serum concentration of epinephrine is 7 times faster with IM administration to the anterolateral thigh.
My question therefore is: Would it be acceptable to administer epinephrine in the anterolateral thigh as opposed to the deltoid? Or, is SWORBHPs preferred administration site the deltoid and if so why?
Simmons, F.E., Kelso J.M., Feldweg A.M. (2015). Anaphylaxis: Rapid recognition and treatment. In T. W. Post (Ed.), UpToDate. Retrieved from http://www.uptodate.com/contents/anaphylaxis-rapid-recognition-and-treatment/
You are correct in that there are proponents for Deltoid IM injection in Anaphylaxis. Proponents of the deltoid route include the American Academy of Allergy Asthma and Immunology (AAAI). This is based on a study examining 13 men to determine when the peak plasma level of epinephrine was reached (not when its targeted action was achieved). However, as a whole, the most consistent and safe IM route is via the deltoid due to todays increasingly adipose-rich population. In fact, a study done examining the EpiPen auto injector (needle length of 1.43cm) found that 42% of the female sample population studied would not be able to reach their IM compartment. Yes, subcutaneous administration will also produce an effect, but much slower than IM due to its less-rich blood supply. Thus, it is base hospitals recommendation to keep the preferred site of IM Epi injection as the deltoid.
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