How to Use an Epinephrine Auto-Injector During Anaphylaxis: A Step-by-Step Guide
Why Timing Matters in Anaphylaxis
Anaphylaxis is a severe allergic reaction that can turn deadly in minutes. Without immediate treatment, it can lead to breathing failure, shock, or death. Using a epinephrine auto-injector correctly and quickly is the only way to save a life. This guide breaks down exactly how to use one, what to avoid, and what to do next.
Step-by-Step Instructions for Using an Epinephrine Auto-Injector
Follow these steps when someone shows signs of anaphylaxis:
- Recognize symptoms - Look for hives, swelling, trouble breathing, dizziness, nausea, or rapid heartbeat. Don’t wait for all symptoms to appear.
- Grab the auto-injector - Check the expiration date. Make sure the liquid inside is clear (not cloudy or discolored).
- Remove the safety cap - For EpiPen, pull the blue cap straight off. For Auvi-Q, remove the grey cap. For Adrenaclick, pull the red safety release.
- Position the person - Have them lie flat on their back. Extend one leg straight out. If they can’t lie down, sit with legs extended. Never stand or walk during injection.
- Inject into the outer thigh - Hold the device at a 90-degree angle. Jab firmly into the thigh muscle. You can inject through clothing-don’t waste time removing clothes.
- Hold for 3 seconds - EpiPen makes a click sound when done. Auvi-Q gives voice instructions saying "Press and hold for 3 seconds." Adrenaclick’s needle retracts after 3 seconds.
- Call 911 immediately - Even if symptoms improve, you need medical help. Tell responders you used epinephrine.
- Lie down with legs elevated - This helps blood flow. Monitor for worsening symptoms.
- Administer a second dose - If symptoms return or worsen after 5-10 minutes, use a second injector if available.
Common Mistakes to Avoid
Many people make errors during emergencies. Avoid these:
- Injecting into the arm - Only the thigh muscle works properly for fast absorption. Injecting elsewhere delays treatment.
- Not holding long enough - 61% of users don’t hold for the full 3 seconds. This reduces the dose delivered.
- Forgetting to call 911 - Emergency responders need to know about the injection and monitor for biphasic reactions.
- Storing in extreme temperatures - Keep devices between 59-86°F (15-30°C). Heat or cold can damage the medication.
- Using discolored liquid - If the solution looks cloudy or brown, replace the device immediately.
What to Do After Administering Epinephrine
Using the injector is just the first step. After injection:
- Always seek emergency care - Even if symptoms fade, medical staff must monitor for a second wave of reactions (biphasic anaphylaxis).
- Keep the used injector - Give it to paramedics. They’ll check how much medication was delivered.
- Rest and avoid activity - Walking or standing after injection can cause dizziness or fainting.
- Check for a second dose - If symptoms return, use another injector. Most reactions require one dose, but severe cases may need two.
Different Types of Auto-Injectors: A Quick Comparison
| Brand | Dose | Key Features | Approx. Cost | Best For |
|---|---|---|---|---|
| EpiPen | 0.15mg (33-66 lbs), 0.3mg (66+ lbs) | Spring-loaded needle, simple design | $678.88 | General use, brand recognition |
| Auvi-Q | 0.15mg or 0.3mg | Voice-guided instructions, compact size | $4,229 (with assistance program) | High-stress situations, visual learners |
| Adrenaclick | 0.15mg or 0.3mg | Manual activation, lower cost | $194.99 | Budget-conscious users |
| Neffy | Nasal spray (no dose variation) | Needle-free, fast absorption | $200 (estimated) | Needle-averse patients |
Frequently Asked Questions
Can I use an epinephrine auto-injector on someone else?
Yes, you can use it on someone else in an emergency. The device is designed for emergency use by anyone, even without medical training. However, always call 911 first and inform responders about the injection. Never hesitate to help someone having anaphylaxis-epinephrine is safe and life-saving.
What if I accidentally inject myself?
Accidental injections happen, especially with EpiPen’s orange tip. If it happens, seek medical attention immediately. While rare, injecting into fingers or hands can cause tissue damage. Always keep the device in its case and carry it with the safety cap on.
How do I store the device properly?
Keep it at room temperature (59-86°F or 15-30°C). Avoid extreme heat (like a car dashboard) or freezing. Store it in its original case to protect from light. Check the expiration date every 6 months and replace it before it expires.
What if the liquid is discolored?
If the liquid looks cloudy, brown, or has particles, replace the device immediately. Discoloration means the medication has degraded and won’t work properly. Always check the color before use.
Can I reuse the device?
No. Auto-injectors are single-use devices. After activation, the needle retracts and the device can’t be reused. Always carry two injectors in case a second dose is needed.
What if I’m not sure if it’s anaphylaxis?
When in doubt, use it. Mild symptoms can quickly worsen. The risks of using epinephrine (like a racing heart) are minor compared to untreated anaphylaxis. Doctors confirm it’s better to use it unnecessarily than to wait too long.