Dr. Silverberg - How to get the extra doses from an epipen

[@jimsumrall]

Most of the comments to this video miss the main point... this is an emergency, you're in the back country, definitive medical care is hours away, you have one epi-pen. You need a second dose. You know what you're doing. We learned this in the Wilderness Medicine course I took some years ago, and it's only something you would do when the alternative was dying. Thanks Doc for a great video.

[@bretthershey9209]

This is great information and obviously for emergencies only. I was curious why you were aspirating air into the chamber prior to administration. I am a paramedic and just curious.

[@sbabcock329]

Think of it as replacing fluid with air, it creates a resistance between the fluid and the rubber plunger thus giving you an air substitute for what would be fluid if it were full, because that has dosing mechanism to limit you to (0.3mg/ml presumably based off standard epi concentration ).

[@RedPhoenixMarie]

Me watching this after watching a news video about a doctor telling people not to do this

[@idk_my_name168]

Same

[@Titancamera530]

Same as well i dont have a epi pen

[@Titancamera530]

@@RedPhoenixMarie i fixed it

[@beadlebb22]

Doctors can’t be trusted hard to say what’s true and not anymore Judging by the price I’m going off it’s a money thing

[@jburche2]

Same. I just got a Hella high from all this epinephrine

[@angelesramos4779]

Came here from an 911 episode. Good to know!!

[@rondamylove9995]

Me too, a short of the episode actually!

[@Halalislife]

Lmfaooo SAME

[@iambubblz]

You have by far the most informative and best video on this content with the best audio. I don't know why you haven't reached youtube stardom!

[@facelessgamerboi8632]

He does not. This "Extra epinephrine needed" is bullcrap unless a doctor tells you otherwise. Too much epinephrine will give you a heart attack

[@TheProGamerMC20]

3 years late but this was on the news lol, they said this is dangerous

[@DougKremer]

HOLY cow, I had no idea. I have no cause to and do not carry one of these but I do receive training every year on them.

[@TheProGamerMC20]

don’t, this was on the news. its not safe because you may not get the right dosage

[@benjamincvcvcv7]

​@@TheProGamerMC20between that and death..... Take the risk

[@dearmamajj]

Oh, and thanks for the video by the way!

[@nazuzuntas3670]

Me too needles: Oh hell naw Me to epipens: Oh yes the prefection

[@Chanel1-h8x6j]

Boi I literally had to spend my rent money on new epipens after an allergic reaction only to find out that there's extra inside of it, the nurses usually just take it away when they ask if I brought with me to prove that I had used it for an emergency 😑

[@finaltwo]

All needles/syringes are single use, even on the same person. While I agree it can be frustrating it’s not safe to use again for any reason. An alternative would be to get a prescription for epinephrine in a ampule and have to inject yourself which you may find intimidating. Remember that epinephrine needs to be injected intramuscular so you would have to give yourself a flu shot into your deltoid/outer thigh in an emergency while drawing the correct dose to avoid overdosing. While also not hitting bone or injecting the medication into your subcutaneous tissue. Which I don’t think you have been trained to do that. I say this as a nurse with epipens for my environmental allergies.

[@Noelsterrr]

I make these for a living, there are no extra doses in any of these pens.

[@PureMagma]

@@Noelsterrr Next time I have to use one I'm definitely going to cut it open out of curiosity. I was rushed to the ER this morning after waking up already in Type 3 anaphylaxis and no EpiPen on hand. I won't be happy if I've been discarding that much epinephrine, since I have to pay full price for them out of my pocket.

[@gsmacka96]

​@@Noelsterrr false. I cut open out last epi pens on the ambulance that exp and theres alot in there. Same amount in the adult and jr one. Difference is the plunger that gives the dose. There is more. Its just wasted.

[@dylanbuckner152]

@@finaltwoyes in a life threatening emergency you can absolutely use a needle multiple times..wtf

[@andrewbrown6522]

Became allergic this year. Sux. My life is outside. Found thia video looking for carrying case reviews. I gotta figure out how to keep them protected from temps even at home as its a trailer and i can be absent for periods. Thanks for the info! Hope i never have to use it. That spring is comparable to a spring in an air rifle ffs. Lol.

[@Leavemealone1893]

That's why it's so expensive

[@facelessgamerboi8632]

It's more expensive because capitalism....it should be free

[@Rajpeanut]

@@facelessgamerboi8632 No its not

[@benjamincvcvcv7]

​@@Rajpeanutyes it is. It costs them $10 to make and they charge $100-800 for them in america. Its 100% capitalism.

[@weekiely1233]

@@facelessgamerboi8632no actually it’s because of a lack of competition If anything such a restricted market is less capitalist (capitalism is just how free a market is btw. It has nothing to do with communism’s scapegoating bs)

[@barneyrubble4827]

​​@@benjamincvcvcv7 We dont have capitslism which is rooted in free markets & competition. We have corporate cspture of govt... fascism, FACT. Look it up. US capitalism is an illusion, we've been fascist for decades. MIC

[@Jimbo_Conn]

Do they still make the pens the same way? Just curious this is an old vid. Thanks

[@NarrowPath_7]

So how do we store it?

[@nazuzuntas3670]

I have allergies to honey and I was at a birthday party and my friend gave me an honey cake (it was winnie the pooh themed 🤠) and I was having sypmtoms and I didnt bring an epipen but one og the workers had one so I was safe lol

[@bonbeenotlive9325]

Good thing someone had a epipen

[@HanselitoPastelito]

Did you get here from the 9-1-1 Season 8 Episode 1? Crazy right it's like what!

[@patrick2912]

All they naysayers in the comments clearly don’t comprehend how serious anaphylaxis can be. This information is to be used when the alternative is death.

[@JohnnYp1234]

Is this still accurate with today's pens?

[@perry9492]

So how are you metering the dose? Seems a bit imprecise. How far should the plunger move?

[@lornahulse8065]

The plunger has a stopper on it so you can’t give too much. Pulling it back with the air resets it and allows another full dose to be given. That is why he is showing multiple extra doses as it isn’t possible to do them all at once with the stopper

[@kingerz]

Excellent

[@Cupcakeonline]

Is it safe though??

[@fluffed_coyote1487]

No

[@patrick2912]

No, but neither is death.

[@davido3403]

How do you avoid injecting air into the person! Push out a little first maybe but pointing down instead of up like you would normally do.

[@User-ny7eo]

It is an intramuscular shot. A little air is acceptable, especially in emergencies. Simply try to remove as much air as possible before administation and you will be fine.

[@dearmamajj]

Hi, I have always been under the impression "air in a needle" can be really harmful to someone. Please explain to me why a person needs to pull back to add the air? And if it would still work if that wasn't done?

[@tnpsupporter]

There is a stop molded into the back of the plunger so that only the correct dose is delivered when the auto-injector is first used. It is not possible to inject more epinephrine without pulling the plunger back. When dangers of injected air are discussed they are typically referring to much larger quantity's than are possible here.

[@dearmamajj]

@@tnpsupporter ah! That makes sense, and thank you.

[@neeks1905]

Also, that is only if the air enters the bloodstream. When he turns the needle right side down, the tip is filled with the liquid and air is at the top.

[@dearmamajj]

@@neeks1905 thanks so much. I re-watched and it makes sense now.

[@katiexyz3263]

You can always “prime it” by pushing a few drops down the needle onto the ground to make sure the air is gone.

[@mingzhu8093]

The dose of adrenaline it gives cost $1 and the manufacturer of the device cost $10. And yet we pay over $100 for it. It is hard to believe such critical low cost device been used to make such big profit. We understand there are patterns involved but each year governments throw billions of money down the drain, but won't they to lower the price for a EpiPen..

[@JustMe11392]

I did this to save money and the liquid discolored quickly. So didn't help me

[@scottcarpenter8449]

You, sir, are the most badass guy ever! So, when I am in the outback with peanut allergy guy, you are directly responsible for that life saved ! Sharing in my circles.

[@facelessgamerboi8632]

@scott carpenter NO NO NO NO NO! To much epinephrine can and will kill you, epinephrine, the medication in an EpiPen is artificial adrenaline, too much of this will cause heart attacks. A person overdosing, even a little Is life threatening. That means a person dying would be on this mans hands. This man said it's a fact you need more epinephrine if you're in the wild. INCORRECT. Only if a licensed doctor says "you need two EpiPen doses if you eat any allergens, or get stung or bit by something causing anaphylaxis take two EpiPens." And you can't afford two $700 EpiPens than you should do this, only in dire situations, I'm eleven, and I'm VERY allergic to yellow jackets and pineapple, I have EpiPens. Now if you don't want to buy EpiPens, make your own, WITH CAUTIOUS APPROACH! They sell vials of epinephrine for $40! Needles and syringes are cheaper than that. So about 100 dollars for one EpiPen, now if you buy a pack of syringes, make multiple. That $40 vial of epinephrine can make 100 doses of 0.3 mg epinephrine injections. Handle these self administering EpiPens with caution.

[@idk_my_name168]

@scott carpenter your clearly dumb for believing this stupid dangerous video and not researching through the ones that has more details plus you think your saving them but your gonna kill them for too much epi

[@danatmonst3594]

@@facelessgamerboi8632 SEVEN HUNDRED DOLLARS *each* ?? Bruh where do you live? That's disgusting. I'd sure be opening up my pen for the other 4 doses if I need them later on at those disgusting prices. I also think you totally missed Scott's point. His point being that IF he needed to, he could save a friend IF that friend needed another dose before they could get to medical attention. Not that he planned on giving his friend all 5 doses at the same time.

[@danatmonst3594]

@@idk_my_name168 You missed Scott's point too: his point was IF he needed to give his allergic friend a second dose because they're no where near a medical post, he could. He at no point said he was gonna open it and give all 5 doses at once.

[@kuhaaica]

@@facelessgamerboi8632 he's showing how to give a dose not encouraginganyone to take all of it... that's saving lives 🙄🤦‍♀️

[@davidwhittington7638]

Although it is said there is no harm in injecting a tiny air bubble into the muscle, there is the risk of air being trapped in the muscle pocket causing “compartment syndrome”. it is good medical practice to extract the air from the syringe first, before injection. Especially if you intend to inject the same area a number of times. However, using the needle several times is dangerous, and overdosing a casualty can lead to cardiac arrest. You as a doctor can state if a casualty requires more doses after the allowed recommended second jab. But a panicky layman, runs the risk overdosing the casualty or hitting a blood vessel, in both cases killing the casualty. May I suggest Dr... you consider a new video explaining the pros and cons of this procedure...

[@finaltwo]

Dude compartment syndrome is an edema within a cast not air in ur muscles. Your arms swells cutting off blood flow to ur appendage in which there is a cast. There’s really no harm in injecting a small amount of air into muscles/subcutaneous tissue. It’s IVs that you need to watch for massive bubbles. “Champagne bubbles” are generally left in IV lines. Also I know meds like lovanox which is a blood thinner that you literally inject the meds with air.

[@davidwhittington7638]

@@finaltwo Any addition pressure within the compartment of muscle can reduce and cut off flow of blood to that region. Compartment syndrome occurs when the pressure within a defined compartmental space increases past a critical pressure threshold, thereby decreasing the perfusion pressure to that compartment, which increases venous capillary pressure. This can lead to cellular ischemia and necrosis. Interstitial edema develops from tissue necrosis and further worsens compartmental swelling.

[@L._.roberts]

There’s no max dose for adrenaline. However doses are usually given in increments of 500micrograms every 5 minutes. The doses in an epipen are usually 300micrograms per dose so even if you gave an additional dose you’d be ok. Maybe a little tachycardic but it wouldn’t kill you. However saying that it’s not really recommended to do this but if it’s life and death situation because an ambulance is taking too long this could potentially save lives. It’s a situation where the benefits outweighs the risks. Also never in the history of intramuscular injections has there been a case of compartment syndrome it’s main cause is usually due to trauma like a fracture or a crush injury

[@davidwhittington7638]

@@L._.roberts Although most of what you said is true, and Crushing Syndrome is most apparent, there have been intramuscular injections causing injury and death, although rare, they do happen. It seems to me regarding emergency situations, depending on the people attending, depends on the treatment given. I mean, those too frightened of getting it wrong and taken to court, and those knowing the grey line between, doing what is right to save a life, but perhaps using unorthodox methods to do so. I expect it comes down to luck and not having a tight arise as a collogue, or being misunderstood by bystanders. Example; Man has Crush Syndrome, been trapped for more than 4 hours, have no fluids to flash, concern of cardiac arrest or renal failure when released from crushing object. Do you use a tourniquet or not to prevent toxins killing the casualty? Things to consider, no one has done enough research to say yes or no. However, we know if the toxins enter the body, the casualty will probably die quickly. The Grey line is there, so what would you do?

[@L._.roberts]

@@davidwhittington7638 emergency medicine in a prehospital setting is a very grey area because of lack of evidence mainly because prehospital emergency care is new in the grand scheme of health care. However there is adequate emergency medicine evidence which can be adapted in a prehospital setting. You’ve gone off topic from the main point of the use of additional adrenaline in an emergency situation. The two are not comparable because the use of more adrenaline has the evidence to prove that the benefits outweigh the risks. For example a patient is on a flight over the Atlantic, has anaphylaxis, it’s completely justifiable to reuse and administer another dose from an epipen. Epipens also come under schedule 19 which means a layperson can administer medication in an emergency situation. Tourniquets however have some evidence but not much and the scenario is highly unlikely or at least not in the U.K. The purpose of a tourniquet is for a catastrophic haemorrhage and the use of tourniquets in crush injuries are more likely cause more harm when used inappropriately there’s no literature to prove it’s efficacy in crush syndrome.

[@sissyturds519]

Thank u this was so helpful

[@idk_my_name168]

THIS IS DANGEROUS NOT HELPFUL

[@alfrednoob9530]

@@idk_my_name168 ok so if im about to die i shouldn’t use it a second time but instead just accept death😂

[@Plantlady100]

A few things... 1. If this was the case why would they make it so difficult to access the additional doses? 2. Why are there no measurements on the syringe? 3. You should never be using the same needle for administration multiple times.

[@jasminescott7155]

I think there is a built in second needle(the one in the cover) maybe but idk if the first one just goes back in. Also it's for emergency.

[@miserere_me9168]

nursoid hands typed this.

[@kimcissell1905]

He is stating in the wilderness. If you rebound back into it.

[@justinleck226]

Every paramedic most likely knows this. Money right? 😡

[@ItsPolarHere]

Nothing against this dude but what if you inject too much epinephrine?

[@benjamincvcvcv7]

Dont do more than 2 doses without medical supervision. However not having it when you need it = death sooooo

[@dereckc9469]

stopped my heart the morning of my confirmation, luckily was in the er

[@ItsPolarHere]

@@dereckc9469 wow that could have ended bad...

[@reemie786]

This is why it coast £89 🤦🏾

[@Noelsterrr]

I make these for a living, there are no extra doses in these pens! There may be a teeny tiny bit extra epinephrine but that's to ensure that you don't get too little.

[@Marzapanmars]

Cap

[@clintonbrooks9339]

So what was all that extra in the one buddy just showed us in the video? Doesn't look edited, or like a tampered with pen to start. I know of I needed these, I'd be cracking open one after using it and cleaning the needle, capping and safely storing it for future use if my new replacement wasn't enough to last me getting to medical aid.

[@sirenofwoodstock558]

No pls DON’T DO THAT

[@benjamincvcvcv7]

Ok ill just die instead. Smh

[@beadlebb22]

Wierd flex bro i know you spent almost a grand making this video lmao

[@YuriyRusko]

Likely an expired epipen