101 Things the Fire Department wishes you knew



Friday, May 29

You Make the Call...Expired Meds

You are assigned to an ALS engine dispatched to a reported asthma attack.

On your arrival a middle aged woman is in severe respiratory distress, tripoding and you see a rash on her neck. Her husband tells you she has allergies to shellfish and may have been exposed at the restaurant they just left.

You reach for your Epi and Benadryl only to find that what you thought was a 12/2009 during this morning's checks is actually a 2/2009. Kicking yourself and swearing to look closer next time you hold them both to your face to make sure.

Both your life saving meds are clearly expired. Her condition is worsening as your officer looks to you and says, "No ambulance assigned yet, something wrong with your drugs?"

Give the expired meds or no? You Make the Call.

15 comments:

Anonymous said...

Give the drugs. The worst that can happen is that they won't work or will work ineffectively. No worse than doing nothing.
DaveO

Jean said...

GIVE! It may buy you some time until fresh drug could be accessed.

brendan said...

Hit her. The chances of them both being completely ineffective are just about zilch (a fact the family lawyer would surely point out in his opening statement).

Music Medic said...

Give the drugs.. As stated before, Your patient is probably better off at any rate until recent drugs can be found, But I'd make it a point to let my superiors and the Hospital know what was going on.

Mat said...

Give the meds. Document document document and bring it up in the hand off.

Having had the experience of getting hit with a couple months expired epi-pen (just for yuks) I can tell you it doesn't stop working the day it expires. It will do *something* which is better than it doing *nothing.* Buys you time to get fresh drugs and continue to monitor the patient. Call for an intercept if needed.

Little Girl said...

I say give the drugs.

The Road Doctor said...

I also say give them. Our PMD has made it perfectly clear that drugs do not magically expire on the their date.

You would also need to advise the ED staff, and document like crazy...

Firecap5 said...

Ditto.

brokenangel said...

give them their effectiveness gradually declines and a few months out of date the effects are likely to be nearly that of the full effect.

Anonymous said...

Same here, do not hesitate. Keep in mind that the expiration dates are an 'AVERAGE" and as a lot of patients keep these drugs in terrible conditons such as glove compartments and on dash boards, yours kept in a drug box at somehwta controlled conditions will last a lot longer. Check to make sure the contents are not cloudy and remain clear, then give the shot, at the same time ask for another fly car or see if the BLS unit coming in has EPI on board. There may be another 'user' in the crowd. A little unorthodox, I grant you, but if your hit has no effect are you going to save the patient, or go with what works. Courts seldom convict someone who is doing everything possible for the patient based on good knowledge. We had a local case a while back where the patient died from anaphylaxis after 4 hits from 4 different expired epi pens, including two of the patients own pens, which were over a year out of date laying on the truck dashboard. The patient was a logger with a bee alergy who had gotten hammered by a hornets nest.
Capt. Tom

medic_9 said...

If the patient is that allergic she probably has her own epi pen. If you are that worried start with that. Otherwise I would barely hesitate on the just-recently-expired epi.

As previously stated the drug doesn't magically go back the day it expires.

"Countries like Canada and the United States mandate that expiry dates are included on all medications. At the time of the medication expiry date, the drug must be at least 90% of the original potency under proper storage conditions."
[http://www.askyourpharmacist.ca/medication_expiry_dates.html]

Three months over that window, I doubt you would see a difference in action.

As also stated, document the circumstances well.

MotorCop said...

I agree with Brendan...but with a caveat.

Administer the drugs....stay with me here....to yourself and then hit her.

Wait, I think I misunderstood the question. Let's all take a minute and be thankful I'm not a medic.

And my 'word verification' for this comment was "draco". Damn you, Malfoy.

Shasta said...

Geez I am glad I don't have your job! My most stressful decisions involve whether or not to let a student make up a missed exam!

Texas Ghostrider said...

I think the vote is in and the motioned carried..... Hit her with your best shot

medicblog999 said...

I'm slow on this one today, you are getting far too many comments these days!!
As with all of the above- give the drug!

However, the real test is, do you own up in your documentation or not??