Glass Ampules

I donít think EMS should carry drugs in glass ampules. I know how to open a glass ampule and how to draw the drug out with a syringe and filtered needle. But I will say it is much easier to use a glass ampule in an ER using a standup table then it is to use it in the street.

Most of our drugs are in vials or prefilled syringes. The only drugs we carry in ampules are epi: 1:1000 and Haldol, which we used to carry in vials. I give epi 1:1000 only three or four times a year for anaphylaxis and severe allergic reactions. These are calls where the patient needs the drug without delay. To open the ampule, after swinging it through the air in a quick circle to get the drug all in the bottom, I take a 4 X 4, hold it over the tip, and snap it. Then I lay it down on the bench seat or a the hood of a car or if, I am in a house, on a table or chair, on another 4X 4, and then carefully draw the drug out. With epi 1:1000, I only have to draw out 0.3 ccs, so if I spill some in opening the ampule, I donít worry too much. With Haldol however, I have to draw up the full cc.

I admit sometimes there is spillage when I open an ampule. Worse sometimes the ampule shatters. I have on several occasions cut the tip of my thumb on the jagged glass edge, causing me to have to put on another glove to contain my bleeding while I take care of the patient.

The last time I cut myself was drawing up Haldol which I was mixing with a
Ativan to give to a man on PCP who suddenly waking from his catatonic state, decided he wanted no part of going anywhere but out of the ambulance and likely back down the street. I drew it up while sitting on the manís legs as my partner sat on his chest and tried to keep him down on the stretcher.

There has been talk with the shortage of epi 1:10,000 in the Bristo Jets, we may have to use 1:1000 glass ampules and mix them with 9 cc of saline for our cardiac arrest epi doses. Here’s where I did my last three cardiac arrests: in a dark crowded bathroom (crowded due to narrow size of bathroom and large size of patient), in the crawlspace behind the lanes of a bowling alley which had not much more width than a backboard, and in a moving ambulance). I am glad we still had the bristojets.

I know with the drug shortages, sometimes EMS services have to get what meds they can get. Iíd just prefer vials. They are safer and easier.

***

When we did run out of the 1:10,000 Bristojets, we did recieve a shipment of multidose epi 1:1000 vials for mixing with 9 cc saline in cardiac arrest, along with warnings not to draw up too much by mistake.

1 Comment

  • BH says:

    Our main hospital is giving out 1:1000 1mg vials for restock now. I don’t know who makes/distributes them, but they’re out there.

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Peter Canning

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  • Comments
    Sandy
    The Ideal Medic
    As a 24 year medic, I finally figured out it wasn't me. Thank you for your article. You can't teach that in any classroom. I have always found that empathy is a great tool. Use it to benefit the patient and teach others what it is all about.
    2015-03-24 22:24:30
    Joseph Eriksen
    The Ideal Medic
    As a 30 year, now retired medic I completely agree. There is nothing wrong with second guessing although one should go with their gut. There are times to be aggressive and times to not. Also humor is one of the most powerful pre-hospital tools in the toolbox although it can't be taught. When appropriate it…
    2015-03-24 19:37:25
    Shawn McCormick
    The Ideal Medic
    I totally agree. To me those make great paramedics. I work as a Operation Supervisor and encourage teamwork/backup whenever the situation calls for it. I encourage feedback from a difficult call my crews responded to. 1) they have the chance to recall the events that took place and they may self evaluate the call. 2)…
    2015-03-24 17:14:14
    Sean Fitch
    The Ideal Medic
    Totally agree Peter, For too long I had the same interpretation and like you now, I would by far take your current description.
    2015-03-24 17:05:33
    tom combs - ER doc/author
    The Ideal Medic
    Twenty-five years as an ER doc in level one trauma centers has me in total agreement. I Interestingly what you say regarding paramedics also, in many ways, applies to ER docs. "Tries to learn from each call...puts the patient first." A great post. I salute to your wisdom!
    2015-03-24 17:04:06

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