AUTO-INJECTORS

SSHK ACE3 Advanced Medical Training

Auto-injectors
 Morphine
 Epinephrine
 Atropine
 Adenosine
Pain
 Divided into nociceptive, neuropathic, phantom,
etc………
 Nociceptors are free nerve endings in tissues
connecting to the central nervous system CNS,
sensitive to pain and tissue damage
 Nociceptors generate nerve impulse (electrical nerve
signal) to the brain when experience an external
stimulus (This process is called transduction)
 Organs/ tissues that rich in nociceptors
 Renal, periosteum, dermis, arterial walls, etc.
Pain - Transduction
 When nerve impulse is generated, the nociceptor
will depolarise, there will be a reversal of polarity
and that will be transmitted from the nociceptor up
towards the CNS and the brain
 Transduction and depolarisation are set at where
the tissues are starting to be damaged
 E.g. Putting your hand in hot water
 Pain sensation is to prevent tissue damage
Neuropathic vs Nociceptive
 Neuropathic comes from the nerves themselves
 E.g. Diabetic patients
 Nociceptive pain starts with an nociceptor
Hyperaglesia
 Algesia = pain
 There will be hyperaglesia if a tissue is inflamed, a
particular stimulus is going to cause pain whereas the
particular stimulus would not
 The nociceptors can be sensitised, transduction occurs
more readily and easily, the depolarisation threshold
of the nociceptors will be lowered
 Meaning a particular stimulus which normally does not
cause pain will cause pain due to hyperaglesia
 E.g. UTI, OA
Morphine
 Opioid Analgesics
 Either naturally occurring (Endogenous) or
chemically synthesised drugs that interact with opioid
receptors in the CNS to produce analgesia
 Weak opioids
 Codenie, Dihydrocodeine, Tramadol
 Strong opioids
 Morphine, Diamorphine, Fentanyl, etc.
Opioid Analgesics
 Major function of endogenous opioids is to
modulate pain signals, manage severe pain,
however, repeated administration may lead to
tolerance and dependence
 Synthesised in response to pain and exert their
effects by binding to opioid receptors in the brain,
spinal cord and CNS
 Morphine mimics the action of endogenous
opioids
Morphine – Injection for severe pain (Adults)

 Intramuscularly/ Subcutaneously
 5-20mg
 Intravenously
 2.5-10mg
Morphine - Contraindications
 Hypersensitivity to morphine
 Respiratory depression or insufficiency
 Renal/ liver failure
 Obstructive airways disease
 Inflammatory bowel disease
 Hypotension
Morphine - Overdose
 Symptoms
 Respiratory depression (Decrease in respiratory rate),
hypotension, cardiac arrest, cold and clammy(sweaty)
skin, death, etc.
 Treatment
 Re-establishment of adequate respiratory exchange
 Oxygen, intravenous fluid, vasopressors and other
supportive measures should be employed as indicated
 Narcotic antagonist – Naloxone, a specific antidote for
morphine
Side Effects
 Nausea & vomiting
 Histamine release
 Dry mouth
 Tolerance and dependence
 Hypotension
 Edema
 Respiratory depression
 ETC
Endocrinology
 The study of chemical communication systems
that provide the means to control a huge number of
physiologic processes
 Like other communication networks, endocrine
systems contain transmitters (Hormone producing
cells), signals (Hormone) and receivers
(Receptors)
Homeostatic Control
 The endocrine system
 Broadcasts its hormonal messages to the target cells by
secretion into blood and extracellular fluid. Cells
MUST bear a receptor for the hormone in order to
respond.
 The nervous systems
 Point-to-point control through nerves (like sending
WhatsApp). Nervous control is electrical in nature and
fast
Endocrinology
Hormones
 Hormones are chemicals secreted into the blood
and carried by blood and tissue fluids to cells.
 Kinds of Hormones
 There are two major classes of hormones:
 Proteins, peptides, and modified amino acids
 Steroids
Endocrinology
 Endocrine Action
 The hormone is distributed in blood and binds to
distant target cells
 Paracrine Action
 The hormone acts locally by diffusing from its source
to target cells in the neighborhood
 Autocrine Action
 The hormone acts on the same cell that produced it
Hormone Action
 Proteins, peptides, modified amino acid
 Synthesized in cells from amino acids
 These hydrophilic hormone molecules bind to
receptors on the surface of “target” cells.
 These “target” cells are able to respond to presence of
the hormone.
 The hormone receptors are transmembrane proteins.
 Binding of the hormone to its receptor initiates a
sequence of intracellular signals that may
 Alter the behaviour of the cell (e.g. opening or closing
membrane channels)
 Stimulate (or repress) gene expression in the nucleus
Epinephrine (Aka Adrenaline)
 Travels in blood, binds to the adrenergic
receptors on target cells
 Many types of “stresses” stimulate the secretion of
epinephrine, including exercise, hypoglycemia,
trauma, etc.
 Acts on nearly all body tissues
Epinephrine Action
 Increase rate and force of contraction of the heart muscle
 Increase metabolic rate
 Constriction of blood vessels
 Dilation of bronchioles
 Dilation of the pupils
 Treating anaphylactic reaction (Type I hypersensitivity reaction)
 Stimulation of lipolysis in fat cells
 Inhibition of certain “non-essential” processes
 E.g. gastrointestinal secretion and motor activity
 Arma 3 Adv Med
 Low HR: increase by ~15
 Normal HR: increase by ~35
 High HR: increase by ~30
 Epinephrine Action

Organ Effects
Heart Increases heart rate, contraction force
Lungs Increases respiratory rate, bronchodilation
Systemic Vasoconstriction, lipolysis, muscle
contraction

Liver Stimulates glycogen breakdown

Epinephrine – Injection for Asystole/ Cardiac
Arrest (Adults)
 Intracardiac injection (An old-school method, only be considered if no
other access available)
 Emergency injections that are given directly into the left ventricles ONCE.
 Needle is inserted in the fourth intercostal space between the ribs
 3-5ml IC 1:10,000
 Intravenous injection (repeated every 3-5 minutes if necessary)
 5-10ml IV 1:10,000
 Endotracheal (via an endotracheal tube directly into bronchial tree
ONCE)
 5-10ml 1:10000
 Increase heart beat, breathing, metabolism.
 Start the heart beat again!!
 Can be also injected intramuscularly as well (commonly use for
anaphylactic reaction)
 0.5ml IM 1:1000
Epinephrine - Contraindications
 Hyperthyroidism
 Hypertension
 Ischemic heart disease
 Diabetes mellitus
 Allergy
Epinephrine - Overdose
 Symptoms
 Breathing trouble, sudden numbness, slurred speech,
problems with vision and balance, HPT
 Cardiac arrhythmias leading to ventricular fibrillation
 Severe hypertension leading to pulmonary edema and
cerebral haemorrhage
 Treatment
 Combined alpha-and-beta-adrenergic blockers may
counteract the effects
 Arma 3 Adv Med- Adenosine injection (6 doses to an
overdose)
Epinephrine – Side Effects
 Fast heartbeats
 Sweating
 Nausea and vomiting
 Dizziness
 Headache
 Nervous, anxious