Intramuscular injectors

Simons PER, Lieberman PL, Read EJ Jr. Edwards ES Hazards of unintentional injection of epinephrine from auto-injectors a systematic review. Ann Allergy Clin Immunol 2009 102 267-272. Rawas-Qalaji MM, Simons PER, Simons KJ Sublingual epinephrine tablets versus intramuscular injection of epinephrine dose equivalence for potential treatment of anaphylaxis. J Allergy Clin Immunol 2006 117 398-403. 

Ingestion Do not induce vomiting first symptoms are likely to be gastrointestinal administer immediately 2-mg intramuscular injection of the MARK I Kit auto injectors seek medical attention immediately. 

Skin Contact Don respiratory mask and remove contaminated clothing wash contaminated skin with copious amounts of soap and water immediately using 10% sodium carbonate solution, or 5% liquid household bleach rinse well with water to remove decontamination if local sweating and muscular symptoms occur, administer an intramuscular injection with the MARK I Kit seek medical attention immediately. Ingestion Do not induce vomiting first symptoms are likely to be gastrointestinal administer immediately 2-mg intramuscular injection of the MARK I Kit auto injectors seek medical attention immediately. 

An individual who has received a known agent exposure or who exhibits definite signs or symptoms of agent exposure shall be given an intramuscular injection immediately with the MARK I kit auto-injectors. 

II.f.1.3. Insulin delivery. Traditionally insulin was given intramuscularly and later subcutaneously. New technology has provided devices for insulin administrations including pen-devices, air powered injectors, external insulin infusion pumps (or continuous subcutaneous insulin infusion, CSII), and implantable insulin infusion pumps. Some novel forms of insulin delivery have been introduced, for example intranasal insulin gives peak insulin concentrations at 10-20 minutes after administration, but most insulin is still administered subcutaneously. 

Injection technique has pharmacokinetic consequences according to whether the insulin is delivered into the subcutaneous tissue or (inadvertently) into muscle. The introduction of a range of appropriate length needles and pen-shaped injectors has enabled patients to inject perpendicularly to the skin without risk of intramuscular injection. The absorption of insulin is as much as 50% more rapid from shallow i.m. injection. Clearly factors such as heat or exercise which alter skin or muscle blood flow can markedly alter the rate of insulin absorption. 

Clostridium novyi type A, a bacterium that was associated with serious infection during the two World Wars, killed 35 injecting heroin users in Britain and Ireland (49). Clostridium novyi type A is present in soil and dust and is a well-recognized cause of infection in sheep, cattle, and other animals. Contaminated batches of heroin from a common source were believed to be responsible for the recent outbreak. The bacteria were able to survive the process of preparation for injection. All recent cases occurred after intramuscular injection, which provides the requisite anerobic conditions for infection. This was the first time that this organism caused an outbreak of infection in drug injectors. In all, 74 cases with the same clinical features were reported. 

In mass casualty situations, intravenous antidotes may not be available. In that case, the intramuscular administration is acceptable. Most Emergency Medical Systems in the United States now stock military Autoinjector units containing atropine and pralidoxime, although kits with pediatric doses may not be available. However, in critical situations, children older than 2 or 3 years of age weighing at least 13 kg might benefit from 2 mg of atropine and 600 mg pralidoxime administered intramuscularly with auto-injectors (7). Experience with the accidental atropine auto-injection in 240 Israeli children unexposed to nerve agents revealed that... 

There are different devices conunerciaUy available for needle-free injectirai. Commonly jet injectors produce a high-velocity jet of medicine that penetrate the skin. Medicines and vaccines can be administered either intramuscularly or subcutaneously by means of a narrow, high velocity fluid jet that penetrates the skin. The gas-forced needle-free injection systems are typically made up of three components including an injection device, a disposable needle free syringe and a gas cartridge. 

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