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Medical English / 3. 8. 2009

Falling Short of the Target / By Tom Secrest

By Tom Secrest

If you like diet and fat jokes then here is another classic, well perhaps not a classic, not yet anyway.

Question: How do you know if you’re too fat?
Answer: Whenever a doctor gives you an IM injection you only get a sub-q.

Admittedly not everyone will appreciate the joke, especially if you are about to go into anaphylactic shock and you just shot 0.3 mg of epinephrine into the hypodermis of your thigh instead of the vastus lateralis underneath.

In the July 2009 issue of Pediatrics, a new study involving 256 children, ages 1 to 12, found that almost 19% had skin-to-muscle surface depths that exceeded the length of the needle used in auto-injectors. This problem involving kids and auto-injectors is a relatively new issue. The same problem in adults hit the journals about 2 years ago. An article published in the 29 January 2007 edition of the Journal of Advanced Nursing, concluded that in overweight, obese, or very obese individuals, IM injections at the dorsogluteal site would miss the muscle in 98% of women and 37% of men and IM injections at the ventrogluteal site would miss the muscle in 97% of women and 57% of men. The final conclusion was that for individuals with a BMI of 24.9 kg/m2 or more, needles longer that 1.5 inch (38 mm) should be used and while the dorsogluteal site could be used for everyone, the ventrogluteal site should be reserved for men that are only slightly overweight.

The skin-to-muscle depth problem has now been extended to children and to epinephrine auto-injectors. A study published in the November 2001 Journal of Allergy and Clinical Immunology clearly showed that IM epinephrine produces significantly higher peak plasma concentrations faster than injections administered into the subcutaneous layer. Peak levels for EpiPen injections into the thigh produced peak concentrations of 12.222 ± 3.829 pg/ml within 10 minutes, which was over 4 times higher than the peak plasma levels reached when epinephrine was injected SC.

Considering the potential delays associated with children, or their parents, being indecisive about whether or not to use their auto-injectors, the ability of the injector system to produce peak plasma concentrations quickly could be of paramount importance.

Dr. Dawn Stecher of the Phoenix Children’s Hospital, Phoenix, Arizona, and her fellow researchers concluded that “increasing the needle length on auto-injectors would increase the likelihood that more children would receive epinephrine by the recommended intramuscular route.”

If you think about it, seeing Nurse Ratched come at you with an 80 mm needle could be a powerful incentive to loose a little weight.

Quiz of the day: Who was Nurse Ratched?


  •  fallingshort – neschopnost, nedostatek
  • admittedly – nepochybně, nesporně
  • appreciate – ocenit, uznat
  • instead of – namísto
  • underneath – pod, vespod, na spodní straně
  • depth – hloubka
  • needle – jehla, vpichovat, očkovat
  • overweight – obézní
  • slightly – mírně, lehce, nepatrně
  • considering – vzhledem, s ohledem na, se zřetelem na, uvážíme-li
  • delay – zpoždění, odkládat, průtah
  • indecisive – nerozhodný, váhavý, neurčitý
  • ability – schopnost, obratnost, zdatnost
  • paramount – rozhodující, hlavní, svrchovaný
  • likelihood – pravděpodobnost, možnost
  • recommended – doporučený
  • incentive – pobídka, motiv 


                                                                                     About Tom Secrest / Tom Secrest online 



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