Intramuscular Injections [Explained]

In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about taking intramuscular injections in paramedic practice.

In today’s lecture, we’re going to talk about intramuscular injections.

So, there are going to be times as a paramedic when you need to give a wide range of drugs through the intramuscular route. So, for those of you who are not familiar with this term, intramuscular just means, into the muscle.

Now, when we’re giving an intramuscular route, what you have to remember is that the volume of drug that you give, cannot be controlled that well. Now, if you compared this to intravenous drug administration, there’s a method called titrate to response.

Now, what that means is, if you have a situation, let’s say, a patient who’s having a convulsion, and you’re giving an anticonvulsant drug, a benzodiazepine for example, if you start to give a certain volume of drug, you can stop the patient convulsing. If they don’t stop convulsing, you give more and more and more ’til eventually, they stop convulsing. That’s called titrate to response.

Now, what you have with an intramuscular route is a muscle that will take a certain volume of drug and it will absorb it into the blood stream at a certain speed and have an accumulative effect all at the same time depending on the health of the muscle. So, there’s less control of the amount that you can give. However, regardless of that, it’s still a commonly used drug route.

So, here we have a list of different types of muscles that we tend to use. The first being the deltoid. The deltoid’s really popular among paramedics because it’s easily accessible and it’s basically this top muscle here.

You also have the rectus remoras and the vastus lateralis. So, in other words, anywhere around the upper femur is absolutely okay.

You then have the gluteus meatus, gluteus maximus. Now when you’re going to give an intramuscular injection in this area, you have to draw an imaginary cross, and you’re giving it in the upper outer quadrant because you don’t want to hit one of the major nerves. The sciatic nerve as you can see here. So, that’s why we use upper outer quadrant. Draw an imaginary line, and it’s here. Then we have the ventrogluteal region as well.

So, four key areas that you can use, but basically you can use any muscle at all, whatsoever.

So, what about the needle, then?

So, here we have an image of the different angles that you give the intramuscular injection at. So, with an intramuscular injection, you’re looking to inject straight down to hit the muscle there. You’re going through the epidermis layer, the dermis, subcutaneous, which is the fat layer and directly into the muscle. Notice how if you angle the needle, you’re avoiding hitting the muscle, so in other words, this is the angle you need. 90 degrees. You tend to do it like a dart. We do have a separate session on this later on and of course you will be able to practice this when you get to the workshops.

Now, this middle needle here, this 25-gauge, is generally what we use for intramuscular, but you can use shorter ones and larger ones if needed. But, generally speaking, the 25-gauge is the one that we tend to use for most people. Now, again, this is a subcutaneous needle, but you can use it with say, children or the elderly, but the choice of needle really does come down to you as to what type of patient you’re presented with.

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