How to Use an EpiPen - First Aid in 6 Steps

The signs to act on: hives or red bumps, puffy eyes or lips, swollen or itchy tongue, wheezing, trouble breathing, sudden drop in blood pressure, or two or more allergic symptoms after a known exposure (food, insect sting, medication).

If you are even slightly unsure, give the shot. The longer you wait, the harder anaphylaxis is to reverse. Mild reactions can become fatal in minutes. About 150 children and young adults die from food allergies each year in the US, and the common factor in fatal cases is delay.

EpiPens are stored in a hard tube case. Flip the cap off the case and slide the pen out. Hold it in a closed fist with the orange tip pointing down toward the leg.

Never put your thumb, finger, or hand over either end. The orange tip is where the spring-loaded needle deploys. If you press it against your own thumb by accident, the needle fires into your thumb instead of the patient's thigh. A fist grip on the middle of the pen is the safe hold.

With the pen in a fist grip, use your other hand to pull the blue safety cap straight up and off. Don't bend it sideways, twist it, or use your thumb to flip it - any of those can fire the pen before you mean to.

While you do this, get the person sitting or lying down. Smaller children sit on a lap or a chair. Older kids and adults sit on the floor or lie flat. The sitting position keeps them from falling if blood pressure drops further during the reaction.

Find the big muscle on the outside of the thigh - the side of the leg, between the hip and the knee. That is where the medicine goes. Avoid the front of the thigh and the inside of the leg.

Hold the person's leg steady so they can't jerk away from the click. Press the orange tip firmly straight in against the thigh until you hear a click. The needle goes through jeans, leggings, and most clothing fabrics - you do not need to expose the skin.

Keep the pen pressed firmly against the thigh for 10 full seconds after the click. Count out loud so you don't shorten the time when adrenaline takes over ("one one-thousand, two one-thousand..."). The medicine takes those 10 seconds to inject fully.

Don't bounce, lift, or re-press. After 10 seconds, pull the pen straight out. The orange tip should extend to cover the needle - it is safe to handle. Keep the used pen with the patient so paramedics know exactly what dose was given.

Call 911 even if symptoms are already improving. Tell the dispatcher "anaphylaxis" so the right response is sent. Epinephrine wears off in 10 to 20 minutes, and the reaction can return harder than the first wave (biphasic anaphylaxis). The person needs hospital observation for at least 4 to 6 hours.

About 1 in 5 people need a second EpiPen before help arrives. Anyone at risk of anaphylaxis should carry two pens at all times. If symptoms come back or never fully resolve, give the second dose into the other thigh using the same steps.