epi and nitro

[NYMedic828]

It is important to consider that anaphylaxis can be a cause of MI.

The risks of epinephrine are often over-blown. For example, one paper is titled "AMI after Administration of Low-Dose Intravenous Epinephrine for Anaphylaxis" (This is the case report that Systemet cites.) Except that the "low-dose" was 0.1 mg IV, which is a pretty high frakin' dose. The only IV dose of epinephrine that has been used in a controlled study environment used 0.005-0.015 mg/minute as a starting dose. Roguemedic just did a column on this!

There are plenty of instance where anaphlaxis has been identified as the cause of STEMI, even in people without cardiac disease:
Acute coronary syndrome triggered by honeybee sting: a case report.
Acute anterior myocardial infarction after multiple bee stings. A case of Kounis syndrome.
Kounis syndrome presenting as ST-segment elevation myocardial infarction following a hymenoptera (bee) sting.

Not to change the subject, but if we consider giving 0.3mg IM or 0.1mg IV to patients as a HIGH dose. Who on earth decided that if someone is in arrest, we should give them upwards of 4mg IV?

 

[Veneficus]

Not to change the subject, but if we consider giving 0.3mg IM or 0.1mg IV to patients as a HIGH dose. Who on earth decided that if someone is in arrest, we should give them upwards of 4mg IV?

I am going to guess somebody who was doing the best they could with the knowledge they had at the time.

Most of the studies performed on any treatment came after the original resuscitation guidlines, which were based on the known theory at the time.

Like I keep saying, there is a major flaw with EBM, new practices or changes require far more evidence than the enshrined practices.

Even when somebody does a study and demonstrates treatment doesn't work, still more evidence is demanded. It never ends.