IM Epi in full arrest with anaphylactic etiology.

[Carlos Danger]

Push dose adrenaline is a pain and very hard to adjust, for anaphylaxis, asthma, septic shock unresponsive to two or three litres of fluid, and certain bradycardias we put 1 mg into 1 litre of NaCl and run at 2 gtt/s initially and go up/down depending on need. Super easy to make up and super easy to adjust and no fart-arseing around with single bolus aliquots.

The exception is small children who get 1:1,000,000 boluses PRN.

Except now your IVF has epi in it, so you can't run it at whatever rate is otherwise indicated. Unless you are talking about putting it in a second bag, which is no less time consuming than making a syringe of 10mcg/ml and giving 1-2cc boluses.

Just draw 1ml of the normal (1:10,000, or 100mcg/ml) concentration epi into a 10cc syringe and then dilute it with 9cc of IVF from the primary bag. Easy peasy and more precise than eyeballing a drip.

When I was doing sick pediatric cases I would always have 2 syringes of epi ready: one 10mcg/ml and one 100mcg/ml. Very easy to give and titrate, since it takes full effect almost immediately.

 

[FiremanMike]

Except now your IVF has epi in it, so you can't run it at whatever rate is otherwise indicated. Unless you are talking about putting it in a second bag, which is no less time consuming than making a syringe of 10mcg/ml and giving 1-2cc boluses.

Just draw 1ml of the normal (1:10,000, or 100mcg/ml) concentration epi into a 10cc syringe and then dilute it with 9cc of IVF from the primary bag. Easy peasy and more precise than eyeballing a drip.

When I was doing sick pediatric cases I would always have 2 syringes of epi ready: one 10mcg/ml and one 100mcg/ml. Very easy to give and titrate, since it takes full effect almost immediately.

I pushed hard for push dose epi to replace dopamine/epi drip.. In the end, the Chiefs rejected the idea because it was too complicated... Sigh

 

[Bosco836]

I realize that this is the ALS section, but how about when working with a BLS rural service with ALS 20 min. away? Would IM epi be worth the time in this anaphylactic arrest scenario?

In Ontario, BLS services have protocols for IM 1:1,000 Epi for Cardiac Arrests where anaphylaxis is suspected to be the causative event.

Reference: Medical Cardiac Arrest Medical Directive - http://www.lhsc.on.ca/About_Us/Base...ctives/SWORBHPPCPMedicalDirectiveBook2015.pdf