Paramedics Often Fail to Give Epinephrine for Anaphylaxis

[RocketMedic]

Quit thinking, you! Kool-Aid!

 

[mycrofft]

I've seen epi given each way and it worked. However, the infarct caused by the epi is better tolerated in the thigh than the deltoid, especially in little old people.

 

[Veneficus]

I just want to be clear - it's not my own crackpot opinion!

I have a high appreciation for crackpot opinions.

Because those crackpots often have something remarkably genius to say.

 

[KellyBracket]

Haha, definitely not assuming its your own opinion. I was just curious because my program advocated the deltoid. My assumption is that it is due to 1 part laziness and 1 part misinformation. The delt is definitely easier to access in most patients and If the instructor doesn't know it, odds are the students aren't going to learn it.

As far as it having a placebo effect in the deltoids i find that a little hard to believe. I have seen it work perfectly fine when given in the deltoids. I would be hard pressed to believe that patients are subconsciously increasing their HR to 150+ bpm. It just doesn't seem possible especially if they don't know what you gave them.




While we are on the topic of paramedics and anaphylaxis, could you take a moment to break down why we don't give atrovent in conjunction with albuterol for treating broncho-constriction in anaphylaxis?

At least here in NYC we don't. We give albuterol only. I have been told in the past we do not give it because anaphyalxis is not a cholinergic mediated process but at the same time wouldn't decreasing parasympathetic tone indirectly increase sympathetic tone aiding in bronchodilation with albuterol and epi?

The studies showed placebo-identical blood levels. It's difficult to compare the clinical effectiveness in actual anaphylaxis, given the rarity, and urgency, of the situation.

As for ipratropium, I haven't read anything on the topic, positive or negative. (Okay, one very rare, negative thing!)I would imagine that, since albuterol (like Benadryl, steroids, etc) is adjunctive treatment, it just doesn't matter. Anaphylaxis is a systemic disorder, and you need more than the local action of inhaled agents.