April 2021

Approach to the Critical Patient

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Paul Z. -

You keep mentioning that IM epi should be given in the lateral thigh. We routinely give it in the deltoid: convenient, minimal possible damage if given in central deltoid - same reason vaccinations are given there. The thigh needs to be used for auto-injectors, as those needles come out like harpoons (they are designed to go through pants) and in the arm would probably hit the humerus unless the person were large. But many EDs draw up their own epi, especially given the cost of auto-injectors. Why the insistence on the lateral thigh? Old dogma, or confusion with auto-injectors? If there is a pharmacologic reason, maybe Brian Hayes could explain it to me? Also, I treat teens like adults - 0.01 per kg - max 0.5 - and many teens - even pre-teens these days - are >50 kg. A number of times I have treated anaphylaxis in a teen with 0.3, got a partial response, give the additional 0.2, got the complete response. I now go up the 0.01/kg to 0.5, same as an adult. Again (if talking to Brian) are kids really pharmacologically different?

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Angioedema Full episode audio for MD edition 92:31 min - 93 MB - M4A