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Paper Chase 2 - Epi, Anaphylaxis, and the Elderly

Sanjay Arora, MD and Mike Menchine, MD
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04:06
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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02:06

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EM:RAP 2017 August Summary 718 KB - PDF

We are much less likely to give epinephrine to older patients with anaphylaxis. This study also found that IM epi led to fewer adverse cardiac effects compared to IV.

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Justin M., M.D. -

I love this paper. 1 quibble though. You say that the paper shows that IM epineprhine had fewer adverse cardiac events then IV epineprhine , however that misses a really important caveat. All 3 patients who had adverse events after IV epineprhine were given an inappropriate dose. All 3 had the IM dose (0.3 mg) given IV. There were no adverse events among patients given an appropriate IV dose. It isn't really fair to blame the IV route when it was actually a medication error that caused the event. In fact, in older patients in whom you might be concerned about using epinephrine, the IV route makes way more sense, because you can titrate the dose you are giving, starting with a much lower dose, whereas the IM dose is given as a single large bolus.
Cheers
Justin

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