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excellent, team..thank you.
tom f.merced(and Brooklyn, Al)
How can INTRAVENOUS adrenalin be given safely and effectively in children and how does it compare to intravenous terbutaline after intramuscular adrenalin or terbtaline not being as effective as hoped ?
Well, Ian, I have to say that Al and Jeff have some great ideas from experience that I may not necessarily have a ton of experience with or literature on! I think I have done IV epi once for peds asthma. But SLOW is the short answer. I found this on JEMS (https://www.jems.com/patient-care/attacking-asthma-five-steps-tr/): Add 1 mg epi to a liter bag of saline and run it at 0.25 mL/minute (1 mcg epi/minute). The shock dose of epi is 0.1–1.0 μg/kg per min. Sometimes asthma is worse than shock, I suppose, so in a desperate situation this seems reasonable. Not sure it is better or worse than terb (not a highly studies area!) but likely more available.
I agree with Ilene...there isn't much available literature or experience with IV epinephrine infusions for pediatric asthma. I would be very cautious with its use and would rely more on the treatment modalities we discussed, including repeat bolus doses of IV terbutaline, followed by some of the ICU-level interventions, including inhaled anesthetics, if necessary.
Absolutely agree. IV epi is really only used in conjunction with an ICU team.
What you do matters.