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.
tom f. - August 5, 2022 1:14 AM
excellent, team..thank you.
tom f.
merced
(and Brooklyn, Al)
Jeff S. - August 7, 2022 4:09 PM
Thank you!
Alfred S. - August 7, 2022 6:22 PM
Thanks Tom.
ilene c. - August 5, 2022 5:11 PM
Thank you!
Ian L. - August 6, 2022 3:08 PM
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 ?
ilene c. - August 6, 2022 3:28 PM
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.
Jeff S. - August 7, 2022 4:06 PM
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.
Alfred S. - August 7, 2022 6:23 PM
Absolutely agree. IV epi is really only used in conjunction with an ICU team.