about patients with life-threatenin...

about patients with life-threatening asthma do not accord to inhaled selective beta-adrenergic agents and subsequently advance to respiratory failure. Although epinephrine has no advantage to these inhaled agents in mild to moderate asthma, intravenous epinephrine may have a usefulness in life-threatening situations. Intravenous administration provides rapid storming of action, reliable dose titration, and the ability to immediately stop administration if adverse purports are noted. Smith and associates demeanored a retrospective chart review to cogitation the effects of intravenous epinephrine use in pair large hospital emergency departments.

Intravenous epinephrine was used at the discretion of the attending physician, usually when other therapies, including inhaled beta agonists and intravenous or oral steroids, failed or when an already at-risk patient had altered mental status or decreased respirations. All patients requiring intravenous epinephrine were admitted to the intensive care unit. During the eight-year consideration 27 patients met the inclusion criteria, with most numerous receiving an intravenous loading dose between 50 mcg and 1 mg of a 1:10000 solution (mean, 200 mcg) of epinephrine. About undivided half received a continuous infusion of intravenous epinephrine ranging between 3 to 20 mcg by min, with most receiving 1 mg above an hour.

No major adverse affairs resulting from epinephrine administration were noted, and none of the subject of attention patients died while hospitalized. individual patient had chest pain that eventually resolv without any sequelae. The alone arrhythmia noted in the studious mood group was sinus tachycardia. There was no evidence of ischemia or increase in cardiac enzyme No patient had any neurologic deficit resulting specifically from the epinephrine administration. There were no significant, untreatable offspring pressure changes. No other adverse meanings were noted.

The authors gather that administration of intravenous epinephrine to patients with life-threatening asthma did not cause hypotension, acute cardiac or cerebral ischemia, or increased mortality. mostly changes in vital signs were caused on intubation, not by epinephrine administration. A prospective trial of intravenous epinephrine in patients with life-threatening asthma would be useful to further define the efficacy and safety of this treatment step

Smith D et al. Intravenous epinephrine in life-threatening asthma. Ann Emerg M May 2003;41:706-11

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