IM Epi in full arrest with anaphylactic etiology.

SpecialK said:

Push dose adrenaline is a pain and very hard to adjust, for anaphylaxis, asthma, septic shock unresponsive to two or three litres of fluid, and certain bradycardias we put 1 mg into 1 litre of NaCl and run at 2 gtt/s initially and go up/down depending on need. Super easy to make up and super easy to adjust and no fart-arseing around with single bolus aliquots.

The exception is small children who get 1:1,000,000 boluses PRN.

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Remi said:

Except now your IVF has epi in it, so you can't run it at whatever rate is otherwise indicated. Unless you are talking about putting it in a second bag, which is no less time consuming than making a syringe of 10mcg/ml and giving 1-2cc boluses.

Just draw 1ml of the normal (1:10,000, or 100mcg/ml) concentration epi into a 10cc syringe and then dilute it with 9cc of IVF from the primary bag. Easy peasy and more precise than eyeballing a drip.

When I was doing sick pediatric cases I would always have 2 syringes of epi ready: one 10mcg/ml and one 100mcg/ml. Very easy to give and titrate, since it takes full effect almost immediately.

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Seirende said:

I realize that this is the ALS section, but how about when working with a BLS rural service with ALS 20 min. away? Would IM epi be worth the time in this anaphylactic arrest scenario?

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