Risk Management Pitfalls In Management Of Allergy And Anaphylaxis
“The patient had an intravenous catheter in place, so I thought it seemed reasonable to give epinephrine through the intravenous line rather than to stick the patient again with an intramuscular injection.”
Expert guidelines recommend administering epinephrine via the intramuscular route. It has a fast time of onset, and there is a lower likelihood of adverse arrhythmias from intramuscular administration versus intravenous administration of epinephrine. If a patient is not reacting appropriately to repeated doses of intramuscular epinephrine or has cardiovascular collapse, consider intravenous epinephrine at that time, and attempt to determine the causes of the refractory response (such as chronic use of beta blockers).
“The patient has urticaria and wheezing after eating a cookie with nuts, but he looks good and is not hypotensive, so I won’t give epinephrine yet. I’ll try albuterol and an antihistamine first. Besides, he is 60 years old, and who knows if he has undiagnosed cardiac disease?”
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