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Rare but Serious Injuries With Epinephrine Autoinjectors

Seventeen children in whom an EpiPen epinephrine autoinjector was used in response to an allergic reaction experienced preventible leg lacerations, and four needles were lodged in children's limbs.  
medscape.com
almost 5 years ago
Sinaiem dark
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doing-away-with-dopamine-for-pediatric-septic-shock

The current Surviving Sepsis Campaign guidelines recommend starting either dopamine up to 10mcg/kg/min or epinephrine 0.05 mcg/kg/min for pediatric patients suffering from fluid-refractory septic shock. There is a significant lack of evidence as to which of the two agents is most beneficial, however, until a recent study published in Critical Care Medicine attempted to address the issue.  
sinaiem.org
almost 5 years ago
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2015 ACLS Guidelines: What happened to VSE?

  . Introduction . In 2008 and 2013, two prospective RCTs from Greece reported benefits from the combination of vasopressin, steroids, and epinephrine (VSE  
pulmcrit.org
almost 5 years ago
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Why You Should More Than Consider a Vasopressin, Steroid, and Epinephrine (VSE) Cocktail - R.E.B.E.L. EM - Emergency Medicine Blog

Two separate randomized, double-blind, placebo-controlled studies, out of Greece, have examined the role of Vasopressin, Steroid, and Epinephrine (VSE).  
rebelem.com
almost 5 years ago
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Sanofi US Recalls All Auvi-Q Epinephrine Injection

The company had received reports that patients experiencing anaphylaxis were receiving inaccurate, inadequate doses of the drug.  
medscape.com
almost 5 years ago
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EpiPen Supply in Schools Not Enough Without Training

One in five people with anaphylaxis have no known allergies, so epinephrine autoinjectors should be kept in stock at all times, and school staff should be trained to use them, researchers said.  
medscape.com
almost 5 years ago
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Epinephrine: The 'Backboard' of Cardiac Arrest?

Epinephrine continues to be recommended for use in cardiac arrest, but is it warranted?  
medscape.com
almost 5 years ago
Canadiem logo leaf only
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tiny-tips-epinephrine-dosing

 
boringem.org
almost 5 years ago
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Epinephrine Autoinjector Shortage Predicted After Recall

Almost half a million autoinjectors are coming off the market. Patients are being advised to call their doctor for an alternative, but some say there won't be enough supply to meet the demand.  
medscape.com
almost 5 years ago
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Tiny Tip: Anaphylaxis Treatment - CanadiEM

Anaphylaxis is a common presentation to the emergency department requiring rapid treatment as death can occur within minutes. From 1986 – 2011, in Ontario, Canada alone there were 82 deaths from anaphylaxis (1). Epinephrine 0.5mg IM (1:1000) is the first line treatment for anaphylaxis and the only lifesaving treatment (2).  
boringem.org
almost 5 years ago
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 Building Trust: More Oxytocin, Less Epinephrine

By Felix Ankel, MD @felixankel and Leah Hanson, PHD @lrbhanson “Trust is like the air we breathe. When it’s present, nobody really notices. But when it’s absent, everybody notices.” Warren Buffett You are a new #MedEd dean charged with modernizing and integrating a postgraduate education program into a recently merged health care delivery system.  The…  
icenetblog.royalcollege.ca
almost 5 years ago
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Critical Care

Severe systemic inflammatory response to infection results in severe sepsis and septic shock, which are the leading causes of death in critically ill patients. Septic shock is characterised by refractory hypotension and is typically managed by fluid resuscitation and administration of catecholamine vasopressors such as norepinephrine. Vasopressin can also be administered to raise mean arterial pressure or decrease the norepinephrine dose. Endogenous norepinephrine and vasopressin are synthesised by the copper-containing enzymes dopamine β-hydroxylase and peptidylglycine α-amidating monooxygenase, respectively. Both of these enzymes require ascorbate as a cofactor for optimal activity. Patients with severe sepsis present with hypovitaminosis C, and pre-clinical and clinical studies have indicated that administration of high-dose ascorbate decreases the levels of pro-inflammatory biomarkers, attenuates organ dysfunction and improves haemodynamic parameters. It is conceivable that administration of ascorbate to septic patients with hypovitaminosis C could improve endogenous vasopressor synthesis and thus ameliorate the requirement for exogenously administered vasopressors. Ascorbate-dependent vasopressor synthesis represents a currently underexplored biochemical mechanism by which ascorbate could act as an adjuvant therapy for severe sepsis and septic shock.  
ccforum.com
almost 5 years ago
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News Quiz: 2015 Big LEAP Year for Allergists

Landmark LEAP results, epinephrine injector recalls, new asthma drugs, guidelines for allergic rhinitis, and the role of gut microflora in cutting-edge treatments had specialists talking this year.  
medscape.com
almost 5 years ago
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R.E.B.E.L. EM - More Dogma: Epi in Digital Nerve Blocks - emdocs

You are working as an EM resident and have just evaluated a patient with a right long finger DIP joint dislocation. You perform a digital nerve block with 1% lidocaine with 1:100,000 epinephrine, and go to present to your attending before attempting the reduction. Your attending, on hearing about the epinephrine use goes berserk, and says “don’t you know that you shouldn’t use epi in fingers, noses, ears and toes?”.  
emdocs.net
over 4 years ago
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AdrenaCard, an Epinephrine Autoinjector The Size of a Credit Card |

EpiPens save lives in cases of anaphylactic shock by letting patients with severe allergies deliver epinephrine quickly and easily. Yet, a lot of people do  
medgadget.com
over 4 years ago
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PUSH HARD AND FAST – AND SAY NO TO DRUGS

Drugs in cardiac arrest has been under bombardement for some time now. Atropine is out, adrenaline is just in there for good old times sake. And now, in an unselected cardiac arrest population, a new NEJM published RCT shows that the silver bullet anti-arrhythmic amiodarone is no more effective in getting better outcomes than injecting saline. The same went for the old Hail Mary rescue drug lidocaine, also included in the RCT. The basics are what matters in cardiac arrest: early and effective chest compressions and early defib.  
scancrit.com
over 4 years ago
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Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis

Objectives To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population.  
feeds.bmj.com
over 4 years ago
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Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis

Objectives To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population.  
feeds.bmj.com
over 4 years ago
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Anaphylaxis: Early Epinephrine Tied to Fewer Overall Doses

Anaphylaxis cases are rising dramatically; epinephrine use before ED arrival was associated with a lower likelihood of requiring multiple doses of epinephrine in the ED among children with anaphylaxis.  
medscape.com
over 4 years ago
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Biphasic anaphylaxis

I have written about anaphylaxis before (in the form of a video) and also shared a Why We Do What We Do on Epinephrine. Perhaps appropriately so, here is a “delayed” post on biphasic reactions, which the actual occurrence of, or the potential for lead to further ED observation and admissions for children with anaphylaxis.  
pemcincinnati.com
over 4 years ago