S Ubcutaneous E Pinephrine in the P Rehospital S Etting

Abstract

The authors did not find significant evidence to contraindicate the use of subcutaneous epinephrine in older patients who are not known to have coronary artery disease, who present with either asthma or allergic reactions.

Intracranial Hemorrhage After Prehospital Administration of Intramuscular Epinephrine

“…Although it is unclear how significant the allergic reaction (tongue swelling) was in our patient before epinephrine administration, the patient reported only minimal resolution of her symptoms upon arrival to the ED, and our initial physical examination revealed only mild lingual edema and lack of any airway compromise. A recent systematic literature review failed to reveal evidence to contraindicate the use of intramuscular epinephrine in older patients who are not known to have coronary artery disease (24). However, in the absence of impending airway compromise, cardiovascular collapse, or true anaphylaxis, it may be prudent to carefully consider the potential risks of intramuscular epinephrine when deciding whether its administration is warranted based upon the presentation and severity of the allergic reaction, particularly in elderly patients.…”

Factors associated with repeated use of epinephrine for the treatment of anaphylaxis

“…This may be because physicians were reluctant to give epinephrine to older patients who are more likely to have cardiovascular comorbidities. However, there is no data to suggest that a history of known coronary artery disease is a contraindication to epinephrine 17. Alternatively, it is possible that younger patients had more severe or persistent symptoms.…”

Anaphylaxis in the prehospital setting

“…Horowitz et al reported a fatal intracranial bleed associated with field administration of 0.5 mg of epinephrine in a misdiagnosed case of anaphylaxis despite presence of a contraindication (severe hypertension) (22). There are also risks of other non-fatal but potentially serious complications (21,23). Although the literature does not suggest that field use of epinephrine is unsafe, the literature to date is based only on paramedic-level administration of epinephrine.…”