anaphylaxis

No, those doses are largely inappropriate and treatment should be based on individual presentation. You should consult a reputable evidence based medical site, I personally like UpToDate.

Short answer- No.

This is a weird place to ask that question. For one thing, a quick google search would give you better information than your current understanding.

Managed a few anaphylactic reactions in the OR....at least 2 required 4 or 5 mg of epi followed by an infusion in addition to everything else (fluid, vasopressin etc.) Very few patients read the book...

On 3/15/2019 at 8:44 PM, offlabel said:

Managed a few anaphylactic reactions in the OR....at least 2 required 4 or 5 mg of epi followed by an infusion in addition to everything else (fluid, vasopressin etc.) Very few patients read the book...

5 mg of epi? That is over 15 doses.

In my last 2 days at work, I treated 2 cases. Both responded well to a standard 0.3 mg dose.

58 minutes ago, hherrn said:

5 mg of epi? That is over 15 doses.

In my last 2 days at work, I treated 2 cases. Both responded well to a standard 0.3 mg dose.

No...it was the dose the patient got.

Here is a quick reference for yeah. This is emergency medicine.

“First Line”

Epinephrine: Less severe reaction: 0.3 to 0.5 mg (0.01 mg/kg in children) = 0.3 to 0.5 mL of a 1:1,000 solution, (0.01 mL/kg in children), IM q20–30 min PRN, up to 3 doses. Life-threatening reactions: 0.5 mg (5 mL of a 1:10,000 solution) (for children: 0.05 to 0.10 mL/kg per dose) IV, slowly: q5–10 min as needed.

Antihistamines: Diphenhydramine: an H1 blocker: 25 to 50 mg IV (IM or PO) q6h for 72 hours (children 1.25 mg/kg to 25 mg)

Cimetidine: an H2 blocker: 300 mg IV over 3 to 5 minutes (children 5 to 10 mg/kg per dose). We often give famotidine or ranitidine

Corticosteroids: Methylprednisolone: 60 to 125 mg IV in adults (1 to 2 mg/kg in children)

Has anyone read the 2015 guidelines? I'm just wondering why we are still pushing the adjunct agents (H1, H2 and Solumedrol) when the current evidence suggests they are probably unnecessary (I do understand their mechanism of action)? Does anyone from ER have a good rationale?

https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/2015-Anaphylaxis-PP-Update.pdf

On 8/8/2019 at 11:00 AM, 2BS Nurse said:

Has anyone read the 2015 guidelines? I'm just wondering why we are still pushing the adjunct agents (H1, H2 and Solumedrol) when the current evidence suggests they are probably unnecessary (I do understand their mechanism of action)? Does anyone from ER have a good rationale?

https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF Documents/Practice and Parameters/2015-Anaphylaxis-PP-Update.pdf

I think there are various reasons. What do your docs/providers offer as a rationale?

On 8/8/2019 at 9:00 AM, 2BS Nurse said:

Has anyone read the 2015 guidelines? I'm just wondering why we are still pushing the adjunct agents (H1, H2 and Solumedrol) when the current evidence suggests they are probably unnecessary (I do understand their mechanism of action)? Does anyone from ER have a good rationale?

https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF Documents/Practice and Parameters/2015-Anaphylaxis-PP-Update.pdf

Probably since the ACEP, AAP, ACAAI, and countless other physician groups still recognize and support the role that adjunctive medications can have and still exist in their emergency management recommendations for anaphylaxis. While adjunctive medications certainly do not replace the need for epinephrine they can support the patient either through their disease or to help with symptom management.

On 8/10/2019 at 12:51 AM, PeakRN said:

Probably since the ACEP, AAP, ACAAI, and countless other physician groups still recognize and support the role that adjunctive medications can have and still exist in their emergency management recommendations for anaphylaxis. While adjunctive medications certainly do not replace the need for epinephrine they can support the patient either through their disease or to help with symptom management.

Especially for Latex Reactions. H1 and H2 blockers are among the primary drugs to get control of the histamine. Those with latex allergies are also advised to use them as "Pre-medication" before going out of the house.

Yes, many specialties pre medicate with benadryl before treatment.

The H1 and H2 blockers are fine when taken at home, but we would still give epi in an anaphylactic reaction caused by latex.

I get that "we've always done it this way", but the patient has to pay for multiple IV pushes when an oral or IM dose of the adjuncts would probably be sufficient post epi administration.