Just wondering how many of your have ever heard of epi spritzers, and how many of your hospitals use them.
I would have posted in a pediatric forum, but I was curious if it was an adult medicine thing as well. So, if you use them - do you work peds or adults?
For those who haven't heard of them, an epi spritzer is where you take 1 code dose of epi and dilute it with NS to a total volume of 10 ml. You would them give 1 ml at a time (1/10th of a code dose).
It would be used for a patient who was becoming hemodynamically unstable, but who you didn't want to slam with a full code dose.
Just a point of order, 1:100 epi means 10 mg/ml and 1:10 epi means 100 mg/ml. These are concentrations that are n used in clinical practice.
1:1000 is the 1 mg/ml amp for mixing infusions and the standard 1:10,000 bristojet "code" epi is 100 mcg/ml.
So called "pedi" epi is 10 mcg/ml, or 1:100,000 epi.
Yes! 'Pedi epi' must be what we use on my unit for 'low dose epi.' Like the 'spritzer' Julius described, it is 1/10 the concentration of the usual abboject code epi (just premixed to that concentration rather than mixing it on the fly). The 'pedi epi' is what we use to prevent cardiac arrest in kids with sick hearts, like I described in my first post. We use weight-based doses at 1/10 the dose you'd use for Epi in PALS (so 0.01 mg/kg for code epi, and 0.001 mg/kg for low dose epi). If you're drawing up both 'code epi' and 'low-dose epi' to have at the bedside, the volume would be the same, but the concentration would be different by a factor of 10.
Like I said, low-dose epi is pretty ubiquitous in my Peds Cardiac ICU. We probably use it at least as often as code epi (maybe more, since we try to prevent more codes than we run). I'm not sure if that's standard practice in PICU, or if it's just a provider preference within my unit, but we seem to have fairly good results.
Sounds like "epi spritzers" are pretty common, but go by many names. Push dose epi, pedi epi, low dose epi. Interesting!
I think a lot of that has to do with the "mystique" of epinepherine. Sort of like how levophed got named "leave 'em dead". People are, by and large only accustomed to using the drug in very specific circumstances in an emergency or really sick patient. Even in anesthesia. The reality is that at these "push dose" (or whatever) doses, it (or levophed, for that matter) can be used in very routine settings where only modest adjustments in hemodynamics are required. It is just a matter of using it more often in that way and the idea of having "pushed epi" isn't so dramatic anymore.
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@Julius Seizure, MSN...
Forgot another routine use of 10mcg/ml epi is for brochospasm and bradycardia in the operating room.