Recently I witnessed a medication error with epinephrine, the patient was a 26 year old female, written for 0.5mg of epinephrine sq due to a allergic reaction to a medication, PT had hives/facial swelling. The patient was given 0.5mg of epinephrine 1:10,000 IV push. The patient for a few moments had sinus tachycardia, shortness of breath, chest pain, decreased vision & the feeling as if they were going to pass out. After a minute or so vitals were back to baseline & the patient only had complaints of a headache. Patient was admitted for observation, troponins/ekg were normal, echocardiogram was normal, also a Mri of the head was done as the patient had continued headache which was negative for any findings. My question is do epinephrine errors happen often? Also, I'm curious how this patient received such a high dose of epi but had no harm done, seems rare.....
Before all the inhalers came to market, Epi 0.3 mg sc PRN was given frequently for asthmatics having a severe asthma attack. Most docs would write it as a PRN order on admission-a standard order on the medical floor. There was little back then that could be done for them. And before the pulse oximeters came around, arterial blood gases was the primary way to know what an asthmatic was doing in the patient was in respiratory trouble. Things have changed for the better in this regard.
ACLS guidelines state that for an allergic reaction SQ epi is the ONLY way.
1. We are dealing with an allergic reaction not a cardiac emergency.
2. Concentration is diff so the dose is too.
3. If you refer to ACLS guidelines, it spells it out
4. Yes. This is actually common. I went to a rapid response where the pt. Was having an allergic rxn to topical betadine and they cracked the crash cart to admin epi IV. I stopped the process and educated staff. It slowed the process but it the right dose and route was administered.
Sounds like a great topic for a unit education session/ inservice. You should co ordinate with your education department and pharmacy to get something started.
All nurses can make a mistake learning from the mistakes can help improve your whole unit.
retiredmednurse
63 Posts
Before all the inhalers came to market, Epi 0.3 mg sc PRN was given frequently for asthmatics having a severe asthma attack. Most docs would write it as a PRN order on admission-a standard order on the medical floor. There was little back then that could be done for them. And before the pulse oximeters came around, arterial blood gases was the primary way to know what an asthmatic was doing in the patient was in respiratory trouble. Things have changed for the better in this regard.