Pass me the epinephrine

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There are the very things that can prove to be as dramatic in medicine as a patient who is dying from an anaphylactic reaction. These patients look awful. They are normal one minute and then swollen, sweating, short of breath and extremely anxious the next. If you make the diagnosis and give these patients some epinephrine, they get markedly better within seconds. The turnaround is amazing. Well, a recent study has found that doctors are reluctant to give epinephrine in this situation. I know that epinephrine isn’t a benign drug. A surge of epi causes the heart to race. It can cause blood vessels to constrict so severely that patients have been reported to have had myocardial ischemia (a heart attack) secondary to lack of blood flow. In my mind, the answer is simple. Give the life-saving drug… then deal with the side effects.

From NPR:

An epinephrine injection can be life-saving for someone with a severe allergic reaction to a bee sting, a peanut or a piece of shrimp. But just half of internal medicine doctors know that epinephrine should be the first treatment, a recent study finds.

And it gets worse in the emergency room — up to 80 percent of the time, a person experiencing anaphylaxis, a severe allergic reaction, isn’t receiving epinephrine when they should, another study found.

“I think moms are probably more aggressive than physicians are in using [epinephrine],” saysDr. Andrew Murphy, an allergist and member of the American Academy of Allergy, Asthma and Immunology.

That’s why a joint task force of allergists published guidelines on Tuesday in the Annals of Allergy, Asthma and Immunology, reinforcing that emergency rooms should be using epinephrine “first and fast” to treat a severe allergic reaction.

Part of the problem may be that doctors use epinephrine to treat cardiac arrest, so it’s “associated with really life-ending events and people get really nervous about it,” says Murphy. (more….)

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