Epinephrine for the out-of-hospital (first-aid) treatment of anaphylaxis in infants: Is the ampule/syringe/needle method practical?

Simons, F. E. R.; Chan, Edmond S.; Gu, Xiaochen; Simons, Keith J.

doi:10.1067/mai.2001.119916

Cited by 114 publications

(74 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, dose preparation can take laypersons as long as 3 to 4 minutes; moreover, doses typically are inaccurate and can sometimes contain no epinephrine at all when the solution is ejected from the syringe along with the air. 36 Although unsealed 1-mL syringes prefilled by a health care professional with infant epinephrine doses also have been recommended, the doses can be lost, and the epinephrine solution typically degrades within a few months as a result of air exposure. 37 After consideration of the aforementioned alternatives that potentially lead to delay in dosing, incorrect dosing, or no dose at all and consideration of the favorable benefit-to-risk ratio of epinephrine in young patients with anaphylaxis, many physicians recommend the use of the 0.15-mg EA in infants.…”

Section: Safety Of Epinephrinementioning

confidence: 99%

Epinephrine for First-aid Management of Anaphylaxis

2017

View full text Add to dashboard Cite

Anaphylaxis is a severe, generalized allergic or hypersensitivity reaction that is rapid in onset and may cause death. Epinephrine (adrenaline) can be life-saving when administered as rapidly as possible once anaphylaxis is recognized. This clinical report from the American Academy of Pediatrics is an update of the 2007 clinical report on this topic. It provides information to help clinicians identify patients at risk of anaphylaxis and new information about epinephrine and epinephrine autoinjectors (EAs). The report also highlights the importance of patient and family education about the recognition and management of anaphylaxis in the community. Key points emphasized include the following: (1) validated clinical criteria are available to facilitate prompt diagnosis of anaphylaxis; (2) prompt intramuscular epinephrine injection in the mid-outer thigh reduces hospitalizations, morbidity, and mortality; (3) prescribing EAs facilitates timely epinephrine injection in community settings for patients with a history of anaphylaxis and, if specifi c circumstances warrant, for some high-risk patients who have not previously experienced anaphylaxis; (4) prescribing epinephrine for infants and young children weighing <15 kg, especially those who weigh 7.5 kg and under, currently presents a dilemma, because the lowest dose available in EAs, 0.15 mg, is a high dose for many infants and some young children; (5) effective management of anaphylaxis in the community requires a comprehensive approach involving children, families, preschools, schools, camps, and sports organizations; and (6) prevention of anaphylaxis recurrences involves confi rmation of the trigger, discussion of specifi c allergen avoidance, allergen immunotherapy (eg, with stinging insect venom, if relevant), and a written, personalized anaphylaxis emergency action plan; and (7) the management of anaphylaxis also involves education of children and supervising adults about anaphylaxis recognition and fi rst-aid treatment.

show abstract

Section: Safety Of Epinephrinementioning

confidence: 99%

Epinephrine for First-aid Management of Anaphylaxis

2017

View full text Add to dashboard Cite

show abstract

“…This approach was studied in 18 parents who were trained in the technique and whose speed and accuracy of drawing up an infant epinephrine dose (0.09 mL) was compared with that of 54 physicians and nurses (controls). 23 The parents took significantly (P Ͻ .05) longer than the controls to draw up the dose. The mean Ϯ SEM times for drawing up doses were 142 Ϯ 13 seconds (range: 83-248 seconds) for parents, 52 Ϯ 3 seconds (range: 30 -83 seconds) for physicians, 40 Ϯ 2 seconds (range: 26 -71 seconds) for general duty nurses, and 29 Ϯ 0.09 seconds (range: 27-33 seconds) for emergency department nurses.…”

Section: Epinephrine Dosing For First-aid Treatment In the Communitymentioning

confidence: 99%

Self-injectable Epinephrine for First-Aid Management of Anaphylaxis

Sicherer¹,

Simons²

2007

Pediatrics

166

129

View full text Add to dashboard Cite

Anaphylaxis is a severe, potentially fatal systemic allergic reaction that is rapid in onset and may cause death. Epinephrine is the primary medical therapy, and it must be administered promptly. This clinical report focuses on practical issues concerning the administration of self-injectable epinephrine for first-aid treatment of anaphylaxis in the community. The recommended epinephrine dose for anaphylaxis in children, based primarily on anecdotal evidence, is 0.01 mg/kg, up to 0.30 mg. Intramuscular injection of epinephrine into the lateral thigh (vastus lateralis) is the preferred route for therapy in first-aid treatment. Epinephrine autoinjectors are currently available in only 2 fixed doses: 0.15 and 0.30 mg. On the basis of current, albeit limited, data, it seems reasonable to recommend autoinjectors with 0.15 mg of epinephrine for otherwise healthy young children who weigh 10 to 25 kg (22-55 lb) and autoinjectors with 0.30 mg of epinephrine for those who weigh approximately 25 kg (55 lb) or more; however, specific clinical circumstances must be considered in these decisions. This report also describes several quandaries in regard to management, including the selection of dose, indications for prescribing an autoinjector, and decisions regarding when to inject epinephrine. Effective care for individuals at risk of anaphylaxis requires a comprehensive management approach involving families, allergic children, schools, camps, and other youth organizations. Risk reduction entails confirmation of the trigger, discussion of avoidance of the relevant allergen, a written individualized emergency anaphylaxis action plan, and education of supervising adults with regard to recognition and treatment of anaphylaxis.

show abstract

“…Sin embargo, en condiciones controladas, el llenado de una jeringa con ampolla de adrenalina difiere mucho entre personas entrenadas y no entrenadas, como los padres (29 s ± 0,09 vs. 142 s ± 13, respectivamente). 27 Este punto es crucial porque el retardo en la aplicación de la adrenalina puede poner en riesgo la vida del paciente. 28 Además, los accidentes relacionados con caídas de ampollas, jeringas, punturas de dedos, etc., son frecuentes y constituyen un riesgo para los pacientes.…”

Section: Preparación De La Adrenalinaunclassified

Actualización en las recomendaciones del tratamiento del choque anafiláctico: novedades sobre el uso de adrenalina

2015

Arch Argent Pediat

View full text Add to dashboard Cite

ResumenEn 1998, la Sociedad Argentina de Pediatría publicó la recomendación del tratamiento del choque anafiláctico. Mientras en dicha recomendación se sugería el uso de adrenalina por vía subcutánea, actualmente se considera la vía intramuscular como la más adecuada. Aspectos farmacodinámicos determinan esta preferencia. Para el tratamiento extrahospitalario, el uso de autoinyectores de manera correcta puede colaborar en el control rápido y eficaz de la afección. El uso del resto de las medicaciones propuestas en la recomendación de 1998 se mantiene sin cambios. Palabras clave: anafilaxia, adrenalina intramuscular, autoinyectores de adrenalina. ABsTRACTIn 1998, the Sociedad Argentina de Pediatría issued the recommendation of the treatment of anaphylactic shock. While this recommendation suggested the use of subcutaneous epinephrine, currently the intramuscular via is considered the most appropriate one. Pharmacological aspects determine this preference. For outpatient treatment, the correct use of autoinjectors can control anaphylaxis quickly and effectively. The use of other medications in the proposed 1998 recommendation remains unchanged. InTRODuCCIÓnEn 1998, la Sociedad Argentina d e P e d i a t r í a ( S A P ) p u b l i c ó l a recomendación sobre el tratamiento integral del choque anafiláctico. 1 Dicho documento tuvo como objetivo unificar las medidas necesarias para el tratamiento de una entidad que requiere precisión en la identificación del paciente y en la elección del tratamiento adecuado para el rescate del niño con este problema.2,3 La anafilaxia es de aparición súbita, potencialmente mortal, por lo general, subdiagnosticada y mal tratada. 4 Esta recomendación es útil y debería considerarse en los programas de entrenamiento de las emergencias pediátricas.N o v e d a d e s i n t r o d u c i d a s e n estos últimos años obligan a realizar una actualización sobre algunos conceptos básicos de las definiciones y tratamiento del choque anafiláctico.Actualmente, se considera que existen dos definiciones de anafilaxia: una fisiopatológica y otra clínica. La primera está relacionada con la propuesta por la recomendación de 1998 y dice: "Cuadro clínico caracterizado por aquellas reacciones sistémicas atribuibles a la liberación de mediadores químicos debidas a causas conocidas (inmunológicas y no inmunológicas) o desconocidas (idiopáticas)". La segunda aclara sobre el tipo de reacción sistémica a la que se hace referencia en la primera: "Reacción alérgica generalizada multisistémica rápidamente evolutiva caracterizada por uno o más síntomas o signos de compromiso respiratorio y/o cardiovascular, y que también involucra a otros sistemas como la piel o el aparato gastrointestinal".

show abstract

Epinephrine for the out-of-hospital (first-aid) treatment of anaphylaxis in infants: Is the ampule/syringe/needle method practical?

Cited by 114 publications

References 6 publications

Epinephrine for First-aid Management of Anaphylaxis

Epinephrine for First-aid Management of Anaphylaxis

Self-injectable Epinephrine for First-Aid Management of Anaphylaxis

Actualización en las recomendaciones del tratamiento del choque anafiláctico: novedades sobre el uso de adrenalina

Contact Info

Product

Resources

About