Thursday, February 28, 2019

IV Bolus Epi for Anaphylaxis

EMCrit CQiR - February 27, 2019 by Ashley Mogul
"Take Home Points:
  • Continue giving your initial dose of epinephrine IM
  • In IV bolus epinephrine: low dose, slow push
  • Don’t give dead people doses of epinephrine to alive people
I would like to acknowledge Diane Lum, PharmD and Guang Mei Fung, PharmD for their assistance with my literature review.

Comments from Weingart
There must be an equivalent IV infusion dose to our standard IM dosing! But I'll be damned if I can find out what it is… So my best clinical recs based on experience actual patients we have tried this on.
  • Start at 5 mcg/min
  • this will almost always be too low
  • titrate every couple of minutes up to 10, 15, 20 mcg
  • For a patient that is peri-code, consider 20-40 mcg/min (as best I can tell, the 0.3 mg IM we give is expected to last approx. 10 minutes, so 30 mcg/min is probably the mean over those 10 minutes (though I'm sure there is a peak/trough rather than steady state)). If someone is truly going down the poop shoot, giving half of an ml of cardiac epi (50 mcg) or 5 mls of EMCrit-style push-dose pressors (50 mcg) may be warranted."