racemic epi

[zzyzx]

Any of you guys use racemic epi for severe asthma? How well does it work?

In my system, we give epi sub Q. I've never had any patients who've been bad enough to need it. Does anyone have experience using sub Q epi? How well did it work and how long did it take to work?

[nsmedic393]

We use racemic epi for infants presenting with stridor, i have used it once and it worked pretty well.

I actually gave epi for an asthma attack a couple of weeks ago. The girl had a near silent chest and I couldn't hardly bag her. Gave an IM shot of 0.3mg and started getting good a/e and compliance to bagging within a couple minutes. By the time we got to hospital she was sitting up and able to take a mask.

[Ridryder 911]

Racemic epi has been around for several decades. I have used it in the past before the use of many of the newer treatments were invented. There is so many less harmful products out there.... with less side effects. I use epi as a last resort and only then.

Of course tachycardia, irritation and nervousness, shaking can occur, as well because of the tachycardia many of the other neb's cannot be used in conjunction.

R/r 911

[AZCEP]

Racemic epinephrine is well suited to stridor causing conditions like croup and epiglottitis, but there are better agents for asthma.

If you've used a maximum dose of albuterol/atrovent and haven't gotten any results, you might consider IM epi rather than SVN.

[kevkei]

Many studies have shown that there is no better efficacy with nebulized epi or racemic epi over albuterol. Considering the added potential of more significant side effects, albuterol is a better choice.

As has been stated, nebulized epi is better where you want to see the alpha effects, like in anaphylaxis (lingual or pharyngeal edema) or croup.

IM is okay if given in a large muscle mass (sub Q is a poor choice given the alpha effects it decreases it's absorption) in severe bronchospasm or when nothing else seems to be working. I've found that albuterol + Atrovent (ipatropium) repeater prn works well and if you need something extra in the moderate/severe patients, add 2 mg of Mag Sulfate IV early in your regimen. Keep in mind this is for the asthmatic, not the COPD'er.

[Spock]

I've used racemic epi in the hospital for post intubation croup in pediatric patients and it works very well. I will extubate in the OR and if I hear even the slightest stridor I will call for racemic epi and take the child to PACU. Respiratory responds immediately to the PACU and will give the treatment there.

Totally agree with all the other comments about albuterol vs. epi. The PEPP (or is it PALS or both?) curriculum does say you can give nebulized epi but I've never done it. The advantage of racemic epi is it does not have the same side effects as regular epi. Chemically, racemic epi is a mirror image of regular epi (levo- vs. dextro- enantomer{sp?}). Organic chemistry at its best!

Does anybody give albuterol via an endotracheal tube in the field?

Live long and prosper.

Spock

Spock

[AZCEP]

PALS and PEPP are put out by the same people at the American Academy of Pediatrics so the information is nearly identical in regards to these medications.

We do have the option of inline SVN treatments, but I've had better luck using it with the BVM, than down the ETT. Purely anectdotal, I realize, but that is my experience. Typically if a patient gets intubated before the breathing treatment, I will use IM/IV epi instead of down the tube. I suppose I could try an atomizer to deliver it into the lungs directly, but haven't had an opportunity present since we've gotten them.

[ERDoc]

Speaking for the ER docs that will be taking care of your pts after you drop them off, please don't give racemic epi unless you absolutely have to. You are committing them to at least a four hour ER stay. Let the ER doc make that decision if you can avoid not giving it. I'll get off my soap box now.

[firefighter523]

ER Doc,

I am curious as to why you buy them a 4 hour ED stay. Please, if you would, explain the rational.

Thank you.

Respectully.

[ERDoc]

ER Doc,

I am curious as to why you buy them a 4 hour ED stay. Please, if you would, explain the rational.

Thank you.

Respectully.

The effects of racemic epi last about two hours. You are going to keep the pt in the ER at least that long to make sure they don't have any rebound. The pediatric literature recommends four hours of observation, giving you 2 hours after the epi has worn off to look for worsening. EM literature says two hours is fine. FP splits the difference and says three hours. It's really up to the treating physician and their comfort level. Here are a few references for your review. Hope it helps.

http://www.fpnotebook.com/LUN125.htm

http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum