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Epinephrine

Dose:
Epinephrine - 1 mg/mL injection, 0.01 mg/kg, (IM, 1 time only) Epinephrine 1 mg/mL, maximum 0.5mg

 

Key results:
Our parent guideline (GINA, 2018, p. 84) recommends EPI IM in addition to conventional therapy for an asthma exacerbation associated with anaphylaxis and angioedema. We make a conditional recommendation to consider epinephrine 1:1000, IM, 0.01 mg/kg, for the patient in the ED with an asthma exacerbation that is not responding to conventional treatment. If the patient is not responding to conventional therapy, the use of EPI IM likely outweighs any adverse side effects. EPI IM may decrease risk of intubation and mechanical intubation. When epinephrine was added to treatment with SABA improvement in PEFR at 20 minutes after treatment was not significantly different from treatment with SABA alone (Becker et al., 1983; Kornberg et al., 1991; Sharma & Madan, 2001). When epinephrine was compared to terbutaline, change in FEV1 (% predicted) was not different (Schwartz et al., 1980)

For additional information click here for the Epinephrine Critically Appraised Topic (CAT)

References: 

Becker, A. B., Nelson, N. A., & Simons, F. E. (1983). Inhaled salbutamol (albuterol) vs injected epinephrine in the treatment of acute asthma in children. J Pediatr, 102(3), 465-469.

GINA. (2018). Global Strategy of Asthma Management and Prevention

Schwartz, A. L., Lipton, J. M., Warburton, D., Johnson, L. B., & Twarog, F. J. (1980). Management of acute asthma in childhood. A randomized evaluation of beta-adrenergic agents. Am J Dis Child, 134(5), 474-478.

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.