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

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:108

Article

Simons, FER ; Chan, ES ; Gu, XC ; Simons, KJ

关键词: epinephrine;    adrenaline;    systemic anaphylaxis;    acute allergic reaction;    infants;    first aid;    EpiPen;    Ana-Kit;   

DOI  :  10.1067/mai.2001.119916

来源: Elsevier

【 摘 要 】

Background: Little information is available about administration of an accurate epinephrine dose to infants experiencing anaphylaxis outside the hospital setting. Objective: Our purpose was to perform a prospective, controlled study of (1) the time needed by parents to draw up an infant epinephrine dose from an ampule and (2) the dose accuracy. Methods: We gave 18 parents written instructions and asked them to draw up epinephrine 0.09 mL. We timed them by means of a stopwatch and measured the epinephrine content (in micrograms) in each dose by using HPLC-UV. Eighteen resident physicians, 18 general duty nurses, and 18 emergency department nurses served as controls. Results: The parents took significantly longer (P<.05) than the controls to draw up the dose; the mean ( SEM) times were 14213 seconds (range, 83-248) for the parents. 52 +/-3 seconds (range, 30-83) for the physicians, 40 +/-2 seconds (range, 26-71) for the general duty nurses, and 29 +/-0.09 seconds (range, 27-33) for the emergency department nurses. The control groups did not differ significantly from each other in speed (P>.05). The epinephrine content of the doses drawn up by the parents ranged 40-fold in contrast to the physicians' doses (7- to 8-fold), general duty nurses' doses (3-fold), and emergency department nurses' doses (2-fold). The mean epinephrine content did not differ significantly (P>.05) among the 4 groups. Conclusions: Most parents were unable to draw up an infant epinephrine dose rapidly or accurately. Most health care professionals drew up the dose rapidly; however, their accuracy was compromised by inherent variations of epinephrine concentrations in the ampules (United States Pharmacopeia compendial limits, 90% to 115%) and the inherent difficulty of measuring low volumes (<0.1 mL) of epinephrine. User-friendly premeasured epinephrine doses suitable for infants should be developed.

【 授权许可】

Free