Today, I reviewed, link to and excerpt from Dr. Larry Mellick’s blog* in Emergency Medicine News, Pulse Dose Pressors for Children and Adults, Thursday, October 30, 2014.
*Link is to a list of blogs on Emergency Medicine News. This list is a great resource for all primary care clinicians.
All that follows is from Dr. Mellick’s post, Pulse Dose Pressors for Children and Adults.
The three videos presented this month demonstrate the technique for mixing and administering pulse dose epinephrine with actual patients. Particularly helpful is the one that demonstrates the administration of pulse dose epinephrine to a pediatric patient. What I really like about the demonstrated pediatric technique (first discussed in my Emergency Medicine News blog on anaphylaxis: http://bit.ly/1CHsX6h) is that it uses the same 1:100,000 concentration used for adults. And, the 0.1 mL/kg is easily remembered because it is the same mL/kg recommendation for the ACLS concentration of epinephrine. There is essentially nothing new to learn.
I first learned about the concept of pulse dose pressors, or as I call them, “push dose pressors,” from the EMCRIT blog by Scott Weingart, MD. (http://bit.ly/10mvXHc.) The value of push dose pressors for treating anaphylaxis presenting with hypotension was immediately apparent to me. It is stressful to treat hypotensive patients with anaphylaxis who are unresponsive to intramuscular epinephrine. Most of us cringe just a little at the thought of giving intravenous epinephrine outside cardiopulmonary arrest. Having a technique for giving well calibrated and exact doses of epinephrine makes the administration of intravenous epinephrine much more palatable. But if giving intravenous epinephrine to an adult is stressful, the angst associated with the pediatric patient is compounded. Viewing these videos should give peace of mind for treating adults and children with intravenous pulse doses of epinephrine.
Don’t cringe when you think of giving epinephrine outside of cardiac arrest. This first video shows pulse dosing during intubation.
This second video shows how to mix epinephrine for pulse dosing.
Pediatric pulse dosing employs the same concentration used for adults. This third video shows how to administer it to a child.
