Q: 44 years old obese male with past medical history of asthma and hypertension (HTN) is admitted to ICU after severe anaphylaxis reaction to bee-sting. Patient required intubation and vasopressors to sustain hemodynamics. Patient is known to have previous severe allergies and was carrying epinephrine injection which was promptly injected. Despite administration of epinephrine injection, patient went into severe anaphylaxis. What could be the multiple reasons?
Answer: There are many reasons where epinephrine doesn't work or partially works to prevent anaphylaxis. Patients who are on beta-blockers, alpha-blockers, or angiotensin-converting enzyme inhibitors may not respond well to "epi-injection". Similar reports have been reported with asthmatic patients.
Another reason in this regard is the improper application of epi-injection. The anterolateral thigh is preferred over other areas as it has relatively less superficial subcutaneous tissue and ample blood supply to absorb epinephrine in the blood. The needle is recommended to pierce an inch to reach the thigh muscle area. Many patients though carry epi-injection but are not properly trained how to apply in panicky situations.
Also, epinephrine should be kept at room temperature to prevent oxidation and inactivation. Carrying epi-injection in hot outdoors for a long period of time may inactivate the injection.
Our patient in this question has various reasons for not responding to epinephrine. He is obese, may have been on the above-mentioned anti-hypertensives, and has a history of asthma.
#hemodynamics
References:
Simons FER. First-aid treatment of anaphylaxis to food: Focus on epinephrine. J Allergy Clin Immunol 2004; 113:837. Copyright ©2004 Elsevier
No comments:
Post a Comment