Division of Cardiology, Department of Medicine, St. John Hospital and Medical Center, Detroit, MI, USA.
Ann Emerg Med. 2010 Apr;55(4):341-4. doi: 10.1016/j.annemergmed.2009.11.008. Epub 2010 Jan 19.
Epinephrine is indicated for various medical emergencies, including cardiac arrest and anaphylaxis, but the dose and route of administration are different for each indication. For anaphylaxis, it is given intramuscularly at a low dose, whereas for cardiac arrest a higher dose is required intravenously. We encountered a patient with suspected anaphylaxis who developed transient severe systolic dysfunction because of inappropriately received cardiac arrest dose, ie, larger dose given as an intravenous push. Three additional patients who experienced potentially lethal cardiac complications after receiving inappropriately higher doses intravenously were also identified. These iatrogenic errors resulted from underlying confusion by physicians about proper dosing of epinephrine for anaphylaxis. The risk of error was amplified by the need for rapid decision making in critically ill anaphylactic patients. An e-mail survey of local hospitals in southeast Michigan revealed that 6 of 7 hospitals did not stock prefilled intramuscular dose syringes for emergency use in anaphylaxis. At our institution, we have introduced prefilled and appropriately labeled intramuscularly dosed epinephrine syringes in crash carts, which are easily distinguished from intravenously dosed epinephrine syringes. In this Concepts article, we describe the clinical problem of inadvertent epinephrine overdose and propose a potential solution. Epinephrine must be clearly packaged and labeled to avoid inappropriate usage and unnecessary, potentially lethal complications in patients with anaphylaxis.
肾上腺素适用于各种医疗紧急情况，包括心脏骤停和过敏反应，但每种适应症的剂量和给药途径都不同。对于过敏反应，它以低剂量肌内给药，而对于心脏骤停，则需要静脉内给予更高剂量。我们遇到了一位疑似过敏反应的患者，由于接受了不适当的心脏骤停剂量，即静脉内推注较大剂量，导致短暂的严重收缩功能障碍。还确定了另外 3 名患者在接受静脉内给予不适当更高剂量后经历了潜在致命的心脏并发症。这些医源性错误是由于医生对过敏反应时肾上腺素的适当剂量存在混淆。在患有严重过敏反应的危急患者中需要快速决策，这增加了发生错误的风险。对密歇根州东南部的当地医院进行的电子邮件调查显示，7 家医院中有 6 家没有为过敏反应急救使用预填充的肌内剂量注射器。在我们的机构中，我们在急救车中引入了预填充和标记适当剂量的肌内注射肾上腺素注射器，与静脉内注射肾上腺素注射器很容易区分开来。在这篇概念文章中，我们描述了意外使用肾上腺素过量的临床问题，并提出了一种潜在的解决方案。肾上腺素必须明确包装和标记，以避免在过敏反应患者中发生不适当的使用和不必要的、潜在致命的并发症。
