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Adverse events associated with the use of intravenous epinephrine in emergency department patients presenting with severe asthma
journal contribution
posted on 2006-06-01, 00:00 authored by M Putland, Debra KerrDebra Kerr, A-M KellySTUDY OBJECTIVE: We determine the rate of adverse effects associated with the use of intravenous (IV) epinephrine by infusion for the treatment of severe asthma in the emergency department (ED). METHODS: This retrospective, structured, medical record review included adult patients who presented to the ED of Western Hospital between 1998 and 2003 and who were triaged as category 1, 2, or 3, had a discharge diagnosis of asthma, and were administered IV epinephrine in the ED. Patients were excluded if they were older than 55 years or if a diagnosis of asthma was not confirmed. The primary outcome measures were occurrence of cardiac arrhythmia or ischemia, local tissue ischemia, hypotension or hypertension, neurologic injury, or death related to epinephrine infusion. RESULTS: Two hundred twenty episodes of care met the inclusion criteria. Adverse events occurred in 67 episodes (30.5%; 95% confidence interval [CI] 24.5% to 37.1%); however, most were minor and self-limiting. There were no deaths. Major adverse events occurred in 3.6% of cases (8/220; 95% CI 1.7% to 7.3%), including 2 cases of supraventricular tachycardia, 1 case of chest pain with ECG changes, 1 case of incidental elevated troponin, and 4 cases of hypotension requiring intervention. CONCLUSION: IV epinephrine is associated with a low rate of major and a moderate rate of minor adverse events in patients with severe asthma; however, a causal relationship has not been established. Further research investigating effectiveness, as well as safety, is warranted.
History
Journal
Annals of emergency medicineVolume
47Issue
6Pagination
559 - 563Publisher
ElsevierLocation
Amsterdam, The NetherlandsPublisher DOI
eISSN
1097-6760Language
engPublication classification
C1.1 Refereed article in a scholarly journalCopyright notice
2006, by the American College of Emergency PhysiciansUsage metrics
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No categories selectedKeywords
Acute DiseaseAdolescentAdultArrhythmias, CardiacAsthmaBronchodilator AgentsCohort StudiesDose-Response Relationship, DrugEmergency MedicineEmergency Service, HospitalEpinephrineFemaleHumansHypertensionHypotensionInfusions, IntravenousMaleMiddle AgedMyocardial IschemiaNecrosisRetrospective StudiesSurvival AnalysisTriageVictoriaScience & TechnologyLife Sciences & Biomedicine
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