Epinephrine and its use in anaphylaxis: Current issues
ABSTRACT Epinephrine is a life-saving medication in the treatment of anaphylaxis, in which it has multiple beneficial pharmacologic effects. Here, we examine the evidence base for its primary role in the treatment of anaphylaxis episodes in community settings.
We review the practical pharmacology of epinephrine in anaphylaxis, its intrinsic limitations, and the pros and cons of different routes of administration. We provide a new perspective on the adverse effects of epinephrine, including its cardiac effects. We describe the evidence base for the use of epinephrine in anaphylaxis. We discuss the role of epinephrine auto-injectors for treatment of anaphylaxis in community settings, including identification of patients who need an auto-injector prescription, current use of auto-injectors, and advances in auto-injector design. We list reasons why physicians fail to prescribe epinephrine auto-injectors for patients with anaphylaxis, and reasons why patients fail to self-inject epinephrine in anaphylaxis. We emphasize the primary role of epinephrine in the context of emergency preparedness for anaphylaxis in the community.
Epinephrine is the medication of choice in the first-aid treatment of anaphylaxis in the community. For ethical reasons, it is not possible to conduct randomized, placebo-controlled trials of epinephrine in anaphylaxis; however, continued efforts are needed towards improving the evidence base for epinephrine injection in this potentially fatal disease.
- SourceAvailable from: Sandra M Salter
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- "While we recognise the importance of an holistic approach in autoinjector device training, pharmacists are a sound option for training in the periods when physician review is not possible. Patients may wait months after diagnosis for an appointment with their allergy specialist, or only see their general practitioner when a new prescription is required to replace an expired device (every 1–2 years) . Consultations may be time-restricted and patients may be overwhelmed with new information, reducing the potential for a memorable device demonstration by physicians. "
ABSTRACT: Background Successful treatment of anaphylaxis in the community relies on early and correct use of epinephrine autoinjectors. Community pharmacists supply these devices and have a crucial role teaching patients how to use them. Supply of epinephrine autoinjectors in Australia increased 70-fold in the past decade. New EpiPen and Anapen autoinjectors were launched in Australia in 2011 and 2012, with the potential to cause confusion. However there is no information about how pharmacists demonstrate epinephrine autoinjectors to patients. Therefore the aim of this study was to assess real-world community pharmacist demonstrations of EpiPen and Anapen. We also sought to identify consultation-based predictors of accurate demonstration. Methods Demonstration accuracy was assessed in simulated patient visits to 300 randomly selected pharmacies. Pharmacists were asked by the simulated patient how to use original EpiPen, new-look EpiPen or Anapen, and assessed against the relevant Australasian Society of Clinical Immunology and Allergy (ASCIA) Action Plan for Anaphylaxis. Other anaphylaxis advice provided by the pharmacist was also recorded. Accuracy was analysed descriptively. Binary logistic regression was used to identify predictors of accurate demonstration. Results All 300 pharmacies were visited. Of 250 pharmacist demonstrations, 46 (18.4%) accurately demonstrated all four steps on ASCIA Action Plan. Failure to state ‘do not touch the needle’ (74.8%) or ‘massage injection site’ (68.8%) reduced accuracy. However 163 (65.2%) accurately demonstrated the three steps required to inject epinephrine (no difference by device, p = 0.15). Associations with accurate demonstration were: checking if the patient had an anaphylaxis action plan (odds ratio, OR = 16.1; 95% CI: 3.86-67.3); stating to call an ambulance after use (OR = 4.0; 95% CI: 1.44-11.1); or explaining side effects of epinephrine (OR = 4.5; 95% CI: 1.48-13.4). Conclusions It is critical that anaphylaxis patients know how to use their prescribed epinephrine autoinjector correctly. Pharmacists have acceptable rates of EpiPen and Anapen demonstration accuracy, although more is needed to improve this. Those who pay attention to the need for action plans, emergency care after epinephrine use, and informing patients about the side effects of epinephrine may have better knowledge about anaphylaxis, and in turn significantly improve demonstration accuracy.Allergy Asthma and Clinical Immunology 09/2014; 10(1):49. DOI:10.1186/1710-1492-10-49
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ABSTRACT: In ultrasonic diffraction tomography, ultrasonic waves are used to probe the object of interest at various angles. The incident waves scatter when encountering inhomogeneities, and thus do not travel in straight lines through the imaged object. When the scattering inhomogeneities are considered weak, the scattering object can be reconstructed by algorithms developed from a generalized central slice theorem. In this work, the authors develop a hybrid algorithm for reconstruction of a scattering object by transforming the measured scattered data into a conventional X-ray-like sinogram thus allowing standard X-ray reconstruction algorithms, such as filtered back-projection, to be applied. The authors systematically investigate and compare the statistical properties of three different algorithms: a direct Fourier inversion algorithm, the filtered back-propagation algorithm (which is analogous to the conventional filtered back-projection algorithm), and the newly developed hybrid algorithm. The authors derive analytical expressions for the variance of the noise in the reconstructed images and investigate the noise properties of the algorithms by performing extensive numerical simulationsNuclear Science Symposium, 1997. IEEE; 12/1997
Conference Paper: An integrated trigger system for the PIERRE AUGER fluorescence detector[Show abstract] [Hide abstract]
ABSTRACT: The PIERRE AUGER fluorescence detector is designed to monitor extensive air showers of energies greater than 10<sup>19</sup> eV. We present a hierarchical trigger-system with hardware and software components for efficient data reduction and event recognition. The first-level trigger uses configurable hardware to allow a flexible and very effective background suppression, in minimum a factor 2·10 <sup>3</sup> larger than conventional approaches as used in the HiRes experiment. It is designed with the hardware description language VHDL and synthesized in one FPGA with about 75000 gates. Due to the excellent noise suppression in the first-level trigger, a software based solution on a digital signal processor is sufficient for the second- and third-level triggerNuclear Science Symposium, 1997. IEEE; 12/1997