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.
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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
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ABSTRACT: Epinephrine can be lifesaving in episodes of anaphylaxis, yet it is underprescribed and underused. Tracking of epinephrine refills over time for patients with a diagnosis of anaphylaxis has not been reported. This study reports on the refill history of 14,677 patients in a large HMO who received an initial dispensing of EpiPen (Dey Pharma, Basking Ridge, NJ) or EpiPen Jr between 2000 and 2006. A total of 6,776 (46%) refilled at least once. Twenty-five percent of the patients who were in the cohort for 5 years or more refilled multiple times, and 11% refilled consistently at all expected refill times. Infants through children 12 years of age were more likely to receive a refill dispensing (63%) compared with teenagers and adults (40%). The most common ICD-9 codes that were linked to the initial epinephrine dispensing were allergic disorder (37%), miscellaneous anaphylaxis/angioedema (23%), hymenoptera/insect bite or sting (14%), and specific or nonspecific food allergy (11%). A total of 79% of patients with a food-related ICD-9 code and 59% of patients with an insect sting-related ICD-9 code refilled epinephrine at least once. An opportunity exists to identify system-based as well as personal barriers in an ongoing effort to provide patients at risk with the tools and empowerment that could reduce their risk during life-threatening anaphylactic reactions.Current Allergy and Asthma Reports 10/2010; 11(1):65-70. DOI:10.1007/s11882-010-0155-6 · 2.45 Impact Factor