In fact, both should be donè. While one person gives the Epinephrine injection, the second person can attempt endotracheal intubation. Anyway, there should not be any delay in administering Epinephrine.
I totally agree to the suggestion above. Epinephrine will reverse bronchoconstriction but it will still takes a couple minutes. If the patient comes in with brochoconstriction for some time, and the circulation was not compromised, s/he ought to have endotracheal intubation. So, the crux of the issue is how long the patient had developed bronchoconstriction.
Shih-Wen Huang, MD
Sorry, I did not make it clear in the letter above.
I do mean if the circulation is compromised. In that case, the effect of Epinephrine will be slower in reaching its maximal effect. We should intubate the patient in that scenario to make sure airway is kept open.
Shih-Wen Huang, MD
Epinephrin Ist. And observe if not improve go ahead for intubation as it is always to manipulate airways in such cases
It really matters how soon you get to see the patient in anaphylactic reaction. It is very likely, unless you are working on the patient and s/he suddenly develops, you will see the anaphylactic reaction happens in front of your eyes. I agree epinephrine injection should go first regardless. If the patient does not response or, if you know her/his SaO2 has dropped significantly, the patient ought to be intubated immediately.
Epinephrine should be chosen firs. After epi endotracheal entubation and if needed second dose of epi should be used.
According to the severity of the case if the patient is severely hypoxic with delirium and impaired conscious save live with intubation followed by epinephrine if condition is hemodynamically stable give epinephrine and wait you may not need intubation
Agree. In essence, this question of "Do you intubate patient when s/he suffered fronm anaphylaxis?" is an open one. To answer this question intelligently, clinician requires assumption of different circumstance. S/he needs to evaluate the situation swiftly but more carefully.
Shih-Wen Huang, MD
There is no reason why several parts of the treatment pathway cannot run in tandem.
Epinephrine is quick and easy to administer,and can be given whilst the patient's airway,breathing and circulation are assessed and the same applies to therpaies such as:
Chlorphenamine
Hydrocortisone
IV fluids.
The decision to intubate if indicated by signs such as cyanosis,severe dyspnoea,confusion,respiratory arrest etc is therefore not delayed by allocating tasks appropriately,and ensuring that experienced airway help is available,along with critical care support.