In my experience using adrenaline nebulisers ( 2.5 - 5mg neat ) in croup
kids, there is little tachycardia, maybe upto 10 beats or so, and it does
work well for the upper airway. There is probably more tachycardia going
on with her through anxiety. A standard nebuliser 2.5 mg salbutamol should
not affect her too much either. There is also the comfort of being treated
with something making an efficient bubbling sound that has a calming effect
over and above its pharmacological value, which 'watching and waiting'
neglects.
So: adrenaline neb
salbutamol neb
x-teplase
Paul Ransom
Consultant A&E Brighton
----- Original Message -----
From: s.carley <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, August 24, 2002 6:43 PM
Subject: catecholamine dilemma
> 45 year female presents 4 hours post central chest pain suggestive of
> myocardial ischaemia.
> 12 lead ECG shows inf.lateral infarction.
>
> P-70
> BP-110/60
>
> Decision is made to thrombolyse with streptokinase
> Patient not given B blockers at any stage
>
> 10 min after start of thrombolysis
> Complains of
> 1. tightening of throat
> 2. SOB
> 3. Tongue swelling
> 4. Hoarse voice.
>
> Examination confirms
> patient in distress and fearful
> slight wheeze
> hoarse voice
> P-90
> BP 105/60
> RR up
> No rash
> Anaphylaxis suspected.
> Strep is stopped.
> Hydrocort (200) and chlorpheniramine (10) given
> tPA was started in place of strep
>
> There was a question of what to do next
> 1. Watch and wait
> 2. Adrenaline
> a. IM
> b. neb
> c. IV
>
> Any thoughts?
>
> Simon
> Simon Carley
> SpR in Emergency Medicine
> [log in to unmask]
> Evidence based emergency medicine
> http://www.bestbets.org
