Peter Antevy shows how to make push-dose epinephrine 1:100,000 for IV use when IM epinephrine fails in anaphylaxis. Remove 9 mL from a 1:10,000 vial, replace with 9 mL saline, then push slowly over 10 minutes.
Hi, everyone, I'm Peter Rantevi. What happens if you have a patient who has anaphylaxis? You're given IM EPI three times and you're still not getting better? Well, you know, most of you carry epi1 2000, and all of you carry epi1 to 10,000. But what happens when that patient now needs epinephrine IV for anaphylaxis? And that's what I wanted to go through today.
So for EPI 1 to 1000.
We know that this is given IM.
And these people are typically still alive. And this is for severe asthma.
And anaphylaxis.
Here you have epi 1 to 10,000.
We know this is given iv, and this is typically for the cardiac arrest patient.
As an IV push.
IV push.
So what happens now if you want to give that patient EPI for anaphylaxis to be at the iv? Well, for that we have to do something different. And that's epi 1 to 100,000. Now, you could make an epi drip, but in the field, oftentimes you don't have the ability to do that.
So I wanted to now show you how to make Epi 1 to 100,000 from Epi 1 and 10,000.
And in order to do that, you need your Epi 1 to 10,000, either a two or three way stopcock and saline. So this could be an IV bag. I'm using a saline flush for the demonstration.
So the first step is that you.
Get these two together.
So you have your EPI 1 to 10,000 and you have your saline flush and your three way stopcock. So the first thing you want to do is empty out 9mls of epi. Let's do that. Here.
I have 1ml of epi 1,10,000 left.
Now I'm going to refill it, as you can see here, with 9 mls of normal saline.
What I have Left now is EPI 1 to 100,000. This is what we called push pressure. Okay, push pressure. EPI. And essentially now we have 0.1 milligrams.
In 10 mls. And that's how we get the EPI 1, 200,000. Now, this is like what we call a poor man's epi drip. So now you would attach this to the IV and you would slowly give this 0.1 milligrams over about 10 minutes. And so this is really less concentrated than epi 1 10, and it's a little bit more concentrated than your standard EPI drip. But this is what you do if a child has anaphylaxis who's had EPI 1 to 1000 three times and still not getting better. Those patients will die unless you go to the next step, which is EPI 1, 100,000. Thank you. Have a great day.
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