Lecture Notes: Croup and Epinephrine Use in EMS

Introduction

• Speaker: Dr. Peter Entebbe
• Topic: Management of croup and the use of epinephrine in EMS

Croup Management in EMS

• Common Error: EMS providers often administer albuterol for croup, which is not recommended.
• Recommended Treatment:
  • Use racemic epinephrine (epi) instead of albuterol.
  • Challenge: Not all EMS providers carry racemic epi.

Alternative to Racemic Epinephrine

• Solution: Use epinephrine 1:1000 (1 mg/mL) directly in the nebulizer.
  • Dosage: Take 3 mL of epinephrine 1:1000.
  • Method: Insert directly into the nebulizer.
• Advantages:
  • Simplicity and availability.
  • Effective for treating croup.

Epinephrine for Asthma

• Dual Use: Epinephrine can also be used for asthma.
• Physiological Effects of Epinephrine:
  • Beta 2 Receptors: Smooth muscle relaxation (similar to albuterol).
  • Alpha 1 Receptors: Vasoconstriction.
• Clinical Application:
  • In severe asthma cases, epinephrine provides both smooth muscle relaxation and vasoconstriction benefits.
  • Useful for critically ill asthmatics who may require intubation.

Practical Application

• Recommendation:
  • Use epinephrine 1:1000 for both croup and severe asthma.
  • Administer via nebulizer for ease of use.

Conclusion

• Key Takeaway: Epinephrine 1:1000 is a versatile and effective treatment for both croup and asthma in an EMS setting.
• Final Note: Utilize existing resources (epinephrine 1:1000) to maximize patient care in acute respiratory conditions.

Closing

• Thank you for attending another edition of the Head's Heavy Minute with Dr. Peter Entebbe.