Epinephrine, commonly known as Epi, is a medication used in emergency situations to manage severe allergic reactions, or anaphylaxis. It is a rapid and effective treatment for life-threatening symptoms. Epinephrine works by relaxing airway muscles, tightening blood vessels, and maintaining heart function, which helps stabilize blood pressure. Its immediate administration is important to reverse serious effects.
Epinephrine for Anaphylaxis: Initial Steps
Anaphylaxis is a severe and rapid allergic reaction that can be life-threatening. It occurs when the immune system overreacts to an allergen, releasing chemicals that cause widespread symptoms. These can include throat and tongue swelling, difficulty breathing, hives, a drop in blood pressure, dizziness, and vomiting. Prompt administration of epinephrine is the first-line treatment.
Epinephrine is typically delivered through an auto-injector into the outer thigh. Auto-injectors are designed for ease of use, with instructions provided directly on the device. The initial dose is one injection, and it is important to administer it as soon as anaphylaxis is suspected, without delay.
When to Administer Additional Doses
A single dose of epinephrine is often effective, but symptoms may persist or worsen. If there is no improvement after the first injection, a second dose may be considered. This subsequent dose is typically administered five to 15 minutes after the initial injection.
The decision to give a second dose is based on the patient’s ongoing symptoms. Reports suggest that approximately 10% to 20% of individuals may require more than one dose. Having access to a second auto-injector is recommended for at-risk individuals.
Understanding the “Limit”
There is no strict numerical limit to the number of epinephrine doses an individual can receive during an acute, life-threatening anaphylactic reaction. While auto-injectors typically contain a single dose, multiple doses can be administered if symptoms do not improve. However, if more than two injections are needed, these should be given under direct medical supervision.
Repeated doses of epinephrine are administered based on symptom persistence and medical professional judgment. Paramedics or hospital staff may provide additional doses, especially in cases of refractory anaphylaxis, where symptoms continue despite initial treatment. Seeking immediate medical evaluation after any epinephrine administration is important.
Immediate Actions After Epinephrine
After administering epinephrine, immediately call emergency services, such as 911. Even if symptoms improve, professional medical evaluation in a hospital setting is necessary. This is because epinephrine’s effects are short-lived, and a second wave of symptoms, known as a biphasic reaction, can occur hours later.
Patients are typically monitored in the emergency department for several hours to observe for any recurrence of symptoms. While waiting for medical help, the person should lie down with legs elevated, unless they have trouble breathing, in which case they may prefer to sit up. If vomiting, they should be placed on their side.