title: Fatal intracranial bleeding associated with prehospital use of epinephrine.
abstract: We present a case of paramedic misjudgment in the execution of a protocol for the treatment of allergic reaction in a case of pulmonary edema with wheezing. The sudden onset of respiratory distress, rash, and a history of a new medicine led the two paramedics on the scene to administer subcutaneous epinephrine. Subsequently, acute cardiac arrest and fatal subarachnoid hemorrhage occurred. Epinephrine has a proven role in cardiac arrest in prehospital care; however, use by paramedics in patients with suspected allergic reaction and severe hypertension should be viewed with caution.
authors.affiliation: Division of Emergency Medicine, University of California, Davis, Medical Center, Sacramento, USA.
authors.forename: B Z
authors.initials: BZ
authors.lastname: Horowitz
authors.forename: S
authors.initials: S
authors.lastname: Jadallah
authors.forename: R W
authors.initials: RW
authors.lastname: Derlet
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy*; D004632:Emergency Medical Services; D004837:Epinephrine / Q000009:adverse effects*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008508:Medication Errors; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced*
chemical_list: D004837:Epinephrine