title: Epinephrine for the out-of-hospital (first-aid) treatment of anaphylaxis in infants: is the ampule/syringe/needle method practical?
abstract: BACKGROUND
  Little information is available about administration of an accurate epinephrine dose to infants experiencing anaphylaxis outside the hospital setting.
  
  
  OBJECTIVE
  Our purpose was to perform a prospective, controlled study of (1) the time needed by parents to draw up an infant epinephrine dose from an ampule and (2) the dose accuracy.
  
  
  METHODS
  We gave 18 parents written instructions and asked them to draw up epinephrine 0.09 mL. We timed them by means of a stopwatch and measured the epinephrine content (in micrograms) in each dose by using HPLC-UV. Eighteen resident physicians, 18 general duty nurses, and 18 emergency department nurses served as controls.
  
  
  RESULTS
  The parents took significantly longer (P < .05) than the controls to draw up the dose; the mean (+/- SEM) times were 142 +/- 13 seconds (range, 83-248) for the parents, 52 +/- 3 seconds (range, 30-83) for the physicians, 40 +/- 2 seconds (range, 26-71) for the general duty nurses, and 29 +/- 0.09 seconds (range, 27-33) for the emergency department nurses. The control groups did not differ significantly from each other in speed (P > .05). The epinephrine content of the doses drawn up by the parents ranged 40-fold in contrast to the physicians' doses (7- to 8-fold), general duty nurses' doses (3-fold), and emergency department nurses' doses (2-fold). The mean epinephrine content did not differ significantly (P > .05) among the 4 groups.
  
  
  CONCLUSIONS
  Most parents were unable to draw up an infant epinephrine dose rapidly or accurately. Most health care professionals drew up the dose rapidly; however, their accuracy was compromised by inherent variations of epinephrine concentrations in the ampules (United States Pharmacopeia compendial limits, 90% to 115%) and the inherent difficulty of measuring low volumes (<0.1 mL) of epinephrine. User-friendly premeasured epinephrine doses suitable for infants should be developed.
authors.affiliation: Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, Faculty of Pharmacy, University of Manitoba, Winnipeg, Canada.
authors.forename: F E
authors.initials: FE
authors.lastname: Simons
authors.forename: E S
authors.initials: ES
authors.lastname: Chan
authors.forename: X
authors.initials: X
authors.lastname: Gu
authors.forename: K J
authors.initials: KJ
authors.lastname: Simons
mesh_terms: D000707:Anaphylaxis / Q000188:drug therapy*; D004837:Epinephrine / Q000008:administration & dosage*; D005392:First Aid; D006801:Humans; D007223:Infant; D009339:Needles; D011446:Prospective Studies; D013594:Syringes
chemical_list: D004837:Epinephrine