title: Errors of epinephrine administration during severe allergic-like contrast reactions: lessons learned from a bi-institutional study using high-fidelity simulation testing.
abstract: OBJECTIVE
  To determine the most common errors of epinephrine administration during severe allergic-like contrast reaction management using high-fidelity simulation surrogates.
  
  
  METHODS
  IRB approval and informed consent were obtained for this HIPAA-compliant bi-institutional prospective study of 40 radiology residents, fellows, and faculty who were asked to manage a structured high-fidelity severe allergic-like contrast reaction scenario (i.e., mild hives progressing to mild bronchospasm, then bronchospasm unresponsive to bronchodilators, and finally anaphylactic shock) on an interactive manikin. Intravenous (IV) and intramuscular epinephrine ampules were available to all participants, and the manikin had a functioning intravenous catheter for all scenarios. Video recordings of their performance were reviewed by experts in contrast reaction management, and errors in epinephrine administration were recorded and characterized.
  
  
  RESULTS
  No participant (0/40) failed to give indicated epinephrine, but more than half (58% [23/40]) committed an error while doing so. The most common mistake was to administer epinephrine as the first-line treatment for mild bronchospasm (33% [13/40]). Other common errors were to administer IV epinephrine without a subsequent IV saline flush or concomitant IV fluids (25% [10/40]), administer an overdose of epinephrine (8% [3/40]), and administer epinephrine 1:1000 intravenously (8% [3/40]).
  
  
  CONCLUSIONS
  Epinephrine administration errors are common. Many radiologists fail to administer albuterol as the first-line treatment for mild bronchospasm and fail to flush the IV catheter when administering IV epinephrine. High-fidelity contrast reaction scenarios can be used to identify areas for training improvement.
authors.affiliation: University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA, wangcl@uw.edu.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Wang
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Davenport
authors.forename: Sankar
authors.initials: S
authors.lastname: Chinnugounder
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Schopp
authors.forename: Kimia
authors.initials: K
authors.lastname: Kani
authors.forename: Sadaf
authors.initials: S
authors.lastname: Zaidi
authors.forename: Dan S
authors.initials: DS
authors.lastname: Hippe
authors.forename: Angelisa M
authors.initials: AM
authors.lastname: Paladin
authors.forename: Neeraj
authors.initials: N
authors.lastname: Lalwani
authors.forename: Puneet
authors.initials: P
authors.lastname: Bhargava
authors.forename: William H
authors.initials: WH
authors.lastname: Bush
mesh_terms: D061605:Administration, Intravenous; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced / Q000188:drug therapy*; D008348:Manikins; D008508:Medication Errors / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011871:Radiology / Q000193:education*
chemical_list: D000316:Adrenergic alpha-Agonists; D003287:Contrast Media; D004837:Epinephrine