Start Peripheral Vasopressors Early in Shock!

It has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line.  However, available evidence doesn’t support this. Diluted solutions of all catecholamines are safe (except Vasopressin) to be administered peripherally via a well functioning 18-20G IV or larger in forearm (no hand/wrist/AC) . No old IVs (>72 hrs) Know how […]


Anaphylaxis is a sudden, severe allergic reaction that may cause death. The single most effective treatment for an episode of anaphylaxis is administration of epinephrine. Epinephrine is a chemical that arrests the chain of reactions that causes the signs and symptoms of anaphylaxis.

Biphasic Anaphylaxis

The late phase response, as noted, refers to the recrudescence of symptoms after an apparent temporary resolution. Such patients are said to experience biphasic anaphylaxis. Biphasic anaphylaxis is recurrent anaphylaxis occurring 1 to 72 hours after resolution of an initial anaphylactic episode, though an outside limit of 78 hours has also been suggested. Estimates of […]

Did you know Adrenaline doesn’t work for Cardiac Arrest?

Adrenaline may improve return of spontaneous circulation, but it does not improve survival to discharge or neurologic outcome. The timing of epinephrine may affect patient outcome, but Basic Life Support measures are the most important aspect of resuscitation and patient survival.  

Adrenaline: It’s just a suggestion

Epinephrine and other ACLS drugs lead to more patients with ROSC but no increase in the number of patients with good neurologic outcomes after OHCA. Something that’s very interesting is the actual 2015 ACLS recommendation for epinephrine. It reads, “it is reasonable to consider administering a 1 mg dose of IV/IO epinephrine every 3 to […]


In Anaphylaxis, IM Adrenaline (lateral thigh) is preferred over subcutaneous injection because it leads to a more rapid rise in plasma concentration. Only use IV if the patient has circulatory collapse – this can be done peripherally for a short time period if necessary…

Severe croup…

Try to KEEP THE CHILD CALM. Provide 5ml nebulized epinephrine (1:1000 concentration) and Steroids (PO is the way to go. However, in severe croup, use IM, or IV if available)  

Emergency Medicine Kenya Foundation