Confusion about epinephrine
o Standard: 0.3-0.5 mg IM 1:1,000 (can repeat q5 minutes)
o Pediatric: 0.01 mg/kg IM 1:1,000
o Severe/refractory: 0.1mg 1:10,000 IV over 5 minutes + start epinephrine drip
- Sources of error include high stress scenarios, confusion about concentrations, multiple concentrations and routes available
- Recognize that epinephrine is a medication prone to errors and be clear with orders, double check if need be
Rocky Mountain Spotted Fever
- Symptoms: Hyponatremia, thrombocytopenia, AMS, fever, abdominal pain/GI symptoms, rash (classically petechial but can vary)
- Only about ½ have history of tick exposure
- Treat adults and children with doxycycline 100 mg BID in adults, 2.2 mg/kg/dose BID in children. Use chloramphenicol in pregnant females (though less effective than doxycycline).
- Doxycyline shortage has resolved, average cost for a 7 day course around $35.
- Presentation: constipation, weakness, intact sensory
- Less than 12 months of age (though majority 6wk-6mo)
- Diagnose by sending stool sample to CDC
o More effective if initiated early (within 7 days)– do not wait for confirmation diagnosis
o Human derived botulism immunoglobulin (BabyBIG) - $45,000
o Binds free toxin to prevent worsening however will not remove toxin already bound to motor endplate (must sprout new motor endplates for recovery)
o Only available through California Department of Health Services – www.infantbotulism.org proves specific instructions on how to acquire immunoglobulin
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