![]() Confusion about epinephrine - Anaphylaxis 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. Infant Botulism - Presentation: constipation, weakness, intact sensory - Less than 12 months of age (though majority 6wk-6mo) - Diagnose by sending stool sample to CDC - Treatment 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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