Nasal Epinephrine Study

[LinksEtc]

I can't be the only one recalling a reaction, though, in which this would be, er-- well, useless, to put it bluntly... given the volume and rate of SNOT production going on.

http://www.asthmaallergieschildren.com/2013/09/28/nasal-epinephrine-good-idea-or-not/

Do you do first-aid picking preparatory

[CMdeux]

 


This is a real gem of an observation:

As a Canadian researcher, Paul M. O'Byrne, has pointed out, one of the biggest weaknesses with all medication is the fact that it doesn't get tested under real-world conditions until it is out in the real world at which point it runs smack into human behavior, not to mention varying phenotypes that respond differently to chemistry.  One of those involved in this new nasal enterprise says, "Only a small fraction of diagnosed at-risk anaphylaxis patients carry an auto-injector, which is in part due to needle phobia and lack of training in their use. Our joint product promises to provide patients [and their families] with a needle-free alternative."  I am just guessing, but I would say that needle phobia is a very small part of the picture.

The largest barrier, IMO, and based on anecdotal evidence from LAYPERSONS over the years-- is actually flipping that mental switch into the red zone.  "Oh, this could result in death.  Right.  Epinephrine it is."

Denial is a VERY potent force there.  I have no idea how you deal with that, other than deliberately setting up a scenario in which to USE epinephrine and see how rapidly it is effective-- which is obviously a horrifically bad idea under any circumstances whatsoever.

[ajasfolks2]

Pilots practice emergency scenarios and emergency procedures umpteen times as part of training the brain (& body) to go through the actions with less denial chatter and fear . . . for some/many pilos it works wonders, but for others they still freeze or go into "nah, it can't be THAT" as part of their calculus.

Human behavior still as unpredictable as anaphylaxis.  Not good that we have BOTH working together when in the grips of emergency.

Besides needle phobia, there seems to be -- in teens for sure -- EMBARRASSMENT phobia.  Don't want to call attention to myself or my medical predicament.
(Ambulance ride with bells and whistles?  Cost and negative attention to self also factor in here . . . )

But I digress.

I'd sure opt for nasal epinephrine if available.  Not sure if either of my kids would go for that given how bad they hate (refuse) other nasal sprays/drops.


Question: How about eyedrops?  Would that work?

[CMdeux]

I don't think so, Ajas, based on what I know of administration routes.


It won't give the "pulse" of Epinephrine.  There is a reason why stimulant drugs of abuse tend to be administered in one of two ways-- injected, or snorted. 

[twinturbo]

One of the EMTs I chatted with in the truck (whee! so many ER trips) said he had seen some studies showing the dispersal of epinephrine from the force of the autoinjector was greater than that of a regular syringe. But you all know how I feel about delivering hearsay. What comes to my mind in nasal spray is did I get it in? Did it puff in enough? What if I miss? Would I overdose accidentally? I guess I get more concerned dosing someone else than myself because I could feel the spray.

[ajasfolks2]

CM, understand  . . . drops into eyes not being snorted/inhaled up to the top of nose and quick-entrance to brain cavity.  Just wasn't sure how much tissue absorption could be counted on with eyes vs snort/inhale via nose . . .

tt -- after reading what you wrote, sounds to me like injection into side of thigh might produce the most "standard" release and response to epinephrine -- not dependent on effectiveness of the inhalation . . . hadn't really thought about that.

But still.

It is GOOD to see the medical establishment (and perhaps fringes too) rethinking mode of imparting epinephrine to the patient.

Investigation and improvement is good.  All good.