Fatal Intracranial Bleeding Associated With Prehospital Use of Epinephrine

We present a case of paramedic misjudgment in the execution of a protocol for the treatment of allergic reaction in a case of pulmonary edema with wheezing. The sudden onset of respiratory distress, rash, and a history of a new medicine led the two paramedics on the scene to administer subcutaneous...

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Bibliographic Details
Published in:Annals of emergency medicine 1996-12, Vol.28 (6), p.725-727
Main Authors: Horowitz, B.Zane, Jadallah, Sami, Derlet, Robert W
Format: Article
Language:English
Subjects:
Adult
Anaphylaxis - drug therapy
Biological and medical sciences
Drug toxicity and drugs side effects treatment
Emergency Medical Services
Epinephrine - adverse effects
Fatal Outcome
Humans
Male
Medical sciences
Medication Errors
Pharmacology. Drug treatments
Subarachnoid Hemorrhage - chemically induced
Toxicity: cardiovascular system
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Summary:We present a case of paramedic misjudgment in the execution of a protocol for the treatment of allergic reaction in a case of pulmonary edema with wheezing. The sudden onset of respiratory distress, rash, and a history of a new medicine led the two paramedics on the scene to administer subcutaneous epinephrine. Subsequently, acute cardiac arrest and fatal subarachnoid hemorrhage occurred. Epinephrine has a proven role in cardiac arrest in prehospital care; however, use by paramedics in patients with suspected allergic reaction and severe hypertension should be viewed with caution. [Horowitz BZ, Jadallah S, Derlet RW: Fatal intracranial bleeding associated with prehospital use of epinephrine. Ann Emerg Med December 1996;28:725-727.]
ISSN:0196-0644
1097-6760
DOI:10.1016/S0196-0644(96)70100-2