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Nebulized racemic epinephrine used in the treatment of severe asthmatic exacerbation: a case report and literature review

Published online by Cambridge University Press:  21 May 2015

Kristopher Wiebe  and
Brian H. Rowe
Kristopher Wiebe*
Affiliation:
Department of Emergency Medicine, Chilliwack General Hospital, Chilliwack, BC
Brian H. Rowe
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
*
46022 Bridleridge Cr., Chilliwack BC V2R 5W2; kriswieb@telus.net

Abstract

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Acute asthma is a common emergency department (ED) problem that is typically treated with bronchodilators and anti-inflammatories. Nebulized selective, short-acting β-agonists, such as salbutamol, are the bronchodilators of choice in most Canadian EDs. Other important treatments in moderate-to-severe cases include systemic corticosteroids and in severe cases may include the addition of ipratropium bromide and magnesium sulfate. Despite aggressive management, some patients do not respond adequately to nebulized salbutamol. Treatment options in these patients are limited to interventions such as parenteral epinephrine, and non-invasive and mechanical ventilation (or both). Both parenteral epinephrine and mechanical ventilation have associated risks, so alternative treatments with a lower risk profile would be useful for the treatment of life-threatening asthma. The following case report describes a patient in whom nebulized racemic epinephrine was used successfully to treat severe acute asthma following failure of standard first-line therapies.

Keywords

asthmaemergency departmentbronchodilators
Type
Case Report • Observation de cas
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 4 , July 2007 , pp. 304 - 308
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

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