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Alpha agonists in anaphylaxis


paramatt_

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When you say that there was no bronchospasms, do yo mean that there was no detectable wheezing in the apices and bases of the lungs with clear in and out breath sounds? Capnography?

I ask that because I have been told when the bronchi is severely constricted, it can be so severe that wheezing may be difficult or impossible to detect with stethoscope. Granted I would imagine that would be a 1 in a million extreme case. But I just wanted to throw something in the mix.

I have never seen the scenario personally that I threw up here. Just making conversation

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It is possible, it is also possible that somebody is not moving enough air to make wheeze and that I have seen, man they were cook!

I would venture a guess that in this particular case there was no respiratory involvement; from a physiologic point of view it seems kind off doesn't it?

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I ask that because I have been told when the bronchi is severely constricted, it can be so severe that wheezing may be difficult or impossible to detect with stethoscope. Granted I would imagine that would be a 1 in a million extreme case. But I just wanted to throw something in the mix.

Definitely can occur, but you would probably be more likely to see this in cases of asthma (extremis) where there is significant air trapping and hyperinflation of the lungs.

To answer your original question, no airway involvement what so ever. No facial edema, no complaints of being short of breath/chest tightness, etc, and was able to swallow and verbalize that everything felt normal. I probably auscultated her lungs 5 or 6 different times as well…quite decent respiratory status overall.

I would venture a guess that in this particular case there was no respiratory involvement; from a physiologic point of view it seems kind off doesn't it?

Respiratory features and bronchospasm always pop into mind straight away when considering anaphylaxis, though it seems such symptoms occur more often in children than adults.

http://www.ncbi.nlm....les/PMC2082667/

http://apjai.digital...viewArticle/370

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  • 3 years later...

The value of alpha agonist in this case would be less treating the neurohumeral  causes of her symptoms (i.e. inflammatory mediators, cytokines) and more just treating her severe vasoplegia that is a result of them. I have to say that I'm surprised metaraminol is still being used or talked about in EM/pre-hospital care, as it is largely ignored in my neck of the woods in CC and by the anesthesia folks. Having been away from pre-hospital/emergency/trauma care for many years, I can't really comment on the reasons for this.

That being said, vasopressin, which every ALS ambulance has, is an excellent treatment for vasoplegia and hypotension refractory to pressors, inopressors and volume.

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