BEcause IM takes to much time to absorb into the bloodstream (5-15 min.) and depending on the drug it takes more to dose.
One ampule of adrenaline contains one milligram. Not to be used the same in one stroke. In anaphylactic shock you need to give half ampule intramuscular and half as subcutaneous dose, if needed. When you give one ampule intramuscular, patient get severe chest pain. To be used very cautiously in elderly patient.
yes you cannot shock a patient unless there heart rhythm is in either v tach or v fib
Intramuscular injections are preffered for delivery of many medications as it is the fastest and simplest way to infect drugs. Adrenaline (epinephrine to the yanks) is the classic example given during anaphalctic shock. Here a fast delivery of the drug is key and so waiting for a trained expert to be found would take too long. Intramuscular inveftion can be given by anyone simply by finding a large muscle (often the gluteus maximus) and injecting it, that simple. The next most simple is subcutaneous. This is again fairy simple but requires being shown how to perform and is a common mode of insulin injection in diabetics. Finally intravenous is the third form of injection but this requires finding a vein which takes some degree of skill and training.
The AED will shock to reset the heart to bring it out of V-Fib or V-Tach.
Anaphylactic shock is the most horrible thing that you can face in your clinical practice. The anaphylactic shock to lidocaine is very rare. when you get it, the patient get collapsed and unconscious. He can not breath. He is chocked due to severe laryngospasm and tracheobronchial tree spasm. His blood pressure falls. So that the pulse can not be felt. What you get is palpitation and tremors. You have only three minutes in your hands to save the life of patients. That is more than enough time, provided you do not loose your confidence. You take out the adrenaline ampule from the anaphylactic kit. You inject half the ampule by intramuscular route in the deltoids muscle of patient. The other half may be given by subcutaneous route, if needed. Within few seconds he regain his consciousness. Then you give injection pheniramine maleate ( Injection Avil) one ampule intravenously. You give injection betamethasone 8 (Injection betnesol 2 ampules) mg IV. All the text books talk of injection hydrocortosone. It takes time to prepare the solution and at time the water for injection may not be available to dissolve the powder. Precious time may be wasted in all this. Betamethasone ( Betnesol) always worked in hundreds of such patients of anaphylactic shock. Betnesol has advantage of very long half life as compared to hydrocortisone. So that there is no rebound anaphylactic shock after few hours and you can safely sent the patient to his home, to be seen next day. Then you put IV line to be on safer side. Give DNS, NS or Ringers lactate and never dextrose solution. Patient is surprised to see the IV line. He does not know about the anaphylactic shock he got. With experience you handle the anaphylactic shock so silently that the other patients in your office do not know that something serious has happened behind the curtain.
The prognosis of an individual patient in shock depends on the stage of shock when treatment was begun, the underlying condition causing shock, and the general medical state of the patient.
Because you too, will get shocked and it'll take away from the amount of shock the patient might need.
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Lay the patient down, elevate the legs, keep the patient warm.
In the 21st century
Precordial shock from the AED
Diagnosis of shock is based on the patient's symptoms.a significant drop in blood pressure.extremely low urine output.blood tests. Other tests are performed.to try to determine the underlying condition responsible for the patient's state of shock.