Background Resuscitation Council Guidelines (RC-UK, 2008) for treating anaphylaxis advocate intramuscular adrenaline in doses of 150, 300 or 500 micrograms, according to age bands [1]. However, ALS guidelines recommend weight-based calculations of 10 micrograms/kg IM, leading to administration of a range of volumes [2].

Aims A survey was conducted to evaluate the availability of fixed dose Epipens versus adrenaline vials in paediatric wards and radiology departments in England.

Methods The questionnaire was sent to 105 paediatric pharmacists at the various paediatric units in UK.

Results 60% responding hospitals had adrenaline available, half of them in vials and 85% with prefilled variable-dose syringes. In 53% units, wards stocked adrenaline 1:10,000 and 64% also had 1:1000. 19% hospitals stocked Epipens on crash trolleys and it was available in 48% wards. Adrenaline was given according to a weight-based dose in 57% wards. For contrast studies, adrenaline was available in 68% departments, 9.5% of which stocked Epipen.

Conclusion Most units still use weight-based doses of adrenaline from vials or pre-filled syringes, with Epipens being available in less than half of units. Adrenaline must always be available on wards and in radiology departments, as most arrests from anaphylaxis occur within 10 minutes. To ensure compliance with RC-UK guidelines, either all wards should stock Epipens or the guidelines should reflect practise and recommend weight-based calculated doses.

References

1. Working Group of the Resuscitation Council (UK). Emergency treatment of anaphylactic reactions: Guidelines for healthcare providers: Resuscitation Council, 2008. Available at: http://www.resus.org.uk/pages/reaction.pdf (accessed 12 December 2012).

2. Samuels M, Wieteska S. Advanced Paediatric Life Support, 5th edition, Wiley-Blackwell Publishing, Oxford, 2011.