Question 1

Can epinephrine be given through clothing?

Accepted Answer

Yes — auto-injectors are designed to be administered through clothing if necessary. Do not delay by asking the patient to remove clothing. The needle is designed to penetrate standard clothing layers. However, aim for bare skin if easily accessible without delay.

Question 2

How soon should symptoms improve after IM epinephrine?

Accepted Answer

Improvement should be seen within 1–5 minutes. If there is no improvement or the patient is deteriorating, repeat the dose every 5–15 minutes as needed. Up to 30% of anaphylaxis patients require more than one dose for adequate response. Persistent hypotension despite 2–3 doses should prompt IV epinephrine infusion.

Question 3

What should I tell a patient being discharged with an auto-injector?

Accepted Answer

Prescribe two auto-injectors (in case one misfires or a second dose is needed). Provide a written anaphylaxis action plan covering: how to recognise anaphylaxis, when to use the auto-injector (at first suspicion, not after waiting), how to administer it, calling emergency services, and carrying the auto-injector at all times.

Question 4

Is epinephrine safe in patients with cardiovascular disease?

Accepted Answer

While epinephrine can cause tachycardia and hypertension (especially with IV administration), it is still indicated in anaphylaxis even in patients with known CAD or arrhythmia. The benefits of treating anaphylaxis outweigh the cardiovascular risks. Use IM route (lower risk), monitor closely, and use lower initial doses if significant cardiac comorbidity.