Fatal Intracranial Bleeding Associated With Prehospital Use of Epinephrine,

We present a case of paramedic misjudgment in the execution of a protocol for the treatment of allergic reaction in a case of pulmonary edema with wheezing. The sudden onset of respiratory distress, rash, and a history of a new medicine led the two paramedics on the scene to administer subcutaneous epinephrine. Subsequently, acute cardiac arrest and fatal subarachnoid hemorrhage occurred. Epinephrine has a proven role in cardiac arrest in prehospital care; however, use by paramedics in patients with suspected allergic reaction and severe hypertension should be viewed with caution. [Horowitz BZ, Jadallah S, Derlet RW: Fatal intracranial bleeding associated with prehospital use of epinephrine. Ann Emerg Med December 1996;28:725-727.]