Does anyone have any supporting documentation for the use of Racemic epinephrine over L epinephrine in croup patients? One fact that no one seems to acknowledge in studies that I've read is that you need 5cc's of L epinephrine 1:1000 to be equivalent to 0.5cc Racemic epinephrine. To me, this seems to be a major downfall when talking about giving a nebulizer treatment to a croupy baby and attempting NOT to create any more irritation to that child. (Anyone who has ever had to give a nebulizer to a croupy baby can agree that they usually don't like it and try to fight it.) The goal is always to give the medication in the most effective way and in the least stressful manner to the croupy child. A 5cc nebulizer treatment is a VERY long time for that child, especially when you can give racemic epinephrine in half the time. Unfortunately, all I can find is that racemic epinephrine and L epinephrine 1:1000 are just as effective as each other. When you consider the time difference involved with delivery and the type of patients it is often given to (croupy, stridorous children in distress - the kind you want to minimize agitation with), it seems the best option would be the racemic epinephrine. Does anyone have any resources that help support this? thanks!
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