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Ralph Bookman, M.D.
JAMA. 1962;180(1):87. doi:10.1001/jama.1962.03050140089027.
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To the Editor:—  It is with hesitation that I write this letter regarding the article entitled "Anaphylactic Drug Reactions" by Dr. Richard A. Kern (JAMA179:19 [Jan. 6] 1962). The emergency treatment of anaphylaxis, whether drug or otherwise induced, is the same and consists of the prompt and repeated hypodermic injections of 0.5 cc. aqueous epinephrine hydrochloride 1:1,000 dilution. This procedure has proven life-saving on innumerable occasions over many years by many physicians, and to delay in favor of any other method of administration or any other medication or manipulation is dangerous! I agree that minutes count but I submit that more than just "some lives" can be saved by promptness. Death can occur while starting an intravenous drip, and it is quicker to dilute some epinephrine in saline (roughly 0.1 cc. to 10 cc. saline) and inject it by vein after the initial hypodermic injection. Hesitation to perform


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