Adrenaline

Question 1

Pharmacology and presentation of Adrenaline?

Answer 1

1mg:1ml
Adrenergic agonist that works on Alpha and Beta receptors.

A1 - peripheral vasoconstriction, glycogenolysis and gluconeogenesis,
B1 - Increase in SA node firing rate, myocardial contractility, AV node conduction velocity and irritability of the ventricles.
B2 - bronchodilation, smooth muscle relaxation and stabilisation of mast cells reducing histamine

Question 2

Indicators of Adrenaline?
(10 - 4 Resp, 4 Heart and 2 Other Routes)

Answer 2

Respiratory
- Anaphylaxis
- Severe Asthma
- Moderate to Severe Stridor
- Imminent Arrest secondary to COPD

Cardiac
- Cardiac Arrest
- Severe Bradycardia
- BP support unresponsive to metaraminol
- Septic, Cardiogenic and Neurogenic shock unresponsive to fluids and metaraminol

Routes
- Topically for significant bleeding from wound
- Nasally for significant epistaxis

Question 3

Contraindications of Adrenaline?

Answer 3

• None

Question 4

Cautions of Adrenaline?

Answer 4

• Myocardial Ischemia (due to increased myocardial oxygen consumption)
• Tachydysrhythmias (due to worsening affects)
• Patients on beta or calcium channel blockers may need increased doses

Question 5

Side Effects of Adrenaline?
(8 - 5 Heart and 3 Others)

Answer 5

Heart
- Tachycardia
- Tachydysrhythmias
- Ventricular ectopy
- Hypertension
- Myocardial Ischemia

Other
- Nausea and Vomiting
- Tremor, and anxiety/sweating
- Hyperglycaemia

Question 6

Dosing Regimes of Adrenaline?

Answer 6

Adrenaline IV Cardiac Arrest Adults & Children ≥50kgs
- Undiluted IV Bolus 1mg:1ml, 4 minutely

Adrenaline IV Cardiac Arrest Children ≤40kgs
- Dilute to 1mg:10ml, administer dose as bolus, 4 minutely
-5kgs = 0.05mg:0.5ml
-10kgs = 0.1mg:1ml
-20kgs = 0.2mg:2ml
-30kgs = 0.3mg:3ml
-40kgs = 0.4mg:4ml

Adrenaline IM
- Adults 0.5mg IM, repeating 10mins prn, or 5mins prn if patient deteriorating for Anaphylaxis
- Same dose for severe asthma not improving with nebulised bronchodilators, but repeating only 10minutely

Adrenaline IM Paediatrics
- 0.1mg per 10kgs IM, repeating 10mins prn, or 5mins prn if patient deteriorating for Anaphylaxis
- Same dose for severe asthma not improving with nebulised bronchodilators, but repeating only 10minutely

Adrenaline Neb
- 5mg:5ml nebulised, no improvement after 10mins repeat prn for Croup and Stridor

Adrenaline Topical
- Dilute to 1mg:10ml

Adrenaline IN
- Dilute to 1mg:10ml for epistaxis
- Greater than or equal to 12years 0.2mg in 2ml per nostril, repeating once after 20mins
- 5-11 years 0.1mg in 1ml per nostril, repeating once after 20 mins

Question 7

Onset and duration of Adrenaline?

Answer 7

Onset:
- IV 5 to 10 secs
- IM 2 to 5 mins
- Other routes is on contact with target site

Duration
- CVS 5 to 15mins
- Mast cell several hours