Adrenaline

Question 1

What is the clinical condition or situation to which the Adrenaline PGD applies?

Answer 1

Persistent hypotension that has not responded to conventional treatment therapy.

Question 2

What are the four inclusion criteria for which the PGD applies?

Answer 2

Post cardiac arrest with a systolic BP <90mmHg or MAP <65mmHg despite a fluid challenge

Recurrent anaphylaxis

Severe sepsis - not responding to IV fluid

Profound bradycardia which has not responded to atropine and the patient remains profoundly hypotensive

Question 3

What are the three exclusion criterias?

Answer 3

Hypersensitivity to sodium metabisulphite or any other excipients.

Tachycardia over 150

Presence of >3 ventricular ectopics

Question 4

Cautions

Answer 4

Young post ROSC patients where the aetiology is suspected to be an arrhythmia E.g. WPW - lower starting dose or accept a lower systolic

Patients who have taken MDMA where a large catecholamine release is suspected - may provoke further arrhythmias

Question 5

Name the form and strength of the medication

Answer 5

Adrenaline (Epinephrine) Injection BP 1 in 1000 1mg (1ml ampoules)

Question 6

How do you prepare the medication?

Answer 6

Add 1ml of adrenaline 1 in 1000 (1mg in 1ml) to 100ml Sodium Chloride 0.9% (1 in 100,000)

Question 7

Dose and frequency for infusion

Answer 7

Infusion using the 1 in 100,000 (10mcg per ml)

Dose of 0.25 - 3mcg a minute - titrate to response

Start infusion at 5ml per hour (50mcg an hour)

Infusion at 5 - 20ml per hour gives a dose of 0.83 - 3.3 mcg/min

If no improvement after 5 minutes increase rate by 2.5ml/hr

Aiming to achieve systolic >90 or MAP >65. Max 30ml/hr

Question 8

Dose and frequency for bolus

Answer 8

Bolus dose of 10mcg/ml in 1 - 2ml increments to achieve a MAP >65

If multiple doses are required consider an infusion

Question 9

Adverse effects

Answer 9

Ventricular ectopics (>3 per min) consider reducing dose by 2.5ml per hour

Arrhythmia - ALS

Tachycardia >150 - discuss with top cover