Adrenaline

Question 1

Mechanism of action (nebulised adrenaline)

Answer 1

Adrenaline stimulates all 4 adrenoreceptors, the most prominent effects are on alpha-1, beta-1 and beta-2.

Question 2

Indications for adrenaline (EMT scope only)

Answer 2

1. IM for anaphylaxis
2. IM for severe asthma
3. Nebulised for Moderate to severe Stridor
4. IN for clinically significant epistaxis
5. Topical for significant bleeding from a wound

Question 3

Contraindications for adrenaline

Answer 3

None

Question 4

Cautions for adrenaline

Answer 4

1. Myocardial ischaemia - Adrenaline will increase myocardial blood consumption
2. tachydysrhythmias - Adrenaline will usually worsen a tachydysrhythmia

Question 5

Pharmacokinetics of adrenaline

Answer 5

1. Adrenaline is metabolised by the liver and taken up by sympathetic nerve endings
2. There are no significant effects from liver impairment on acute administration

Question 6

Common adverse effects of adrenaline

Answer 6

1. Tachycardia
2. tachydysrhythmia
3. Myocardial ischaemia
4. Ventricular ectopy
5. Hypertension
6. Nausea and vomiting
7. Tremor, anxiety and sweating
8. Hyperglycaemia

Question 7

Dosage (IM adrenaline)

Answer 7

5kg / <1 year = 0.05mg
10kg / 1 year = 0.10mg
20kg / 2-5 years = 0.20mg
30kg / 6-10 years = 0.30mg
40kg / 11-13 years = 0.40mg
Adult = 0.50mg

Question 8

Dosage (IN adrenaline)

Answer 8

5-11 years = 0.1mg
>12 years = 0.2mg

Question 9

Dosage (nebulised adrenaline)

Answer 9

5mg

Question 10

Dosage (Topical adrenaline)

Answer 10

Dependant on size of wound.
Always use a 1:10,000 solution