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?
- 4 resp
- 4 rhythms
- Perfusion

Answer 2

Respiratory
- Anaphylaxis
- Severe Asthma
- Unconscious asthma with no BP
- Croup/Epiglottitis

Cardiac
- Persistent VF or unconscious & pulseless VT
- Asystole
- Electro-mechanical dissociation/PEA
- Bradycardia with poor perfusion
- Inadequate perfusion for (Cardiogenic, Non-cardiogenic & Non Hypovolaemic causes)

Question 3

Contraindications of Adrenaline?

Answer 3

• Hypovolaemic shock without adequate fluid replacement

Question 4

Cautions of Adrenaline?

Answer 4

• Elderly/frail
• Cardiovascular disease
• Patients on monoamine oxidase inhibitors (MAOI)
• Higher doses may be required for patients on beta blockers.

Question 5

Side Effects of Adrenaline?

Answer 5

Heart
- Sinus Tachycardia
- Supraventricular arrhythmias
- Ventricular arrhythmias
- Hypertension
- Increase size of myocardial infarction

Other
- Pupil dilation
- Anxiety/palpitations
- Tremor

Question 6

Dosing Regimes of Adrenaline?

Answer 6

Adrenaline IV Cardiac Arrest Adults & Children ≥12yrs
- Undiluted IV Bolus 1mg:1ml, 4 minutely
- Hypothermia <30 deg withhold adrenaline, >30 deg double the interval until >35 deg

Adrenaline IV Cardiac Arrest Children <12years
- Dilute to 1mg:10ml, administer dose as bolus, 4 minutely
- 10mcg/kg
- Hypothermia <30 deg withhold adrenaline, >30 deg double the interval until >35 deg

Question 7

Onset and duration of Adrenaline?

Answer 7

Onset:
- IV 30secs
- IM 30-90secs

Duration
- 5 to 10mins
- Mast cell several hours