Adrenaline

Question 1

What type of drug is adrenaline

Answer 1

Sympathomimetic

Question 2

What is the action of Adrenaline

Answer 2

*Stimulates the ALPHA and BETA receptors of the sympathetic nervous system to produce the “Fight or
Flight” reaction
1 ALPHA stimulation causes peripheral vasoconstriction. It raises the perfusion pressure of vital organs
during cardiac arrest and it decreases capillary permeability and increases blood pressure in anaphylaxis
2 BETA 1 stimulation causes increased myocardial excitability, tachycardia and increased myocardial
contractility
3 BETA 2 stimulation causes bronchodilation
Uses

Question 3

Adrenaline
Describe
Route IM, IV, NEB by their Onset, Peak and Duration.

Answer 3

Route ONSET PEAK DURATION
IM 3-90sec 4-10min 5-10min
IV 30 sec 3-5min 5-10min
NEB 1-5min N/A up to 20min

Question 4

Adrenaline 8 protocol uses

Answer 4

C3 - Cardiac arrest
C7 - Bradycardia
C6 - Cardiogenic shock
M4 - Asthma
M16 - Anaphylaxis & Allergic Reactions
M7 - Croup
OP4 - Newborn resuscitation
C16 - Return of Spontaneous Circulation

Question 5

Adrenaline Averse Effects 6

Answer 5

Tachycardia
Dysrhythmias, including ventricular fibrillation
Hypertension
Pupillary dilation
Anxiety
Nausea & Vomiting

Question 6

Adrenalin Contraindications

Answer 6

Nill for NSWAS

Question 7

Adrenaline notes

Answer 7

1 As two concentrations are available: Read the label carefully and cross check prior to administration
2 During inter-hospital transports paramedics unable to obtain IV access may use existing IO access if
available
3 Patients < 1 year of age must have their ETT dose diluted to 1mL total volume with NaCl prior to
administration
4 ETT adrenaline must only be used if IV/IO access is unavailable

Question 8

Adrenaline Adult doses and routes during Cardiac arrest, i.e 16yo or older

Answer 8

IV 1mg (1:10,000) bolus
2nd Cycle (Approx 4 min)
No maximum

ETT 2mg (1:1,000)
10mg MAX

Question 9

Adrenaline Cardiac arrest Paed Note

Answer 9

<1yo, ETT dose diluted to 1ml with NaCl prior to administration.

Question 10

Adrenaline
Paed (<16) doses for
cardiac arrest.

Answer 10

IV/IO 10mcg/kg (1:10,000) bolus
No maximum

ETT 100mcg/kg (1:1,000) bolus* (Max bolus: 2mg)
Max 5 doses

Question 11

Adrenaline Life Threatening Asthma (LTA) Indication for IV

Answer 11

Unresponsive to 4 IM adrenaline bolus injections.

Question 12

Adrenaline LTA Adult dose
(16 or over)

Answer 12

IM 500mcg 1:1,000 bolus into lateral aspect of thigh
Repeat 5 min
No maximum

IV 50mcg 1:10,000 bolus (If unresponsive to IM 4 times)
Repeat 1 min
No maximum

Question 13

Adrenaline LTA Paediatric dose

Answer 13

IM 10mcg/kg 1:1,000 bolus into lateral aspect of thigh (Max bolus: 500mcg)
Repeat 5 min
No maximum

IV/IO 2mcg/kg 1:10,000 bolus (Max bolus: 50mcg)
Repeat 2 min
No maximum

Question 14

Adrenaline Severe/Life Threatening Anaphylaxis
Adult dose (16 or over)

Answer 14

IM 500mcg 1:1,000 bolus lateral aspect of thigh
Repeat 5 min
No maximum

Adrenaline infusion (is indicated for all patients ≥ 16 years of age unresponsive to a minimum of 4 IM injections - Adrenaline Infusion -
1mg 1:10,000 diluted in 90mL compound sodium lactate via burette with micro drip. Commence 5mcg/min (30 drops per minute) and titrate whilst
indicated

Question 15

Adrenaline Severe/Life Threatening Anaphylaxis

Paediatric

Answer 15

IM 10mcg/kg 1:1,000 bolus lateral aspect of thigh
(Max bolus: 500mcg)
Repeat 5 min
No maximum

Question 16

Adrenaline Severe/Life Threatening Anaphylaxis

WITH

Continuing signs of upper airway obstruction post IM adrenaline

ADULT

Answer 16

NEB 5mg 1:1,000
Repeat 30 min
No maximum

Question 17

Adrenaline Severe/Life Threatening Anaphylaxis

WITH

Continuing signs of upper airway obstruction post IM adrenaline

PAEDIATRIC

Answer 17

NEB 500mcg/kg 1:1,000 (Max bolus: 5mg) 30 min
No
maximum

Question 18

Adrenaline for Newborn Resuscitation

Indication

Answer 18

PR <60 despite effective CPR newborn resuscitation

Question 19

Adrenaline for Newborn Resuscitation Dose

Answer 19

IV/IO 10mcg/kg 1:10,000
Repeat 4 min
No maximum

Question 20

Adrenaline for Severe Croup

Age group

Answer 20

<16

Question 21

Adrenaline for Severe Croup

Dose

Answer 21

NEB 500mcg/kg 1:1,000 (Max bolus: 5mg)
Repeat 30 min
No maximum

Question 22

Adrenaline for Bradycardia

Adult dose

Answer 22

IV 50mcg 1:10,000 bolus
Repeat 1 min until PR > 40 and/ or perfusion is adequate or a
continuous adrenaline infusion is running
No maximum

Adrenaline Infusion -
1mg 1:10,000 diluted in 90mL compound sodium lactate via burette with micro drip.
Commence 5mcg/min (30 drops per minute) and titrate whilst indicated

Question 23

Adrenaline for Bradycardia

Paediatric dose

Answer 23

IV/IO 2mcg/kg 1:10,000 bolus (Max bolus: 50mcg)
Repeat 2 min
No maximum

Question 24

Adrenaline for Cardiogenic Shock

ADULT ONLY DOSE (16 or older)

Answer 24

Adrenaline Infusion - 1mg 1:10,000 diluted in 90mL compound sodium lactate via burette with micro drip.
Commence 5mcg/min (30 drops per minute) and titrate whilst indicated

Question 25

Adrenaline for Cardiac Arrest with ROSC ADULT ONLY DOSE (16 or older)

Answer 25

IV 50mcg 1:10,000 Repeat 1 min until systolic BP>100mmHg or adrenaline infusion insitu No maximum Adrenaline Infusion - 1mg 1:10,000 diluted in 90mL compound sodium lactate via burette with micro drip. Commence 5mcg/min (30 drops per minute) and titrate whilst indicated