Adrenaline (201)

Question 1

What type of medication 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
• ALPHA stimulation causes peripheral vasoconstriction. It raises the perfusion pressure of vital organs during cardiac arrest, and decreases capillary permeability and increases blood pressure in anaphylaxis
• BETA 1 stimulation causes increased myocardial excitability, tachycardia, and increased myocardial contractility
• BETA 2 stimulation causes bronchoconstriction

Question 3

Onset, Peak, Duration of IM adrenaline

Answer 3

Onset: 30-90 seconds
Peak: 4-10 minutes
Duration: 5-10 minutes

Question 4

Onset, Peak, Duration of IV adrenaline

Answer 4

Onset: 30 seconds
Peak: 3-5 minutes
Duration: 5-10 minutes

Question 5

Onset, Peak, Duration of NEB adrenaline

Answer 5

Onset: 1-5 minutes
Peak: N/A
Duration: Up to 20 minutes

Question 6

Adrenaline is used for 7 protocols

Answer 6

• Cardiac arrest (C3)
• Cardiogenic shock (C6)
• Bradycardia (C7)
• Asthma (M4)
• Croup (M7)
• Anaphylaxis (M16)
• Newborn resuscitation (O6)

Question 7

Adverse effects of adrenaline

Answer 7

• Tachycardia
• Dysrhythmias, including VF
• Hypertension
• Pupillary dilation
• Anxiety
• Nausea and vomiting

Question 8

Preparation of adrenaline

Answer 8

• 1mg in 1mL ampoule (1:1,000)
• 1mg in 10mL ampoule (1:10,000)
• Infusion: 1mg (10mL) 1:10,000 diluted in 90mL compound sodium lactate via burette with micro drip

Question 9

Adrenaline infusion
Patients >= 16yo
Dose, repeats

Answer 9

Dose: 5mcg/min (30dpm), titrate whilst indicated

Question 10

Adrenaline infusion
<16yo
Dose, Repeats

Answer 10

Not authorised

Question 12

Adrenaline for cardiac arrest
Patients >= 16yo
IV, ETT, Post-ROSC
Dose, repeats, max

Answer 12

IV
Dose: 1mg (10mL) 1:10,000 bolus
Repeat: every 2nd cycle (approx 4 minutes)
Max: no max
Note: during interhospital transports paramedics unable to obtain IV access may use existing IO access if available.

ETT
Dose: 2mg (2mL) 1:1,000 bolus
Repeat: every 2nd cycle (approx 4 minutes)
Max: 10mg (10mL)

Post-ROSC IV
Dose: 50mcg (0.5mL) 1:10,000 bolus
Repeats: every minute
Max: until SBP>100mmHg or an adrenaline infusion is running

Question 13

Adrenaline for cardiac arrest
Patients <16yo
IV/IO, ETT
Dose, repeats, max

Answer 13

IV/IO
Dose: 10mcg/kg (0.1mL/kg) 1:10,000 bolus
Repeat: every 2nd cycle (approx 4 min)
Max: no max

ETT*:
Dose: 100mcg/kg (0.1mL/kg) 1:1,000 bolus
Repeat: every 2nd cycle (approx 4 min)
Max bolus: 2mg (2mL)
Max ETT dose: 5 total doses
*Pt <1yo should have ETT dose diluted to 1mL in total with sodium chloride 0.9%

Question 14

Adrenaline for bradycardia
>=16yo
Dose, Repeat, Max

Answer 14

Dose: 100mcg (1mL) 1:10,000 IV bolus
Repeat: every minute until HR>60 and perfusion is adequate OR a continuous adrenaline infusion is running
Max: no max

Question 15

Adrenaline for bradycardia
<16yo
Dose, Repeat, Max

Answer 15

Dose: 10mcg/kg (0.1mL/kg) 1:10,000 IV/IO bolus slowly
Repeat: every 3 minutes whilst indicated
Max bolus dose: 100mcg (1mL)
Max dose: no max

Question 16

Adrenaline for newborn resuscitation
Indication
Dose, Repeat, Max

Answer 16

Indication: HR <60/min despite effective CPR
Dose: 10mcg/kg (0.1mL/kg) 1:10,000 IV/IO bolus
Repeat: every 4 minutes whilst indicated
Max dose: no max

Question 17

Adrenaline for severe/life-threatening asthma
>=16yo
IM, IV
Dose, Repeat, Max

Answer 17

IM
Dose: 500mcg (0.5mL) 1:1,000 IM into lateral aspect of thigh
Repeat: every 5 minutes whilst indicated
Max dose: no max

IV
Dose: 100mcg (1mL) 1:10,000 IV bolus if unresponsive to IM injection
Repeat: every minute whilst indicated
Max dose: no max

Question 18

Adrenaline for severe/life-threatening asthma
<16yo
IM, IV
Dose, Repeat, Max

Answer 18

IM
Dose: 10mcg/kg (0.01mL/kg) 1:1,000 IM bolus into lateral aspect of thigh
Repeat: every 5 minutes whilst indicated
Max dose: no max

IV
Dose: 10mcg/kg (0.1mL/kg) 1:10,000 IV bolus slowly if unresponsive to IM injection
Repeat: every 5 minutes whilst indicated
Max bolus: 100mcg (1mL)
Max dose: no max

Question 19

Adrenaline for severe/life-threatening anaphylaxis
>=16yo
Dose, Repeat, Max

Answer 19

Dose: 500mcg (0.5mL) 1:1,000 IM bolus into lateral aspect of thigh
Repeat: every 5 minutes whilst indicated
Max dose: no max

• Adrenaline infusion indicated for this patient if unresponsive to 4+ IM injections

Question 20

Adrenaline for severe croup
>=16yo
Dose, Repeat, Max

Answer 20

Not indicated.

Question 21

Adrenaline for severe/life-threatening anaphylaxis
<16yo
Dose, Repeat, Max

Answer 21

Dose: 10mcg/kg (0.01mL/kg) 1:1,000 IM bolus into lateral aspect of thigh
Repeat: every 5 minutes whilst indicated
Max dose: No max

Question 23

Adrenaline for severe croup
<16yo
Dose, Repeat, Max

Answer 23

Dose: 500mcg/kg (0.5mL/kg) 1:1,000 NEB
Repeat: 30 minutes if indicated
Max bolus dose: 5mg (5mL)
Max dose: no max

Question 24

Adrenaline for cardiogenic shock
>=16yo
Dose, Repeat, Max

Answer 24

Adrenaline infusion if unresponsive to compound sodium lactate

Dose: 5mcg/min (30dpm), titrate whilst indicated.

Question 25

Adrenaline for cardiogenic shock
<16yo
Dose, Repeat, Max

Answer 25

Not authorised.