Adrenaline

Question 1

Adrenaline - Drug Class

Answer 1

Sympathomimetic

Question 2

Adrenaline - Pharmacology

Answer 2

Adrenaline (epinephrine) is a naturally occurring catecholamine which primarily acts on Alpha and Beta adrenergic receptors. The actions of these receptors cause an increase in heart rate (B1), increase in the force of myocardial contractions (B1), increase in the irritability of the ventricles (B1), bronchodilation (B2) and peripheral vasoconstriction (A1).

Question 3

Adrenaline - Metabolism

Answer 3

The majority of circulating adrenalin is metabolised by sympathetic nerve endings. It is subject to the process of mitochondrial enzymatic breakdown by monoamine oxidase at the synaptic level.

Question 4

Adrenaline - Indications

Answer 4

• Anaphylaxis OR severe allergic reaction
• Severe life threatening bronchospasm OR silent chest (patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC)
• Cardiac Arrest
• Croup (with stridor at rest)
  CCP - Shock unresponsive to adequate fluid resuscitation (excluding hemorrhagic cause)
  CCP - Bradycardia with poor perfusion (unresponsive to Atropine AND/OR TCP)

Question 5

Adrenaline - Contraindications

Answer 5

Nil

Question 6

Adrenaline - Precautions

Answer 6

• Hypertension
• Hypovolaemic shock
• Concurrent MAOI therapy

Question 7

Adrenaline - Side Effects

Answer 7

• Palpitations/Tachyarrhythmias
• Tremor
• Hypertension
• Anxiety
• Pupil dilation

Question 8

Adrenaline - Presentation

Answer 8

• Ampoule 1mg/1mL (1:1,000)

- Ampoule 1mg/10mL (1:10,000)

Question 9

Adrenaline - Onset, Duration & Half-life

Answer 9

Onset - 30 seconds IV, 60 seconds IM
Duration - 5-10 minutes
Half-life - 2 minutes

Question 10

Adrenaline - Schedule

Answer 10

1mg/1mL - S3 1mg/10mL - unscheduled

Question 11

Adrenaline - Routes of administration

Answer 11

NEB, IM, IV, IO, IV INF

Question 12

Adrenaline - Adult dose - Anaphylaxis OR severe allergic reaction

Answer 12

IM - 300microg. 5 min intervals. No max dose.
NEB - 5mg. Single dose only. May be administered for facial or tongue swelling thought to be allergic in origin. IM or IV adrenaline must be administered.

Question 13

Adrenaline - Paed dose - Anaphylaxis OR severe allergic reaction

Answer 13

IM - > (or equal to) 6yo - 300microg. 5 min intervals. No max dose.
IM - <6yo - 150microg. 5 min intervals. No max dose.
NEB - 5mg. Single dose only. For facial or tongue swelling thought to be allergic in origin. If stridor present IM or IV must be used.

Question 14

Adrenaline - Adult dose - Severe life-threatening bronchospasm OR silent chest

Answer 14

IM - 300microg. 5 min intervals. No max dose.

Question 15

Adrenaline - Paed dose - Severe life-threatening bronchospasm OR silent chest

Answer 15

IM - > (or equal to) 6yo - 300microg. 5 min intervals. No max dose.
IM - <6yo - 150microg. 5 min intervals. No max dose.

Question 16

Adrenaline - Adult dose - Cardiac Arrest

Answer 16

IV - 1mg. 3-5 min intervals. No max dose.

Question 17

Adrenaline - Paed dose - Cardiac Arrest

Answer 17

IV - > (or equal to) 10kg (1 yo) - 10microg/kg. 3-5 min intervals. No max dose.
IV - <10kg (1yo) - 100microg. 3-5 min intervals. No max dose.

Question 18

Adrenaline - Paed dose - Croup (with stridor at rest)

Answer 18

NEB - 5mg. Single dose only.

Question 19

Adrenaline - Special Notes

Answer 19

• All time critical adrenaline IM injections should be administered in the vastus lateralis (improved absorption).