Adrenaline

Question 1

What is the MOA for adrenaline?

Answer 1

Alpha 1, beta 1 and beta 2 receptor stimulation

• Alpha 1 - causes smooth muscle contraction, vasoconstriction of BV and stimulation of glygenolysis and gluconeogenesis
• Beta 1 - increased heart performance - causes an increase in cardiac contractility (inotropy), increase in heart rate (chronotropy) and an increase in electrical conductivity (dromotropy) in the heart - ino-chrono-dromo
• Beta 2 - smooth muscle relaxation, skeletal muscle vasoconstriction, bronchodilation and stabilisation of mast cell memberances reducing histamine release from mast cells.

Question 2

What are the indications for adrenaline?

Answer 2

1. Cardiac arrest
2. Anaphylaxis
3. Severe asthma
4. Moderate to severe stridor
5. Imminent respiratory arrest from CORD
6. Severe bradycardia
7. Septic, cardiogenic and neurogenic shck unresponsive to NaCl IV
8. Intranasal for clinically significant bleeding from the nose
9. Topical for clinically significant bleeding from a wound

Question 3

What are the contraindications for adrenaline?

Answer 3

There are no contraindications for adrenaline

Question 4

What are the cautions for adrenaline?

Answer 4

1. Myocardial ischameia (Adrenaline increase myocardial oxygen consumption)
2. Tachydysrhythmias. (abnormal cardiac rhythms with a rate more than 100 bpm)

Question 5

What dose of adrenaline should be given for topical treatment of a wound?

Answer 5

Typically up to 10 ml of 0.1mg/ml - ie dilute one ampoule with 9ml of 0.9% NaCl

Question 6

What dose of adrenaline and method of administration should be used for treatment of a bad nose bleed?

Answer 6

dilute to 0.1mg/ml with 9ml of 0.9% NaCl, Administer 2ml of this solution via a mucosal atomiser in addition to direct pressure

Question 7

What dose of adrenaline should you use for a person in Anaphylaxis?

Answer 7

0.5mg IM, see paediatric dose rates for children
Repeat adrenaline IM after 10 minutes if pt not improving
Calling backup for IV adrenaline therapy recommended in severe cases.
5mg adrenaline neb is recommended if there is upper airway swelling or odema

Question 8

Under what circumstances should adrenaline be given in cases of asthma and how should it be given?

Answer 8

Adrenaline is given in severe or life threatening cases of asthma. Should be delivered 0.5mg IM every 10 min if no IV access

Question 9

How should you set up an IV for a paramedic with adrenaline

Answer 9

Need 1mg adrenaline and a 1 L bag of 0.9% NaCl

Question 10

What site should be used to deliver IM adrenaline?

Answer 10

Lateral thigh or if not suitable lateral upper arm

Question 11

What are common adverse effects of adrenaline?

Answer 11

Tachycardia
Tachydysryhthmia
Myocardial ischaemia
Ventricular ecotopy
Hypertension
Nausea and vomiting
Tremor, anxiety, seating
Hyperglycaemia (causes glycogenolysis)