Adrenaline

Question 1

What type of medication is Adrenaline?

Answer 1

A sympathomimetic.

This means it mimics stimulation of the sympathetic nervous system.

Question 2

What is the action of Adrenaline?

Answer 2

Stimulation of the ALPHA and BETA cells of the central nervous system to produce the “fight or flight” reaction.

ALPHA stimulation causes peripheral vasoconstriction. It raises the perfusion pressure of internal organs during cardiac arrest, and it decreases capillary permeability and increases blood pressure during anaphylaxis.

BETA 1 stimulation causes increased myocardial contractility and excitability, and tachycardia.

Beta 2 stimulation causes bronchodilation.

Question 3

What are the different routes, onsets, peaks and durations for Adrenaline delivery?

Answer 3

IM: Onset is 30-90s, the peak is 4-10 min, and the duration is 5-10 min.

IV: Onset is 30s, the peak is 3-5min, and the duration is 5-10min.

NEB: Onset is 1-5min, there is no peak, and the duration is up to 20min.

Question 4

What conditions/situations indicate the use of Adrenaline?

Answer 4

Life threatening asthma, Anaphylaxis; Allergic Reactions, Bradycardia, Cardiac Arrest/ROSC, C6 Cardiogenic Shock, M7 Croup, OP4 Newborn Resuscitation

Question 5

What are the adverse effects of Adrenaline?

Answer 5

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

Question 6

What are the contraindications of Adrenaline?

Answer 6

Nil for NSW Ambulance

Question 7

What preparations of Adrenaline are available?

Answer 7

1mg in 1ml ampoules (1:1,000)

1mg in 10ml ampoules (1:10,000)

Question 8

When is ETT Adrenaline administration indicated?

Answer 8

ETT adrenaline must only be used if IV/IO access is unavailable.

Question 9

What is the correct dose of Adrenaline for cardiac arrest?

Answer 9

for patients 16yrs or older, 1mg (1:10,000) every 4 min with no max dose.

Question 10

What is the correct dose of Adrenaline for life threatening asthma?

Answer 10

For patients <16yrs old, 10mcg/kg (1:1,000) bolus into lateral aspect of thigh (max bolus size 500mcg). Repeat every 5 min, no max dose.

For patients 16yrs or older, 500mcg (1:1,000) bolus into lateral aspect of thigh. Repeat every 5 min, no max dose.

Question 11

What is the correct dose of Adrenaline for severe/life threatening anaphylaxis?

Answer 11

For patients <16yrs old, 10mcg/kg (1:1,000) bolus into lateral aspect of thigh (max bolus size 500mcg). Repeat every 5 min, no max dose.

For patients 16yrs or older, 500mcg (1:1,00) bolus into lateral aspect of thigh. Repeat every 5 min, no max dose.

Question 12

What is the correct dose and route for Adrenaline for severe/life threatening anaphylaxis if there are continuing signs of upper airway obstruction post IM adrenaline administration?

Answer 12

If patients <16yrs old, 500mcg/kg (1:1,000) given via Nebuliser (max bolus 5mg). Repeat every 30 min, nil max dose.

If patients 16yrs or older, 5mg (1:1,000) given via Nebuliser. Repeat every 30 min, nil max dose.

Question 13

What is the correct dose of Adrenaline for severe croup?

Answer 13

For patients <16yrs old, 500mcg/kg (1:1,000) given via Nebuliser (max bolus 5mg). Repeat every 30 min, nil max dose.

Question 14

What is the correct dose of adrenaline for cardiac arrest?

Answer 14

1mg (1:10,000), given via IV, repeat every 4min, nil max dose.