ADRENALINE (A) (Jan 2010)

Question 1

TYPE:

Answer 1

A naturally occurring catecholamine [S3]

Question 2

PRESENTATION:

Answer 2

1: 10000 - 1 mg in 10 ml – IMS Mini-jet
1: 1000 - 1 mg in 1 ml – ampoules

Question 3

ACTIONS:

Answer 3

1. Peripheral vasoconstriction ( effect)
2. Increased rate of sinus node
3. Increased myocardial contractility
4. Increased AV conduction
5. Increased myocardial irritably (1 effect)
6. Bronchodilatation
7. Vasodilatation of skeletal muscle (2effect)
   Onset: 30 seconds IV; IM: 30 – 90 seconds
   Max effect: 3 – 5 minutes IV; IM: 4 – 10 minutes
   Endotracheal use: slightly longer times

Question 4

USES:

Answer 4

Ventricular fibrillation & VT No Output
Asystole
Pulseless Electrical Activity (PEA)
Anaphylaxis
Severe life-threatening asthma
Bradyarrhythmias resistant to Atropine
Severe upper airway obstruction due to swelling

Question 5

ADVERSE EFFECTS:

Answer 5

Tachycardia
Tachyarrhythmias
Hypertension

Question 6

CONTRA-INDICATIONS:

Answer 6

Known hypersensitivity

Question 7

PRECAUTIONS:

Answer 7

These apply to patients with cardiac output only:
Care with patients with history of hypertension.
Care with patients with history of ischaemic heart
disease.
Give extremely slowly to patients on MAO Inhibitor
antidepressants (e.g.: Marplan, Parstelin, Marsilid,
Nardil, Parnate) as Adrenaline may provoke a greatly
exaggerated response. Generally, patients on MAOIs
with cardiac output should receive no more than ¼ normal
dose of adrenaline, titrated to response.

Question 8

DOSE: CARDIAC ARREST

Answer 8

Adult: 1 mg, IV fast push
Paediatric: 0.01 mg/kg IV / IO fast push
(If no IV or IO access, administer via endotracheal tube)
No limit on the number of doses in cardiac arrest

Question 9

DOSE: ANAPHYLAXIS / SEVERE LIFE-THREATENING ASTHMA:

Answer 9

Adult: 0.5 mg IM
Paediatric: 0.01 mg/kg IM (to 50 kg)
Repeat IM dose x 1 as required
(The preferred IM site for anaphylaxis is the thigh)
If required, IV Adrenaline by infusion: 1 mg in 1000 mls Normal Saline (= mcg/ml)
Titrate to response (20 dpm = 1 ml/min = 1 mcg/min)
Paediatric - use burette
If the patient is critically ill, slow IV, up to 0.01 mg/kg, no faster than 50mcg/minute
(i.e. 0.5ml of 1:10000/min)
NOTE: IV Adrenaline in anaphylaxis & asthma should be used very cautiously.

Question 10

DOSE: BRADYARRHYTHMIAS RESISTANT TO ATROPINE:

IV Adrenaline by infusion:

Answer 10

1 mg in 1000 mls Normal Saline ( = 1 mcg/ml)
Titrate to response (20 dpm = 1 ml/min = 1 mcg/min)
Paediatric - use burette

Question 11

DOSE: SEVERE UPPER AIRWAY SWELLING:

Answer 11

Adrenaline 1:1000:
wt > 10 kg - nebulise 5 mls Adrenaline 1:1000
wt < 10 kg - nebulise 0.5 ml/kg Adrenaline 1:1000
(make volume up to 5 mls with saline, as required)
Single dose only

Question 12

SPECIAL NOTE:

Answer 12

Adrenaline in 1000ml flask is to have medication label attached!