Adrenaline CPG

Question 1

Adrenaline - Presentation

Answer 1

1 mg in 1 mL glass ampoule (1:1000)

1 mg in 10 mL glass ampoule (1:10,000)

Question 2

Adrenaline - Pharmacology

Answer 2

A naturally occurring alpha and beta-adrenergic stimulant

Actions:

• Increases HR by increasing SA node firing rate (Beta1)
• Increases conduction velocity through AV node (Beta1)
• Increases myocardial contractility (Beta 1)
• Increases the irritability of the ventricles (Beta 1)
• Causes bronchodilatation (Beta 2)
• Causes Peripheral vasoconstriction (Alpha)

Question 3

Adrenaline - Metabolism

Answer 3

By monoamine oxidase and other enzymes in the blood, liver and around nerve endings; excreted by kidneys

Question 4

Adrenaline - Primary emergency indications

Answer 4

1. Cardiac arrest - VF/VT, Asystole or PEA
2. Inadequate perfusion (cardiogenic or non-cariogenic/non-hypovolaemic)
3. Bradycardia with poor perfusion
4. Anaphylaxis
5. Severe asthma - imminent life threat not responding to nebuliser therapy, or unconscious with no BP
6. Croup

Question 5

Adrenaline - Contraindications

Answer 5

1. Hypovolaemic shock without adequate fluid replacement

Question 6

Adrenaline - Precautions

Answer 6

Consider reduced dose for:

1. Elderly/frail Pt
2. Pt with cardiovascular disease
3. Pt on monoamine oxidase inhibitors
4. Higher doses may be considered for Pts on beta blockers

Question 7

Adrenaline - Route of administration

Answer 7

IV

IM

Nebulised

IV infusion

IO

Question 8

Adrenaline - Side effects

Answer 8

Sinus tachycardia

Supraventricular arrhythmias

Ventricular arrhythmias

Hypertension

Pupillary dilatation

May increase size of MI

Feeling of anxiety/palpatations in the conscious Pt

Question 9

Adrenaline - Special Notes

Answer 9

IV Adrenaline should be reserved for life threatening situations.

IV effects:

Onset: 30sec

Peak: 3-5min

Duration: 5-10min

IM effects:

Onset: 30-90sec

Peak: 4-10min

Duration: 5-10min