Epinephrine

Question 1

Class / Action

Answer 1

Beta Adrenergic and Alpha Stimulator

1. Alpha and Beta Adrenergic Effects
   a. Increases force of contraction
   b. Increases HR and BP
   c. Increases conduction velocity through the AV node
   d. Increases ventricular irritability
   e. Dilates bronchi and coronary arteries
   f. Increases cerebral perfusion (alpha effects)

Question 2

Onset / Duration of Action

Answer 2

ONSET:

1. IV/IO/ET: Immediate
2. Push-dose IV: 1min
3. IM: Variable
4. Inhalation: 3-5min
5. SQ: 6-15min

DURATION:

1. IV/IO/ET: 1-4hours
2. Push-dose IV: 2-5min
3. IM: Variable
4. Inhalation: 1-3hours
5. SQ: Variable

Question 3

Indications

Answer 3

1. Cardiac Arrest: VF, pulseless VT, Asystole, PEA
2. Anaphylactic shock
3. Allergic Reactions
4. Status Asthmaticus
5. Bradycardia unresponsive to Atropine, TCP, Dopamine
6. Croup
7. Upper airway obstruction edema
8. Hypotension

Question 4

Contraindications

Answer 4

1. Chest pain accompanied by ectopic beats or tachycardia
2. Do Not Mix with Sodium Bicarbonate
3. Do Not Use to treat VT S/T cocaine or hydrocarbon overdose

Question 5

Precautions

Answer 5

1. Bronchial asthma and significant emphysema, when pts may also have congestive heart disease
2. Raising BP and HR may cause myocardial ischemia, angina, and increase O2 demand

Question 6

Dosages / Administration

Answer 6

(1: 10,000 = 0.1mg/mL; 1:1000 = 1mg/mL)
1. ADULT:
a. Cardiac Arrest:
i. IV/IO 1mg (10mL of 1:10,000) every 3-5min; followed by 20mL NS flush and elevate arm for 10-20sec after dose
ii. ET: 2-2.5mg of 1:1000 mixed with 10mL NS
b. Profound Bradycardia or Hypotension:
i. Push-Dose IV: Mix 1mL of 1:10,000 epi with 9mL NS in a 10mL syringe (10mg/mL) and administer 0.5-2mL of push-dose epi every 2-5min; or
ii. Infusion IV: Mix 1mg in 250mL NS; administer at 2-10mcg/min (0.5mL-2.5mL), titrations to effect
c. Allergic Reaction: 0.3-0.5mg 1:1000 IM
d. Anaphylactic Shock:
i. IM: 0.3-0.5mg of 1:1000
ii. IV/IO: 0.5mg (5mL of 1:10,000)
iii. ET: 2-2.5mg of 1:1000 mixed with 10mL NS
e. Asthma: 0.3mg of 1:1000 IM; may repeat in 20min if necessary
f. Upper airway edema d/t obstruction:
i. I’m 0.3mg of 1:1000
ii. IV: 0.3mg of 1:10,000
2. PED:
a. Croup: 1:1000
i. 2mL (undiluted) SVN blow-by <6years old
ii. 3mL (undiluted) SVN blow-by >5years old
b. Cardiac Arrest/Bradycardia/Anaphylaxis: 0.1mg/kg of 1:10,000 solution
(0. 1mL = 0.01mg of 1:10,000 solution; Maximum Dose 1mg) IV/IO. ET - Use 0.1mg/kg (1:1000 0.1mL/kg)
c. Anaphylactic Shock:
i. IM:
a. 1:1000 0.3-0.5mg for PEDS >65lbs (>29kg)
b. 1:1000 0.15mg for PEDS <66lbs (<29kg)
ii. IV/IO: 1:10,000 0.3mg
d. Allergic Reaction/Asthma: 0.1mg/kg; Maximum Dose 0.3mg IM (0.01mg = 0.01mL of 1:1000)
e. Upper Airway Edema D/T Obstruction:
i. IM: 1:1000 0.01mg/kg Max Dose 0.3mg
ii. IV/IO: 1:10,000 0.01mg/kg Max Dose 0.3mg

Question 7

Adverse Reactions

Answer 7

Myocardial Infarction, Hypertension, SVT, PVCs, V-Tach, V-Fib.