Epinephrine

Question 1

Epinephrine (______, _____)

Answer 1

Adrenaline, Epi

Question 2

Epi Class:

Answer 2

Catecholamine: Sympathomimetic (both alpha and beta effects)

Question 3

Epi Action:

Answer 3

• On the bronchi: bronchodilation (beta-2)
• On the peripheral vasculature: vasoconstriction (alpha)
• On the heart:
  
  • increased heart rate (beta-1) / chronotropic
  • increased contractility / inotropic
  • increased AV conduction / dromotropic
  • increased automaticity / dromotropic

Question 4

Epi Onset

Answer 4

IV/IO = 1-2 min , IM = 5-10 min

Question 5

Epi Duration

Answer 5

IV/IO = 5-10 min , IM = 1-4 hours

Question 6

Epi Indications

Answer 6

Allergic Reaction / Anaphylaxis (S-122,162)
- Anaphylaxis Treatment

Respiratory Distress: (S-136,167)
- Severe respiratory distress/failure OR inadequate response to Albuterol / Ipratropium
- Adult: History of asthma or suspected allergic reaction

PEDS: Respiratory Distress (S-167)
- with stridor at rest

PEDS: Burns (S-170)
- Respiratory Distress with stridor

CPR/Arrhythmias (S-127, S-163)
- Cardiac Arrest (VF/VT/PEA/Asystole)

CPR/Arrhythmias (S-163)
- Unstable Bradycardia: after BVM for 30 sec.

Newborn with HR <60min (S-133, 166)
- If HR remains <60 after BVM and CPR

Question 7

Epi Dosage/Route

Answer 7

Allergic Rxn/ Anaphylaxis:
Adult:
0.3 mg IM (1:1,000) MR x2 q5 min SO
Peds:
PDC IM (1:1,000) MR x2 q5 min SO

Resp. Distress (Severe or no response to Albuterol / Ipratropium)
Adult:
0.3 mg IM (1:1,000) MR x2 q5 min SO
If no definitive history of asthma: Dosing as above per BHPO
Peds:
PDC IM (1:1,000) MR x2 q5 min SO

PEDS: Resp. Distress
- with stridor at rest
PDC (1:1,000) via nebulizer (combined with 3ml normal saline) MRx1 SO

PEDS: Burns
- Respiratory distress with stridor
PDC (1:1,000 via nebulizer (combined with 3ml normal saline) MRx1 SO

If not improved after Epi via Neb x2 OR
Impending Airway Compromise:
PDC (1:1,000) IM SO MR x2 q5 min SO

CPR/Arrhythmias
Adult:
1mg IV/IO (1:10,000) SO MR q3-5min SO
PEDS:
PDC IV/IO 1:10,000 q3-5 min SO

CPR/Arrhythmias (S-163) Brady after BVM
PEDS:
PDC IV/IO (1:10,000) SO
MR x2 q3-5 min SO, MR q3-5” BHO

Newborn with HR <60min
PEDS:
PDC IV/IO 1:10,000 SO , MR q3-5 min SO

Question 8

Epi Contraindications

Answer 8

None

Question 9

Epi Adverse Effects

Answer 9

• anxiety / restlessness
• palpitations / tachyarrhythmias
• ventricular irritability
• increased myocardial O2 demands
• Hypertension

Question 10

Epi Packaging

Answer 10

1:10,000= 1mg/10ml (preloaded syringe)
1:1,000= 1mg/1ml (single or multidose containers)

Question 11

Epi Administration

Answer 11

• IV/IO routes: use 1:10,000 concentration
• IM / Nebulizer routes: use 1:1,000 conc.
• Dilute nebulizer Epinephrine dose with 3mL Normal Saline
• Cardiac Arrest with Hypothermia: limit Epinephrine to 1 dose until patient temp is >=86 Fahrenheit OR >= 30 Celsius

Question 12

Epi Cautions & Considerations

Answer 12

• Use caution in respiratory patients if: known cardiac history or history of HTN or BP>150 or age >40
• Monitor ECG, may aggravate pre-existing tachycardia
• For patients who meet anaphylaxis criteria, Epinephrine is administered first. Not indicated for allergic rxns with skin signs only.
• Diphenhydramine may be administered between epinephrine doses in anaphylaxis

Question 13

Epi Special info

Answer 13

• Aerosols may cause sensitivity / irritation to providers; consider goggles and face shield when administering nebulized Epi
• Up to 5 single dose ampules may be required if no multi dose vials are available. Use filter needle with glass ampules.
• In Allergic / Anaphylaxis patients, signs and symptoms can occur minutes to hours after exposure.