Epinephrine

Question 0

Epinephrine Action

Answer 0

• 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
• ONSET = IV/IO 1-2 minutes, IM /SC 5-10 minutes.
• DURATION = IV/IO 5-10 minutes, IM/SC 1-4 hrs

Question 1

Epinephrine class

Answer 1

(Adrenalin, EPI)
Class
• catecholamine: sympathomimetic (both alpha and beta effects)

Question 2

Epinephrine indications

Answer 2

• allergic reaction (s-122, s-162)
- acute (facial/cervical angioedema, bronchospasm or wheezing)
• anaphylaxis ( S-122, s-162)
- shock or cyanosis
• respiratory distress ( s-136, s-167)
- severe respiratory distress/failure or inadequate response to albuterol/atrovent
• PEDS: respiratory distress (s-167)
-with strider at rest
• dysrhythmias ( s-127, s-163)
- cardiac arrest ( pulseless patient)
• PEDS: dysrhythmias (s-163)
- unstable bradycardia after being for d30 sec.
• PEDS: newborn deliveries. (S-166)
-if HR remains <60 after 30 sec of CPR.

Question 3

Epinephrine dosage/route

Answer 3

Allergic reactions
Adult:
.3mg IM 1:1000; MR x2 q10"
PEDS: 
PDC IM 1:1000; MR x2 q10"

Anaphylaxis
Adult:
.3mg IM 1:1000 MR x2 q10"
.1mg IV/IO 1:10000 BHO mRx2 q3-5" BHO
PEDS: 
pDC - IM 1:1000 MR x 2 q10"
PDC-  PDF- IV/IO 1:1000 BHO mr x2

Respiratory distress. 
Adult:
.3mg IM 1:1000 mr MR x2 q 10"
If no definate history of asthma:
Dosing as above bet BHPO
PEDS: PDC - IM 1:1000 mr x2 q10" 

PEDS: respiratory distress
1:1000 PDC via nebulizer MRx1

Dysrhythmias
Adult:
1mg IV/IO 1:10000MR q 3-5
PEDS: PDC IV/IO 1:10000; MR x2 q3-5”

PEDS new born deliveries
PEDS: IV/io 1:10000 mr x2 q3-5” mr x2 q3-5” mr q3-5” mr q3-45” BHO

Question 4

Epinephrine contraindications

Answer 4

None

Question 5

Epinephrine Side effects

Answer 5

• anxiety / restlessness
• palpations/ tachyarrhythmias
• ventricular irritability
• increased myocardial O2 demands.
• hypertension
• angina

Question 6

Epinephrine special information

1.
2.
3. 
4.
5.
6.

Answer 6

Concentrations: 1:10000= 1mg/10ml; 1:1000= 1mg/1ml

1. Use with caution (IM dose) if known cardiac hx or hx of HTN or BP >150 or age > 40
2. BHPO required (respiratory distress s-136) if no definite hx of asthma.
3. Monitor ECG may aggravate pre existing tachycardia.
4. Use IV EPI in anaphylaxis with s/s of poor perfusion:
   
   • severe hypotension
   • cyanosis
5. Alpha effects override Berta effects in peripheral vasculature.
6. Nebulizer EPI 1:1000 concentration only
   
   • can cause sensitivity / irritation to providers; may need goggles and face shield
   • may cause rebound exacerbation of croup.
   • is used full strength in nebulizer do not dilute
   • up to 5 single dose ampules may be required if no multi dose vials are available.