Epinephrine (Adrenalin)

Question 1

Epinephrine classification

Answer 1

Beta-adrenergic and alpha stimulator

Question 2

Epinephrine action

Answer 2

1. Alpha and beta-adrenergic effects
   a. Positive inotropic
   b. Positive chronotropic
   c. Positive dromotropic
   d. Increase irritability of ventricles
   e. Dilates bronchi and coronary arteries
   f. Increased cerebral blood flow

Question 3

Epinephrine onset and duration

Answer 3

1. IV, ET, IO = Immediate
IM = Variable
SQ = 6-15 min
Inhalation = 3-5 min
2. IV, ET, IO = 1-4 hrs
IM = unknown
SQ = unknown
Inhalation = 1-3 hrs

Question 4

Epinephrine indications

Answer 4

1. CARDIAC ARREST: VF, PULSELESS VT, ASYSTOLE, PEA
2. ANAPHYLACTIC SHOCK
3. SEVERE ALLERGIC REACTIONS
4. STATUS ASTHMATICUS
5. BRADYCARDIA UNRESPONSIVE TO ATROPINE, TCP, DOPAMINE
6. CROUP
7. Upper airway obstruction with edema

Question 5

Epinephrine contraindications

Answer 5

1. Chest pain accompanied by ectopic beats for tachycardia
2. Do not mix with sodium bicarb
3. Do not use to treat VT secondary to cocaine

Question 6

Epinephrine cautions

Answer 6

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

Question 7

Epinephrine Dosage and administration for and Adult

Answer 7

1. Adult:
   a. Cardiac arrest: 1mg IV/IO (10ml of 1:10,000) every 3-5 min; If no IV/IO, mix 2-2.5mg of 1:1,000 with 10ml NS, give in ET
   b. Bradycardia; mix 1mg in 250ml NS; administer at 2-10mcg/min, .atitrate to effect
   c. Acute allergic reaction .3-.5mg 1:1,000 IM
   d. Anaphylaxis: .3-.5mg IV/IO (3-5ml of 1:10,000). If no IV/IO mix 2-2.5mg of 1:1,000 with 5ml NS in ET
   e. Asthma; .3mg of 1:1000 IM, may repeat in 20 min
   f. mUpper airway edema due to obstruction: .3mg of 1:1,000 IM or .3mg of 1:10,000 IV

Question 8

Epinephrine Dosage and administration for and Pediatric

Answer 8

1. Croupe: 1:1,000
   a. = 6yo 3ml undiluted blow by
   b. Cardiac arrest/bradycardia/anaphylaxis; .01mg/kg of 1:10,000 (max dose 1mg) IV/IO, ET use .1mg/kg (1:1000)
   c. Allergic Reaction/Asthma: .01mg/kg to max of .3mg IM (1:1000)
   d Upper airway edema due to obstruction: .01mg/kg IV/IO

Question 9

Epinephrine Dosage and Administration for Epi Pen

Answer 9

Epi pen or EMT draw up from vial 1:1000

a. Adult (>65lbs) .3mg
b. Pediatric: .15mg
c. Injection site lateral portion of thigh midway between waist and knee given IM

Question 10

Epinephrine adverse reactions

Answer 10

Hypertension, SVT, ventricular arrhythmias

Question 11

Epinephrine referencing protocol

Answer 11

Cardiac arrest
Shock (anaphylactic shock)
Respiratory (asthma, croup, upper airway obstruction, allergic reaction)
Environmental (envenomations)
OB/GYN (neonatal resuscitation)
Pediatric cardiac arrest