Adrenaline

Question 1

What is the presentation?

Answer 1

1 mg in 1 mL (1:1,00)

Question 2

How does it work?

Answer 2

A naturally occurring sympathomimetic hormone and neurotransmitter which acts on nearly all body tissues.
A nonselective agonist of all adrenergic receptors, including the major subtype’s α1, α2, β1, β2, and β3.

Question 3

What effects does it have on the body? (4)

Answer 3

Causes peripheral vasoconstriction
Stimulation of cardiac conduction system causes increased contractions
Causes bronchodilation
Dilation of blood vessels in muscles

Question 4

What are the times of onset, peak and duration?

Answer 4

Onset: IV/IO - 30 seconds, IM - Onset 30-90 seconds.
Peak: IV/IO - 3-5 minutes, IM - 5-10 minutes
Duration: IV/IO/IM - 5-10 minutes

Question 5

What are the indications?

Answer 5

Cardiac arrest
Anaphylaxis 
Life threatening asthma 
Severe croup 
Post ROSC

Question 6

What are the contraindications?

Answer 6

None

Question 7

What are the precautions?

Answer 7

Ischaemic Heart Disease

Do not walk patient pre/post IM adrenaline administration in anaphylaxis

Question 8

What are the dosages in a cardiac arrest scenario?

Answer 8

Adult: 1mg IV/IO every 3-5 minutes

Paediatric / Newborn: Dilute 1mg adrenaline in 9ml normal saline (1000 mcg in 10mls, 1:10,000)
10mcg/kg = 0.1ml/kg (1:10000) every 3-5 minutes.

Question 9

What are the dosages post ROSC?

Answer 9

Adult: Dilute 1mg Adrenaline in 9ml normal saline (1000 mcg in 10mls, 1:10,000)
50 mcg (0.5ml) every 3-5 min as required to maintain systolic blood pressure >90mmHg

Paediatric: Dilute 1mg Adrenaline in 9ml normal saline (1000 mcg in 10mls, 1:10,000)
1mcg/kg every 3-5 min (max bolus 50mcg) to maintain systolic blood pressure > 80 mmHg

Titrate Adrenaline as required, to achieve and / or maintain the SBP requirements as listed above.

Question 10

What are the dosages in an anaphylaxis situation?

Answer 10

Adult: 0.5mg IM into lateral mid-thigh (0.5ml of 1:1000), repeat every 5 minutes as clinically required
Pregnant Females experiencing anaphylaxis:

Pregnant adults: 0.3mg IM into lateral mid-thigh (0.3ml of 1:1000), repeat every 5 minutes as clinically required
Paediatric:

Paeds:0.01mg/kg IM into lateral mid-thigh, repeat every 5 minutes as clinically required

Question 11

What are the dosages in a life-threatening asthma situation?

Answer 11

Adult: 0.5mg IM into lateral mid-thigh (0.5ml of 1:1000), repeat every 5 minutes as clinically required
Pregnant Females experiencing anaphylaxis:

Pregnant adults: 0.3mg IM into lateral mid-thigh (0.3ml of 1:1000), repeat every 5 minutes as clinically required
Paediatric:

Paeds:0.01mg/kg IM into lateral mid-thigh, repeat every 5 minutes as clinically required

Question 12

What are the dosages in a severe croup situation?

Answer 12

Infants/Paediatric: 5mg in 5mls nebulised once only

Question 13

What side effects could occur?

Answer 13

Dysrhythmias
Hypertension
Pupil dilation
Tremor
Anxiety
Palpitations