Adrenaline

Question 1

Presentation

Answer 1

1 mg in 1 ml glass ampoule (1:1,000)

1 mg in 10 ml glass ampoule (1:10,000)

Question 2

Pharmacology

Answer 2

Natural occurring alpha and beta-adrenergic stimulant

Beta 1

• Increases HR by increasing SA node firing rate
• Increases conduction velocity through AV node
• Increases myocardial contractility
• Increases irritability of ventricles

Beta 2
- Bronchodilatation

Alpha
- Peripheral vasoconstriction

Question 3

Metabolism

Answer 3

By monoamine oxidase and other enzymes in the blood, liver and around nerve endings

Excreted by the kidneys

Question 4

Indications

Answer 4

• Cardiac arrest - VF/VT, Asystole or PEA
• Inadequate perfusion (cardiogenic or non/cardiogenic/non-hypovolaemic)
• Bradycardia with poor perfusion
• Anaphylaxis
• Severe asthma - imminent life threat not responding to nebulised therapy, or unconscious with no BP
• Croup

Question 5

Contras

Answer 5

Hypovolaemic shock without adequate fluid replacement

Question 6

Precautions

Answer 6

Consider reduced doses:

• Elderly/frail
• Cardiovascular disease
• Monoamine oxidase inhibitors (depression/parkinsons)
• Higher doses may be required for pt’s on beta blockers

Question 7

Route of administration

Answer 7

• IV
• IM
• Nebulised
• IV infusion
• IO

Question 8

Side effects

Answer 8

• Sinus tachycardia
• Supraventricular arrhythmias
• Ventricular arrhythmias
• Hypertension
• Pupillary dilatation
• May increase size of MI
• Feeling of anxiety/palpitations in the conscious pt

Question 9

Special notes

Answer 9

IV Adrenaline should be reserved for life threatening situations

Question 10

IV effects

Answer 10

Onset: 30 secs
Peak: 3-5 mins
Duration: 5-10 mins

Question 11

IM effects

Answer 11

Onset: 30-90 secs
Peak: 4-10 mins
Duration: 5-10 mins

Question 12

Cardiac arrest

Answer 12

1 mg IV
repeat every 2nd cycle (4 minutely)
Flush with 20-30 mL saline

Question 13

Inadequate perfusion - cardiogenic (PE)

Answer 13

MICA - adrenaline infusion

Question 14

Inadequate perfusion - non-cardiogenic/non-hypovolaemic (Sepsis)

Answer 14

MICA - adrenaline infusion

Question 15

Bradycardia

Answer 15

MICA - adrenaline infusion

Question 16

Anaphylaxis

Answer 16

Adult
500 mcg IM - repeat @ 5 mins until satisfactory results or side effects occur

<60kg/frail/elderly
300 mcg IM - repeat @ 5 mins until satisfactory results or side effects occur

Peadiatrics
10 mcg/kg IM - repeat @ 5 mins until satisfactory results or side effects occur

Upper airway obstruction - 5 mg Nebulised - repeat @ 5 mins until satisfactory results

Consider MICA for adrenaline infusion in all pt groups

Question 17

Severe asthma

Answer 17

Adults
500 mcg IM - repeat @ 5-10 mins, max 1.5 mg

Peadiatrics
10 mcg/kg IM - repeat @ 5-10 mins, max 30 mcg/kg IM

Consider MICA for adrenaline infusion in all pt groups

Question 18

Thunderstorm asthma

Answer 18

Consult clinician for:
20 mcg IV at 2 min intervals

Presentation for thunderstorm asthma
1 mg in 1 ml - dilute with 9 ml saline
= 1 mg in 10 ml (1000 mcg in 10 ml)

100 mcg in 1 ml - dilute (again) with 9ml saline
= 100 mcg in 10 ml

10 mcg in 1 ml

Consider MICA for adrenaline infusion

Question 19

Croup

Answer 19

5 mg Nebulised - repeat @ 5 mins until satisfactory results