Epinephrine G3

Question 1

Epinephrine Class

Answer 1

• Sympathomimetic (alpha/beta adrenergic agonist)

Question 2

Epinephrine MOA

Answer 2

• Catecholamine with strong alpha, strong beta-1 and moderate beta-2 effects
• Vasoconstrictor, increases peripheral vascular resistance and afterload
• Bronchial, intestinal, and urinary smooth muscle relaxer

Question 3

Epinephrine Indications

Answer 3

• Cardiac arrest (V-fib, PVT, asystole, PEA)
• Severe bronchospasm (asthma, bronchiolitis)
• Hypotension/shock (refractory to any other therapy)
• Bradycardia
• Anaphylaxis
• Croup

Question 4

Epinephrine Adult dose

Answer 4

• Pulseless arrest:
  • 1mg (10 mL of 1:10,000) IV/IO, repeat every 3-5 min. (no max dose)
• Hypoperfusion, symptomatic bradycardia or R.O.S.C. (to maintain SBP > 90 or MAP > 65 mmHg)
  • 10 – 20 mcg (1 – 2 mL) IV/IO push every 2 min., (1 mL Epi 1:10,000 in 9mL NS = 10 mcg/mL)
  • 2 – 10 mcg/min IV/IO (2 mL of 1:1,000 added to 250 mL D5W/NS gives 8 mcg/mL)
• Anaphylaxis /asthma with impending respiratory failure:
  • 0.3 mg (0.3 mL 1:1000) IM
  • 2–4 mcg/min IV/IO continuous infusion (2 mL of 1:1,000 added to 250 mL D5W/NS gives 8 mcg/mL)
• Croup or upper airway edema indicated by stridor:
  • 5 mg (5 mL of 1:1,000) in 3 mL of NS via SVN, may repeat every 5-15 min.

Question 5

Epinephrine Contraindications

Answer 5

• Known hypersensitivity
• Acute coronary syndrome
• Cardiac dilation
• Uncontrolled Hypertension - Hypothermia
• Pulmonary Edema
• Myocardial Ischemia
• Hypovolemic Shock

Question 6

Epinephrine Adverse reactions

Answer 6

• CV: increased myocardial oxygen demand, dysrhythmias, chest pain, hypertension
• CNS: nervousness, headache
• GI: nausea & vomiting

Question 7

Epinephrine Pediatric dose

Answer 7

• Pulseless arrest:
  • 0.01 mg/kg (0.1 mL Epi 1:10,000/kg) IV/IO, repeat every 3-5 min.
  (max single dose is 1 mg [10 mL of 1:10,000])
• Hypoperfusion (to maintain 5th percentile SBP):
  • 1–10 mcg push every 2min. (1mL Epi 1:10,000 in 9mL NS = 10mcg/mL)
  • 0.1 – 1 mcg/min IV/IO (0.5 mL of 1:1,000 added to 250 mL NS gives 2 mcg/mL)
• Anaphylaxis/asthma:
  • < 25 kg: 0.15 mg IM (0.15 mL 1:1000) in the lateral thigh, repeat every 5 – 15 min. as needed
  • ≥ 25 kg: 0.3 mg IM (0.3 mL 1:1000) in the lateral thigh, repeat every 5 – 15 min. as needed
• Croup/stridor:
  • 5mg (5mL of 1:1,000) in 3mL of NS via SVN
• Newborn bradycardia:
  • 0.01 to 0.03 mg/kg (0.1 to 0.3 mL/kg of 1:10,000) via IV/IO, followed by 5 mL NS flush, may repeat every 3 – 5 min. until HR is greater than 60 bpm