ADRENALINE (EPINEPHRINE)

1mg/ml (1:1000)
Paediatric Cardiac Arrest Algorhytm
Definition

• Adrenaline (Epinephrine) belongs to a class of

drugs called sympathomimetic agents.
Adrenaline injection can be used for the
emergency treatment of severe allergic
reactions (www.medicines.org.uk)
Action

• Peripheral vasoconstriction (Alpha effect) useful in the cardiac arrest patient as the alpha effect raises the
perfusion pressure of vital organs and decreases capillary permeability in anaphylaxis
• Increases rate of sinus node, increases myocardial contractility, increases atrio ventricular conduction
and incre
• Bronchodilatation (Beta 2 effect)
• Onset of actions
• Intravenous: 30 seconds (i.v. is not recommended by manufacture)
• Intramuscular: 30 - 90 seconds
•Maximum effect
•Intravenous: 3 - 5 minutes (i.v. is not recommended by manufacture)
•Intramuscular: 4 - 10 minutes
 • Adrenaline (Epinephrine) belongs
to a class of drugs called
sympathomimetic agents.
Adrenaline injection can be used
for the emergency treatment of
severe allergic reactions
Uses
 Cardiac arrest (Ventricular Fibrillation /
Asystole
• Improve Perfusion during cardiac arrest
• Convert fine VF to course VF which is
more susceptible to counter shock
• Simulate myocardial excitability and
increase myocardial contractility in
asystole, PEA and other
bradyarrythmias
Uses
 Anaphylaxis
• With upper and/or lower airway
obstruction or shock with a BP < 80
systolic

Life threatening asthma

• Patients in extremis with decreased level of
consciousness or minimal air movement
(reduced tidal volume/decreased respiratory
rate)
Uses
Adverse Efect

• Like all medicines Adrenaline Injection can cause

side effects, although not everybody gets them.
• If you experience any of these following side
effects, stop using this medicine and report to a
doctor immediately :
• allergic reactions
• any sudden wheeziness
• Adverse Effect
• Tachycardia
• Tachyarrhythmia’s
• Hypertension
Precaution

• Care with patients with history hypertension

• Care with patients with history of ischaemic heart disease
• Give extremely slowly to patients on MAO inhibitor
antidepressants adrenaline may provoke a greatly
exaggerated response
• CV diseases;
• hyperthyroidism
• DM; Parkinson's disease
• Elderly
• Pregnancy
• lactation.
Contraindications

• Preexisting hypertension; occlusive vascular disease;

angle-closure glaucoma (eye drops); hypersensitivity;
cardiac arrhythmias or tachycardia. When used in
addition to local anaesthetics: Procedures involving digits,
ears, nose, penis or scrotum.
 Indication and Dosage

inhalation/Respiratory
Acute asthma
Adult: Spray: Aqueous solution with an adrenaline content equivalent
to 1:100. Pressurised aerosols delivering metered doses equivalent to
approximately 160-275 mcg: 1-2 inhalations, may repeat after 3 hr if
necessary.
 Indication and Dosage

Intramuscular
Anaphylactic shock
Adult: As 1:1,000 solution: 500 mcg (0.5 ml), repeat every 5 minutes as needed until
improvement occurs. For emergency self-admin (e.g. via autoinjector): A dose of 300
mcg (0.3 ml) may be used.
Child: Dose depends on age and weight. Usual dose: 10 mcg/kg.

intravenous
Anaphylactic shock
Adult: 0.5 mg (5 mL of a 1:10,000 solution) given at a slow rate of 100 mcg/minute,
stopping when a response is achieved.
Child: 10 mcg/kg. If autoinjectors are used, doses are based on body wt: 15-30 kg: 150
mcg and >30 kg: 300 mcg.
 Indication and Dosage

Intravenous
Advanced cardiac life support
Adult: Initially, 1 mg (10 mL of a 1:10,000 solution), may
repeat as often as every 3-5 minutes throughout the resuscitation
process. May also be given via intraosseous route at the same
dosage. For endotracheal doses: 2-2.5 mg every 3-5 minutes.
Child: Adrenaline 0.01mg/kg as per ventricular fibrillation /
Asystole protocol (double the dose for endotracheal
administration if no IVI or IOI access)
 references

• https://www.mims.com/indonesia/drug/info/epinephrine?mtype=generic
• https://www.medicines.org.uk/emc/files/pil.3673.pdf