EMT CAD

Adrenaline Indications

• Cardiac arrest.

• Anaphylaxis.

• Severe asthma.

• Imminent respiratory arrest from COPD.

• Bradycardia with moderate or severe cardiovascular compromise.

• Blood pressure support if unresponsive to metaraminol.

• Septic shock, cardiogenic shock, and neurogenic shock, unresponsive to 0.9% sodium chloride IV and metaraminol IV.

• Stridor causing moderate or severe respiratory distress.

• IN for clinically significant epistaxis.

• Topical for clinically significant bleeding from a wound.

Adrenaline Contraindications

• None.

Adrenaline Cautions

• Myocardial ischaemia. Adrenaline will increase myocardial oxygen consumption.

• Tachydysrhythmias. Adrenaline will usually make tachydysrhythmias worse.

Adrenaline Mechanism

• Adrenaline stimulates alpha and beta receptors, with the predominant effects occurring at alpha 1, beta 1 and beta 2 receptors.

• Alpha 1 stimulation causes smooth muscle contraction, vasoconstriction of blood vessels and stimulation of glycogenolysis and gluconeogenesis.

• Beta 1 stimulation causes an increase in inotropy (cardiac contractility), an increase in chronotropy (heart rate) and an increase in dromotropy (speed of electrical conduction within the heart).

• Beta 2 stimulation causes smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation, and stabilisation of mast cell membranes, reducing histamine release.

Adrenaline Route/Dose/Administration

• Topical: dilute each mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Apply topically in addition to direct pressure.

• IN: dilute each mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Administer the appropriate dose into each bleeding nostril using a mucosal atomising device, in addition to direct pressure.

• Nebulised: administer undiluted.

• IM: administer undiluted. The preferred IM site is the lateral thigh. If this site is not suitable use the lateral upper arm.

• Cardiac arrest:

  • Adults and children whose weight has been rounded to 50 kg or more: administer undiluted as an IV bolus.

  • Children whose weight has been rounded to 40 kg or less: dilute 1 mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Draw up the dose from this solution and administer as an IV bolus.

• IV infusion: place 1 mg of adrenaline into a 1 litre bag of 0.9% sodium chloride. Shake well and label. This solution is 1:1,000,000 and contains 0.001 mg/ml.

  • For an adult: administer as an IV infusion starting at 2 drops/second. Adjust the rate to the patient’s condition.

  • For a child aged 5-14 years: administer as an IV infusion starting at 1 drop/second. Adjust the rate to the patient’s condition.

• When administering an IV infusion of adrenaline using 1 mg of adrenaline in a 1 litre bag of 0.9% sodium chloride:

  • 2 drops/second via a standard IV administration set will administer approximately 0.4 mg/hour of adrenaline.

  • Record an estimate of the total dose of adrenaline administered.

• For all other IV administration: place 1 mg of adrenaline into a 1 litre bag of 0.9% sodium chloride, Shake well and label. This solution is 1:1,000,000 and contains 0.001 mg/ml. Draw up the dose from this solution and administer as an IV bolus.

Adrenaline - Duration

Onset

• IV: 5-10 seconds.

• IM: 2-5 minutes.

• Nebulised, IN and topical: on contact with the target site.

Effect

• The cardiovascular effects last 5-15 minutes.

• The mast cell membrane effects may last for several hours.

Adrenaline - Side effects

• Tachycardia.

• Tachydysrhythmia.

• Myocardial ischaemia.

• Ventricular ectopy.

• Hypertension.

• Nausea and vomiting.

• Tremor, anxiety and sweating.

• Hyperglycaemia.