EPINEPHRINE

Class

Sympathomimetic

Pharmacology and Actions

1. Catecholamine with alpha and beta effects
2. Cardiovascular: Increased heart rate, increased blood pressure, arterial vasoconstriction, increased myocardial contractile force, increased myocardial oxygen consumption, and increased myocardial automaticity and irritability
3. Pulmonary: Potent bronchodilator

Indications

1. Medical cardiac arrest, including:
   1. Ventricular fibrillation and pulseless ventricular tachycardia, asystole, and PEA
2. Bradycardia:
   1. Pediatric patients with signs of poor perfusion.
3. Asthma
4. Mild to moderate allergic reactions, anaphylaxis or severe angioedema
5. Life-threatening airway obstruction suspected secondary to croup or epiglottitis.

Contraindications

1. Epinephrine 1:1000:
   1. Hypertension
   2. Pregnancy
   3. Patients with tachyarrhythmias
2. Epinephrine 1:10,000 is for intravenous or endotracheal use; it should not be used in patients who do not require extensive resuscitive efforts.

Precautions

1. Do not add to solutions containing bicarbonate.
2. Increase in myocardial oxygen consumption can precipitate angina or MI in patients with coronary artery disease.
3. Use with caution in patients with hypertension, hyperthyroidism, peripheral vascular disease, or cerebrovascular disease or any patient over the age of 50.
4. Asthma is not the only cause of wheezing. Epinephrine is contraindicated in pulmonary edema.
5. Anaphylaxis is a systemic allergic reaction with cardiovascular collapse. Angioedema involves swelling of mucous membranes; potential exists for airway compromise. Mild or moderate allergic reactions with urticaria or wheezing may progress to anaphylaxis or severe angioedema. Monitor patient carefully and treat according to patient status.
6. Epinephrine comes in two strengths. Use of the wrong formulation will result in a ten-fold difference in dosage. Be sure to use the right one.

Administration

1. Adult
   1. Cardiac arrest
      1. 1.0 mg (10 mL of 1:10,000 solution) IV/IO every 3-5 minutes
   2. Moderate or severe allergic reactions
      1. 0.3 (0.3 mL of 1:1000 solution) SQ/IM
   3. Anaphylaxis
      1. Consider administration of Epinephrine 0.1 mL of 1:1,000 solution or 1 mL of 1:10,000 solution IV/IO for refractory anaphylactic shock.  Dilute with 9-10 mL NS or administer with IV running wide open
   4. Asthma
      1. 0.3 (0.3 mL of 1:1000 solution) SQ/IM
2. Pediatric
   1. Cardiac arrest
      1. IV/IO dose: 0.01 mg/kg (0.1 mg/kg of 1:10,000 concentration). Administer every 3 to 5 minutes during arrest.
      2. All tracheal doses: 0.1 mg/kg (0.1mL/kg of 1:1000 concentration). Note: Administer every 3-5 minutes of arrest until IV/IO access achieved; then begin with first IV dose.
   2. Symptomatic Bradycardia
      1. All IV/IO doses: 0.01 mg/kg (0.1 mL/kg of 1:10,000 concentration).
      2. All tracheal doses: 0.1 mg/kg (0.1 mL/kg of 1:1000 concentration).
   3. Mild or Moderte allergic reactions
      1. 0.01 mg/kg (0.01 mL/kg of 1:1000 solution) SQ/IM
   4. Anaphylaxis (Contact medical control)
      1. 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) IV/IO.
   5. Asthma
      1. 0.01 mg/kg (0.1 mL/kg of 1:1000 solution) SQ/IM
3. IV doses may be given through ET at 10 times the IV dose.

Side Effects and Special Notes

1. Anxiety, tremor, palpitations, vomiting, and headache are common.