Adrenaline
About these monographs
Category:
Cardiac, Vascular, Respiratory & Systemic
Description:
Sympathetic agonist, naturally occurring catecholamine
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Indications:
Cardiac arrest, bradycardia, cardiogenic/neurogenic/septic shock, anaphylaxis, stridor, severe asthma/bronchospasm, peri-arrest COPD, croup, significant bleeding, epistaxis.
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Mechanism of Action:
Activation of alpha-1 adrenoceptors induces vasoconstriction, smooth muscle contraction, and stimulation of glycogenolysis and gluconeogenesis. Vasoconstriction leads to increased systemic vascular resistance, blood pressure, cerebral and coronary blood flow. Activation of beta-1 adrenoceptors induces increased inotropy, chronotropy, and dromotropy resulting in increased cardiac output. Activation of beta-2 adrenoceptors induces bronchodilation, smooth muscle relaxation, stabilisation of mast cells, and skeletal muscle vasodilation.
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Pharmacokinetics:
INTRAVENOUS
Onset: 5-10 seconds
Peak Effects: <1 minute
Duration: 5-15 minutes
INTRAMUSCULAR
Onset: 2-5 minutes
Peak Effects: variable
Duration: 20 minutes
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Contraindications:
None in the setting of anaphylaxis. Otherwise, hypertension, tachycardia.
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Adverse Effects:
Heart palpitations, anxiety, tremors, headache, dizziness, nausea, vomiting, tachycardia, arrhythmias, pupil dilation, and increased myocardial oxygen demand
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Precautions and Facts:
Can be deactivated by alkaline solutions.
Adrenaline will increase myocardial oxygen demand, should be used with caution if concurrent myocardial ischaemia is present.
Will increase myocardial irritability should be used cautiously with tachydysrhythmias.
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Presentation:
1 mg/mL ampoules and 0.15, 0.3 or 0.5 mg auto-injectors (1:1,000) or 1 mg/10 mL minijets and
1 mg/10 mL ampoules (1:10,000)
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Common Uses
IV: Cardiac arrest, bradycardia and cardiogenic shock
IV Infusion: Hypotension, hypotension post cardiac arrest, cardiogenic shock and bradycardia
IM/SQ: Asthma and anaphylaxis
IN: Epistaxis
Topical: Localised bleeding
Nebulised: Anaphylaxis, croup & upper airway oedema
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Dosages:
ADULT CARDIAC ARREST
Route: INTRAVENOUS
Initial Dose: 1 mg
Dose Intervals: every 4 minutes
Volume/Dilution: 1 mg in 1 mL (1:1000)
Maximum Dose: n/a
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PAEDIATRIC CARDIAC ARREST
Route: INTRAVENOUS
Initial Dose: 0.01 mg
Dose Intervals: every 4 minutes
Volume/Dilution: 1 mg in 10 mL (1:10,000)
Maximum Dose: n/a
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ADULT INFUSION
Route: INTRAVENOUS
Initial Dose: 0.01 mg
Dose Intervals: 1 mg in 1000 mL of normal saline solution, titrate to effect
Volume/Dilution: 1 mg in 1000 mL
Maximum Dose: titrate to effect
CHILD INFUSION (5-14 YEARS)
Route: INTRAVENOUS
Initial Dose: 0.005 mg
Dose Intervals: 1 mg in 1000 mL of normal saline solution, titrate to effect
Volume/Dilution: 1 mg in 1000 mL
Maximum Dose: titrate to effect
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PAEDIATRIC INFUSION
Route: INTRAVENOUS
Initial Dose: 0002 mg/kg
Dose Intervals: 1 mg in 1000 mL of normal saline solution, titrate to effect
Volume/Dilution: 1 mg in 1000 mL
Maximum Dose: titrate to effect
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INTRAMUSCULAR ADULT
Initial Dose: 0.3-0.5 mg
Dose Intervals: 5-10 minutes
Volume/Dilution: 1 mg in 1mL (1:1000)
Maximum Dose: titrate to effect
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INTRAMUSCULAR PAEDIATRIC
Initial Dose: 0.15 to 0.3 mg
Dose Intervals: 5-10 minutes
Volume/Dilution: 1 mg in 1 mL (1:1000)
Maximum Dose: titrate to effect
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INTRANASAL ADULT
Initial Dose: 0.2 mg
Dose Intervals: 20 minutes
Volume/Dilution: 1 mg in 10 mL (1:10,000)
Maximum Dose: 2 doses total
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INTRANASAL CHILD (5-14 years)
Initial Dose: 0.1 mg
Dose Intervals: 20 minutes
Volume/Dilution: 1 mg in 10 mL (1:10,000)
Maximum Dose: 2 doses total
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TOPICAL (ADULT/PAED)
Initial Dose: 1-5 mg
Dose Intervals: N/A
Volume/Dilution: 1 mg in 10 mL (1:10,000)
Maximum Dose: 5 MG
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NEBULISED (ADULT/PAED)
Initial Dose: 5 mg
Dose Intervals: 10 minutes
Volume/Dilution: 1 mg in 1 mL (1:1000)
Maximum Dose: n/a
Cite as: Maria, S., Colbeck, M., & Caffey, M. (Eds.). (2020). Adrenaline. In Paramedic & Emergency Pharmacology Guidelines (2nd ed.). Melbourne, Victoria: Pearson.
This book is for information purposes only and is designed as a general reference for paramedics, students and healthcare professionals No responsibility will be taken for inaccuracies, omissions or errors The authors do not accept liability to any person or organization for the information that may result in loss or damages incurred as a result of reliance upon the material in this guide While every effort has been made to ensure that the information in this text is up to date, accurate and in accordance with current clinical recommendations and practice, the dynamic nature of healthcare and pharmaceutical information requires any student or health professional to exercise independent clinical judgement when referring, using or providing information from this book
A body of evidence for the development of this guide has been collected by the authors to support the pharmacokinetics, indication, contraindications, adverse effects and dosage behind each medication This body reflects information provided by Australia’s Therapeutic Goods Administration, Monthly Index of Medical Specialities, the United States’ Food and Drug Administration, and both peer-reviewed studies and clinical trials demonstrating the approved efficacy, usage and current understanding of each medication Additionally, the Australian Resuscitation Council guidelines and each state ambulance service’s clinical practice guidelines in Australia and New Zealand were reviewed and applied in order to maximize the clinical application of this reference guide Lastly, this guide’s information is not endorsed, nor does it reflect preferences by any particular pharmaceutical company or ambulance service as this reference was compiled only to the most current and universal information available from the above listed, publicly available resources