Adrenaline

Question 1

Pharmacology and presentation of Adrenaline?

Answer 1

1mg:1ml
Adrenergic agonist that works on Alpha and Beta receptors.

A1 - peripheral vasoconstriction, glycogenolysis and gluconeogenesis,
B1 - Increase in SA node firing rate, myocardial contractility, AV node conduction velocity and irritability of the ventricles.
B2 - bronchodilation, smooth muscle relaxation and stabilisation of mast cells reducing histamine

Question 2

Indicators of Adrenaline?

• 3x Resp + 3x Cardiac

Answer 2

• Cardiac arrest
• Croup or upper airway stridor
• Anaphylaxis or severe allergic reaction
• Severe asthma
• Inadequate perfusion (cardiac, non-cardiac, excluding haemorrhage).
• Bradycardia with poor perfusion refractory to Atropine

Question 3

Contraindications of Adrenaline?

Answer 3

• Known allergy
• Hypovolaemic shock without adequate fluid replacement.

Question 4

Cautions of Adrenaline?

• 3x Up + 1x Down

Answer 4

• Elderly and frail
• Hypertension
• Patients on monoamine oxidase inhibitors (MAOI)
• Higher doses may be required for patients on beta blockers.

Question 5

Side Effects of Adrenaline?

• HAHA PVP

Answer 5

• Tachycardia/palpitations
• Hypertension
• Headache
• Nausea and/or vomiting
• Pupil dilation
• Anxiety
• Arrhythmia.

Question 6

Dosing Regimes of Adrenaline?

Answer 6

Cardiac Arrest
- Adult = 1mg IV/IO every 4 mins, no max dose
- Paeds = >1year = 10mcg/kg IV/IO or <1year = 100mcg IV/IO, every 4 mins no max dose

Croup/Upper Airway stridor
- 5mg Nebulised, one repeat if required to a max of 10mg

Anaphlyaxis, Asthma or Severe Allergic Reaction
- Adults 0.5mg IM, 5 minutely as required no max
- Paeds <6years = 0 .15mg IM or >6years = 0.3mg IM, 5 minutely as required no max
- Nebulised once at 5mg for stridor if necessary

Question 7

Onset and duration of Adrenaline?

Answer 7

• Onset = 30 seconds IV or 5–10 minutes IM
• Duration = 5–10 minutes