UNCONTROLLED WHEN PRINTED
Introduction
  • Presentation:
    • 1 mg/1 mL (1:1000) ampoule
  • A naturally occurring sympathomimetic agent
  • Causes peripheral vasoconstriction
  • Stimulation of cardiac conduction system causes increased contractions
  • Causes bronchodilation and dilation of blood vessels in muscles
  • IV/IO: Onset 30 seconds, half-life 5 minutes, duration 5-10 minutes
  • IM: Onset 60 seconds, half-life 5 minutes, duration 5-10 minutes

Pharmacology Review

Indications
  • Anaphylaxis
  • Life-threatening asthma
  • Cardiac Arrest
  • Post-ROSC
  • Severe croup
Contraindications
  • There are no absolute contraindications to adrenaline
Precautions / Notes
  • Ischaemic Heart Disease
  • Hypertension
  • Hypovolaemia
  • Do not walk patient pre or post IM adrenaline administration in anaphylaxis - usually a minimum of 1 hour after 1 dose of Adrenaline and 4 hours if more than 1 dose of Adrenaline given
  • If given IV into a peripheral vein, follow each dose with a sodium chloride flush
Management
Cardiac Arrest

Adult:

  • 1 mg IV/IO, repeat every 3-5 minutes as clinically indicated

Paediatric / Newborn:

  • Dilute 1 mL of 1:1000 adrenaline solution with 9 mL sodium chloride 0.9% to produce 1000 microg in 10 mL (1:10,000)
  • 10 microg/kg = 0.1 mL/kg of 1:10,000 adrenaline solution IV/IO, repeat every 3-5 minutes as clinically indicated. Maximum bolus dose 1mg (10mL of 1:10,000 adrenaline solution).
Post-ROSC

Dilute 1 mL of 1:1000 adrenaline solution with 9 mL sodium chloride 0.9% to produce 1000 microg in 10 mL (1:10,000)

Adult:

  • 50 microg (0.5 mL) every 3-5 min as required to maintain systolic blood pressure >100 mmHg

Paediatric:

  • 1 microg/kg every 3-5 min (maximum bolus 50 microg (0.5 mL)) to maintain systolic blood pressure > 80 mmHg

Titrate Adrenaline as required, to achieve and / or maintain the SBP requirements as listed above.

Anaphylaxis or life-threatening Asthma

Adult:

  • 0.5 mg IM into lateral mid-thigh (0.5 mL of 1:1000), repeat every 5 minutes as clinically required

Paediatric > 1 month:

  • 10 microg/kg IM into lateral mid-thigh (0.01 mL of 1:1000) (maximum single dose = 0.5 mg or 0.5 mL), repeat every 5 minutes as clinically required
Croup

Infants (>1 month) / Paediatric:

  • Nebulise 5 mg (5 mL of 1:1000) undiluted, as a single dose
Special Considerations
  • Tachyarrhythmias, palpitations
  • Hypertension
  • Pupil dilation
  • Tremor
  • Anxiety

References
References
Presentation
1 mg/1 mL (1:1000) ampoule
Aderenaline
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