Epinephrine Class?
Sympathomimetic, catecholamine, inotropic agent, vasopressor, antidysrhythmic bronchodilator (C)
Epinephrine Indications?
- Cardiac arrest (asystole, pulseless electrical activity, v-fib, pulseless v-tach)
- Anaphylaxis or severe allergic reaction
- Severe reactive airway disease (asthma, COPD)
- Hypotension
- Symptomatic bradycardia (only in pediatric patients)
Epinephrine Mechanism?
Acts directly on alpha and beta receptors of the sympathetic nervous system to increase inotropy, chronotropy, dromotrope, automaticity, systemic vascular resistance, and bronchial smooth muscle dilation; decreases vascular permeability.
Epinephrine Side effects?
- Anxiety
- Chest pain
- Dizziness
- Dysrhythmias
- Headache
- Hypertension
- Nausea
- Palpitations
- Seizures
- Tachycardia
- Tremors
- Ventricular fibrillation
- Vomiting
Epinephrine Precautions?
- Will increase myocardial oxygen demand
- may potentially increase myocardial ischemia
- use caution in patients with underlying cardiovascular disease or who are pregnant
- protect from light Interactions
- epinephrine is pH dependent and can be inactivated by alkaline solutions such as sodium bicarbonate
- effects are intensified in patients taking antidepressants
Epinephrine Contraindications?
- Hypertension
- Tachydysrhythmias
- Hypovolemia
- No contraindications in cardiac arrest
Epinephrine Routes of administration?
IV, IO, IVPB, ET*, SC, IM (vastus lateralis [anterolateral thigh] preferred) *If no IV/IO in cardiac arrest, may be administered 0.1 mg/kg (1:1,000) (1 mg/mL) via ETT every 3–5 minutes.
Epinephrine Onset?
Immediate
Epinephrine Duration?
3–5 minutes
Epinephrine Adult Dose - Cardiac Arrest?
1 mg (1:10,000) (0.1 mg/mL) IV/IO; every 3–5 minutes, no max
Epinephrine Adult Dose - Anaphylaxis/Asthma
0.3 mg IM adult autoinjector (preferred) or 0.3 mg IM (1:1,000) (1 mg/mL) every 5–15 minutes
Epinephrine Adult Dose - Profound bradycardia or hypotension
2–10 mcg/min titrated to effect (mix 1 mg for every 100 mL NaCl)
Epinephrine Adult Dose - Croup
3 mg (1:1,000) (1 mg/mL) in 3 mL NaCl via nebulizer every 5–15 min
Epinephrine Pedi Dose - Cardiac Arrest
0.01 mg/kg (1:10,000) (0.1 mg/mL) IV/IO every 3–5 minutes
Epinephrine Pedi Dose - Anaphylaxis/Asthma
0.01 mg/kg 1:1,000 SQ/IM max single dose 0.3mg
Epinephrine Pedi Dose - Profound bradycardia or hypotension?
0.1–1 mcg/kg/min titrated to effect (mix 1 mg for every
100 mL NaCl)
Epinephrine Pedi Dose - Croup
3 mg (1:1,000) (1 mg/mL) in 3 mL NaCl via nebulizer every 5–15 min
