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Adrenaline (Epinephrine)

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Anaesthetics and Critical Care

Obstetrics Gynaecology

Trauma and Orthopaedics

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Urology

Version Jan 2023

Use IV Adrenaline (Epinephrine) only in extremis e.g. cardiac arrest otherwise the IM route is safest. For Cardiac arrest 10 ml of 1 in 10,000 is the recommended dose and concentration and is considered the optimum volume of adrenaline during cardiac arrest, and is recommended by the UK Resuscitation Council.

About : Always check the BNF link here

Fight or flight hormone is given to augment circulatory support
Aim is to maintain or improve brain and coronary perfusion

Action

Alpha adrenoreceptors → vasoconstriction
Beta1 adrenoreceptors → increased Heart rate, increased contractility
Beta2 adrenoreceptors → Vasodilation, bronchodilation, relaxes uterus

Dose

Name	Cardiac arrest dose	Frequency	Route
Adrenaline(Epinephrine)	1 mg as 10 ml (1 in 10,000) mini-jet	Stat and every 3-5 minutes	Fast IV into large or central vein
Name	Anaphylaxis Dose	Frequency	Route
Adrenaline(Epinephrine)	0.5-1 mg IM given as 0.5-1 ml (1 in 1000)	stat and repeated after 5 minutes if needed	Give into anterolateral aspect of muscle bulk of the middle third of the thigh in adults
Name	Bradycardia Dose	Frequency	Route
Adrenaline(Epinephrine)	2-10 mcg/min IV.	IV infusion titrated to heart rate and BP	IV infusion
Adrenaline(Epinephrine)	0.12-0.6 mg/hr IV.	IV infusion titrated to heart rate and BP	IV infusion Adrenaline 6mg is diluted in 100ml dextrose 5% and run initially at 3-10ml/hr. Check with local guidance**

Indications

Anaphylaxis, Cardiac arrest, Bronchospasm/Life-threatening asthma

Interactions

Increased toxicity with TCAs, MAOIs, Ergotamine, Oxytocin
Non selective beta-blockers can cause low BP and low Heart rate

Cautions

Severe risk of arrhythmias. Extreme caution particularly with IV route. Telemetry and resus equipment needed.
second stage of labour, Hyperthyroidism, Acute stroke, HOCM

Contraindications

All relative in an extremis situation - see cautions

Side effects

Arrhythmias - Sinus tachycardia, AF, VT, VF , Death
Anxiety, sweats, hypertension, palpitations
Tremor, headache, hyperglycaemia, Acute stroke

References

Adrenaline in BNF

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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