Emergency meds 6: Epinephrine (AKA Adrenaline, for those across the pond)
Epinephrine is a little fucker but itās pretty useful so thatās ok.
Hereās me holding the 1:10,000 prefilled syringe (try to ignore my classmateās horrifying neon-red shoes, his normal boots went missing that day or something)
NOTE: this med comes in two concentrations, 1:10,000 and 1:1,000. NEVER give 1:1,000 concentration through an IV/IO. Itās used for IM/SC.
- sympathomimetic (stimulates the sympathetic nervous system, or as I like to call it, the āGas pedalā, with the parasympathetic nervous system as the ābrake pedalā)
- Alpha receptor Agonist: vasoconstrictor, increases systemic vascular resistance (SVR)
- Beta2 receptor agonist: bronchial smooth muscle relaxation/bronchodilator
- beta1 receptor agonist: positive inotropic effects (contractility), positive dromotropic effects (electrical conduction velocity), and positive chronotropic effects (increases heart rate). These, hopefully, can sort of ājump-startā the heart to start doing something, even if itās something horrible but still treatable, like VFib or Vtach.
- Increases myocardial workload and oxygen demands
- VFib/Pulseless Vtach/PEA/asystole
- symptomatic bradycardia
- hypotension that refuses to respond to other treatments (like fluids)
CV: ventricular dysrhythmias, tachycardia, hypertension, angina
ADULT DOSE FOR PULSELESS ARREST
- 1 mg of 1:10,000 solution every 3-5 minutes IV/IO OR 2-2.5 mg of 1:10,000 via ET tube
ADULT INFUSION FOR BRADYCARDIA/HYPOTENSION:
- 1mg 1:10,000 added to 500 ml of Normal saline administered at 1 mcg/m titrated to desired effect (range of 2-10 mcg/m)
ADULT DOSE FOR ANAPHYLAXIS/ASTHMA
- 0.3-0.5 mg 1:1,000 solution IM/SC, may repeat every 15 to 20 minutes
- IN EXTREME CASES, 0.1 mg of 1:10,000 solution given IV/IO every 5 minutes, or infused at 1-4 mcg/m
PEDIATRIC PULSELESS ARREST
- 0.01 mg/kg of 1:10,000 every three to five minutes (maximum single dose of 1 mg) IV/IO
- 0.1 mg/kg of 1:1,000 solution diluted with normal saline to a volume of 3-5 ml via ET tube, max single dose of 10 mg
PEDIATRIC ANAPHYLAXIS/ASTHMA
- 0.01 mg/kg of 1:1,000 solution, via IM/SC, max single dose of 0.5 mg
- 3 mg 1:1,000 mixed in 3ml of Normal Saline via SVN