EMFANA
Emergency Medications for Anaesthesic Nurses Australia
** Cardiac arrest, anaphylaxis, bronchospasm, bradycardia with poor perfusion
What is Adrenaline?
Adrenaline, also called epinephrine, is a drug that stimulates alpha and beta receptors. It can tighten blood vessels, raise blood pressure, increase heart activity, and help open the airways. In anaesthesia, it is mainly used for anaphylaxis, severe hypotension, and cardiac arrest. In cardiac arrest, it is used mainly to improve perfusion during resuscitation rather than simply to “increase heart rate.”
Common Adult Dose
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Cardiac Arrest: 1 mg (1 mL of 1:1000, or 10 mL of 1:10 000) via IV or IO
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Anaphylaxis: 0.5mg / 500mcg. This is half a millitre, so 0.5ml of a 1ml vial of 1:1000
- Note that auto-injects you get from the pharmacy gives a dose of 300mcg of adrenaline
Typical Volume found in vials
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1:1000 means 1 mg of adrenaline is in in 1 ml of fluid (this is a common vial)
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1:10,000 means 1 mg of adrenaline in 10 mL of fluid, which equates to a concentration of 0.1 mg (100mcg) in 1 mL (this is a common vial), and the full 10ml is 1mg of adrenaline (so the 1:10000 is much more dilute than the 1:1000).
ADRENALINE DURING CARDIAC ARREST
Frequency:
-VF/VT after 2nd shock, then every 2nd loop
-PEA/Asystole in initial loop, then every 2nd loop
When is it often used?
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anaphylaxis
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severe hypotension / circulatory collapse
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peri-arrest or cardiac arrest
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severe bronchospasm as part of anaphylaxis management
What usually happens after adrenaline administration?
Blood pressure should rise, and the patient may also have an increase in heart rate and stronger cardiac activity. In anaphylaxis, airway swelling and bronchospasm may improve. In cardiac arrest, the aim is to support circulation during CPR
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tachycardia
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palpitations
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hypertension
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tremor
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anxiety or restlessness
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arrhythmias
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headache
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sweating
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pallor