epinephrine

Sympathomimetic.

Direct-acting alpha- and beta-agonist. Alpha: vasoconstriction. Beta-1: positive inotropic, chronotropic, and dromotropic effects. Beta-2: bronchial smooth muscle relaxation and dilation of skeletal vasculature.

Cardiac arrest (V-fib/pulseless V-tach, asystole, PEA), symptomatic bradycardia as an alternative infusion to dopamine, severe hypotension secondary to bradycardia when atropine and transcutaneous pacing are unsuccessful, allergic reactions, anaphylaxis, asthma.

Hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock.

Hypertension, tachycardia, arrythmias, pulmonary edema, anxiety, restlessness, psychomotor agitation, nausea, headache, angina.

Potentiates other sympathomimetics, deactivated by alkaline solutions (ie, sodium bicarbonate), monamine oxidase inhibitors (MAOIs) may potentiate effects, beta blockers may blunt effects.

1;1,000 Solution: ampules and vials containing 1mg/ml. 1:10,000 solution: prefilled syringes containing 1mg in 10ml (0.1mg/ml). Auto-injector (EpiPen): 0.5mg/ml (1:2,000).

Adult:mild allergic reactions and asthma:0.3-0.5mg (0.3-0.5 ml of 1;1,1000) SC. Anaphylaxis: 0.1mg (1ml of 1:10,000) IV/IO over 5 minutes. Cardiac arrest: IV/IO dose:1mg (10ml of 1:10,000 solution) every 3-5 minutes during resuscitation. Follow each dose with 20ml flush and elevate arm for 10 to 20 seconds after dose. Higher dose:higher doses (up to 0.2mg/kg) may be used for specific indications (beta blocker or calcium channel blocker overdose). Continuous infusion:add 1mg (1ml of 1:1,000 solution) to 500ml NS or D5W. Initial infusion rate of 1mcg/min titrated to effect (typical dose:2-10 mcg/min). endotracheal (ET) dose:2-2.5 mg diluted in 10ml NS. Profound Bradycardia or hypotension: 2-10mcg/min; titrate to pt. response.

Pediatric:mild allergic reactions and asthma:0.01mg/kg (0.01ml/kg) of 1:1,000 solution SC (maximum of 0.3 ml). Cardiac arrest:IV/IO dose:0.01mg/kg (0.1 ml/kg) of 1:10,000 solution every 3-5 minutes during arrest. All endotracheal (ET) doses: 0.1 mg/kg (0.1 ml/kg) of 1:1,000 solution. Symptomatic bradycardia:IV/IO dose:0.01 mg/kg (0.1 ml/kg) of 1:10,000 solution. All ET doses:0.1 mg/kg (0.1ml/kg) of 1:1,000 solution. Continuous IV/IO infusion: begin with rapid infusion, then titrate to response. Typical initial infusion:0.1-1mcg/min. higher doses may be effective.

• onset: immediate.
• Peak effect: minutes
• Duration: several minutes

• Pregnancy safety: Catergory C.
• May cause syncope in asthmatic children.
• May increase myocardial oxygen demand.