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Generic/Trade Name
Epinephrine/
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Class
Sympathetic agonist
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Description
- Acts directly on alpha- and beta-adrenergic receptors
- Effects on beta-recepetors are much more profound that effects on alpha-receptors
- Effects include:
- Increased heart rate
- Increased cardiac contractile force
- Increased electrical activity in the myocardium
- Increased SVR
- Increased blood pressure
- Increased automaticity
- Can be used to convert fine v-fib to coarse v-fib. (increases chance of successful shock)
- In asystole it's used to initiate electrical activity in myocardium
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Pharmacokinetics
- Onset: <2 minutes (IV/ETT)
- Peak Effects: <5 minutes (IV/ETT)
- Duration: 5-10 minutes (IV/ETT)
- Half-life: 5 minutes
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Indications
- Cardiac arrest (asystole, v-fib, pulseless v-tach, PEA)
- Severe anaphylaxsis
- Severe reactive airway disease
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Contraindications
- 1:10,000 contraindicated in patients who do not require extensive cardiopulmonary resuscitation.
- 1:1,000 sub-q is fine for simple allergic reactions and asthma
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Precautions
- Protect from light
- Can be deactivated by alkaline solutions (flush line in-between)
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Side Effects
- Palpatations
- Anxiety
- Tremulousness
- Headache
- Dizziness
- Nausea
- Vomiting
- Increases myocardial oxygen demand (can cause ischemia)
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Interactions
- pH dependant (can be deactivated by alkaline solutions)
- Effects can be intensifed by patients taking antidepressents
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Dosage:
- Epinephrine can be administered IV, IO, or
- through the ETT
- Cardiac arrest adult:
- 1.0mg of 1:10,000 solution IV
- Repeat every 3-5 minutes as needed
- If given through ETT, does should be 2-2.5x the IV dose
- Cardiac arrest pediatrics:
- 0.01mg/kg of 1:10,000 solution IV (0.1mL/kg)
- 2nd and subsequent doses should be 0.1mg/kg of 1:1,000 solution (0.1mL/kg)
- Severe anaphylaxis or severe asthma adult:
- IV epinephrine should only be used in life-threatening emergencies
- Use initial does of 0.3-0.5mg IV
- Can be repeated 5-15 minutes as needed
- Epinephrine drip may be needed
- Less severe cases can be treated with epinephrine 1:1,000 subcutaneously.
- Severe anaphylaxis or severe asthma children:
- IV epinephrine should only be used in life-threatening emergencies
- Use initial does of 0.01mg/kg IV
- Can be repeated 5-15 minutes as needed
- Epinephrine drip may be needed
- Less severe cases can be treated with epinephrine 1:1,000 subcutaneously.
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