Epinephrine, commonly known as adrenaline, is a chemical that narrows blood vessels and
opens airways in the lungs.
These effects can reverse severe low blood pressure.
Adrenaline is a hormone that is secreted mainly by the medulla of the adrenal glands and functions
primarily to increase cardiac output and to raise blood glucose levels.
Epinephrine is normally released during acute stress, and its effects are known to prepare
an individual for either “fight or flight” which is why it’s a primary medication for
non perfusing cardiac arrests.
Epinephrine is used in Cardiac arrest arrhythmias such as ventricular fibrillation and pulseless
ventricular tachycardia, asystole and pulseless electrical activity known as PEA.
It can also be used in symptomatic bradycardia.
It would be administered after atropine as an alternative to infusing dopamine.
Epi can also be administered to treat severe hypotension.
It’s been established that Epinephrine can be administered when external pacing and atropine
fail and when bradycardia causes hypotension.
It is safe to be administered with phosphodiesterase enzyme inhibitors.
Epi is also an effective treatment for anaphylaxis.
It’s recommended that it be combined with large volumes of fluid, corticosteroids and
antihistamines.
Care should be given when administering epinephrine in cases where raising the blood pressure
and increasing heart rates may cause myocardial ischemia, angina and increased demand for
myocardial oxygen.
It should be noted that high doses do not improve neurological outcomes or survival
rates and may actually contribute to post-resuscitation complications like myocardial dysfunction.
We commonly see high dose treatments with poison or drug-induced shock.
Epinephrine is available in 1:10,000 or 1:1,000 concentrations.
For cardiac arrest, Epinephrine should be delivered IV or IO at 1 mg which is 10 ML
of 1:10,000 solution administered every 3 to 5 minutes during the resuscitation.
Follow each dose of Epi with 20 ML of normal saline as a flush, elevate the arm of delivery
for 10 to 20 seconds after the dose is delivered.
If Epi delivery is administered via endotracheal tube, we’re going to deliver 2 to 2.5 mg
diluted in 10 ml normal saline.
Higher dose epi which is up to .2 mg/kg may be used for specific indications like Beta
Blocker or Calcium channel blocker overdose.
If administering epinephrine as a continuous infusion, initial rate is usually .1 to .5
mcg per kg per minute.
Now an example of this would be: in a 90 kg patient who would receive 9 to 45 mcg per
minute titrated to a positive patient’s response.
Now for profound bradycardia or hypotension, we want to deliver 2 to 10 mcg per minute
titrated to the patient response delivering a drip via an IV infusion.
We want to add 1 mg of epinephrine (or l ml of 1: l,000 solution) to a 250 ml or 500 ml
of normal saline.
For treatment of anaphylactic shock epinephrine 1:1,000 is given at .01 mg per kg via intramuscular
delivery.