Epinephrine Hydrochloride

Classification:        

Sympathomimetic agent (catecholamine)

Bronchodilator

Actions:                   

Increases cardiac output due to increased inotropy,

chronotropy and AV conduction                                       

Increases systolic blood pressure due to increased cardiac

output and vasoconstriction

Alleviates wheezing and dyspnea by relaxing smooth

muscles of the respiratory tract

Increases coronary perfusion during CPR due to increased

aortic diastolic pressure 

Prevents hypotension and loss of intravascular fluid in

anaphylactic reactions by counteracting vasodilation and

decreasing vascular permeability

Indications:            

Cardiopulmonary arrest:

       -Ventricular fibrillation

       -Pulseless Ventricluar tachycardia

       -Pulseless electrical activity (PEA)

       -Asystole

Acute Asthma

Allergic reaction/Anaphylaxis

Symptomatic bradycardia

Contraindications: 

 Hypovolemia

Hypertension

Adverse Effects:     

Cardiovascular                       

tachycardia

hypertension 

chest pain 

ventricular fibrillation 

Neurological                                      

seizures

dizziness

headache

anxiety                                

Gastrointestinal

Nausea/vomiting

Administration:                  

Cardiac Arrest          

1mg (1:10,000) IV/IO. May repeat IV/IO every 3-5 minutes

Bradycardia              

4mg (1:10,000) in 500cc NS 2-8 mcg/min. Titrate to effect.

Asthma / Allergic reaction without shock

0.3mg (1:1,000) SQ.  May repeat every 20 minutes two times.

Anaphylaxis with shock

0.5-1.0 mg (1:10,000) slow IV/IO over 60 seconds or 0.3 mg SQ(1:1,000).  May repeat IV/IO dose every 3-5 minutes.  May repeat SQ dose every 20 minutes two times.

Pediatrics:   

Cardiac Arrest                      

0.01mg/kg(1:10,000)  IV/IO May repeat 0.01mg/kg (1:10,000) every 3-5 minutes as needed.

Asthma / Allergic reaction without shock

0.01mg/kg (1:1000) SQ.  (Maximum single dose 0.3mg).   May repeat every 20 minutes two times.

Anaphylaxis with shock

0.01 mg/kg (1:10,000) slow IV/IO.  May repeat every 10-15 minutes.  

Onset:                      

Duration:                   

Onset:        IV/IO               1 – 2 minutes

                   SQ                 3 – 10 minutes

Duration:      IV/IO               5 – 10 minutes

                      SQ              20 - 30 minutes

Precautions:           

Flush IV tubing before and after administration of sodium bicarbonate or establish a second venous access site.  Epinephrine is inactivated by sodium bicarbonate.