adrenaline 1:10,000
presentation - what the drug is sealed in, its concentration and how it might look
Pre-filled syringe containing 1 milligram of adrenaline (epinephrine) in 10 ml (1:10,000) ADX.
INDICATIONS - reasons you should administer this drug
Cardiac arrest.Post ROSC circulatory support.Bradycardia not responsive to atropine sulfate.
CONTRAINDICATIONS - reasons you should not administer this drug
Do NOT administer adrenaline when the patient’s core temperature is less than 30˚C.
When the patient's temperature is between 30-35˚C, double the time period between doses only when hypothermia is thought to be the main or precipitating cause of the arrest.
cautions - reasons that if you administer this drug you must monitor for side effects more than usual
Severe hypertension may occur in patients on non-cardioselective beta-blockers (e.g. propranolol).
pharmacological action - what does it to the body and what does the body do to it?
FREC 3 and FREC 4:
Adrenaline is a sympathomimetic that stimulates both alpha- and beta-adrenergic receptors. As a result myocardial and cerebral blood flow is enhanced during CPR and CPR becomes more effective due to increased peripheral resistance which improves perfusion pressures.
FREUC 5 and L4 AAP
Pharmacokinetics:
Absorption: Given IV/IO for cardiac arrest. Immediate onset with peak effect within seconds; duration ~2–5 minutes.
Distribution: Rapid systemic distribution; does not significantly cross the blood–brain barrier but does cross the placenta.
Metabolism: Rapidly metabolised by hepatic and extra-hepatic enzymes (COMT and MAO).
Elimination: Metabolites excreted mainly in urine; very short plasma half-life (~2 minutes).
Pharmacodynamics
Cardiac effects:
Positive inotrope: increases myocardial contractility.
Positive chronotrope: increases heart rate.
Positive dromotrope: increases AV nodal conduction and automaticity.
Vascular effects:
Potent vasoconstriction: increases systemic vascular resistance and improves coronary and cerebral perfusion during CPR.
Respiratory effects (less relevant in 1:10,000 use but mechanistically present):
Bronchodilation: relaxes airway smooth muscle.
Other effects:
Restores perfusion pressures in cardiac arrest by increasing diastolic pressure → improved coronary perfusion → increased likelihood of ROSC.
side effects - unwanted secondary effects of this drug
None when used appropriately.
dosage and administration - how much do we give and how do we give it?
Adults:
Cardiac Arrest
Route: IV/IO
Initial dose: 1mg
Repeat dose: 1mg
Dose Interval: 3-5 minutes
Concentration: 1mg/10ml (1:10, 000)
Volume: 10ml
Max dose: Unlimited
Post ROSC Circulatory Support:
Careful administration of an adrenaline bolus, repeated as required, every 3-5 mins to maintain the systolic BP >100 mmHg. Follow each adrenaline bolus with a flush of 20 ml 0.9% of sodium chloride.
Route: IV/IO
Initial dose: 50mcg
Repeat dose: 50 - 100mcg
Dose Interval: 3-5 minutes
Concentration: 1mg/10ml (1:10, 000)
Volume: 0.5ml to 1ml
Max dose: Unlimited
Bradycardia not responsive to atropine
Careful administration of an adrenaline bolus, repeated as required, every 3-5 mins to maintain the systolic BP >90 mmHg. Follow each adrenaline bolus with a flush of 20 ml 0.9% of sodium chloride.
Route: IV/IO
Initial dose: 50mcg
Repeat dose: 50mcg
Dose Interval: 3-5 minutes
Concentration: 1mg/10ml (1:10, 000)
Volume: 0.5ml
Max dose: Unlimited
Children:
Please see JRCALC Page for Age guidelines.
Tip: Due to it’s low cost and high reward profile, K2 International recommends drawing up several doses at the same time into 2ml syringes (4 doses per syringe). This will allow you to give 0.5 ml accurately per does, but give you mulptile pre-draw doses so you are not drawing up drugs enroute to ED.
legislation and regulations - what legal class of drug is it, who can possess it and who can give it?
Adrenaline 1:1,000 falls into these categories:
Prescription-Only Medicine (POM)
Adrenaline 1:10,000 is a Prescription-Only Medicine (POM).
Normally this would require a prescription from an authorised prescriber such as a doctor or Advanced Paramedic.
Schedule 17 (HCP Exemptions)
Adrenaline 1:10, 000 is listed in Schedule 17 of the Human Medicines Regulations 2012.
Schedule 17 allows Paramedics to administer it for immediate life-saving treatment,
It can therefore be given without a prescription or PGD in these emergencies.
bibliography
National Institute for Health and Care Excellence. 2018. Adrenaline/Epinephrine. Available from: