epinephrine
Catecholamine (α- and β-sympathomimetic)
Preparation: 1 mg/ml (1 ml = 1 mg) · 0.1 mg/ml (1 mg made up to 10 ml with NaCl 0.9 %)
Resuscitation – adults
- 1 mg i.v./i.o.[1]every 3–5 min · 0.1 mg/ml (1 mg made up to 10 ml with NaCl 0.9 %) · = 10 ml
Give diluted: 1 ml adrenaline 1 mg/ml + 9 ml NaCl 0.9 % = 10 ml (0.1 mg/ml) – 1 mg = 10 ml, then flush with NaCl 0.9 % (SmPC). Prefilled syringes 1 mg/10 ml likewise. Non-shockable rhythm – as early as possible. Shockable rhythm – after the 3rd shock.
Resuscitation – children
- 0.01 mg/kg (10 µg/kg) i.v./i.o.[2]max. 1 mg · every 4 min (every 2nd cycle) · 0.1 mg/ml (1 mg made up to 10 ml with NaCl 0.9 %)
10 µg/kg = 0.1 ml/kg of the 0.1 mg/ml dilution. Non-shockable rhythm – as early as possible (within 3 min). Shockable rhythm – after the 3rd and 5th shock, then every 4 min.
| BW | 0.01 mg/kg (10 µg/kg) i.v./i.o. · 0.1 mg/ml |
|---|---|
| 3 kg | 0.03 mg 0.3 ml |
| 5 kg | 0.05 mg 0.5 ml |
| 10 kg | 0.1 mg 1 ml |
| 15 kg | 0.15 mg 1.5 ml |
| 20 kg | 0.2 mg 2 ml |
| 25 kg | 0.25 mg 2.5 ml |
| 30 kg | 0.3 mg 3 ml |
| 40 kg | 0.4 mg 4 ml |
Anaphylaxis
- 0.01 mg/kg (10 µg/kg) i.m. (anterolateral thigh, middle third)[2]max. 0.5 mg · every 5 min as long as there is no improvement · 1 mg/ml (1 ml = 1 mg)
- > 12 y and adults 0.5 mg · 6–12 y 0.3 mg · 1–5 y 0.15 mg · < 1 y 0.01 mg/kg i.m. – fixed dose by age[2]
Intramuscular, undiluted, immediately on suspicion. Age bands according to the Austrian SmPC of an adrenaline product differ from ERC – 6 months to 6 y 0.15 mg, infants initially 0.01 mg/kg (> 12 y 0.5 mg and 6–12 y 0.3 mg as in ERC). Refractory (symptoms despite 2 i.m. doses) or patient already monitored (resuscitation room, operating theatre, ICU) – adrenaline i.v. as an infusion, start at 0.1 µg/kg/min, titrate to effect; only by experienced clinicians with full monitoring.
| BW | 0.01 mg/kg (10 µg/kg) i.m. (anterolateral thigh, middle third) · 1 mg/ml |
|---|---|
| 3 kg | 0.03 mg 0.03 ml |
| 5 kg | 0.05 mg 0.05 ml |
| 10 kg | 0.1 mg 0.1 ml |
| 15 kg | 0.15 mg 0.15 ml |
| 20 kg | 0.2 mg 0.2 ml |
| 25 kg | 0.25 mg 0.25 ml |
| 30 kg | 0.3 mg 0.3 ml |
| 40 kg | 0.4 mg 0.4 ml |
Contraindications
- No absolute contraindications in cardiac arrest and anaphylaxis.
Notes
- Tachycardia, arrhythmias, hypertension and myocardial ischaemia possible.
- Loss of effect when mixed with alkaline solutions (e.g. sodium bicarbonate) – flush the line.