Epinepherine

EPINEPHERINE

CLASSIFICATION Catecholamine, sympathomimetic

DESIRED EFFECTS Vasoconstriction, tachycardia, bronchodilation, increases in heart rate and force of contraction. Lowers the threshold for VF; elevates BP in shock.

MECHANISM OF ACTION Sympathomimetic amine that stimulates alpha and beta adrenergic receptors

INDICATIONS  Cardiac arrest  Anaphylactic reactions  Bronchospasm unresponsive to other interventions  Profound shock or bradycardia

CONTRAINDICATIONS  None in cardiac arrest  Suspected intracranial hemorrhage  Bronchospasm in patients with CAD  Tachyarrhythmias  Angina

ADVERSE REACTIONS  Palpitations; tachycardia; ventricular ectopy; hypertension  Tremors; anxiety; headache  Cerebral hemorrhage  Nausea and vomiting  Cardiac ischemia

DRUG INTERACTIONS  Antagonizes the effects of vasodilators, adrenergic blockers and anti-diabetic medications  Inactivated by aminophylline, calcium chloride, diazepam, and sodium bicarbonate.

PRECAUTIONS  Use extreme caution in patients with history of CAD in non-arrest situations or in patients with arrhythmias. May increase myocardial oxygen demand.

SPECIAL CONSIDERATIONS Outcome of cardiac arrest is not affected by administering higher doses of epinephrine. In cases of refractory VFib, use maximum of 3 doses of epinephrine.

Effective 6/1/18 Drug Index Epinephrine Replaces 9/1/16 EPINEPHRINE

DOSING REGIMEN  Adult o Cardiac arrest 1mg 1:10,000 IV/IO push every 3-5 minutes (preferred)

May give down ET tube 2mg 1:1,000 diluted with 10ml normal saline

o Anaphylaxis or Severe Asthma 0.3mg 1:1,000 IM lateral thigh

0.3 - 0.5mg 1:10,000 slow IV push for severe anaphylactic reactions with presence of anaphylactic shock

0.1 - 0.25 mg 1:10,000 slow IV push for severe asthma

o Fluid-Refractory Hypotension/Shock OR symptomatic bradycardia resistant to Atropine and transcutaneous pacing 1 mg / 500 mL or 2 mg / 1000 mL 2-10 mcg/min IVPB See Epi Drip Label for further dosing calculations ------ Pediatric o Cardiac arrest 0.01mg/kg (0.1ml/kg) 1:10,000 IV/IO push every 3-5 minutes

May give down ET tube 0.1mg/kg (0.1ml/kg) 1:1,000 diluted with 2ml normal saline

o Anaphylaxis/Bronchospasm 0.01mg/kg 1:1,000 IM

o Upper Airway (croup) or bronchiolitis Epi 1:1000 0.5mg/kg MAX 5 mg/ml via nebulizer

o Newborn resuscitation (pulseless or heart rate less than 60 despite CPR) 0.01 -0.03 mg/kg (0.1ml/kg) 1:10,000 IV/IO push every 3-5 minutes

PROTOCOL LOCATION  Allergic Reaction & Anaphylactic Shock  Cardiac Arrest  Childbirth & OB Emergencies – Newborn Resuscitation  Dysrhythmias EPI DRIP LABEL  Respiratory Emergencies – Pediatric Airway Obstruction and Wheezing  Sepsis  Shock Effective 6/1/18 Drug Index Epinephrine Replaces 9/1/16

Effective 6/1/18 Drug Index Epinephrine Replaces 9/1/16