NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5307

POLICIES AND PROCEDURES

Subject: Medical Direction

Epinephrine (Adrenline) Protocol

Associated Policies: 01/10/98

  1. Class:
  1. Naturally occurring catecholamine with alpha and beta adrenergic effects.
  1. Indications:
  1. Anaphylactic shock.
  2. Acute asthma.
  3. Cardiac Arrest.
  4. Bradycardia refractory to atropine.
  5. Treatment of shock with profound hypotension from any cause unresponsive to fluid resuscitation.
  6. Severe croup.
  7. Life threatening epiglotitis.
  1. Therapeutic Effects:
  1. Bronchodilator.
  2. Maintains Blood Pressure.
  3. Stimulates spontaneous contractions of myocardium.
  4. Increases myocardial tone.
  1. Contraindications:
  1. Absolute:
  1. None.
  1. Relative:
  1. Use with cautions in persons over 40 years of age or known ischemic heart disease.
  1. Adverse Effects:
  1. Tachycardia.
  2. Palpitations.
  3. Tremors.
  1. Administration and Dosage:
  1. Anaphylactic shock:
  1. Adult:
    1. Epinephrine 1:1,000 0.3 mg- 0.5 mg SQ or PVP, may repeat every 15 minutes as necessary.
    2. Epinephrine 1:10,000 slow IV (15-60 seconds) in 0.1 mg increments to maximum of 0.5 mg titrated to relieve signs of shock.

 

  1. Pediatric:

a. Epinephrine 1:1,000: 0.01 mg/ kg (maximum dose 0.5 mg) SQ or PVP.

b. Epinephrine: 1:10,000 slow IV (15-60 seconds) in 0.05 mg (0.5 cc) increments to maximum of 0.01 mg/kg.

  1. Asthma:

1. Adult:

a. Epinephrine 1:1,000: 0.01 mg/ kg SQ (maximum single dose 0.5 mg). May repeat in 20 minutes.

2. Pediatric:

a. Epinephrine 1: 1,000: 0.01 mg/ kg SQ (maximum single dose 0.5 mg). May repeat in 20 minutes.

  1. Cardiac Arrest:

1. Adults:

a. Epinephrine 1:10,000: 1 mg IV or 2-2.5 mg ET every 3 to 5 minutes.

If no response consider:

    1. Intermediate dose, 2-5 mg of 1: 10,000 IV every 3 to 5 minutes,

or

    1. Escalating dose, 1 mg, then 3 mg, then 5 mg 1:10,000 IV 3 minutes apart,

or

    1. High dose, 0.1 mg / kg IV every 3 to 5 minutes.

2. Pediatric:

a. Epinephrine 1:10,000: 0.01 mg/ kg, IV or IO.

b. Epinephrine 1:1,000: 0.1 mg/ kg ET diluted with normal saline to total volume of 3-5 ml.

c. Subsequent doses Epinephrine 1:1,000: 0.1-0.2 mg/kg IV, IO, or ET every 3 to 5 minutes.

  1. Severe Bradycardia and Hypotensive shock state:

1. Adult:

a. Dilute 1 mg epinephrine in 500 ml D5W or NS (0r 0.5 mg in 250 ml) = 2 mcg/ ml. Initial infusion rate = 1 mcg/minute, titrated to the desired effect, (average infusion dose range = 2 -10 mcg/ min).

Drip Set Used

Drops per Minute to Deliver Desired Dose per Minute

 

1mcg

2mcg

3mcg

4mcg

5mcg

6mcg

7mcg

8mcg

9mcg

10mcg

10gtts/ml set

5

10

15

20

25

30

35

40

45

50

15gtts/ml set

7.5

15

23

30

38

45

53

60

68

75

20gtts/ml set

10

20

30

40

50

60

70

80

90

100

60gtts/ml set

30

60

90

120

150

180

210

240

270

300

2. Pediatric:

a. Dilute Epinephrine 1:1,000: 0.6 mg/ kg in enough NS to create a 100 ml solution. 1 ml/ hr (60 gtt tubing) delivers 0.1 mcg/kg/min.

Initiate infusion at 20 ml/ hr until tachycardia ensues. Then reduce infusion to the desired rate.

Average dose range = 0.1-1 mcg/kg/minute.

or

b. Use the Pediatric Resuscitation tape, refer to each weight for specific doses, mls to remove and add to make 100 ml solution, and delivery rate. Each weight will provide a different concentration of the infusion solution and rate of delivery.

  1. Severe Croup or Epiglotitis:

1. Adult and pediatric:

a. Nebulize 5 cc Epinephrine 1:1000 via SVN without dilution. Do not repeat within 60 minutes.

Per Base Physician Verbal Order only.

  1. Special Information:

A. Incompatible with bicarbonate and furosemide solutions. Flush IV lines between injections.