Medication 7-329 - Epinephrine (Adrenalin)

CMH EMS & MIH Protocols

Scope of Practice:

• Emergency Medical Technician
• Advanced Emergency Medical Technician
• Registered Nurse
• Paramedic
• Community Paramedic

Route(s):

• ET, IM/SQ, IO, IV, Neb,

Pharmacodynamics (class and mechanism of action):

• Sympathomimetic (Binds with both alpha and beta receptors increasing chronotropy, dromotropy, inotropy, and bronchodilation.).

Pharmacokinetics:

• Half-life: Unknown.
• Onset time:
• IM: Variable
• IO/IV: Immediate.
• Neb: 1-5 minutes.
• Peak action time:
• IM: Unknown.
• IO/IV: 5 minutes.
• Neb: Unknown.
• Duration of action:
• IM: 1-4 hours.
• IO/IV: Short.
• Neb: 1-3 hours.

• Peak	15	30	45	60	75	90	105	120	135	150	165	minutes
  Duration	15	30	45	60	75	90	105	120	135	150	165	minutes

Dosing:

• Refer to specific protocol(s) below for dose(s).
• Epinephrine 1:1,000 = 1 mg/ml (ampule or vial).
• Do not administer IV or IO without dilution.
• Epinephrine 1:10,000 = 0.1 mg/ml (pre-filled syringe).
• Epinephrine 1:100,000 = 0.01 mg/ml (mixed push-dose pressor).

• Instructions for preparing Push-Dose Epi:

1. Waste 10 ml out of 100 ml NS bag.
2. Push 10 ml (1 mg) of Epinephrine 1:10,000 into bag.
3. You now have Epinephrine 1:100,000 (1,000 mcg in 100 ml) at a concentration of 10 mcg/ml.
4. Do not hang bag or connect bag directly to a patient with a pulse.
5. Draw 10 ml at a time for a typical push dose of 5-20 mcg (0.5-2 ml) every 2-5 minutes.

Indications:

• Protocol 2-066 - Allergic Reaction.
• Protocol 2-154 - Bradycardia.
• Protocol 2-198 - Cardiac Arrest.
• Protocol 2-583 - Hypotension / Shock.
• Protocol 2-616 - Newly Born.
• Protocol 2-770 - Respiratory Distress.
• Medication 7-504 - Labetalol.

Contraindications:

• When used on patients with a pulse:
• Cardiovascular disease.
• Cerebrovascular disease.
• Severe Hypertension.
• Pregnancy.
• Patients with tachyarrhythmias.
• When used for cardiac arrest:
• None when used in emergency setting.

Pregnancy Risk Factor:

• Category C
• Risk not ruled out: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. FDA requires a relatively large amount of high-quality data on a pharmaceutical for it to be defined as Pregnancy Category A. As a result of this, many drugs that would be considered Pregnancy Category A in other countries are allocated to Category C by the FDA.

Potential Incompatibilities:

• NA.

Precautions and Adverse Effects:

• Use caution in patients with diabetic patients. Monitor blood sugar levels after administration.
• Medication should be protected from light.
• Blood pressure, pulse and ECG must be constantly monitored.
• Can be deactivated by alkaline solutions.
• May cause palpitations, Tachycardia, anxiousness, headache, tremor, Myocardial Ischemia in older patients, anxiety, Nausea, Vomiting, and/or Hypertension.

Antidote:

• NA.

Controlled Substance Information:

• Not a scheduled drug
• The DEA and FDA have not identified this drug with a schedule classification.
• DEA number: NA.
• Narcotic: No.
• Street names: NA.

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Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.