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Adrenaline (Epinephrine) 💊

⚠️ Safety Note: Use IV Adrenaline (Epinephrine) only in extremis (e.g. 🚨 cardiac arrest). For most emergencies, the IM route is safest. 💉 In cardiac arrest: give 10 mL of 1 in 10,000 (1 mg) IV – this is the Resuscitation Council UK recommended optimum volume.

📖 About

Always check the BNF link here.

💪 “Fight or flight” hormone used to support circulation in life-threatening states.
🎯 Aim: improve brain and coronary perfusion.

⚡ Mechanism of Action

🅰️ Alpha receptors → Vasoconstriction (↑ BP, maintains coronary & cerebral perfusion).
❤️ Beta-1 receptors → ↑ Heart rate & contractility.
🌬️ Beta-2 receptors → Bronchodilation, vasodilation, uterine relaxation.

💊 Doses (check local protocols)

Scenario	Details
🚨 Cardiac Arrest (Adult)	Dose: 1 mg (10 mL of 1 in 10,000) Frequency: Stat; repeat every 3–5 min Route: Fast IV via large/central vein
🤧 Anaphylaxis (Adult)	Dose: 0.5–1 mg IM (0.5–1 mL of 1 in 1000) Frequency: Stat; repeat every 5 min if needed Route: IM into anterolateral thigh
🐢 Symptomatic Bradycardia (Adult)	Dose: 2–10 micrograms/min IV infusion Frequency: Titrate to HR & BP Route: IV infusion
💔 Resistant Hypotension (Adult)	Dose: 0.12–0.6 mg/hr IV infusion Prep: 6 mg in 100 mL 5% dextrose = 60 micrograms/mL Rate: 3–10 mL/hr Frequency: Titrate to HR & BP Route: IV infusion (⚠️ check local guidance)
👶 Paediatric (Cardiac Arrest)	Dose: 10 micrograms/kg (0.1 mL/kg of 1 in 10,000) Frequency: Stat; repeat every 3–5 min Route: IV/IO
👧 Paediatric (Anaphylaxis)	Dose: 0.01 mg/kg IM (0.01 mL/kg of 1 in 1000) Max: 0.5 mg per dose Frequency: Repeat every 5 min if needed Route: IM into anterolateral thigh

🩺 Indications

🚑 Anaphylaxis.
🚨 Cardiac arrest.
🌬️ Severe bronchospasm / life-threatening asthma.
💢 Severe bradycardia or shock resistant to fluids/other agents.

⚠️ Interactions

⬆️ Toxicity with TCAs, MAOIs, Ergotamine, Oxytocin.
❌ Non-selective beta-blockers → paradoxical hypertension/bradycardia.

⚠️ Cautions

💓 High arrhythmia risk, especially IV → continuous monitoring + resus facilities essential.
🤰 Use with caution in second stage of labour.
🔥 Caution in hyperthyroidism, acute stroke, hypertrophic cardiomyopathy (HOCM).

🚫 Contraindications

None are absolute in life-threatening emergencies. 📌 In extremis, benefits outweigh risks.

💥 Side Effects

💓 Arrhythmias: sinus tachycardia, AF, VT, VF – may be fatal.
😰 Anxiety, sweating, palpitations, hypertension.
🤲 Tremor, headache, hyperglycaemia.
🧠 Risk of acute stroke (secondary to hypertension/vasospasm).

📑 References

BNF: Adrenaline (Epinephrine)

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