Epinephrine

In this lesson, we'll go over the medication epinephrine and all of its effects, including indications, precautions and contraindications, and pediatric dosages.

Epinephrine, also commonly referred to as epi, is a chemical that narrows the blood vessels and opens the airways in the lungs. And it's also commonly known as adrenaline.

Adrenaline is a hormone that is secreted mainly by the medulla of the adrenal glands and functions primarily to increase cardiac output and to raise blood glucose levels.

Epinephrine is typically released during periods of acute stress and its effects are a built-in defense mechanism and what prepares an individual for either a fight or flight response. For this reason, it's also a primary medication for non-perfusing cardiac arrest in pediatric patients.

One common effect of epinephrine is reversing low blood pressure.

Epinephrine Indications

Now let's take a look at epinephrine indications.

Epinephrine is used in cardiac arrest arrhythmias such as VFib, pulseless V-tach, asystole, and pulseless electrical activity (or PEA). Epinephrine can also be used in symptomatic bradycardia and for the treatment of severe hypotension.

Epinephrine can be administered via a nebulizer for the treatment of croup and other upper airway obstructions. And it's also an effective treatment for anaphylactic reactions.

Epinephrine Precautions and Contraindications

Epinephrine has a few precautions and contraindications that we should note.

Care should especially be taken when administering epinephrine in cases where raising the patient's blood pressure and increasing their heart rate might cause myocardial ischemia and increase the demand for myocardial oxygen.

Pediatric Dosage of Epinephrine

Now let's look at the pediatric dosage of epinephrine.

The two available concentrations are 1:1000 and 1:10,000. And for cardiac arrest in pediatric patients, you should use the 1:10,000 concentration at .01mg/kg and it should be administered via the IV or IO route.

This dose can be repeated every 3 to 5 minutes. And make sure to follow the epinephrine dose with a bolus of 20cc of normal saline to flush the line and get the drug into the central circulatory system more appropriately, thus increasing its effectiveness.

If you encounter a situation where there is no IV or IO access, epinephrine may be delivered via the endotracheal route with a dose of .1mg/kg of the 1:1000 concentration. But remember, that concentration is only for an ET delivery.

For the treatment of anaphylactic shock, an epinephrine concentration of 1:1000 is given to patients who weigh less than 30kg (or roughly 66 pounds) at .15mg IM (intramuscular) or subcutaneously into the thigh. And this dose may be repeated as necessary.

A Word About the Management of Shock in Pediatric Patients

We'll be getting more into the treatment of shock in pediatric patients in the next section – Case Studies – however, consider this Word as either a preview of things to come or supplemental information that could come in handy later.

Supporting Airway, Oxygenation, and Ventilation

With pediatric patients who are exhibiting signs and symptoms of shock, it's important to maintain an open airway and support oxygenation and ventilation. To do this, provide a high concentration of supplementary O2 to all pediatric patients with shock.

Usually, O2 is best delivered via a high-flow O2 delivery system. And sometimes O2 delivery must be combined with ventilatory support if the patient's mental status is impaired, respirations are ineffective, or the patient's breathing effort is significantly increased.

Appropriate interventions can include noninvasive positive airway pressure or mechanical ventilation after endotracheal intubation.

Vascular Access

Once the patient's airway is open and oxygenation and ventilation are supported,
obtain vascular access for the administration of medications and for fluid resuscitation.

For patients with compensated shock, initial attempts at peripheral venous cannulation are appropriate.

For patients with hypotensive shock, immediate vascular access is critical and is best accomplished by the intraosseous (IO) route if peripheral IV access is not readily available or easily achieved.

Depending on your individual experience and expertise and, of course, the clinical circumstances, central venous access could prove useful. However, it's important to remember that gaining central venous access will take longer than the placement of IO access.