ADRENALINE

*Asystole/pulseless arrest, pulseless ventricular tachycardia/ventricular fibrillation, Cardiopulmonary resuscitation:* BY IV INJ: Adult: 1 mg every 3-5 minutes, a 1 in 10000 (100 mcg/ml) solution is recommended, until spontaneous circulation established, higher doses of epinephrine (up to 0.2 mg/kg) have been used for treatment of specific problems BY IV INJ: Infant & Children: 0.01 mg/kg (0.1 ml/kg of 1:10,000 [0.1 mg/ml] solution) (max 1 mg/dose) every 3-5 minutes until spontaneous circulation established. *Endotracheal:* BY IV INJ: Adult: 2-2.5 mg every 3-5 minutes until spontaneous circulation established, dilute in 5-10 ml NS or sterile water. BY IV INJ: Infant & Children: 0.1 mg/kg (0.1 ml/kg of 1:1000 [1 mg/ml] solution) (max 2.5 mg/dose) every 3-5 minutes until spontaneous circulation established, dilute in 5-10 ml NS or sterile water. *Control of bradycardia in patients with arrhythmias after myocardial infarction, if there is a risk of asystole, or if the patient is unstable and has failed to respond to atropine:* BY IV INF: Adult: 2-10 mcg/minute or 0.1-0.5 mcg/kg/ minute (7-35 mcg/minute in a 70 kg patient); adjust according to response BY IV INF: Infant& Children: 0.01 mg/kg (0.1 ml/kg of 1:10,000 [0.1 mg/ml] solution) (max 1 mg/dose) every 3-5 minutes as needed. *Bronchodilator:* BY SC INJ: Adult: 0.3-0.5 mg (1:1000 [1 mg/ml] solution) every 20 minutes for 3 doses. BY SC INJ: Infant & Children: 0.01 mg/kg (0.01 ml/kg of 1:1000 [1 mg/ml] solution); max 0.5 mg/dose) every 20 minutes for 3 doses. *Acute anaphylaxis when there is doubt as to the adequacy of the circulation, Angioedema (if laryngeal oedema is present):* BY SLOW IV INJ: Adult: 50 mcg, using 0.5ml of the dilute 1 in 10 000 adrenaline injection, dose to be repeated according to response, if multiple doses required, adrenaline should be given as a slow IV INF stopping when a response has been obtained. *Hypotension/shock, severe and fluid resistant:* BY CONT. IV INF: Adult: Initially 0.1-0.5 mcg/kg/minute (7-35 mcg/minute in a 70 kg patient) adjust according to desired response. Children & Neonate: Initially 100 nanograms/kg/minute, adjusted according to response, higher doses up to 1.5 mcg/kg/minute have been used in acute hypotension. *Post-resuscitation INF to maintain cardiac output or stabilize:* BY IV INF: Infant & Children: 0.1-1 mcg/kg/minute; doses less than 0.3 mcg/kg/minute generally produce beta-adrenergic effects and higher doses (more than 0.3mcg/kg/minute) generally produce alpha-adrenergic vasoconstriction, increase dose to desired effect. *Emergency treatment of acute anaphylaxis, Angioedema (if laryngeal oedema is present):* BY IM INJ: Adult: 500 mcg, to be injected preferably into the anterolateral aspect of the middle third of the thigh, doses may be repeated several times if necessary at 5 minute intervals according to blood pressure, pulse, and respiratory function. Children 1 month-5 yrs: 150 mcg, Children 6-11 yrs: 300 mcg, Children above 12 yrs: Same as adult.

Central administration only; IV infusions require an infusion pump. Endotracheal: Doses (2-2.5 times the IV dose) should be diluted to 10 ml with NS or distilled - water.IM: Intramuscularly into anterolateral aspect of thigh. SC: Use only 1:1000 solution. Continuous IV Infusion: Rate of infusion (ml/hr) = dose (mcg/kg/min) x weight (kg) x 60 min/hr divided by the concentration (mcg/min). Max concentration: 64 mcg/ min. Direct IV or Intraosseous: Dilute to a max Concentration of 100 mcg/ ml (if using 1:10000 concentrations, no dilution is necessary). The World Health Organization recommends the availability of one dose for every 10-20 minutes of travel time to a medical emergency facility for self-administration. More than 2 doses should only be administered under direct medical supervision.

Cardiac arrhythmias, angle-closure glaucoma.

Diabetes mellitus, cardiovascular disease (angina, tachycardia, MI), thyroid disease, or cerebral arterio-sclerosis.

Halogenated inhalational, anaesthetics; alpha and beta-blocking agents, phenothiazines, tricyclic antidepressants.

Anxiety, tremor, tachycardia, headache, cold extremities, arrhythmias, cerebral haemorrhage, pulmonary oedema, nausea, vomiting, sweating, weakness, dizziness and hyperglycaemia.