Epinephrine

What is Epinephrine?

Epinephrine is a vasopressor used in ACLS to treat a number of conditions including cardiac arrest, bradycardia and anaphylaxis. Epinephrine acts in the body as a hormone and neurotransmitter to regulate the heart rate and the diameter of blood vessels.

Epinephrine has 2 primary mechanisms utilized in ACLS.

It functions as an alpha-adrenergic agonist in which it binds with alpha-1 adrenergic receptors within blood vessels and causes vasoconstriction. This improves perfusion to vital organs.

It also functions as a beta-1 agonist in which it binds with beta-1 receptors in the heart to cause increased contractility which in turn, improves cardiac output.

Epinephrine Indications

• Cardiac Arrest
• Symptomatic Bradycardia
• Anaphylaxis / Severe Allergic Reactions
• Severe Hypotension

Epinephrine Dosage

• 1 mg via IV/IO (10 mL of 1:10,000 solution)
• Repeat every 3 – 5 minutes as needed
• IV 20 mL fluid flush following each dose
• Can also be given through an endotracheal tube at higher dosages of 2 - 2.5 mg every 3 - 5 minutes, diluted in 10 ml of NS.

Epinephrine Precautions/Side Notes

• Higher doses may be required in cases of beta-blocker or calcium channel blocker overdoses. Continuous infusion may also be required.
• High dose may not improve survival / neurological outcome
• High dose ceases myocardial dysfunction during post-resuscitation period