The Epinephrine Effect

- February 28, 2013

The Effects of Epinephrine During a Pulseless Arrest

Drug Therapy: Epinephrine

· Epinephrine 1mg (1:10,000 solution) IV/IO q3-5min

· ETT dose (1:1000 solution) 2mg diluted in 10cc of NS

· Increases systemic vascular resistance (vasoconstriction)

· Increase coronary and cerebral perfusion pressures during CPR

· Escalating or high doses without demonstrable benefit

· After drug delivery and approximately 5 cycles (or about 2 minutes) of CPR then recheck the rhythm

Algorithms and dosages

· Pulseless VF/VT Epinephrine 1mg (1:10,000 solution) IV/IO q3-5min

· Asystole: Epinephrine 1mg (1:10,000 solution) IV/IO q3-5min

· PEA: Epinephrine 1mg (1:10,000 solution) IV/IO q3-5min

· Unstable bradycardia Epinephrine 2-10 mcg/min infusion

The effects of epinephrine usually last about 3-5 minutes. Initially one may observe a ventricular tachycardia, wide complex tachycardia, or a narrow complex tachycardia, depending upon the underlying problem. The patient may even have a strong or bounding pulse and an elevated blood pressure reading But as the effects wear off, the heart rate begins to slow down as observed in the following strips.

I have observed that some people want to treat the tachycardia, especially if it is either a wide-complex tachycardia or ventricular tachycardia with a pulse. I caution against giving the patient an antiarrhythmic because once given, you cannot take the medication back and most of the time the tachydysarrhythmia is the result of the epinephrine doing what it is supposed to do. I have observed some successfully defibrillate this rhythm to a bradyasystolic rhythm. During this brief time of return to spontaneous circulation focus on correcting the underlying causes of the arrest (the Hs and Ts) and continue respiratory support, fluids, and perhaps begins some catecholamines that will sustain not only the heart rate but the blood pressure. Any thoughts on this?