ACLS and Epinephrine
ACLS and Epinephrine
Epinephrine is the primary drug used in the pulseless arrest algorithm. It is used for its potent vasoconstrictive effects and also for its ability to increase cardiac output. Epinephrine is considered a vasopressor.
Indications for ACLS
- Vasoconstriction effects: epinephrine binds directly to alpha-1 adrenergic receptors of the blood vessels (arteries and veins) causing direct vasoconstriction, thus, improving perfusion pressure to the brain and heart.
- Cardiac Output: epinephrine also binds to beta-1-adrenergic receptors of the heart. This indirectly improves cardiac output by:
- Increasing heart rate
- Increasing heart muscle contractility
- Increasing conductivity through the AV node
Epinephrine is used in the pulseless arrest algorithm as a direct IV push and also in the bradycardia algorithm as an infusion. See the respective algorithm pages for more information about their use in each.
Routes
During ACLS, epinephrine can be given 3 ways: intravenous; intraosseous, and endotracheal tube
Dosing
- Intravenous Push/IO: 1mg epinephrine IV is given every 3-5 minutes.
- IV infusion for bradycardia: 1mg epinephrine is mixed with 500ml of NS or D5W. The infusion should run at 2-10 micrograms/min (titrated to effect).
- Endotracheal Tube: 2-2.5mg epinephrine is diluted in 10cc NS and given directly into the ET tube.
Epinephrine should be used with caution in patients suffering from myocardial infarction since epinephrine increases heart rate and raises blood pressure. This increase in HR and BP can increase myocardial oxygen demand and worsen ischemia.
Note: There is no clinical evidence that the use of epinephrine, when used during cardiac arrest, increases rates of survival to discharge from the hospital. However, studies have shown that epinephrine and vasopressin improve rates of ROSC (return of spontaneous circulation).
Can you explain the difference in uses for 1:10,000 and 1:1,000 concentrations of epinephrine?
Epinephrine vials are labeled by concentration of a ratio of medication per mL.
CONCENTRATION
1:1,000=1mg/ml
1:10,000=0.1mg/ml
1:1000 is for SQ/IM since the volume is less. If you had too this one is for ET administration
1:10,000 normally for IV/IO use.
The 1:1,000 is easier to use when preparing an epinephrine drip.
Kind regards,
Jeff
Kind regards,
Jeff
How come epi’ s dose is not wt based on this page?
If you look under the subheading of “dosing,” you will see all of the different methods of dosing within ACLS protocol which includes weight based dosing for bradycardia.
Kind regards,
Jeff
Thank you so much for this site. This has been a wonderful addition to the lectures from my instructor to help me pass not only her test on cardiac emergencies but the pharmocology and hesi exit exam. thank you again
thank a lot
So Amiodarone needs to be given with D5W flushes, it seems most of what I have read is you hang NS or LR as a fluid. So you have to use only D5 with amiodarone? Would LR work?
D5W should be used if you are Diluting amiodarone. You may follow amiodarone with NS flush or LR flush. Flushing with either one of these is not a problem.
Kind regards,
Jeff