Epinephrine
Epinephrine in Pediatric Emergency Medicine
Epinephrine, also known as adrenaline, is a crucial catecholamine used in various pediatric emergencies. It acts on both alpha and beta adrenergic receptors, producing potent cardiovascular and respiratory effects.
Key Points:
- First-line drug in pediatric cardiac arrest and anaphylaxis
- Available in multiple concentrations: 1:1,000 (1 mg/mL) and 1:10,000 (0.1 mg/mL)
- Route of administration varies based on the clinical situation
- Rapid onset of action with short duration, requiring repeated doses in prolonged emergencies
- Dosing and concentration must be double-checked to prevent potentially fatal errors
Indications for Epinephrine Use in Pediatrics
- Cardiac arrest (asystole, pulseless electrical activity, ventricular fibrillation)
- Anaphylaxis
- Severe bronchospasm/status asthmaticus
- Croup (nebulized epinephrine)
- Bradycardia with poor perfusion unresponsive to ventilation and oxygenation
- Septic shock unresponsive to fluid resuscitation
- As an adjunct in local anesthetics to prolong effect and reduce bleeding
Dosage and Administration
Cardiac Arrest:
- 0.01 mg/kg of 1:10,000 solution IV/IO every 3-5 minutes
- Maximum single dose: 1 mg
Anaphylaxis:
- IM: 0.01 mg/kg of 1:1,000 solution (max 0.3 mg for children, 0.5 mg for adolescents)
- Can be repeated every 5-15 minutes
Severe Asthma/Anaphylaxis with Shock:
- IV/IO infusion: 0.1-1 mcg/kg/minute, titrated to effect
Nebulized (for croup or severe asthma):
- 0.5 mL/kg of 1:1,000 solution (maximum 5 mL) mixed with 3 mL normal saline
Precautions and Side Effects
Precautions:
- Use with caution in patients with cardiovascular diseases, hypertension, hyperthyroidism, and diabetes
- Potential for medication errors due to different concentrations – always double-check
- Can cause tissue necrosis if extravasation occurs with IV administration
Side Effects:
- Tachycardia, palpitations, arrhythmias
- Hypertension
- Anxiety, restlessness, tremor
- Headache, dizziness
- Nausea, vomiting
- Hyperglycemia
- Pulmonary edema (rare)
Monitoring
- Continuous cardiac monitoring
- Frequent blood pressure measurements
- Pulse oximetry
- Capnography (if intubated)
- Blood glucose levels
- Urine output
- Mental status changes
- Injection site for signs of extravasation (for IV/IO administration)
In cardiac arrest scenarios, focus on high-quality CPR and defibrillation when indicated, with minimal interruptions for epinephrine administration.
