Adrenaline is essential in the management of anaphylaxis due to its amazing ability to reverse the dangerous clinical effects and halt the histamine release from mast cells. 🚨🫀
In the operating theatre, we can give it intravenously because the patient is adequately monitored and usually has IV access. With the correct doses, adrenaline will cause increased cardiac output, bronchodilation and vasoconstriction as well as stabilising the mast cells.
Some cases will respond to 20-50mcg (0.2-0.5ml of 1/10,000), others will require multiple, increasing doses (500mcg - 5mg) and some will progress rapidly to a cardiac arrest. Remember that all adrenaline ampoules contain 1mg. If you’re drawing up for a bolus, it’s easier to use a large ampoule (1/10,000), and if you’re making an infusion, the smaller (1/1,000) ampoules are suitable. Ultimately, you need to be ready with plenty of adrenaline! 🥵👊
Once the patient is stabilised, they will need an adrenaline infusion titrated. This will usually remain for several hours. To draw up an infusion, add 3 x 1mg ampoules of adrenaline (1/1000) to 47ml of saline in a 50ml syringe.
Learning how to draw up adrenaline is an essential skill for perianaesthesia nurses. Grab some expired stock and start practicing! 🧐
Ref: Anaphylaxis summary document, Live Series 3. Author J Madden. Available at periopconcepts.com
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