In life-threatening situations, adrenaline is administered first then prescribed later. In adult cardiac arrest associated with a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia), adrenaline 1 mg IV is given just after the third shock, and repeated every 3–5 minutes thereafter (i.e. every other cycle of CPR). If the rhythm is not shockable (asystole or pulseless electrical activity), adrenaline 1 mg IV is given as soon as IV access is available, and then repeated every 3–5 minutes. In anaphylaxis, the dose of adrenaline is 500 micrograms IM, repeated after 5 minutes if necessary. Take particular note of the route of administration: do not administer IV adrenaline in anaphylaxis, unless cardiac arrest supervenes. When administered with a local anaesthetic to induce local vasoconstriction, a readymixed adrenaline–anaesthetic preparation should be used;
usually this contains adrenaline at a concentration of 1:200,000 (5 micrograms/mL) along with the anaesthetic.
The name ‘adrenaline’ is still used for prescribing in the UK, although the international non-proprietary name (epinephrine) is also printed on product packaging.
Administration: In cardiac arrest, adrenaline is administered from a pre-filled syringe containing a 1 : 10,000 (1 mg in 10 mL) solution. Administer the whole 10 mL, followed by a flush (e.g. 10 mL of 0.9% sodium chloride). In
anaphylaxis, give 0.5 mL of a 1 : 1000 (1 mg in 1 mL) adrenaline solution by IM injection. Inject this into the anterolateral aspect of the thigh halfway between the knee and the hip, from where it should be rapidly absorbed. In obese patients you need to inject deeply in order to be confident of IM rather than SC administration.
Communication: In anaphylaxis, simultaneously with providing treatment, explain to the patient that they are experiencing a severe allergic reaction and that you are giving them an injection of adrenaline to treat this.
Monitoring: In the context of cardiac arrest and anaphylaxis, intensive clinical and haemodynamic monitoring is essential.
Cost: is not relevant to decisions regarding the use of adrenaline.