Emergency Medications: Epinephrine Overview

Emergency Medications

• Epinephrine is a first-line drug in Advanced Cardiovascular Life Support (ACLS)
• It increases arterial blood pressure and coronary perfusion during CPR
• It acts on beta1 and alpha1 adrenergic receptors
• Coronary perfusion pressure of 15-20 mmHg is needed for ROSC
• Dosing: Epinephrine 1 mg Q3-5 minutes (as per ACLS guidelines)
• Potential harmful effects and survival rates are being studied
• Route of administration: IV
• Used in severe allergic reactions, hypotension with septic shock, upper airway obstruction/asthma, and cardiac arrest
• It affects beta1 and beta2 receptors, producing bronchodilation
• It also affects alpha receptors, but the extent depends on the dosage
• Therapeutic effects: bronchodilation and maintaining heart rate and blood pressure (BP)
• Contraindications: Hypersensitivity
• Precautions: Older adults are more prone to adverse reactions and might need a lower dose
• Adverse reactions: angina, arrhythmias, hypertension, tachycardia, nervousness, restlessness, tremor, and paradoxical bronchospasm

Epinephrine - Anaphylaxis

• Signs and symptoms: swelling of the throat and tongue, difficulty breathing, difficulty swallowing, wheezing, coughing, noisy breathing, tiredness, confusion, fainting, dizziness, cool and clammy skin
• Activates beta2 adrenergic receptors in the lungs
• Dilates airways
• Route of administration: IV, IM, SubQ

Epinephrine - Respiratory Emergencies

• Used in treating acute respiratory conditions
• Used in pediatric conditions like bronchiolitis and croup
• Route of administration: nebulizer
• Adverse effects are noted

Nursing Responsibilities for Epinephrine Administration

• Mrs. Keystone: medical history including COPD, angina, hypertension, and early-stage chronic renal insufficiency; awaiting knee replacement surgery
• On assessment: drowsy, HR 50, BP 88/52, denies shortness of breath, chest pain, afebrile, RR 26/min, Sats 87%
• Contraindications/precautions should be considered before administering epinephrine to Mrs. Keystone
• Assessment would include baseline monitoring of vital signs, lung sounds, and other relevant parameters before administering epinephrine
• Compatibility concerns exist between the current IV solution and the antibiotic infusion

Epinephrine - Cardiac Arrest

• First-line drug in Advanced Cardiovascular Life Support (ACLS)
• Increases arterial blood pressure and coronary perfusion during CPR
• Acts on beta1 and alpha1 adrenergic receptors
• A coronary perfusion pressure of 15-20 mmHg is crucial for ROSC
• Dosing: Epinephrine 1 mg every 3-5 minutes (as per ACLS guidelines)
• Clinical trials evaluating potential harmful effects and survival rates ongoing.
• Route of administration: IV

Naloxone

• Naloxone (Narcan): an opioid antagonist
• Used to reverse opioid-related respiratory and central nervous system (CNS) depression
• Blocks opioid effects, but does not itself cause opioid excitation
• Reverses signs of opioid overdose
• Contraindications: Hypersensitivity
• Precautions: Physically opioid-dependent individuals
• Adverse Reactions: hypertension, hypotension, ventricular arrhythmias
• Route of Administration: IV or IM
• Dosage: Varies with age (adult or pediatric) and can take 2-3 minutes to work

Narcan in the Community

• Kits contain:
• One zippered case
• Three 0.4mg doses of naloxone in ampoules
• Three auto-retractable safety syringes
• Three ampoule breakers
• Three alcohol preparation pads
• A pair of non-latex gloves
• One-way rescue breathing barrier mask
• Steps for responding to an opioid overdose
• Training for recognizing overdose
• Prevent death and brain damage
• Encourage individuals to seek medical attention
• Potential issues: hypersensitivity, opioid withdrawal
• Calling 911 and receiving additional medical attention is crucial

Naloxone Educational Resources

• Government of Saskatchewan naloxone training webpage
• Educational videos
• Prairie Harm Reduction

Reflective Questions

• Assessments for patients who receive naloxone from a take-home kit before hospitalization
• Concerns regarding depth and quality of public naloxone information
• Barriers to effective use of home naloxone kits in Saskatchewan communities