Epinephrine Injection: Uses, Dosage, Side Effects, Nursing Care Guide

 


💉 Introduction:

Epinephrine, also known as Adrenaline, is a life-saving emergency drug commonly used in the treatment of cardiac arrest, anaphylaxis, and severe asthma attacks. As a potent adrenergic agonist, it stimulates multiple receptors in the body, producing widespread and immediate effects on the cardiovascular and respiratory systems.

Whether you're a nursing student, practicing nurse, or medical professional, understanding epinephrine's pharmacology and clinical application is vital for emergency care.

💊 Generic Name:

Epinephrine

💼 Trade Names:

  • Adrenalin

  • EpiPen

  • Auvi-Q

  • Symjepi

🧪 Class / Action:

  • Pharmacologic Class: Adrenergic agonist (non-selective)

  • Therapeutic Class: Vasopressor, bronchodilator, cardiac stimulant

  • Action: Mimics the sympathetic nervous system (fight-or-flight response) by stimulating alpha and beta adrenergic receptors.

💉 Route / Dosage:

Routes of Administration:

  • Intramuscular (IM)

  • Intravenous (IV)

  • Subcutaneous (SC)

  • Inhalation

  • Endotracheal (ET)

  • Intracardiac (rare/emergency)

Dosage (Adults):

Anaphylaxis (IM):

  • 0.3–0.5 mg IM every 5–15 minutes as needed

Cardiac Arrest (IV/IO):

  • 1 mg every 3–5 minutes during CPR

Asthma (SC/IM):

  • 0.3–0.5 mg every 20 minutes up to 3 doses

Pediatric Dosage:

  • Based on weight (0.01 mg/kg)

⚠️ High Alert Medication:

YES ✅
Due to its potent cardiovascular effects, epinephrine is considered a high-alert medication. Improper dosing or administration may result in fatal arrhythmias, hypertension, or cardiac arrest.

💡 Indications:

  1. Anaphylaxis (severe allergic reaction)
  2. Cardiac arrest (asystole, PEA, VF, pulseless VT)
  3. Severe bronchospasm/asthma
  4. Hypotension and shock unresponsive to fluids
  5. Local anesthetic adjunct to prolong duration and reduce bleeding
  6. Stridor/croup (nebulized form in pediatrics)

🔬 Mechanism of Action:

Epinephrine stimulates alpha-1, beta-1, and beta-2 adrenergic receptors:

  • Alpha-1: Vasoconstriction → increases blood pressure

  • Beta-1: Increases heart rate and contractility

  • Beta-2: Bronchodilation → opens airways

These combined actions restore perfusion, reverse airway obstruction, and support cardiovascular function, especially in life-threatening emergencies.

🚫 Contraindications:

  1. Hypersensitivity to epinephrine (rare, ironic since it treats allergies)
  2. Narrow-angle glaucoma
  3. Patients on non-selective beta-blockers (may cause paradoxical hypertension)
  4. Labor and delivery (can delay labor via uterine relaxation)
  5. Use caution in elderly, hypertensive, and cardiac patients

⚠️ Adverse Reactions / Side Effects:

Common:

  1. Anxiety
  2. Palpitations
  3. Tremors
  4. Headache
  5. Dizziness
  6. Sweating
  7. Nausea

Serious:

  1. Arrhythmias (ventricular fibrillation, tachycardia)
  2. Hypertensive crisis
  3. Stroke
  4. Myocardial infarction
  5. Pulmonary edema
  6. Tissue necrosis if extravasated (IV)

🩺 Nursing Implications:

  • Monitor vital signs (BP, HR, ECG) continuously during administration.

  • Use correct concentration:

    • 1:1,000 for IM/subcut

    • 1:10,000 for IV (cardiac arrest)

  • Administer IM in anterolateral thigh (vastus lateralis) for fastest absorption.

  • Monitor for chest pain, arrhythmias, and hypertension.

  • Have resuscitation equipment ready if given IV.

  • Watch for signs of rebound bronchospasm or allergic response.

  • Rotate injection sites if repeated dosing is needed.

  • Use caution in patients taking MAO inhibitors, tricyclic antidepressants, or beta-blockers.

🧑‍⚕️ Patient Education:

  1. Teach patients (especially with allergies) how to use auto-injectors (EpiPen) properly.
  2. Instruct to seek emergency care immediately after use of EpiPen—effects are temporary.
  3. Do not inject into hands, feet, or buttocks (risk of ischemia).
  4. Store auto-injectors at room temperature, away from light and heat.
  5. Inform that shakiness and fast heartbeat are common but temporary effects.
  6. Carry medical identification if prescribed for anaphylaxis or asthma.

📋 Notes for Nurses:

  1. Always double-check concentration (1:1,000 vs 1:10,000) to prevent fatal dosing errors.
  2. IM route is preferred in anaphylaxis for safety and rapid absorption.
  3. In cardiac arrest, administer via IV push followed by flush.
  4. Document time, route, and patient response clearly.
  5. Be alert for extravasation with IV administration—can cause tissue necrosis; use central line when possible.
  6. Consider phentolamine (alpha-blocker) if extravasation occurs.
  7. Educate caregivers and patients on emergency use and replacement schedule for expired auto-injectors.

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