Explain Inj Adrenaline 1mg (1:10000) given

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adrenaline epinephrine 1mg 1:10000 IV cardiac arrest mechanism dose administration

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Inj. Adrenaline 1 mg (1:10,000) - Complete Explanation

Understanding the Concentration

The ratio 1:10,000 means 1 g of adrenaline in 10,000 mL of solution, which equals 0.1 mg/mL (1 mg in 10 mL).

Concentration	mg per mL	Volume for 1 mg	Route
1:1,000	1 mg/mL	1 mL	IM (anaphylaxis)
1:10,000	0.1 mg/mL	10 mL	IV (cardiac arrest)

So when you give 1 mg (1:10,000), you are drawing up and injecting 10 mL of solution intravenously.

Primary Indication

Cardiac Arrest / Cardiopulmonary Resuscitation (CPR)

The 1:10,000 formulation is the standard IV resuscitation concentration. It is stocked on crash carts specifically for this purpose.

Mechanism of Action

Adrenaline (epinephrine) acts on multiple adrenoceptors:

Receptor	Effect	Benefit in Arrest
Alpha-1	Peripheral vasoconstriction	Increases aortic diastolic pressure - improves coronary and cerebral perfusion pressure during CPR
Beta-1	Positive inotropy, chronotropy, dromotropy	Increases heart rate and contractility; helps restore spontaneous contraction
Beta-2	Bronchodilation, coronary vasodilation	Secondary benefit

The primary benefit in cardiac arrest is alpha-1 mediated vasoconstriction - it raises coronary perfusion pressure during chest compressions, making defibrillation more likely to succeed and spontaneous circulation more achievable.

(K J Lee's Essential Otolaryngology - receptor pharmacology; web-verified clinical dosing)

Dosing Protocol (Adults)

Cardiac Arrest (VF / Pulseless VT / PEA / Asystole)

Dose: 1 mg IV/IO (= 10 mL of 1:10,000 solution)
Repeat every 3-5 minutes throughout resuscitation
Follow each dose with a 20 mL normal saline flush
Elevate the limb of administration for 10-20 seconds to aid central circulation entry
Preferred route: central venous access; if peripheral, use a large vein + flush

Post-Cardiac Surgery Arrest (more cautious)

0.05 mg - 0.1 mg (0.5-1 mL of 1:10,000), titrated carefully

Endotracheal Route (last resort only, when no IV/IO access)

2-2.5 mg = 20-25 mL of 1:10,000 solution (2.5x the IV dose)

Paediatric Dose

0.01 mg/kg IV/IO (= 0.1 mL/kg of 1:10,000 solution), up to 1 mg max
Repeat every 3-5 minutes

Administration Route Preference

Central venous catheter - preferred for fastest drug delivery to central circulation
Large peripheral vein (e.g., antecubital) - acceptable, must be followed by 20 mL saline flush + limb elevation
Intraosseous (IO) - equivalent to IV; used when IV access unavailable
Endotracheal - last resort only; absorption is unreliable

Timing in the ALS Algorithm

For Shockable rhythms (VF/pVT): Give adrenaline after the 3rd shock, then every 3-5 minutes (during alternate cycles)
For Non-shockable rhythms (PEA/Asystole): Give adrenaline as soon as IV/IO access is obtained, then every 3-5 minutes

Important Cautions and Side Effects

Issue	Details
Tachyarrhythmias	Can induce or worsen ventricular arrhythmias post-ROSC
Post-resuscitation myocardial dysfunction	Excessive catecholamine load can cause transient cardiomyopathy
High doses	Do NOT improve neurological outcomes or survival; may worsen post-resuscitation complications
Drug-induced/poison arrest	High-dose epinephrine occasionally used in specific toxicological contexts
Anaphylaxis (IV use)	If IV route required (profound refractory shock), use slow titrated boluses of 0.05 mg at a time - NOT 1 mg bolus, which can cause severe cardiovascular toxicity

Concentration Confusion Warning

This is a high-alert medication. Many crash carts stock only the 1:10,000 IV formulation. Giving 1 mg of the 1:1,000 concentration IV as a bolus (instead of IM for anaphylaxis) can cause:

Severe hypertension
Ventricular arrhythmias
Cardiogenic shock (EF dropping to ~15% has been reported)

Always verify the concentration label before administration.

How to Prepare if 1:10,000 Prefilled Syringe is Unavailable

Draw up 1 mL of the 1:1,000 ampoule + add 9 mL of 0.9% NaCl = 10 mL of 1:10,000 (1 mg total). Mix well before use.

Summary Table

Parameter	Detail
Drug	Adrenaline (Epinephrine)
Concentration	1:10,000 = 0.1 mg/mL
Volume for 1 mg	10 mL
Adult dose (arrest)	1 mg IV/IO every 3-5 min
Route	IV (central > large peripheral) or IO
Flush	20 mL saline + limb elevation
Main mechanism	Alpha-1 vasoconstriction → coronary perfusion pressure
Key caution	Concentrate confusion risk; post-ROSC arrhythmias

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