Overview
Skill sheet on intramuscular adrenaline for anaphylaxis and severe asthma, including indications, dosing, procedure, complications, and assessment criteria.
Pharmacology and Background
- Adrenaline acts on alpha 1, beta 1, beta 2 adrenergic receptors.
- Alpha 1: smooth muscle contraction, vasoconstriction, glycogenolysis, gluconeogenesis.
- Beta 1: increases contractility, heart rate, conduction velocity.
- Beta 2: smooth muscle relaxation, vasodilation, bronchodilation, stabilizes mast cells.
Indications, Contraindications, Cautions
- Indications: anaphylaxis; severe asthma.
- Contraindications: none.
- Cautions: myocardial ischaemia; tachydysrhythmias; increased myocardial oxygen demand.
Equipment and Preparation
- Adrenaline 1 mg/1 ml ampoule; 1 ml or 3 ml syringe; drawing-up needle; injection needle; sharps container.
- For 5 kg patients: 10 ml syringe and 10 ml 0.9% sodium chloride for dilution.
- Verify five rights: medicine, dose, patient, route, time; second check if available.
Dosing and Volumes (IM)
| Weight/Age | Dose (mg) | Volume (ml) | Preparation |
|---|
| 5 kg / <1 year | 0.05 | 0.5 | 1:10,000 dilution (from 1 mg/ml to 10 ml total) |
| 10 kg / 1 year | 0.1 | 0.1 | Undiluted 1 mg/ml |
| 20 kg / 2–5 years | 0.2 | 0.2 | Undiluted 1 mg/ml |
| 30 kg / 6–10 years | 0.3 | 0.3 | Undiluted 1 mg/ml |
| 40 kg / 11–13 years | 0.4 | 0.4 | Undiluted 1 mg/ml |
| Adult | 0.5* | 0.5 | Undiluted 1 mg/ml |
| Note | | | *Paramedics/ICP/CCP may reduce dose if small, frail, or IHD. |
IM Administration Procedure
- Explain procedure; obtain informed consent where possible.
- Assemble equipment; attach drawing-up needle to syringe.
- Check ampoule; demonstrate and verbalize five rights; second check if present.
- Open ampoule facing dot; break away; discard top immediately in sharps.
- 5 kg/<1 year: draw 1 ml, dilute to 10 ml with 0.9% NaCl for 1:10,000.
- Others: withdraw required undiluted dose from 1 mg/ml ampoule.
- Remove drawing-up needle; discard ampoule; attach injection needle.
- Prepare patient and site; preferred site lateral thigh, alternative lateral upper arm.
- Remove safety cap; inject IM using correct technique and asepsis.
- Dispose needle/syringe into sharps container.
- Document on ePRF: medicine, dose, route, time.
Repeat Dosing Guidance
- Asthma: repeat IM every 10 minutes if deteriorating and no IV adrenaline administered.
- Anaphylaxis: repeat IM every 10 minutes if not improving; every 5 minutes if deteriorating.
Potential Adverse Effects and Complications
- Injection site pain; injection site bleeding.
- Common adverse effects: tachycardia; tachydysrhythmia; myocardial ischaemia; hypertension.
- Nausea, vomiting; tremor, anxiety, sweating; hyperglycaemia; ventricular ectopy.
- Increased doses may be required with beta-blocker or calcium channel blocker use, especially overdose.
Preferred IM Sites
- Lateral thigh preferred for IM administration.
- Lateral upper arm if thigh unsuitable.
Assessment Criteria Highlights
- Indications: anaphylaxis; severe asthma.
- Contraindications: none; cautions: myocardial ischaemia; tachydysrhythmias.
- Identify preferred sites: lateral thigh; lateral upper arm.
- Medication preparation: confirm five rights; correct draw-up and dilution as required.
- Administration competence: explain, consent, prepare site, aseptic technique, correct IM technique, sharps safety, ePRF documentation.
Action Items
- Ensure availability of 10 ml syringes and 0.9% NaCl for infant dilution.
- Reinforce documentation on ePRF with medicine, dose, route, time.
- Verify staff familiarity with repeat dosing intervals for anaphylaxis and asthma.
Decisions
- Adult dose may be reduced by Paramedics/ICP/CCP for small, frail, or ischaemic heart disease patients.