Inotropic support: adrenaline

Adrenaline is the first-line inotrope for cardiogenic shock and bradycardia due to verapamil or diltiazem poisoning. If hypotension and bradycardia persist after initial resuscitation with intravenous fluids, use:

adrenaline (epinephrine) 10 to 20 micrograms (child: 0.1 micrograms/kg) intravenously, every 2 to 3 minutes aiming for adequate perfusion (guided by heart rate and blood pressure) CCB verapamil and diltiazem poisoning

FOLLOWED BY

adrenaline (epinephrine) by intravenous infusion (see Adrenaline (epinephrine) intravenous infusion instructions for advice on preparation and administration).

If the inotropic response to adrenaline is inadequate, seek advice from a clinical toxicologist on whether to add high-dose insulin euglycaemia therapy (HIET).

If the patient has vasoplegic shock, use a vasopressor; see Inotropic support: vasopressor.

For treatment of refractory hypotension and cardiac arrest, see here.