During CPR ratio of Adrenaline dilution is used?

NIMHANS Nursing Officer - 2019

Pharmacology

Easy

Appeared in: NIMHANS Nursing Officer - 2019

Explanation

During CPR, adrenaline is administered intravenously (IV) or intraosseously (IO) to increase perfusion to the heart and brain.
The standard concentration for this route in cardiac arrest is 1:10,000, which translates to 1 mg of adrenaline in 10 mL of solution (0.1 mg/mL).
This dilution achieves systemic vasoconstriction via alpha-1 receptor stimulation, increasing systemic vascular resistance and aortic diastolic pressure, thereby improving coronary and cerebral perfusion pressure.
The standard adult dose is 1 mg (10 mL of 1:10,000 solution) repeated every 3-5 minutes.

Option A: This is a higher concentration (1 mg/mL) primarily used for intramuscular (IM) injection during anaphylaxis.
Option C: This is a very dilute concentration that is too weak to produce the necessary systemic vasoconstrictive effects required during cardiac arrest.
Option D: This is an extremely high, non-standard concentration that is not used for systemic medical administration. Administering it would be highly toxic and likely fatal.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacology of Emergency Drugs: Adrenaline (Epinephrine) Dilution as background academic context rather than a clinical decision trigger.
Administering the correct concentration of adrenaline is critical for patient safety. A medication error, such as giving the 1:1,000 concentration IV during CPR, can cause fatal cardiac arrhythmias and severe hypertension if circulation returns.
Nurses must always perform the '5 Rights' of medication administration and verbally confirm the drug and concentration with the team, especially in a high-stress CPR event.
What if? If only a 1:1,000 ampule is available during a cardiac arrest and IV access is established, the nurse must immediately prepare the correct dilution. This is done by taking 1 mL of the 1:1,000 solution and diluting it with 9 mL of normal saline to create 10 mL of a 1:10,000 solution before IV administration.

How to Approach the Question

First, identify the clinical context of the question, which is Cardiopulmonary Resuscitation (CPR), a specific emergency situation.
Next, identify the specific drug and parameter in question: Adrenaline (epinephrine) and its dilution ratio for administration.
Recognize this as a factual recall question based on standard Advanced Cardiac Life Support (ACLS) guidelines for emergency pharmacology.
Mentally differentiate the formulation used in CPR from those used in other clinical scenarios, such as anaphylaxis (1:1,000) or as an adjunct to local anesthesia (1:100,000), as these are common distractors.
Select the option that matches the standard IV/IO concentration for cardiac arrest.

Concept Tested & Keywords

Concept Tested: Pharmacology of Emergency Drugs: Adrenaline (Epinephrine) Dilution
Stem keywords: CPR, Adrenaline, dilution, ratio
Lead-in keywords: is used

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