Epinephrine ???????????????????????????

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(No Transcript)
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Knowledge Sharing ??????????????????
Epinephrine ???????????????? ???????????

• Drug Information Service (DIS)
• Pharmacy Dept.,
• Yaring Hospital

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????????? ?????????????????????????????????????
???????????????? 30 ?????? ???????????????????????
?????????????????? 30 ?????? ???? HRlt60
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???????????????? Epinephrine

• ??????????? 110,000 ???????? (0.1mg/ml)
• ???????????????
• ??? iv (????????)
• ??????????????????????????????????????
  ????????????????????????????? (?????????????
  ?????????????????????????????? ???????????????????
  ??????????????????????)

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???????????????? Epinephrine

• ????????? iv 0.1-0.3 ml/kg ????? Epinephrine
  110,000 (???????????? 0.01-0.03 mg/kg)
• ??????? ETT 0.3-1 ml/kg ????? 110,000
• ?????????????????? ??????????????? ETT ??????
  Epi ??????????????????????????????????????????????
  ?
• ??????????????????????????????????????????????????
  ???? ETT
• ??????????????????????????????????????????????????
  ?????

??????????????????? BW ???????????
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???????????????? Epinephrine

• ??????????? ETT ??????????????????????????????????
  ????????? ????????????????????????????????????????
  ?????????
• ????????? catheter ???????????????????????????????
  ???? ETT (??????????????????)

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???????????????? Epinephrine

• ???????????????????????????? ETT
  ????????????????????????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ??
• ???????????????????????? ETT ??? label ???????
  ?????????????????????????? ETT ????????
  ???????????????????????????? iv
• ?????? iv ????????

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???????????????? Epinephrine

• ??????????????????????????????????????????????????
  ?????????? ?????? NSS 0.5-1 ml ???????
  ???????????????????????????????????????
• ??????????????????????????? ????????????????????
  ???????

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???????????????? Epinephrine

• ?????????????? 30 ?????????? ????????????????????
  ??????????????????????????????????????????????????
  ?????????????
• ??? HR ??? lt 60 ?????/min ????????????????? ? 3-5
  ???? (??????????????)

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Epinephrine
High Alert Drug
High Alert Drug
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Epinephrine ???????

• ??????????????????
• ?????????????????????????
• ?????????????????????????????????????????
  ?????????????????????????? (ß1)
• ??????????????????????????????? (peripheral
  vasoconstriction) (a1)
• ?????????????????????????????????????????????????
  ?????
• ???????/????????? ?????????????????? (ß2)

High Alert Drug
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Epinephrine ????????????

• ????????? IV
• Onset (?????????????????) ?????
• Peak (??????????????????) 2-5 ????
• Duration (?????????????????????) 5-10 ????

High Alert Drug
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?????????

• ????????????????????? ? ???????????????????
• ?????????????????????? ??????
• ??????????????? T ????
• ??????????????????????????? syringe ???????????
  oxidation ??? ??? ? ?????????????????
  ?????????????????????
• ?????????????????????????????????? ??????
  (????????????????????? ?) ???????????
• ????????????????????? alkalies ???? Sodium Bicarb

High Alert Drug
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??????? Epinephrine

• ??????? (?????????-??????????????)
• ????????????????????????? O2
• ???????????????????????????????????
• ???????????????????????????, ?????????????????????
  ??, ????????? lactate ????????????????????-??????
  CPR

High Alert Drug
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??????? Epinephrine

• ?????? CPR ??????????? ?????????????
  a-adrenergic receptor ??? epi ???????????????????
  ???????
• Epi ?? t ½ ???? ?????? 20-40 ????
  (??????????????????????) (?????? 3-5 ????)
• ?????????????????????????????????????????????
  epi (???? vasopressin a not ß1)

High Alert Drug
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Epinephrine??????

• ??????? spontaneous/??????? Oxytocin-induced
  contractions
• ??????? 2nd stage of labor
• ???????????????????????? uterine contraction
  ???????????? prolonged period uterine atony w/
  hemorrhage
• ???????????????? ?????????? anoxia

High Alert Drug
AHFS,2009 p1393
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Epinephrine??????

• ????????????? ACLS ????????? CPR ??????? blood
  flow ??? uterus ????????????????????????????
  Resuscitation ???????????????????????????
• ???????????????????????? ????????? parenteral
  ?????? 2nd stage of labor ?????? parenteral
  ?????????????????????????????????????? spinal
  anesthesia ???????? ???????? FHS ???????
  ?????????????????????????????????????? 130/80
  mmHg
• ????????????????????????????? !!!

High Alert Drug
AHFS,2009 p1393
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???????????? Epinephrine

• Outside US Adrenaline
• US/INN Epinephrine
• ?????? US ?????? Adrenaline ??????????????????????
  ???????????????? Adrenalin (????? e) ???
  ??????Parke-Davis Co.
• British Approved Name (BAN) Adrenaline
• ??????????????????? Epinephrine Adrenergics,
  ??????????? Adrenergics receptors/Adrenoceptors

High Alert Drug
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???????????????????
1 mg/ml 1,000 mg/1,000 ml 1 g/1,000 ml
11,000 (g/ml) 1g/L ?????????? 1L ???????
1g ?????????? 1ml ??????? 1mg
High Alert Drug
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?? 1??? ???? 1?????
m1v1 m2v2

• 11000(g/ml)x1 ml110000(g/ml)x V2
• 0.001(g/ml)x1(ml)0.0001(g/ml)x V2
• V2
• V2 10 ml
• ????? 1??? ?? 1 Amp (1ml) ??????????????????????
  ??????????? 10 ml (????????????????? 9 ml)
  ??????? 1?????

0.001(g/ml)x1(ml)
0.0001(g/ml)
High Alert Drug
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?? 1??? ???? 1?????
?? Syringe 10 cc ??? ???? 1 cc/??????????????? 10
cc (1mg/10ml)
1 cc
9 cc
??????? 1 ?????????????????????????? ?????????
0.1 mg (0.1mg/ml)
High Alert Drug
Dose ?????????? 0.01-0.03 mg/kg ???
110000 0.1-0.3 ml/kg
Epinephrine
???????????????????
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???????????????????

• NS D5W D10W DEXTRAN 70 in NS
• ?????????? SODIUM BICARBONATE 5 w/v ???? Other
  alkaline solutions.

High Alert Drug
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Med. Error ??????????????????????

• ???????? 11000 ??? 110,000
• Epinephrine 11000 1mg/ml ?????????????? IM
• Epinephrine 110,000 0.1mg/ml ?????? IV

High Alert Drug
Pediatric Dosage Handbook, 15th edition,
2008-2009, p650
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Med. Error ???????????????????????????

• ????? order 3 ml ??? Epinephrine 110,000
• ?????????????????? 3ml ??? Epinephrine 11,000

High Alert Drug
?????????????????????????????????????
??????????????????????? (?????????)
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????????

• ?????????????????????????? (????????/??????????)
  ??????????????????? (??????????????????
  ?????????????????????????/T ????)
• ??????????????????????? ?????????????????????????
  ?????????? ??????????????????????? (??????????
  peripheral iv ??????)

High Alert Drug
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??????????????????

• ???????????????????????
• Anxiety, ????, ????????, ??????, ??????,
  ????????????????????????????????????????,
  N/V,???, lactic acidosis
• ??????????????, ???????????????, ?????????????,
  ?????????????????? (????????????????? dose sc
  ?????? iv ????????????)
• ????????????????????????? (???????????????????????
  ?/??????)
• ????????? ???????????????? ?????????? ????????
  ??????????????????
• ????????? ?????????????? ????????????? BP ???
  ??????????

High Alert Drug
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-The End-