What are the treatment options for adrenaline crash symptoms?

Treatment Options for Adrenaline Crash Symptoms

Epinephrine (adrenaline) is the cornerstone of treatment for adrenaline crash symptoms, particularly in cases of anaphylaxis, and should be administered promptly to prevent progression to life-threatening complications. 1, 2

First-Line Treatment

• Intramuscular epinephrine is the preferred initial route for treatment due to its ease of administration, effectiveness, and safety 1, 2
• The recommended dose is 0.2 to 0.5 mg (1:1000) intramuscularly, which can be repeated every 5 to 15 minutes as needed 1
• Injection into the lateral aspect of the thigh produces rapid peak plasma epinephrine concentrations 1
• For adults, an epinephrine autoinjector will deliver 0.3 mg of epinephrine 1

Intravenous Administration Options

• When an IV line is already in place, it is reasonable to consider IV epinephrine at a dose of 0.05 to 0.1 mg (0.1 mg/mL or 1:10,000) 1
• IV infusion of epinephrine (5-15 μg/min) is a reasonable alternative to IV boluses for treatment of severe symptoms in patients not in cardiac arrest 1
• Close hemodynamic monitoring is essential when administering IV epinephrine due to risk of fatal overdose 1

Fluid Resuscitation

• Aggressive fluid resuscitation with isotonic crystalloid (e.g., normal saline) is recommended for vasogenic shock 1
• Repeated administration of 1000-mL bolus doses of isotonic crystalloid titrated to maintain systolic blood pressure above 90 mm Hg is effective 1

Airway Management

• Early recognition of potential airway difficulties is critical in patients who develop hoarseness, lingual edema, stridor, or oropharyngeal swelling 1
• Immediate referral to a healthcare professional with expertise in advanced airway management, including surgical airway techniques, is recommended 1
• Administration of warm humidified oxygen may be beneficial 1

Adjunctive Treatments

• Antihistamines, inhaled beta-agonists, and IV corticosteroids have no proven benefit during severe adrenaline crash symptoms that progress to cardiac arrest 1
• However, these medications may be considered as supportive therapy in less severe cases 1
• Chlorphenamine 10 mg IV and hydrocortisone 200 mg IV can be administered as part of secondary management 1

Special Considerations

• For persistent bronchospasm, consider intravenous infusion of salbutamol, use of a metered-dose inhaler (if appropriate connector is available), or administration of intravenous aminophylline or magnesium sulfate 1
• If blood pressure does not recover despite epinephrine infusion, alternative vasopressors such as metaraminol may be considered 1
• Isosorbide is contraindicated as it is a vasodilator that could worsen hypotension 2

Monitoring and Follow-up

• Patients with severe symptoms are critically ill, and their cardiovascular and respiratory status can change rapidly, making close monitoring imperative 1
• Arrange transfer to an appropriate Critical Care area for ongoing management 1
• Blood samples for Mast Cell Tryptase testing should be collected at specific intervals: as soon as feasible after resuscitation begins, 1-2 hours after symptom onset, and at 24 hours or during convalescence 1

Cardiac Arrest Management

• In cardiac arrest secondary to severe adrenaline crash symptoms, standard resuscitative measures following Advanced Life Support guidelines should be implemented immediately 1
• The standard dose of epinephrine for cardiac arrest is 1 mg IV every 3 minutes 1
• For patients with return of spontaneous circulation after cardiac arrest, epinephrine infusion may be considered for post-arrest shock 1

The management of adrenaline crash symptoms requires prompt recognition and aggressive treatment, with epinephrine as the mainstay therapy. Early administration of appropriate doses through the correct route based on symptom severity is critical for preventing progression to life-threatening complications.