Epinephrine

Question 1

List the indications for use of epinephrine.

Answer 1

❑ Cardiac Arrest – V-fib, Pulseless V-Tach, Asystole, PEA
❑ Symptomatic bradycardia, particularly if associated with hypotension, for whom atropine may be inappropriate or after atropine fails
❑ Used to treat severe hypotension (e.g., systolic blood pressure < 70 mm Hg)
❑ Maintain cardiac output during Post-Cardiac Arrest Care
❑ Anaphylaxis
❑ Severe status asthmaticus
❑ Beta Blocker/Ca+ channel Blocker overdose

Question 2

What is the dose of epinephrine in cardiac arrest?

Answer 2

Adult: 1 mg (1:10,000) IVP q 3-5 minutes

Pediatric: 0.01mg/kg to a max of 1mg (1:10,00) IVP q3-5 minutes

Question 3

What is the ADULT dose of epinephrine for symptomatic bradycardia with hypotension?

Answer 3

Adult: 2 to 10 mcg/minute IV infusion

Mix 4 mg of Epinephrine (1:1000) in 250 ml of N/S (concentration 16 mcg/ml)

Question 4

What is the PEDIATRIC dose of epinephrine for symptomatic bradycardia with hypotension?

Answer 4

Pediatric: 0.01mg/kg to a max of 1mg (1;10,00) IVP q3-5 minutes

Question 5

What is the dose for racemic epinephrine used in Croup / Anaphylaxis?

Answer 5

Adult/Pediatric: 5mg neb (1:1000). Repeat q5 minutes to a max of 10mg.

Question 6

What is the ADULT dose of epinephrine for use in Anaphylactic Shock / Severe bronchospasm, and Asthma (refractory to initial treatment)?

Answer 6

0.2 to 0.5 mg IM q5 min prn (repeat only in absence of clinical improvement); Max of 1.5 mg.

(AHS protocols - 0.3mg IM q5 min prn Max 0.9mg)

Question 7

What is the PEDIATRIC dose of epinephrine for use in Anaphylactic Shock / Severe bronchospasm, and Asthma (refractory to initial treatment)?

Answer 7

0.01mg/kg to a single max dose of 0.3mg q 5min prn

AHS protocols:

• less than 30kg = 0.15mg IM q5min prn Max 0.45mg
• greater than 30kg = 0.3mg IM q5min prn Max 0.9mg

Question 8

What is the dosage for Push Dose Epinephrine?

Answer 8

Adult: 20 to 50 mcg. Repeat q 2 minutes PRN
Pediatric: 1mcg/kg to single max dose 50 mcg, q 2 min

Question 9

What is the dosage for an epinephrine infusion? How do you mix it?

Answer 9

Adult and Pediatric: 0.1 to 1 mcg/kg/min IV infusion (titrate to desired effect)

*Mix 4 mg of Epinephrine (1:1000) in 250 ml of
N/S (concentration 16 mcg/ml)

Question 10

What are the contraindications to epinephrine administration?

Answer 10

None in the emergent setting.

Question 11

When is push dose epinephrine used?

Answer 11

In an acutely deteriorating patient as a temporary measure while initiating an infusion.

Question 12

How do you draw up push dose epinephrine?

Answer 12

There are a few ways, and all give you a concentration of 10mcg/mL.

• Draw up 1mL of 0.1mg/mL (from 1:10,000 preload) into a 10mL syringe and top up with 9mL normal saline.
• Add 10mL of 0.1mg/mL (from a 1:10,000 preload) to a 100mL bag of normal saline (after wasting 10mL saline from the bag)
• Draw up 1mL from an ampule of 1mg/mL (1:1000) and add to a 100mL bag of normal saline (after wasting 1mL from bag).