Epinephrine

1mg/1ml ampoules (IV, IM, IO, nebulization, subcutaneous)

Executive Summary

(February 2023)

Epinephrine is an endogenous catecholamine non-selective agonist of all adrenergic receptors with a major role in emergency medicine on a variety of different diagnoses. 


*ROSC: Return of Spontaneous Circulation


Adult dose for anaphylaxis
0.01mg/kg (max 0.5mg per dose) IM into the anterolateral aspect of the thigh.

 

Adult dose for cardiac arrest
1mg every 3 to 5 minutes IV or IO.

Indications

FDA-Labeled (5)


Off-label

Adult dose

Anaphylaxis (3)

Cardiac Arrest (10)


Crashing asthmatic

Pediatric dose

Anaphylaxis (3)

 

Cardiac Arrest (11)


Crashing asthmatic

Pathophysiology of anaphylaxis: epinephrine role

Current concerns about epinephrine in cardiac arrest

In recent years, epinephrine utility has been questioned because of conflicting data on long term survival and its association with detrimental neurological outcomes (7, 9). 

 

2020 Adult Advanced Life Support Guidelines state the following (10): 


PARAMEDIC-2 compendium available at The Bottom Line - PARAMEDIC2

Must-read articles

Anaphylaxis

 

Cardiac Arrest Advanced Cardiovascular Life Support 

"Treatment Recommendations

References

Anaphylaxis


Cardiac arrest

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EMDrugs Team