Pharmacologic Category 

Indications & Dosing

  1. Cardiac Arrest: Asystole/pulseless arrest, pulseless VT/VF
    • 1 mg (IV/IO) every 3-5 minutes until return of spontaneous circulation (ROSC)
    • 2 to 2.5 mg (ET) every 3 to 5 minutes until IV/IO access established or ROSC
      • dilute in 5 to 10 mL NS or sterile water
    • Increases coronary perfusion pressure during cardiopulmonary resuscitation
  2. Bronchospasm – reversible airway disease due to Asthma or COPD 
  3. Anaphylaxis and other systemic allergic reactions; epinephrine is the agent of choice.
    • 0.2 to 0.5 mg IM every 5 to 15 minutes in the absence of clinical improvement
    • Start a dirty epi drip (see below)
  4. Cardiogenic shock, especially if a vasodilator is added.
  5. Bradycardia (symptomatic; unresponsive to atropine or pacing)
  6. Hypotension
    • 2-10 mcg per minute
    • To make a dirty epi drip (great article by Zlatan Coralic, PharmD on ALIEM)
      1. Take code-cart epinephrine. It doesn’t matter if it is 1:1,000 or 1:10,000!
      2. Inject full 1 mg into a 1,000 mL normal saline bag (final concentration 1 mcg/mL).
      3. Run wide open until the patient’s hemodynamics stabilize.

Administration

  •  IV (by central line)
  • Endotracheal tube (rapidly absorbed by tracheal mucosa)
  • Subcutaneous
  • Intramuscular

Concentration

  • 1:1,000 is equivalent to 1 mg/mL
  • 1:10,000 is equivalent to 100 mcg/mL 

Work’s Consulted 

  • Davis’s Canadian Drug Guide for Nurses
  • Marino’s ICU Book
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