Epinephrine

Aliases: Adrenaline 

Indications: Cardiac arrest, Bradycardia, Allergic reaction or Anaphylaxis, Respiratory distress with presumed bronchospasm, Uncontrollable external hemorrhage 

Contraindications: None in the emergency setting 

Concentrations: 

Injection: 1 mg/10 mL (0.1 mg/mL or 100 mcg/mL)

Injection: 1 mg/mL (1 mg/mL or 1000 mcg/mL)

Infusion: 4 mcg/mL

Dosing

Adult:

Indication	Dose	Concentration	Route	Note
Cardiac Arrest	1 mg	0.1 mg/ml (1:10,000)	IV	Every 5 minutes. Max of 3 doses
-Push Dose Epinephrine  -Non-hemorrhagic hypotension  -Bradycardia	20 mcg	10 mcg/mL	IV	Titrate to MAP > 65 mmHg
-Push Dose Epinephrine  -Non-hemorrhagic hypotension  -Bradycardia	2-20mcg/min		Infusion	Titrate to MAP > 65 mmHg
-Anaphylaxis   -Respiratory failure from bronchospasm  -Angioedema	0.3 mg	1 mg/ml (1:1,000)	IM	May repeat every 5 minutes up to total 1.2 mg
-Anaphylaxis   -Respiratory failure from bronchospasm  -Angioedema	2 mg	1 mg/ml (1:1,000)	Nebulizer	2 mg (2 mL) mixed with 1 ml NS
-Anaphylaxis   -Respiratory failure from bronchospasm  -Angioedema	2-20 mcg/min		Infusion	Titrate to respiratory and circulatory effect
Uncontrollable external hemorrhage	1 mg	1 mg/ml (1:1,000)	Topical/Nebulizer	-Topical soaked in gauze or IN atomizer for epistaxis -Tonsil, mix 1 mL into 2.5 ml NS

Pediatric:

Indication	Dose	Concentration	Route	Note
Cardiac Arrest	0.01 mg/kg Max: 1 mg	0.1 mg/ml (1:10,000)	IV	Every 4 minutes.
-Push Dose Epinephrine  -Non-hemorrhagic hypotension  -Bradycardia	10 mcg	10 mcg/mL	IV	Repeat every minute PRN
-Push Dose Epinephrine  -Non-hemorrhagic hypotension  -Bradycardia	0.1-1 mcg/min		Infusion
-Anaphylaxis   -Respiratory failure from bronchospasm  -Angioedema	0.01 mg/kg Max: 0.3 mg	1 mg/ml (1:1,000)	IM
-Anaphylaxis   -Respiratory failure from bronchospasm  -Angioedema	0.1-10 mcg/min		Infusion	Give for anaphylactic shock
Severe Bronchospasm  Angioedema  Stridor/Barking/Croup  Bronchiolitis (< 2 y/o)	0.01 mg/kg Max: 0.3 mg	1 mg/ml (1:1,000)	IM/Nebulizer	Mix with 4 mL NS

Precautions: Harm of epinephrine is small when indicated even with history of CAD

Adverse/Side Effects: Palpitations, anxiety, tremulousness, headache, dizziness, nausea, vomiting, increased myocardial oxygen demand  

Class: Sympathetic Agonist. Epinephrine is a naturally occurring catecholamine. It is a potent alpha- and beta-adrenergic stimulant with more profound beta effects.  

Mechanism of Action: Epinephrine works directly on alpha- and beta-adrenergic receptors with effects of increased heart rate, cardiac contractile force, increased electrical activity in the myocardium, increased systemic vascular resistance, increased blood pressure, and increased automaticity. It also causes bronchodilation. 

Onset of Action	Peak Effect	Duration of Action
<1 minute	Few minutes	Varies