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Epinephrine

Updated: Dec 3, 2021



Epinephrine or Epi, also known in most parts of the world as Adrenaline, is probably the most widely known and most used emergency medication.


Epinephrine is a non-selective Adrenergic agonist or receptor activator and works on all major adrenergic receptors:

  • Alpha 1 works mainly on our smooth muscle contraction in blood vessels providing vasoconstriction. Vasoconstriction increases Cerebral and Coronary Blood flow. Epinephrine does this by increasing mean Arterial pressure and Aortic Diastolic pressure, which improves perfusion pressure to the Brain and Heart.

  • Beta 1 impacts our heart, causing increased Inotropy and chronotropy, causing an increase in the Heart Rate.

  • Beta 2 helps with smooth muscle relaxation in the airways.


The indications of Epinephrine includes:

  • Cardiac Arrest Management,

  • Symptomatic Bradycardia,

  • Severe Hypotension,

  • Post Resuscitation Care

  • Anaphylaxis


Adult Dosages:


For Adult Cardiac arrest we administer 1 mg of the 0.1 mg/mL solution or 1: 10 000. We can repeat the dose every 3-5 minutes during resuscitation, but for educational efficiency can give every 4 minutes as a midrange. Each dose should be followed with a 20 mL flush and then elevate the arm for 10-20 seconds.


For the Endotracheal route, we will use 2-2.5mg diluted in 10 mL Normal Saline, as the uptake of Epinephrine down the ET tube is not the most reliable.


Higher doses up to 0.2 mg/kg may be used for specific indications like beta-blocker or calcium channel blocker overdose.


For Profound Bradycardia or Hypotension, we can start an infusion at 2-10 mcg/min and titrate against the effect.


For a continuous infusion, the Initial rate is 0.1-0.5 mcg/kg per minute. This means for a 70-kg patient; we will give 7.35 mcg/min. Always titrate the dose against the effect.

Pediatric Dosages:


For Pediatric Cardiac Arrest, the IV/IO dose: 0.01 mg/kg or 0.1 mL/kg of the 0.1 mg/mL concentration. Administer every 3-5 minutes during arrest not to exceed the maximum single dose of 1 mg.


The endotracheal doses are 0.1 mg/kg or 0.1 mL/kg of the 1 mg/mL concentration. Administer every 3-5 minutes of the arrest until IV/IO access is achieved.


For Symptomatic Bradycardia the IV/O doses is 0.01 mg/kg or 0.1 mL/kg of the 0.1 mg/mL concentration.


For continuous IV infusions, the typical dose is 0.1-1 mcg/kg per minute.


For Anaphylaxis or Severe Status Asthmaticus, we can administer an IM dose of 0.01 mg/kg or 0.1 mL/kg of the 1 mg/mL concentration. Maximum single dose: 0.3 mg Repeat as needed.


Neonatal Dosages:


For Neonatal Resuscitation, we will use the 0.1mg/ml concentration of 1: 10 000:


For the IV dose, we will use 0.1- 0.3ml/kg as per the American Academy of Pediatrics but can use 0.2ml/kg for educational efficiency. We will use 0.5-1ml/kg for the ET dose but can use 1ml/kg for educational efficiency.



Disclaimer: This video is for educational purposes only and is not intended as medical advice. While we strive for 100% accuracy, errors may occur, and medications or protocols may change over time.

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