View source for 5-9 PUSH DOSE EPINEPHRINE (PARAMEDIC ONLY)

'''MECHANISM OF ACTION:'''  Stimulates both Alpha– and Beta– Adrenergic receptors; causing bronchodilation, cardiac stimulation, and peripheral vasoconstriction.

'''INDICATIONS:'''

# Persistent hypotension with symptoms of hypo-perfusion, not responsive to IV fluids. 
# Severe anaphylaxis or asthma.

'''CONTRAINDICATIONS:'''

# None during cardiac arrest profound anaphylaxis or profound hypotension

'''PRECAUTIONS:'''

# May precipitate with sodium bicarbonate if tubing is not flushed between drugs.

'''ADVERSE REACTIONS/SIDE EFFECTS:'''

# Nervousness, restlessness, and tremors
# Headache and HTN
# Arrhythmias and angina
# May induce or exacerbate ventricular ectopy, especially in patients receiving digitalis.

{| class="wikitable"
|'''Paramedic'''
|}
There are 2 options for administering epinephrine for cardiopulmonary support:

# Epinephrine infusion.
# Push Dose Epinephrine.


'''Epinephrine infusion.'''  ''To prepare:''

# Take a 1L bag of NS and waste 750mL, so that you are left with 250ml of NS.
# Mix 2mg of '''Epi 1:1,000''' in 250mL of NS using a 60 drop micro set.
## This concentration is '''[8mcg/mL.]'''
## Administer '''2-10mcg/min''' '''IV/IO''' to maintain cardiopulmonary support.
### Titrate to maintain SBP > 90mmHg and/or adequate respiratory status.

'''Push Dose Epinephrine.'''  ''To prepare:''

# Take a 10mL NS flush and waste 1mL of NS, so that you are left with 9mL.
# With this syringe of 9mL of NS, draw up 1mL of '''Epi 1:10,000''' from the prefilled syringe.
## '''You now have 10mL of Epi with a concentration of [10mcg/mL.]'''
#  Administer '''0.5 – 2mL IV/IO''' every 2-5 minutes (5-20mcg) to maintain cardiopulmonary support.
## Titrate to maintain SBP > 90mmHg and/or adequate respiratory status.
# Onset:  1 minute
# Duration: 5-10 minutes.


'''PEDIATRIC CONSIDERATIONS:'''

# For Cardiac Arrest:
## Refer to the weight-based resuscitation tape and administer one dose of 0.01 mg/kg IV/IO push every 3-5 minutes as indicated.
# For Cardiopulmonary instability: (anaphylaxis, severe shock, severe asthma) with concern for imminent respiratory or cardiac arrest:
## Administer Epi Infusion or Push Dose Epinephrine 0.1-0.5 mcg/kg/min titrated to maintain SBP > 90mmHg.
## Administration of “Push-Dose Epi” in quantities of < 0.5mLfor a single dose is likely to be difficult.  Thus administration of 0.5mL as a minimum dose is reasonable.

'''SPECIAL NOTES:'''

'''1:10,000''' is the highest epinephrine concentration appropriate for direct intravascular administration.