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:

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

CONTRAINDICATIONS:

1. None during cardiac arrest profound anaphylaxis or profound hypotension

PRECAUTIONS:

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

ADVERSE REACTIONS/SIDE EFFECTS:

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

Paramedic

There are 2 options for administering epinephrine for cardiopulmonary support:

1. Epinephrine infusion.
2. Push Dose Epinephrine.

Epinephrine infusion.  To prepare:

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

Push Dose Epinephrine.  To prepare:

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

PEDIATRIC CONSIDERATIONS:

1. For Cardiac Arrest:
   1. 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.
2. For Cardiopulmonary instability: (anaphylaxis, severe shock, severe asthma) with concern for imminent respiratory or cardiac arrest:
   1. Administer Epi Infusion or Push Dose Epinephrine 0.1-0.5 mcg/kg/min titrated to maintain SBP > 90mmHg.
   2. 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.