Page 123 - 2026 SMOG

EPINEPHRINE 0.1mg/mL (ADRENALIN)
Class/Mechanism of Action
• Alpha and Beta Agonist B
Sympathomimetic. Stimulates both alpha- and beta-adrenergic receptors, causing relaxation of
the bronchial tree, cardiac stimulation, and dilation of skeletal muscle blood vessels.
Indications
• Labeled Indications
˚ Cardiac Arrest (VF, pulseless VT, asystole, PEA)
˚ Drip-Dose: Bradycardia (Symptomatic), Fluid-Resistant Shock
˚ Push-Dose: Refractory Anaphylaxis
Contraindications
• There are no absolute contraindications to the use of intranasal or injectable epinephrine
in a life-threatening situation.
˚ Hypersensitivity to sympathomimetic amines, glaucoma, and non-anaphylactic shock
Adverse Reactions/Precautions
• No applicable use in hemorrhagic shock unless fluid replacement therapy is maximized!
Maximize the use of blood products/crystalloids before considering use in hemorrhagic
shock.
• Chest Pain, tachycardia, arrhythmias, palpitations, sudden death
• Anxiety, cerebral hemorrhage, headache
• Vesicant: Avoid extravasation, as it will cause tissue damage/necrosis
• Use with caution in patients taking tricyclic antidepressants; effects of epinephrine may be
increased
• Pregnancy: Category C
• Lactation: Use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Asystole/Pulseless Arrest, Pulseless VT/VF Asystole, PEA, Pulseless VT/VF,
• IV: 1mg/10mL (0.1mg/mL) prefilled 10cc Unresponsive and Symptomatic Bradycardia
syringe q3–5min to ROSC. Follow each dose • IV/IO
with 20mL flush ˚ 0.01mg/kg (0.1mL/kg of 0.1mg/mL)
Drip-Dose: Bradycardia (Symptomatic), q3–5min (max SINGLE dose: 1mg)
Hypotension-Fluid Resistant Shock Severe Hypotension/Shock and Fluid
• IV Continuous Infusion Resistant
˚ Bradycardia: 2–10mcg/min titrate to • IV/IO Continuous Infusion
0.1–1mcg/kg/min titrated to desired
desired effect (HR >60, MAP >65)
˚ Hypotension/Shock: 2–10mcg/min ˚ effect
titrated to clinical end-point (BP, end-
organ perfusion)
Push-Dose: Refractory Anaphylaxis
• IV/IO: Utilize the 0.1mg/mL solution further
diluted in 10mL of NS
˚ 0.05–0.1mg administered over 1–10min.
May repeat once after 3min if the patient
remains unresponsive to the initial dose
2026 Standard Medical Operating Guidelines (SMOG) • 115