Page 134 - 2023 SMOG Digital

EPINEPHRINE Lactation? (Caution) Trade Name: EpiPen / EpiPen
1mg/mL (formerly 1:1000) Jr
Class / Mechanism of Action
Alpha & Beta Agonist
Sympathomimetic, stimulates both alpha and beta adrenergic receptors, causing relaxation of the
bronchial tree, cardiac stimulation (increasing myocardial oxygen consumption), and dilation of skeletal
muscle blood vessels
Indications
• Allergic Reactions, Anaphylaxis
• Asthma (Bronchoconstriction)
Contraindications
• Not for IV use, must first dilute into 10mL NS syringe for Cardiac/IV use
Adverse Reactions / Precautions
• No applicable use in hemorrhagic shock unless fluid replacement therapy maximized!
Maximize 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, will cause tissue damage/necrosis
• Use with caution in patients taking tricyclic antidepressants; effects of epinephrine may be increased
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Bronchodilator: Bronchodilator:
SubQ, IM: 1mg/mL SubQ: Infants and Children 1mg/mL
• 0.3-0.5mg q20min for 3 doses • 0.01mg/kg (0.01mL/kg) (maximum single
Nebulization: dose: 0.5mg) q20min for 3 doses
• Add 0.5mL to nebulizer and dilute with 3mL of Nebulization:
NS; administer over 15 minutes • Children <4 years: Croup: 0.05mL/kg
(maximum dose: 0.5mL); dilute in 3mL of NS.
Anaphylaxis / Hypersensitivity reaction Administer over 15 minutes; do not administer
(ALS,2020): more frequently than q2hr
IM: 1mg/mL • Children ≥4 years: Adult dosing
• 0.3-0.5mg 5-15min until clinical improvement
Anaphylaxis / Hypersensitivity reaction
(PALS,2020): Infants and Children
IV Infusion: IM:
• Initiate with an infusion at 5-15mcg/minute • 0.01mg/kg (0.01mL/kg of 1mg/mL solution)
(with crystalloid) (See infusion chart next page) (maximum single dose: 0.3mg) q5-15min
Acute Hemolytic reaction EpiPen Jr, Children <15kg:
IM: 1mg/mL • 0.15mg; if anaphylactic symptoms persist,
• 0.5mg IM in lateral thigh dose may be repeated in 5-15 minutes using
o Repeat q5-15min for moderate an additional EpiPen Jr
bronchospasm or facial/laryngeal EpiPen, Children ≥15 kg:
edema. • 0.3mg; if anaphylactic symptoms persist, dose
• Follow with Diphenhydramine 50mg IV Push may be repeated in 5-15 minutes using an
additional EpiPen

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