Epinephrine 1:1,000

Adult Dose:

• Allergic reaction: 0.3 mg - 0.5 mg SQ - standing order, single dose only
  
• Anaphylactic shock: 0.3 mg – 0.5 mg SQ, every 20 minutes up to 3 doses (including any given by autoinjector) - standing order
  
• Administer only one dose for bronchospasm unresponsive to nebulizers, CPAP, or magnesium sulfate

• Allergic reaction/anaphylactic shock: 0.01 mg/kg (max 0.3 mg per dose) - standing order, single dose only
  
• Bronchospasm unresponsive to inhaled beta-agonists: 0.01 mg/kg (max 0.3 mg per dose) SQ - BIOTEL AUTHORIZATION ONLY

Alpha effects produce peripheral vasoconstriction which:

• Increases coronary and cerebral perfusion
  
• Increases blood pressure in anaphylaxis
  

Beta₁ effects:

• Increases heart rate
  Improves force of ventricular contractions

Beta₂ effects produce bronchodilation

• Allergic reaction/anaphylactic shock
  
• Bronchospasm unresponsive to inhaled beta-agonists

Allergic reaction/anaphylactic shock/refractory bronchospasm:

• Monitor ECG closely
  
• Patients on beta blockers may need glucagon or higher doses of epinephrine

Anaphylaxis:

• Tachycardia
  
• Ventricular arrhythmias
  
• Headache
  
• Flushing
  
• Nausea/vomiting
  
• Chest pain

• Allergic reaction: None
  
• Refractory bronchospasm: Heart disease, History of AMI, Age > 45 years, Arrhythmia, Labor