ACLS and Epinephrine | ACLS-Algorithms.com

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    • ACLS says

      Yes. That is correct. The epinephrine concentration used for endotracheal administration in pediatrics is typically 1:1000, which corresponds to 1 mg/mL.

      Kind regards,
      Jeff

  1. AHMED says

    Hi
    If we have vial of 1 mg in one ml adrenaline with no strength mentioned then WHAT does it mean.? Is it 1:1000.? And if yes then we have it dilute it in 9 ml normal saline to make it 1:10000 before giving in CPR.?

    • ACLS says

      1 mg per ML is 1:1,000 concentration strength. Yes, you would dilute this with 9 ml of NS to make it 1:10,000 (0.1 mg/ml)

      Kind regards,
      Jeff

  2. kamin says

    Hi , i would like to ask can adrenaline be given via im route for cardiac arrest case? in a situation in which difficult
    to gain iv access and the difficult intubation patient while preparing for other measure

    • ACLS says

      No, epinephrine is typically administered intravenously (IV) during cardiac arrest to rapidly increase the heart’s pumping strength and stimulate blood flow. Intramuscular administration is not recommended for cardiac arrest situations, as it may not be as effective in delivering the medication quickly to the bloodstream.
      Kind regards, Jeff

    • ACLS says

      The dilution in 9 mL of normal saline is done improve the delivery and distribution of the medication, a larger volume of fluid is often used to help push the medication into the bloodstream and increase its overall effectiveness.

      Kind regards,
      Jeff

      • Ronald Quah says

        Hi ACLS. Is there any study or clinical study to your answer. Because as I understand, during a resus, the faster we give adrenaline, the quicker the effect. It would be a waste of time to further dilute the adrenaline than to just immediately administer it immediately without dilute.

      • ACLS says

        Concentrated epinephrine that is not diluted prior to injection can worsen ischemia. When a medication like epinephrine is concentrated, the pharmacological effects are much stronger. When epinephrine is diluted prior to injection it will result in the positive vasoactive effect without the increased risk of worsening ischemia.
        Kind regards, Jeff

    • ACLS says

      This is not clarified within the AHA guidelines. I have seen it done either way. Some people stop the drip and only use the Epi pushes and some people leave the epi drip going and still use the Epi pushes.

      Kind regards,
      Jeff

    • ACLS says

      The maximum single dose that can be given during a code is 1 mg. There are no standards that call for anything greater than 1 mg IV push every 3 to 5 minutes.

      Kind regards,
      Jeff

  3. Lauren says

    Hi Jeff,

    Should epi being given during a code be given rapid IV push? I have seen ACLS guidelines specifically mention giving Amiodarone rapidly, but I have not seen any specifics mentioned for epi. Thanks so much in advance.

  4. Cecilia says

    Thank you for taking questions.
    Is the dosing of 2-10 mcg/min for the epi infusion in the brady algorithm and in post cardiac care algorithm using the epinephrine concentration of 1:10,000 or 1:1000? Thank you again.

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