Epinephrine is the primary drug used in the cardiac arrest algorithm. It is used for its potent vasoconstrictive effects and also for its ability to increase cardiac output. Epinephrine is considered a vasopressor.
Indications for ACLS
- Vasoconstriction effects: epinephrine binds directly to alpha-1 adrenergic receptors of the blood vessels (arteries and veins) causing direct vasoconstriction, thus, improving perfusion pressure to the brain and heart.
- Cardiac Output: epinephrine also binds to beta-1-adrenergic receptors of the heart. This indirectly improves cardiac output by:
- Increasing heart rate
- Increasing heart muscle contractility
- Increasing conductivity through the AV node
- Intravenous Push/IO: 1mg epinephrine IV is given every 3-5 minutes.
- IV infusion for bradycardia: 1mg epinephrine is mixed with 500ml of NS or D5W. The infusion should run at 2-10 micrograms/min (titrated to effect).
- IV infusion for post-cardiac arrest hypotension: The dosing is 2 to 10 micrograms/min.
- Endotracheal Tube: 2-2.5mg epinephrine is diluted in 10cc NS and given directly into the ET tube.
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Epinephrine is used in the cardiac arrest algorithm as a direct IV push and also in the bradycardia algorithm as an infusion. See the respective algorithm pages for more information about their use in each.
Routes
During ACLS, epinephrine can be given 3 ways: intravenous; intraosseous, and endotracheal tube
Dosing
Epinephrine should be used with caution in patients suffering from myocardial infarction since epinephrine increases heart rate and raises blood pressure. This increase in HR and BP can increase myocardial oxygen demand and worsen ischemia.
Note: There is no clinical evidence that the use of epinephrine, when used during cardiac arrest, increases rates of survival to discharge from the hospital. However, studies have shown that epinephrine and vasopressin improve rates of ROSC (return of spontaneous circulation).
Return to ACLS Drugs Main Page.
Acey says
When is the medication usually given? During what rhythm of the ECG reading?
Jeff with admin. says
Epinephrine is given as an IV/IO push in the pulseless arrest algorithm and it is given as an drip in the bradycardia algorithm.
If you go through the megacode scenarios they will teach you when to properly give epinephrine during a code.
Kind regards, Jeff
Judy Taylor says
Hi Jeff
1mg epinephrine is mixed with 500ml of NS or D5W.
Which solution? 1:1000 or 1:10000?
Jeff with admin. says
Epinephrine vials are also labeled by concentration of a ratio of medication per mL.
CONCENTRATION
1:1,000=1mg/ml
1:10,000=0.1mg/ml
So if you use 1:1000 you would mix 1mg with the 500 ml of NS or D5W.
– 1:1000 is much more concentrated
And if you use 1:10,000 you would mix 10ml with the 500 ml of NS or D5W.
Lenny says
What is the “preferred” method of access for administering epi during an arrest??
Jeff with admin. says
The preferred method is IV.
Andronica says
don’t forget to elevate the extremity after pushing the medication
monica Tolliver student nurse says
afterpushing epinephrine is the purpose to elevate the extremity is for perfusion to the Heart?
Jeff with admin. says
Yes this is correct. It supposedly helps to get the medication in the venous system back to the heart in a more timely manner. Kind regards, Jeff
Christine says
What drug can be used in place of epinephrine during ACLS? Vasopressin?
Jeff with admin. says
That is correct.
Christine says
Thank you.
Kimberly Halterman says
Can all ACLS be “slammed” or are they all pushed over 2 min like everything else?
Jeff with admin. says
The most common ACLS drugs (the ones in the algorithm diagrams) are given rapid IV push. That means give them as fast as fast as possible Don’t forget to follow with 20ml of NS as fast as possible. The idea is to get the bolus in as undiluted as possible so that it will hit the heart quickly. –Jeff
Amabelle says
Except for Amiodarone, we have to give a bolus of D5W, NS will cause the medication to precipitate.
Jeff with admin. says
Yes, amiodarone is diluted with D5W not NS. Thank you for that. —Jeff
Bobby Hemker says
Appreciate the fact that you posted the med boxes here for an added visual aide to recall drugs and doses! Seems like you thought of everything! Thank you for having this site! It takes the fear out of ACLS!
James Bergen says
Epi is given 1 mg every IV 3-5 min. Saline flush before and after? What is the max dose?
Jeff with admin. says
There really is no max dose. Epi is metabolized farily rapidly in the body.
Denise Earles says
1:1000 is for SQ/IM since the volume is less. If you had too this one is for ET administration, but ET administration is not recomended.
You should always use 1:10,000 for IV/IO.
Earl Winzinowich says
We are dealing with shortages of epi 1:10,000. Why should the 1:10,000 always be used for IV/IO? We are considering diluting 1:1000 to make a 1:10:000 solution. This may result in errors at the bedside during a code.
Razgriz says
1mg epinephrine q 3-5 minutes in circumstances following acls protocols; is the use of 1:1000 concentration possible or is it too high a conc for too high a dose?
Jeff with admin. says
If you need to use smaller amount of fluid 1:1000 would be a better choice. The use of 1:1000 concentration would be acceptable.
Meray Elahdab says
I love your site…. easy and simple for a review! Thank you for allowing us and giving us those information for free 🙂
Missyme says
I am so grateful for this!!!
cliff williams says
What the differance between 1:10,000 and 1:1000 when it come down to giving these specific doses.
Chris with admin. says
Hi Cliff,
1:1000= 1mg/1ml
1:10000= 0.1mg/1ml
If you are needing to use small volumes, 1:1000 is better. Say you needed to give 0.3mg of epi; you would the only need to give 0.3ml. Kind Regards, Chris
Genevieve semet says
Easier to understand. Thanks.
kay collins says
very helpful preparing for acls class