ACLS and Epinephrine | ACLS-Algorithms.com

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    • ACLS says

      Epinephrine may be continued throughout the code until the patient is pronounced deceased. Epinephrine is given every 3 to 5 minutes. Kind regards, Jeff

  1. Sophie says

    I understand that it’s not recommended to dilute Epinephrine with D5W or DNS as it’s incompatible . Epinephrine also induces hyperglycemia… Can you clarify..?

    • ACLS says

      The typical solution that epinephrine is diluted with is normal saline. For the purposes of ACLS hyperglycemia would not be a consideration with regard to the administration of Epi. I’m not sure what else you would like me to clarify. If there is something further that you’re wondering about please rephrase the question so that I can better understand what you’re asking.

      Kind regards,
      Jeff

      • ACLS says

        The maximum dose for epinephrine in the cardiac arrest algorithm is 1 mg.

        I have never seen a higher dose recommended.

        Kind regards,
        Jeff

  2. Jill says

    In a skilled nursing home setting, do you need to have special certification to administer epi during a code? I see that it is not recommended in every code situation so how do you qualify to make that call.
    Thank you,

    • ACLS says

      You would need to be a registered nurse and he would most likely have procedures and protocols that were approved by your facility.

      If these medications are available to you in a crash cart you need to make sure that you are authorized by you were facility to administer in emergencies.

      Kind regards,
      Jeff

  3. Emmanuel Rama says

    Good day!

    I just wanna ask, when can we give the 1st dose of epinephrine? is there any specifications like after the 1st cycle of cpr? 2nd cycle, 3rd cycle, etc.

    • ACLS says

      For the left branch of the cardiac arrest algorithm when treating ventricular fibrillation and pulseless ventricular tachycardia, epinephrine is to be given After the second shock during CPR.

      For the right branch of the cardiac arrest algorithm when treating pulseless electrical activity or asystole, Epinephrine is given as soon as intervenous access is available

      Kind regards,
      Jeff

  4. Aiman says

    If the patient is on Epinephrine drip IV and has cardiac arrest that require boluse of epinephrine , what should we do with the drip. Continue the same? increase the rate? Or stop during the ode and epinephrine boluses?

    • ACLS says

      The amount of epinephrine that is infusing in the epinephrine drip is extremely small. The drip may be stopped or the drip may be left infusing. It will not change The outcome and will not affect the epinephrine boluses that are being given.

      Kind regards,
      Jeff

      • Marielle says

        Hi, I have a question. During a code, in giving IV epi, is it necessary to dilute it with NS or is it okay to just give the drug as is? (Assuming an IV line has been established already)

        Thanks.

      • ACLS says

        1 mg of Epinephrine should always be diluted in 10 mL of normal saline. Many crash carts will have this already prepared in pre-diluted vials. However, some crash carts have a concentrated solution of 1 mg in 1 mL. In this case, you would want to dilute with an additional 9 mL of NS.

        Kind regards,
        Jeff

  5. Johny says

    I’m sorry for the question but I just need to clarify that for cardiac arrest, we need to administer 10ml of Epinephrine every 3-5 minutes? Since that equates to 1mg of Epi? Thank you so much!

      • Cherry says

        hi! what if the available stock for epinephrine is 1mg/ml ampule. Do we still need to dilute in nss to complete 10ml? why? thank you.

      • ACLS says

        Yes, it does need to be diluted with normal Saline 10 mL to achieve a 1mg/10ml (1:10000) dilution.

        1mg/ml (1:1000) is highly concentrated and if given IV push bolus, this can lead to potent vasoconstriction and possible cardiac ischemia.

        Kind regards, Jeff

  6. R J Ramamurthi says

    Single most important drug for effective resuscitation – why can’t we agree on ‘Epinephrine’ as a universal name instead of ‘adrenaline’; understand lots of countries still use the name ‘adrenaline’, but wouldn’t it be safer to agree on ONE name to avoid confusion?

  7. Pornthep Wong says

    As recommended by AHA, 20ml of fluid should be flushed after each dose of epinephrine iv via peripheral vein.

  8. Alicia says

    Can you give epinephrine IV push through a peripheral vein? Or does it have to be through a central line or IO?

    • ACLS says

      Epinephrine can be given IV push through a peripheral IV. All of the medications that are used in basic ACLS can be given through a peripheral IV. Kind regards, Jeff

  9. Dr karam says

    What is the dose of epinephrine through the et tube for adult or pediatric?
    How it should be given ? Diluted or not

    • ACLS says

      Adult:
      Endotracheal Tube: 2-2.5mg epinephrine is diluted in 10cc NS and given directly into the ET tube.

      Pediatric:
      The recommended tracheal dose of epinephrine during pediatric resuscitation is approximately 10 times the dose given via IV. This would be 0.1 mg/kg diluted in 1-5 ml of NS.

      Kind regards, Jeff

    • ACLS says

      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). So this is not weight based.

      IV infusion for post-cardiac arrest hypotension: The dosing is 0.1-0.5 mcg/kg/min (for example a 70kg adult: 7-35 mcg/min would be given). So for a 50 kg patient this would be (0.1x 50/min – 0.5 x 50/min) which works out to 5-25 mcg/min.

      Hope that makes sense.

      Kind regards,
      Jeff

  10. Jaber says

    In cpr when i give 4 mg adrinalin in 4 times
    Can i contenu cpr and give more adrinalin or 4 mg is maximum

    • ACLS says

      There is no limit on the amount of adrenaline (epinephrine) that can be given. You just give 1 mg every 3-5 minutes for the duration of the code.

      Kind regards,
      Jeff

    • ACLS says

      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).

      Kind regards,
      Jeff

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