Medication guide
Epinephrine dosing.
The most confused drug in EMS. Right concentration, right route, right dose — every time.
Concentration cheat
- 1:1,000 = 1 mg/mL — IM for anaphylaxis, or dilute for infusion.
- 1:10,000 = 0.1 mg/mL — IV/IO push in cardiac arrest.
Dose table
| Indication | Adult | Pediatric | Route |
|---|---|---|---|
| Cardiac arrest | 1 mg (10 mL of 1:10,000) q3–5 min | 0.01 mg/kg (0.1 mL/kg of 1:10,000) q3–5 min; max 1 mg | IV/IO |
| Anaphylaxis | 0.3 mg (0.3 mL of 1:1,000) q5–15 min | 0.01 mg/kg of 1:1,000; max 0.3 mg | IM thigh |
| Severe asthma / bronchospasm | 0.3–0.5 mg of 1:1,000 | 0.01 mg/kg of 1:1,000; max 0.5 mg | IM |
| Symptomatic bradycardia (post-atropine) | 2–10 mcg/min infusion, titrated | 0.1–0.3 mcg/kg/min infusion | IV drip |
| Post-ROSC hypotension | 0.1–0.5 mcg/kg/min infusion | 0.1–1 mcg/kg/min infusion | IV drip |
| Croup (racemic epi) | — | 0.5 mL of 2.25% in 3 mL NS | Nebulized |
Auto-injectors
- EpiPen Jr / 0.15 mg — children ~15–30 kg (33–66 lb).
- EpiPen / 0.3 mg — adults and children ≥ 30 kg.
- Site: mid-outer thigh, through clothing OK. Hold 3 seconds. Massage site.
- Repeat every 5–15 minutes if symptoms persist and transport is prolonged.
Common errors to avoid
- Giving 1:1,000 IV push in arrest — causes severe hypertension and tachyarrhythmia.
- Giving 1:10,000 IM for anaphylaxis — underdoses a critical patient.
- Delaying epi in anaphylaxis to try antihistamines or steroids first. IM epi is first-line.
- Injecting into the deltoid instead of the vastus lateralis — slower absorption.
NREMT tip
When a stem describes hives + wheezing + hypotension, the answer is 0.3 mg IM epi 1:1,000, then IV fluids and O2. Don't overthink it.
FAQ
What is the adult epinephrine dose in cardiac arrest?
1 mg IV/IO of 1:10,000 (0.1 mg/mL) every 3–5 minutes during CPR.
What is the adult epinephrine dose in anaphylaxis?
0.3 mg IM of 1:1,000 (1 mg/mL) into the mid-outer thigh (vastus lateralis). Repeat every 5–15 minutes as needed.
What is the pediatric dose for anaphylaxis?
0.01 mg/kg IM of 1:1,000 up to 0.3 mg. Auto-injector: 0.15 mg for children roughly 15–30 kg, 0.3 mg for ≥30 kg.
How is epinephrine used for symptomatic bradycardia?
As an infusion at 2–10 mcg/min IV, titrated to heart rate and perfusion, after atropine and transcutaneous pacing per ACLS.
What's the difference between 1:1,000 and 1:10,000?
1:1,000 = 1 mg/mL (concentrated — IM for anaphylaxis). 1:10,000 = 0.1 mg/mL (dilute — IV/IO push in arrest). Wrong concentration = wrong route = harm.
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