Push-dose pressors.

Push-dose epinephrine

Mixing: 1 mL of 1:10,000 cardiac epi (100 mcg) into a 9 mL saline flush → 10 mL of 10 mcg/mL.

• Dose: 0.5–2 mL (5–20 mcg) IV every 2–5 min.
• Onset: ~1 min. Duration: 5–10 min.
• Best for: peri-arrest, post-ROSC, bradycardic hypotension, anaphylaxis awaiting IM effect.

Push-dose phenylephrine

Mixing: 1 mL of 10 mg/mL phenylephrine into 100 mL NS → 100 mcg/mL, then draw 1 mL into 9 mL flush → 10 mcg/mL.

• Dose: 50–200 mcg IV every 2–5 min.
• Pure alpha — no chronotropy. Ideal for tachycardic hypotension.
• Reflex bradycardia possible.

When to reach for it

• Peri-intubation hypotension.
• Post-ROSC hypotension while a drip is being spiked.
• Refractory anaphylactic shock after IM epi.
• Sepsis with critical hypotension awaiting central pressors.

Frequently asked

What is push-dose epi?

Diluted epinephrine (10 mcg/mL) given in small IV boluses (5–20 mcg every 2–5 min) as a temporizing pressor while a norepinephrine drip is being prepared.

How do you mix push-dose epi?

Take 1 mL of cardiac epi (0.1 mg/mL, i.e. 1:10,000) and inject it into a 9 mL saline flush. Total 10 mL = 10 mcg/mL. Label it clearly.

When is push-dose phenylephrine preferred?

In tachycardic patients where you want pure alpha (vasoconstriction) without beta effects. Common after intubation of septic patients or in post-ROSC hypotension with tachycardia.

What are the risks of push-dose pressors?

Dosing errors are the #1 danger. Confusing cardiac-arrest epi (1 mg) with push-dose (10 mcg) has killed patients. Always label the syringe and double-check the concentration.