Epinephrine: Anaphylaxis & Arrest

Why This Is Hard

Epinephrine is one drug label with multiple emergency personalities. Confusing anaphylaxis IM dosing with cardiac arrest IV concentrations is a classic, deadly med error theme. Your job is indication → concentration → route → protocol dose → monitor.

Two Big Contexts (Education)

Anaphylaxis

• Usually IM in the mid-outer thigh early.
• Concentration and dose per protocol/autoinjector training.
• May redose per protocol if refractory.

Cardiac arrest

• IV/IO pathway in ACLS-style frameworks on a timed cycle — follow your protocol exactly.
• Different preparation and concentration habits than IM anaphylaxis in many systems.

Some systems also use push-dose or infusion epi for shock — only if trained and authorized (see push-dose lesson).

Safety Habits

• Say out loud: indication, concentration, route, volume.
• Never “just grab epi” without reading the vial/label.
• Partner check on concentration for IV pushes when available.
• Know your packaging (1 mg/mL vs 0.1 mg/mL teaching examples — verify your stock).

Key Points for Paramedics

• Anaphylaxis: do not delay IM epi for IV access.
• Arrest: high-quality CPR remains the backbone; epi timing follows protocol.
• This site does not publish operational doses — protocol is authority.

Field Pitfalls

• Giving arrest-style IV concentration IM or the reverse without checking labels.
• Using epi for pure hypovolemic trauma shock without protocol indication.
• Skipping documentation of time and route.

Practice

With a training vial set, practice reading labels and stating route for two scenarios: anaphylaxis vs arrest. Related: Anaphylaxis recognition, Dosing safety.

Sources & Further Study

• Your formulary, anaphylaxis, and cardiac arrest protocols.