Quick Epinephrine Drip

November 26th, 2009
by reuben in resus

I take a milligram of crash cart epi, just because it’s the most available and already in a syringe, and put it into a 1 liter bag of NS. Attach to IV and titrate to effect using the knob. If the patient has a full or mostly-full bag of IVNS already hanging, I’ll just grab the crash cart epi and dump it in. Nothing could be faster.

1 mg epinephrine in 1000cc NS = 1 microgram/cc

20 drops/cc


2 drops per second = 6 mcg/min

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Responses to “Quick Epinephrine Drip”

  1. If extravasation develops [of an adrenergic agent], infiltrate 5 to 10 mg of phentolamine diluted in 10 to 15 mL of saline into the site of extravasation as soon as possible to prevent tissue death and sloughing. [from 2010 ACLS guidelines]

  2. Intramuscular epinephrine is dosed at 0.3 to 0.5 mg of 1:1000 (1 mg in 1 mL) solution, which is 0.3 to 0.5 mL. This may be repeated several minutes later as needed. Once the second intramuscular dose of epinephrine is given, preparations are made to give intravenous epinephrine. Small boluses of either “crash cart epi,” which is 1:10,000 concentration (1 mg in 10 mL) or other dilute epinephrine solutions are acceptable, however we recommend the immediate initiation of a continuous epinephrine infusion in patients requiring more than 2 intramuscular treatments. A variety of techniques for preparing an epinephrine drip are described; one easy approach is to add 1 mg of epinephrine (from either the 1:1000 vial or 1:10,000 syringe) to a liter of normal saline, which results in a 1 mcg/mL solution. This may be formally infused using a pump at 2-10 mcg/min; 2 mcg/min is 120 mL/hour of this preparation. If there is a delay in setting up a pump, approximately 20 drops are equivalent to 1 mL, therefore the bag can be hung and manually titrated, starting at 1 drop per second, which is 3 mcg/min. [from anaphylaxis issue of Emergency Medicine Guidelines Update]

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