Vasopressors and inotropes
Epinephrine (Adrenalin) drip
Adrenalin
Watch the explainer
Dosing
| Start | 0.02–0.05 mcg/kg/min (1–4 mcg/min) |
|---|---|
| Titrate | 0.01–0.05 mcg/kg/min every 5 minutes |
| Maximum | Usually up to 0.5–1 mcg/kg/min (label allows up to 2 in septic shock) |
| Common bags | 4 mg in 250 mL (16 mcg/mL); 1 mg in 250 mL (4 mcg/mL); 8 mg in 250 mL (32 mcg/mL) |
| Dose units | mcg/kg/min, mcg/min |
Line and administration
- Central line preferred; peripheral is acceptable short term in a large proximal arm vein with frequent site checks
- Extravasation: stop, aspirate, phentolamine 5–10 mg in 10–15 mL saline injected into the area
Watch for
- Tachyarrhythmias and myocardial ischemia
- Raises lactate and glucose by itself
Epinephrine: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Toxins, Stings and Anaphylaxis in the FieldBites and stings on land: Large local reaction: Swelling peaks near 48 h, may fill a limb: Cold pack, oral antihistamine; often mistaken for cellulitis; no epinephrine
- Vasopressors and InotropesReceptors and effects: Epinephrine: β1, β2, α1: ↑↑ / ↑↑ / ↑ (↓ at low dose)
- ACLS Algorithms in BriefCardiac arrest: two tracks: First move: Shock, resume CPR at once: CPR and epinephrine ASAP
- Pediatric Assessment and EmergenciesCroup, epiglottitis, bronchiolitis: Croup, paramedic (NASEMSO): dexamethasone 0.6 mg/kg (max 16 mg); nebulized epinephrine 5 mg (5 mL of 1 mg/mL), may repeat in 20 min, per protocol
- Shock Types at a GlanceFindings and first treatments: Anaphylactic: Hives, angioedema, wheeze or stridor: IM epinephrine first; IV fluids; epinephrine infusion if refractory
- Newborn Care and ResuscitationCompressions, epinephrine and volume: HR below 60 after 60 s of compressions: epinephrine every 3 to 5 min
Practice Toxins, Stings and Anaphylaxis in the Field questions free62 exam-style questions with rationales on the topic where epinephrine comes up most. No account or download needed.
Other vasopressors and inotropes
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.