# Epinephrine

Anaphylaxis, cardiac arrest, and push-dose shock treatment: concentrations and age-specific rules.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/epinephrine/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- 1 mg/mL, 0.1 mg/mL, and 10 mcg/mL are different preparations. Never interchange their volumes.
- PR-230 excludes hypovolemic shock before fluid replacement, a perfusing non-shock state, and suspected stimulant intoxication. Pediatric PR-205 has corresponding exclusions and retains the base-order requirement.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [SO-M-015 — Allergic Reaction / Anaphylaxis](https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-M-15%20Allergic%20Rxn%204-2023.pdf)
- [SO-P-060 — Allergic Reaction / Anaphylaxis - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-P-60%20Allergic%20Rxn%204-2023.pdf)
- [SO-C-010 — Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic](https://www.ochealthinfo.com/sites/hca/files/2021-06/SO-C-10%20Cardopulmonary%20Arrest%20-%20AdultAdolescent%20Non-Traumatic%20%2810-1-2021%29%20-%20Revised.pdf)
- [SO-P-040 — Cardiopulmonary Arrest - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf)
- [PR-230 — Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2026-01/PR-230%20Push%20Dose%20Epi%201-2026.pdf)
- [PR-205 — Preparation and Dosing of Push Dose Epinephrine - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-10/PR-205%20Peds%20Push%20Dose%20Epi%209-2024.pdf)
- [B-045 — Epinephrine Auto Injector (BLS Optional Equipment)](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12436.pdf)
- [SO-P-045 — Bradycardia - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-45%20Bradycardia%20peds.pdf)

## Use in OCEMS

- Epinephrine has several OCEMS indications with different concentrations, routes, and authority. Select the indication before selecting a syringe.
- Bronchospasm that does not improve with albuterol may prompt a base-order request for IM epinephrine; do not assume the anaphylaxis standing order applies to isolated asthma.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Anaphylaxis — first dose | 0.5 mg IM into the lateral thigh using 1 mg/mL. Count a prearrival auto-injector as the first dose. |
| Persistent anaphylaxis after 5 minutes | A second 0.5 mg IM dose OR 0.3 mg IV/IO using 0.1 mg/mL, under SO-M-015. |
| Cardiac arrest | 1 mg IV/IO using 0.1 mg/mL; I-15 lists repetition every 3 minutes in the arrest pathway. |
| Push-dose shock treatment — PR-230 | 10 mcg (1 mL of 10 mcg/mL) IV/IO every 3 minutes, titrated to systolic BP above 90. PR-230 effective April 2026 states that base contact/order is no longer required for this procedure. |

## Pediatric

- Anaphylaxis: 0.01 mg/kg IM of 1 mg/mL, maximum 0.5 mg. If qualifying symptoms persist after about 5 minutes, repeat IM OR give 0.01 mg/kg IV/IO of 0.1 mg/mL, maximum 0.3 mg, under SO-P-060.
- Cardiac arrest: 0.01 mg/kg IV/IO of 0.1 mg/mL. SO-P-040 uses about 3-minute intervals for VF/pulseless VT and 3–5 minutes for PEA/asystole. Base contact is required.
- Push dose: PR-205 still REQUIRES a base order. Give 1 mcg/kg (0.1 mL/kg of 10 mcg/mL), maximum 10 mcg per dose, every 3 minutes as ordered. Target systolic BP above 70 + 2 × age through age 9; from age 10, above 90.
- BLS auto-injector procedure B-045 lists 0.3 mg for adults and 0.15 mg for children younger than 12, with an ALS response required. This is a separate product/scope pathway.

## Pediatric weight table — Anaphylaxis — IM

- Source: SO-P-060. Dose rule: 0.01 mg/kg; route: IM.
- 0.01 mg/kg IM using 1 mg/mL; maximum 0.5 mg. For qualifying symptoms persisting after about 5 minutes, the source allows a repeat IM dose OR the separate IV/IO regimen.
- Count an epinephrine auto-injector given before EMS arrival as the first IM dose in the anaphylaxis pathway. The isolated facial/cervical angioedema branch holds its one-time IM dose if an auto-injector was already given.
- Base contact is required for the pediatric anaphylaxis pathway. Do not use this 1 mg/mL volume for IV administration.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IM | Volume at 1 mg/mL |
| --- | --- | --- |
| 3 kg | 0.03 mg | 0.03 mL |
| 4 kg | 0.04 mg | 0.04 mL |
| 5 kg | 0.05 mg | 0.05 mL |
| 6 kg | 0.06 mg | 0.06 mL |
| 8 kg | 0.08 mg | 0.08 mL |
| 10 kg | 0.1 mg | 0.1 mL |
| 12 kg | 0.12 mg | 0.12 mL |
| 15 kg | 0.15 mg | 0.15 mL |
| 20 kg | 0.2 mg | 0.2 mL |
| 25 kg | 0.25 mg | 0.25 mL |
| 30 kg | 0.3 mg | 0.3 mL |
| 35 kg | 0.35 mg | 0.35 mL |
| 40 kg | 0.4 mg | 0.4 mL |
| 45 kg | 0.45 mg | 0.45 mL |
| 50 kg | 0.5 mg | 0.5 mL |
| 60 kg | 0.5 mg | 0.5 mL |

## Pediatric weight table — Persistent anaphylaxis — IV/IO

- Source: SO-P-060. Dose rule: 0.01 mg/kg; route: IV/IO.
- After the source-specified IM treatment and reassessment: 0.01 mg/kg IV/IO using 0.1 mg/mL; maximum 0.3 mg. This is an alternative to repeating IM when qualifying symptoms persist.
- Base contact is required. The IV/IO maximum differs from the IM maximum; confirm the concentration and route before administration.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO | Volume at 0.1 mg/mL |
| --- | --- | --- |
| 3 kg | 0.03 mg | 0.3 mL |
| 4 kg | 0.04 mg | 0.4 mL |
| 5 kg | 0.05 mg | 0.5 mL |
| 6 kg | 0.06 mg | 0.6 mL |
| 8 kg | 0.08 mg | 0.8 mL |
| 10 kg | 0.1 mg | 1 mL |
| 12 kg | 0.12 mg | 1.2 mL |
| 15 kg | 0.15 mg | 1.5 mL |
| 20 kg | 0.2 mg | 2 mL |
| 25 kg | 0.25 mg | 2.5 mL |
| 30 kg | 0.3 mg | 3 mL |
| 35 kg | 0.3 mg | 3 mL |
| 40 kg | 0.3 mg | 3 mL |
| 45 kg | 0.3 mg | 3 mL |
| 50 kg | 0.3 mg | 3 mL |
| 60 kg | 0.3 mg | 3 mL |

## Pediatric weight table — Cardiac arrest

- Source: SO-P-040. Dose rule: 0.01 mg/kg; route: IV/IO.
- 0.01 mg/kg IV/IO using 0.1 mg/mL. Repeat approximately every 3 minutes for VF/pulseless VT or every 3–5 minutes for PEA/asystole under SO-P-040.
- Base contact is required. These arrest volumes are not the IM anaphylaxis or diluted push-dose volumes.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO | Volume at 0.1 mg/mL |
| --- | --- | --- |
| 3 kg | 0.03 mg | 0.3 mL |
| 4 kg | 0.04 mg | 0.4 mL |
| 5 kg | 0.05 mg | 0.5 mL |
| 6 kg | 0.06 mg | 0.6 mL |
| 8 kg | 0.08 mg | 0.8 mL |
| 10 kg | 0.1 mg | 1 mL |
| 12 kg | 0.12 mg | 1.2 mL |
| 15 kg | 0.15 mg | 1.5 mL |
| 20 kg | 0.2 mg | 2 mL |
| 25 kg | 0.25 mg | 2.5 mL |
| 30 kg | 0.3 mg | 3 mL |
| 35 kg | 0.35 mg | 3.5 mL |
| 40 kg | 0.4 mg | 4 mL |
| 45 kg | 0.45 mg | 4.5 mL |
| 50 kg | 0.5 mg | 5 mL |
| 60 kg | 0.6 mg | 6 mL |

## Pediatric weight table — Bradycardia with poor perfusion despite ventilation

- Source: SO-P-045. Dose rule: 0.01 mg/kg; route: IV/IO.
- After oxygenation/ventilation, heart rate below 60/min with continued poor perfusion triggers CPR and the pediatric bradycardia sequence. Epinephrine is 0.01 mg/kg IV/IO of 0.1 mg/mL; may repeat every 3–5 minutes.
- Base contact is required. This is a resuscitation dose, not the diluted pediatric push-dose regimen.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO | Volume at 0.1 mg/mL |
| --- | --- | --- |
| 3 kg | 0.03 mg | 0.3 mL |
| 4 kg | 0.04 mg | 0.4 mL |
| 5 kg | 0.05 mg | 0.5 mL |
| 6 kg | 0.06 mg | 0.6 mL |
| 8 kg | 0.08 mg | 0.8 mL |
| 10 kg | 0.1 mg | 1 mL |
| 12 kg | 0.12 mg | 1.2 mL |
| 15 kg | 0.15 mg | 1.5 mL |
| 20 kg | 0.2 mg | 2 mL |
| 25 kg | 0.25 mg | 2.5 mL |
| 30 kg | 0.3 mg | 3 mL |
| 35 kg | 0.35 mg | 3.5 mL |
| 40 kg | 0.4 mg | 4 mL |
| 45 kg | 0.45 mg | 4.5 mL |
| 50 kg | 0.5 mg | 5 mL |
| 60 kg | 0.6 mg | 6 mL |

## Pediatric weight table — Push dose — base order required

- Source: PR-205. Dose rule: 1 mcg/kg; route: IV/IO.
- 1 mcg/kg (0.1 mL/kg of 10 mcg/mL), maximum 10 mcg / 1 mL per dose. May repeat every 3 minutes under the base order.
- Base contact AND an order are required before giving pediatric push-dose epinephrine. For cardiogenic shock with pulmonary edema, contact base without a fluid bolus.
- PR-205 preparation: retain 1 mL of the 0.1 mg/mL cardiac preparation and add 9 mL normal saline; mix to make 10 mL at 10 mcg/mL. Independently verify the dilution.
- Target systolic BP above 70 + 2 × age in years through age 9; for age 10 and older, above 90.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO | Volume at 10 mcg/mL — diluted preparation |
| --- | --- | --- |
| 3 kg | 3 mcg | 0.3 mL |
| 4 kg | 4 mcg | 0.4 mL |
| 5 kg | 5 mcg | 0.5 mL |
| 6 kg | 6 mcg | 0.6 mL |
| 8 kg | 8 mcg | 0.8 mL |
| 10 kg | 10 mcg | 1 mL |
| 12 kg | 10 mcg | 1 mL |
| 15 kg | 10 mcg | 1 mL |
| 20 kg | 10 mcg | 1 mL |
| 25 kg | 10 mcg | 1 mL |
| 30 kg | 10 mcg | 1 mL |
| 35 kg | 10 mcg | 1 mL |
| 40 kg | 10 mcg | 1 mL |
| 45 kg | 10 mcg | 1 mL |
| 50 kg | 10 mcg | 1 mL |
| 60 kg | 10 mcg | 1 mL |

## Preparation & reassessment

- Push-dose preparation in PR-230/205: retain 1 mL from a 1 mg/10 mL cardiac epinephrine syringe, add 9 mL normal saline, and mix. The resulting 10 mL contains 10 mcg/mL.
- For pediatric cardiogenic shock with pulmonary edema, PR-205 directs base contact without a fluid bolus.
- Older adult condition orders may still mention a push-dose base order. The April 2026 PR-230 revision explicitly changes that requirement; other condition/destination contact requirements still apply.
- Continuously reassess rhythm, blood pressure, respiratory status, and perfusion; document concentration, dose, route, and response.