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Epinephrine

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

OCEMS source summary · Updated 2026-09-16

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.

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 / routeDose & limits
Anaphylaxis — first dose0.5 mg IM into the lateral thigh using 1 mg/mL. Count a prearrival auto-injector as the first dose.
Persistent anaphylaxis after 5 minutesA second 0.5 mg IM dose OR 0.3 mg IV/IO using 0.1 mg/mL, under SO-M-015.
Cardiac arrest1 mg IV/IO using 0.1 mg/mL; I-15 lists repetition every 3 minutes in the arrest pathway.
Push-dose shock treatment — PR-23010 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 weightDose — IMVolume at 1 mg/mL
3 kg0.03 mg0.03 mL
4 kg0.04 mg0.04 mL
5 kg0.05 mg0.05 mL
6 kg0.06 mg0.06 mL
8 kg0.08 mg0.08 mL
10 kg0.1 mg0.1 mL
12 kg0.12 mg0.12 mL
15 kg0.15 mg0.15 mL
20 kg0.2 mg0.2 mL
25 kg0.25 mg0.25 mL
30 kg0.3 mg0.3 mL
35 kg0.35 mg0.35 mL
40 kg0.4 mg0.4 mL
45 kg0.45 mg0.45 mL
50 kg0.5 mg0.5 mL
60 kg0.5 mg0.5 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 weightDose — IV/IOVolume at 0.1 mg/mL
3 kg0.03 mg0.3 mL
4 kg0.04 mg0.4 mL
5 kg0.05 mg0.5 mL
6 kg0.06 mg0.6 mL
8 kg0.08 mg0.8 mL
10 kg0.1 mg1 mL
12 kg0.12 mg1.2 mL
15 kg0.15 mg1.5 mL
20 kg0.2 mg2 mL
25 kg0.25 mg2.5 mL
30 kg0.3 mg3 mL
35 kg0.3 mg3 mL
40 kg0.3 mg3 mL
45 kg0.3 mg3 mL
50 kg0.3 mg3 mL
60 kg0.3 mg3 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 weightDose — IV/IOVolume at 0.1 mg/mL
3 kg0.03 mg0.3 mL
4 kg0.04 mg0.4 mL
5 kg0.05 mg0.5 mL
6 kg0.06 mg0.6 mL
8 kg0.08 mg0.8 mL
10 kg0.1 mg1 mL
12 kg0.12 mg1.2 mL
15 kg0.15 mg1.5 mL
20 kg0.2 mg2 mL
25 kg0.25 mg2.5 mL
30 kg0.3 mg3 mL
35 kg0.35 mg3.5 mL
40 kg0.4 mg4 mL
45 kg0.45 mg4.5 mL
50 kg0.5 mg5 mL
60 kg0.6 mg6 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 weightDose — IV/IOVolume at 0.1 mg/mL
3 kg0.03 mg0.3 mL
4 kg0.04 mg0.4 mL
5 kg0.05 mg0.5 mL
6 kg0.06 mg0.6 mL
8 kg0.08 mg0.8 mL
10 kg0.1 mg1 mL
12 kg0.12 mg1.2 mL
15 kg0.15 mg1.5 mL
20 kg0.2 mg2 mL
25 kg0.25 mg2.5 mL
30 kg0.3 mg3 mL
35 kg0.35 mg3.5 mL
40 kg0.4 mg4 mL
45 kg0.45 mg4.5 mL
50 kg0.5 mg5 mL
60 kg0.6 mg6 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 weightDose — IV/IOVolume at 10 mcg/mL — diluted preparation
3 kg3 mcg0.3 mL
4 kg4 mcg0.4 mL
5 kg5 mcg0.5 mL
6 kg6 mcg0.6 mL
8 kg8 mcg0.8 mL
10 kg10 mcg1 mL
12 kg10 mcg1 mL
15 kg10 mcg1 mL
20 kg10 mcg1 mL
25 kg10 mcg1 mL
30 kg10 mcg1 mL
35 kg10 mcg1 mL
40 kg10 mcg1 mL
45 kg10 mcg1 mL
50 kg10 mcg1 mL
60 kg10 mcg1 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.

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