FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Anaphylaxis/allergic reaction beyond simple rash, cardiac arrest, or the specified shock/post-ROSC pathway. Indication determines route, concentration and authority.
Contraindications & local exclusions
- The cited injectable epinephrine label lists no absolute contraindications. It does not establish authorization for all routes, concentrations or indications on this page.
Precautions
- Monitor for hypertension, arrhythmias and ischemia; IV extravasation can injure tissue. Distinguish 1 mg/mL, 0.1 mg/mL and push-dose preparations. Auto-injector assistance/use and drawn-up ALS medication have different scope requirements.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
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 / 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
- SO-P-060 pediatric dose: 0.01 mg/kg IM.
- Give 0.01 mg/kg IM using 1 mg/mL; maximum 0.5 mg. If qualifying symptoms persist after about 5 minutes, repeat the IM dose OR use 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
- SO-P-060 pediatric dose: 0.01 mg/kg IV/IO.
- After the initial IM treatment and reassessment, give 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
- SO-P-040 pediatric dose: 0.01 mg/kg 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
- SO-P-045 pediatric dose: 0.01 mg/kg 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
- PR-205 pediatric dose: 1 mcg/kg 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.
VISUAL FIELD REFERENCE
Three concentrations. Confirm the indication first.
Adult & pediatric guidance · ALS
Adult examples only; this is not every indication. Use the pediatric and persistent-anaphylaxis sections for their distinct regimens.
- 1 mg/mL
IM anaphylaxis preparation
0.5 mg IM into the lateral thigh using 1 mg/mL. Count a prearrival auto-injector as the first dose.
- 0.1 mg/mL
IV / IO cardiac-arrest preparation
1 mg IV/IO using 0.1 mg/mL; I-15 lists repetition every 3 minutes in the arrest pathway.
- 10 mcg/mL
Adult push-dose preparation
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.
- 1 mg/mL, 0.1 mg/mL, and 10 mcg/mL are different preparations. Never interchange their volumes.
- 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.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. I-15 · I-20 · SO-M-015 · SO-P-060 · SO-C-010 · SO-P-040 · PR-230 · PR-205 · B-045 · SO-P-045
UNDERSTAND THE CARE
Why “epinephrine” is not a complete medication order
The name alone does not identify the preparation. The local guides use different concentrations, dose units, routes and administration sequences for anaphylaxis, arrest and push-dose support. Read back the indication and intended route with the concentration, dose and volume before delivery.
Applying the guidance
For push-dose use, preparation and authorization are separate checks. The newer adult procedure removes its base-order requirement while pediatric PR-205 retains one; neither statement replaces other condition-specific contact requirements. For anaphylaxis, count prearrival autoinjectors and apply the correct repeat criteria. For arrest, maintain the rhythm sequence and cumulative record.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Indication
- Anaphylaxis, arrest or eligible shock.
- Preparation
- Confirm concentration and mg/mcg units.
- Authority
- Adult and pediatric requirements differ.
- Delivery and response
- Route, volume, timing and reassessment.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- SO-M-015 — Allergic Reaction / Anaphylaxis
- SO-P-060 — Allergic Reaction / Anaphylaxis - Pediatric
- SO-C-010 — Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic
- SO-P-040 — Cardiopulmonary Arrest - Pediatric
- PR-230 — Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent
- PR-205 — Preparation and Dosing of Push Dose Epinephrine - Pediatric
- B-045 — Epinephrine Auto Injector (BLS Optional Equipment)
- SO-P-045 — Bradycardia - Pediatric
- Product label — EPINEPHRINE injection
Read back the complete epinephrine preparation
Before administration, make the verbal check specific enough that a second clinician can reconstruct the intended treatment: indication, patient group, route, concentration, dose unit and volume. “Epinephrine ready” leaves the most consequential distinctions unstated. The anaphylaxis, arrest and push-dose rows should remain separate throughout preparation and documentation.
For a practice drill, hand one clinician a simulated order and have another select the matching row without looking at the first clinician’s syringe. Ask whether they agree on milligrams or micrograms, the final concentration and the route. A correct drug name with the wrong preparation is still an incorrect match.
When care changes from one clinical pathway to another, deliberately repeat this check. Preserve prior dose times, prearrival autoinjector use and the applicable repeat limits. Adult and pediatric push-dose authorization differ; confirmation of the preparation does not resolve that separate authority question. Record the final delivered concentration so the receiving team does not have to infer it from the medication name.