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Making Push Dose Epi

​For quite some time, Dopamine has been taught in paramedic programs across the country as the "Gold Standard" as a vasopressor in different types of shock. However, further research has found that there are other vasopressors (norepinephrine) that have a lower incidence of arrhythmias and a lower incidence of mortality in certain types of shock (i.e. cardiogenic).

This research led some in the industry to ditch the Dopamine and move to epinephrine. Remember, epinephrine works on the sympathetic (adrenergic) nervous system and specifically acts on Alpha-1 to produce vasoconstriction and Beta-1 to produce positive chronotropy (heart rate), increases the rate of impulse conduction (dromotropy), and increase cardiac contractile force (inotropy). Additionally, epinephrine will stimulate the Beta-2 receptor sites, causing bronchodilation.


How to Make It: The "cardiac arrest" epinephrine (1:10,000) is packaged as 0.1mg/mL (100mcg/mL), however, to make push dose epi, it needs to be diluted down to a concentration of 0.01mg/mL or 10mcg/mL.

To do this, we need to take a 10mL syringe and draw out 1mL from the epinephrine 1:10,000 pre-filled syringe (0.1mg/mL = 100mcg/mL). Next, we need to draw up 9mL of normal saline into that same syringe.

That has diluted the concentration down to 10mcg/mL.

**Another option = use a 10mL flush and eliminate 1mL then draw up the 1mL of epinephrine from the prefilled epinephrine syringe.

DOSING: Always follow your local protocol, but a general dosing range for push dose epi is 5 - 20mcg/minute (0.5 - 2.0mL/minute). However, it's often recommended to start with 0.5mL (5mcg) pushes titrated to a SBP of > 90mmHg.

Although it can be used for any type of shock or hypotension unresponsive to fluid boluses, most often, push dose epi would be used to treat shock after ROSC, septic shock, and cardiogenic shock.

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