If 0.3 mg IM 1:1000 epinephrine does not improve the patient and peripheral perfusion is poor, what is the indicated route and concentration of epinephrine?

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Multiple Choice

If 0.3 mg IM 1:1000 epinephrine does not improve the patient and peripheral perfusion is poor, what is the indicated route and concentration of epinephrine?

When perfusion is poor, absorption of injected epinephrine by muscle or tissue is unreliable, so a rapid, controllable systemic effect is needed. Intravenous administration of epinephrine at a dilution of 1:10,000 provides an immediate, titratable response to improve perfusion and blood pressure. The 1:10,000 concentration (0.1 mg/mL) is suitable for IV use; a common practice is a 1 mg IV bolus (which is 10 mL of 1:10,000) started and then titrated as needed or given as an infusion. Oral epinephrine is not used in acute settings due to poor and unpredictable bioavailability. Subcutaneous or IM epinephrine at 1:1000 relies on absorption and would not reliably effect the circulation when perfusion is compromised.

When perfusion is poor, absorption of injected epinephrine by muscle or tissue is unreliable, so a rapid, controllable systemic effect is needed. Intravenous administration of epinephrine at a dilution of 1:10,000 provides an immediate, titratable response to improve perfusion and blood pressure. The 1:10,000 concentration (0.1 mg/mL) is suitable for IV use; a common practice is a 1 mg IV bolus (which is 10 mL of 1:10,000) started and then titrated as needed or given as an infusion. Oral epinephrine is not used in acute settings due to poor and unpredictable bioavailability. Subcutaneous or IM epinephrine at 1:1000 relies on absorption and would not reliably effect the circulation when perfusion is compromised.

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