Epinephrine use in ACLS

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Epinephrine pharmacology and uses in Advanced Cardiac Life Support

Epinephrine is the primary drug used in the pulseless arrest algorithm. It is used for its potent vasoconstrictive effects and also for its ability to increase cardiac output. Epinephrine is considered a vasopressor.


1. Vasoconstriction effects: epinephrine binds directly to alpha-1 adrenergic receptors of the blood vessels (arteries and veins) causing direct vasoconstriction, thus, improving perfusion pressure to the brain and heart.

2.Cardiac Output: epinephrine also binds to beta-1-adrenergic receptors of the heart. This indirectly improves cardiac output by:

Increasing heart rate
Increasing heart muscle contractility
Increasing conductivity through the AV node

Epinephrine is used in the pulseless arrest algorithm as a direct IV push for v-fib, pulseless v-tach. asystole, and PEA. Epinephrine is also in the bradycardia algorithm as an infusion or IV drip. See the respective algorithm pages for more information about their use in each.

Administration Routes

During ACLS, epinephrine can be given 3 ways: intravenous; intraosseous, and endotracheal tube.
Peripheral IV is the preferred method for administering Epi.


1. Intravenous Push/IO: 1mg epinephrine IV is given every 3-5 minutes.
2. IV infusion for bradycardia: 1mg epinephrine is mixed with 500ml of NS or D5W. The infusion should run at 2-10 micrograms/min (titrated to effect).
3. Endotracheal Tube: 2-2.5mg epinephrine is diluted in 10cc NS and given directly into the ET

Stat Life Medical Training conducts ACLS classes in Orlando FL, Orange Park FL, and Jacksonville FL.

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