- Cardiopulmonary resuscitation
- Hypotension/Shock, Inotropic support
Cardiopulmonary resuscitation:
- ETT: In emergency situations, when IV access is unavailable.
- Draw up dose in a 3 or 5 mL syringe and label "for ETT". Administer rapidly. Do not follow with a flush.
- IV direct: Preferred route.
- Draw up dose in a 1 mL syringe and label "for IV/UVC". Administer rapidly over 1 minute. Follow with up to 3 mL 0.9% NaCl flush.
Hypotension/Shock, Inotropic support:
- IV continuous infusion
- Cardiopulmonary Resuscitation
- ETT: 0.1 mg/kg (1 mL/kg of a 1: 10 000 (0.1 mg/mL) solution).
- IV/UVC: 0.02* mg/kg (0.2 mL/kg of a 1: 10 000 (0.1 mg/mL) solution) every 3 to 5 minutes PRN.
* the dosage range is 0.01-0.03 mg/kg (0.1-0.3 mL/kg), however 0.02 mg/kg is the recommended initial dose.
- Hypotension/Shock, Inotropic support
- IV continuous infusion usual dose: 0.05 to 0.1 mcg/kg/minute for inotrope support; up to 0.3 mcg/kg/minute for vasopressor effect
- Recommended max: 1 mcg/kg/minute
- Titration Recommendation: Titrate by 0.01 mcg/kg/minute to maintain goal BP, Q 15 minutes1
1 meant to be general guidance for titrations, use clinical judgment
- CVS: cardiac arrhythmia, hypertension, tachycardia, vasoconstriction
- Local: IV infiltration may cause tissue ischemia and necrosis
- HR
- BP
- ECG
- Site of injection
For Hypotension/Shock, Inotropic support
- EPINEPHrine 0.1 mg/mL (1:10 000) (prefilled syringe)
- Take 1.2 mL (0.12 mg) and add to 18.8 mL D5W
- Final concentration: 6 mcg/mL
- EPINEPHrine 0.1 mg/mL (1:10 000) (prefilled syringe)
- Take 5 mL (0.5 mg) and add to 15 mL D5W
- Final concentration: 25 mcg/mL
- EPINEPHrine 0.1 mg/mL (1:10 000) (prefilled syringe)
- Take 10 mL (1 mg) and add to 10 mL D5W
- Final concentration: 50 mcg/mL (only with central line)
- Solutions Compatible: D5W, D10W, 0.9% NaCl, dextrose-saline combinations
- Y-site Compatible: dobutamine, dopamine, hydrocortisone, midazolam, morphine, potassium chloride (up to 40 mmol/L), SMOF, TPN
- Incompatible: sodium bicarbonate
- Do not use if solution is brown or a precipitate is present
- Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 19th Edition. Hudson: Lexi-Comp Inc; 2012
-Trissel LA. Handbook on Injectable Drugs. 16th Editions. Bethesda: American Society of health-System Pharmacists 2011
- Canadian Pediatric Society- updated NRP Guidelines 2022
- Evidence-based Practice for Improving Quality (EPIQ) Recommendations on Hemodynamics 2023.