Bedside Snapshot

Use It For
Cardiac arrest, any rhythm (adult and pediatric); neonatal resuscitation with heart rate <60/min; shock and atropine-refractory bradycardia (infusion); refractory anaphylaxis; push-dose bridge
Adult Dose
  • Arrest: 1 mg (10 mL) IV/IO every 3–5 min (no max)
  • Septic shock: 0.05–2 mcg/kg/min IV infusion to MAP
  • Bradycardia: 2–10 mcg/min IV infusion
Pediatric Dose
Arrest or bradycardia: 0.01 mg/kg (0.1 mL/kg) IV/IO every 3–5 min (max 1 mg/dose). Newborn: 0.01–0.03 mg/kg (0.1–0.3 mL/kg) IV/IO while HR <60/min
Onset / Duration
IV/IO: <5 min / BP effect gone within 20 min; infusion steady state in 10–15 min
Do Not Give / Hold If
No absolute contraindication in arrest. Never a 1 mg IV push with a pulse. Reduce or hold for new VT or ectopy, ischemic ECG change or MAP above goal
Watch For
Tachyarrhythmias and VF (ECG); myocardial ischemia (ST change, chest pain); severe hypertension or pulmonary edema; distal, gut or renal ischemia; extravasation (blanching at the site)
Reversal / Rescue
No antidote: stop; effect fades within minutes. Extravasation: phentolamine 5–10 mg in 10–15 mL 0.9% NaCl infiltrated into the site (within 12 hr)
Must Remember
Three strengths, each tenfold apart: 1 mg/mL (IM), 0.1 mg/mL (arrest: 1 mg = 10 mL), 10 mcg/mL (push-dose: 10–20 mcg = 1–2 mL). Name mg/mL and dose on every syringe

Indications

Emergency & Prehospital

  • Cardiac arrest, any rhythm (adult and pediatric): asystole and PEA as soon as feasible; VF or pulseless VT after initial defibrillation attempts fail
  • Neonatal resuscitation: heart rate still <60/min after 60 seconds of chest compressions with effective ventilation
  • Symptomatic bradycardia unresponsive to atropine: infusion as a bridge to transcutaneous pacing
  • Refractory anaphylaxis: low-dose IV infusion when symptoms persist after 2 doses of IM epinephrine 1 mg/mL and fluids
  • Transient severe hypotension: push-dose boluses as a bridge to an infusion (off-label)

ED / ICU / Transport

  • Septic shock in adults: the FDA-labeled use for this concentration, as a diluted infusion. In the Surviving Sepsis Campaign (SSC) 2026 it ranks third, behind norepinephrine and vasopressin. With cardiac dysfunction it moves up to first-line.
  • Pediatric septic shock: epinephrine or norepinephrine, chosen by bedside assessment (see Pediatric Shock). SSC 2026 makes no recommendation for either.
  • Cardiogenic shock and post-ROSC hypotension: inotrope-vasopressor when output and pressure are both low. AHA 2025 Part 11 finds insufficient evidence for a specific vasopressor after arrest (2b, B-NR)
Label vs guideline use: The FDA label for the 0.1 mg/mL syringe stops at adult septic-shock hypotension. Every other use runs on AHA, AAP or specialist guidance.

Dosing & Administration

The doses here are the AHA, AAP and NASEMSO values. Push-dose and the refractory anaphylaxis infusion have no single house dose. Follow protocol and medical direction.

Available Forms

  • Prefilled syringe (EMS and code cart): 0.1 mg/mL (1:10,000), 10 mL (1 mg). 1 mg = 10 mL, 0.01 mg = 0.1 mL. Contains sodium metabisulfite
  • Premixed infusion bags: in 0.9% NaCl, e.g. 4 mg/250 mL (16 mcg/mL) or 16 mg/250 mL (64 mcg/mL)
  • Concentrate vial: 1 mg/mL (1:1,000), for IM use or compounding; never push undiluted IV
  • Push-dose syringe: 10 mcg/mL (100 mcg in 10 mL), prefilled where stocked
High-Alert Medication: Three errors kill here. One: 1 mg IV (a full arrest syringe or 1 mL of 1 mg/mL) given to a patient with a pulse. Two: the 0.1 mg/mL syringe mistaken for the 10 mcg/mL push-dose syringe. Three: mcg/min mixed up with mcg/kg/min on the pump. Double-check concentration, units, volume and pump settings independently, with a second set of eyes.

Adult Dosing

IndicationDose & RouteRepeat / MaxNotes
Cardiac arrest (all rhythms)
1 mg IV/IO every 3–5 min (10 mL of 0.1 mg/mL)
Until ROSC or termination; no fixed max
High-alert Nonshockable: as soon as feasible (AHA 2025 Part 9, 2a, B-NR). Shockable: after initial defibrillation attempts fail (2a, B-NR). IV first (Class 1, A); IO if IV fails or is not feasible (2a, A). High-dose epinephrine not recommended (3: No Benefit, B-R)
Septic shock (weight-based infusion)
0.05–2 mcg/kg/min IV infusion, titrated to MAP
Titrate every 10–15 min by 0.05–0.2 mcg/kg/min; label range up to 2 mcg/kg/min
High-alert SSC 2026: third-line after norepinephrine plus vasopressin; first-line option with cardiac dysfunction
Cardiogenic or post-ROSC shock
Weight-based IV infusion as for septic shock, titrated to MAP ≥65 mmHg and perfusion
No fixed max: titrate to effect
High-alert Cardiogenic-shock data suggest a less favorable safety profile than norepinephrine
Bradycardia unresponsive to atropine
2–10 mcg/min IV infusion
Titrate to heart rate and perfusion; bridge to pacing
High-alert After atropine; treat reversible causes; prepare pacing (AHA 2025 Part 9, 2b, C-LD)
Refractory anaphylaxis
Start about 0.1 mcg/kg/min IV infusion (10 mcg/mL at 0.5 mL/kg/hr); 1 mL/kg/hr if hypotensive or hypoxic
Titrate to lowest effective rate; no fixed max
High-alert Repeat IM every 5 min until the infusion runs. Experienced clinicians only: 50 mcg IV bolus (0.5 mL of 0.1 mg/mL) while the infusion is set up
Push-dose for transient hypotension (off-label)
10–20 mcg IV (1–2 mL of 10 mcg/mL)
Every 2–5 min to target; start an infusion if repeats are needed
High-alert Bridge only, under protocol. Never push from the undiluted 0.1 mg/mL syringe (except the specialist anaphylaxis bolus above)

Dosing weight: Arrest dosing is a fixed 1 mg. For mcg/kg/min infusions, pick one convention per patient (usually actual body weight) and say which one at handoff.

Pediatric Dosing

IndicationDose (per kg) & RouteMax Single / Max TotalNotes
Cardiac arrest
0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL) IV/IO every 3–5 min
Max 1 mg/dose; no total max
High-alert Nonshockable: first dose as early as possible (AHA/AAP 2025 Part 8, 2a, C-LD). Shockable: after 2 defibrillation attempts, or sooner only if rapid defibrillation is not possible (2b, C-LD)
Bradycardia with poor perfusion
0.01 mg/kg (0.1 mL/kg) IV/IO every 3–5 min
Max 1 mg/dose
High-alert Heart rate <60/min with poor perfusion despite oxygenation and ventilation; start CPR (Part 8, Class 1)
Fluid-refractory or cardiogenic shock
0.05–0.3 mcg/kg/min IV/IO infusion
Titrate to perfusion and age-based BP; no fixed max
High-alert Differs from the FDA label, which does not establish pediatric septic-shock use. Specialist use; range from NASEMSO Shock (p. 109).
Refractory anaphylaxis
0.5 mcg/kg/min IV/IO infusion after repeated IM doses and 60 mL/kg fluid (NASEMSO v3.0 lists this for all ages; not a pediatric-specific dose)
Titrate to lowest effective rate; no fixed max
High-alert IV boluses in children: specialist use only; no evidence-based dose. RCUK 2021 gives 0.5–1 mL/kg/hr of 10 mcg/mL (0.5 mL/kg/hr is about 0.1 mcg/kg/min; 1 mL/kg/hr about 0.17) in children and adults; follow local protocol and medical direction
Push-dose, bradycardia with poor perfusion (off-label outside arrest)
1 mcg/kg (0.1 mL/kg of 10 mcg/mL) IV/IO push, diluted
Max 10 mcg (1 mL) per dose; every 3–5 min to MAP >65 mmHg
High-alert NASEMSO v3.0 Bradycardia (p. 36). Never use the adult 10–20 mcg push-dose in a child. Protocol use only

The arrest and bradycardia rows come from AHA/AAP 2025 PALS: 0.01 mg/kg of 0.1 mg/mL, maximum 1 mg, every 3–5 min. Use length-based tape or weight-based dosing checks. A pediatric arrest dose never exceeds the adult 1 mg.

Neonatal Resuscitation

  • When: heart rate <60/min after 60 seconds of compressions with effective ventilation. Fix ventilation first.
  • Intravascular (preferred): 0.01–0.03 mg/kg (0.1–0.3 mL/kg of 0.1 mg/mL) via low-lying UVC or IO (AHA 2025 Part 5, Class 1, B-NR), then 3 mL 0.9% NaCl flush.
  • Endotracheal (only while access is obtained): 0.05–0.1 mg/kg (0.5–1 mL/kg of 0.1 mg/mL) (Part 5, 2a, C-LD).
  • Repeat: every 3–5 min while heart rate stays <60/min (Part 5, 2b, C-LD). Known blood loss without response: 10–20 mL/kg 0.9% NaCl or O-negative blood over 5–10 min.

The full resuscitation sequence is in Neonatal Resuscitation.

Continuous Infusion

SettingExample ConcentrationStartTitrateUsual Range / Max
Adult septic or cardiogenic shock
4 mg/250 mL (16 mcg/mL), example (institution-specific)
0.05 mcg/kg/min
0.05–0.2 mcg/kg/min every 10–15 min
Label range up to 2 mcg/kg/min
Adult bradycardia (fixed rate)
4 mg/250 mL (16 mcg/mL), example
2 mcg/min
To heart rate and BP
2–10 mcg/min
Refractory anaphylaxis (adult)
1 mg in 100 mL D5W or D5/0.9% NaCl (about 10 mcg/mL), example
0.5 mL/kg/hr (about 0.1 mcg/kg/min)
Up or down by response; steady state in 5–10 min
1 mL/kg/hr if severe; no fixed max
Anaphylaxis with shock (NASEMSO, all ages)
Smart-pump standard concentration (institution-specific)
0.5 mcg/kg/min after repeated IM doses and 60 mL/kg fluid
To perfusion and BP
0.5 mcg/kg/min (NASEMSO v3.0, all ages); RCUK 2021: 0.5–1 mL/kg/hr of 10 mcg/mL in children and adults; no fixed max
Pediatric shock
Smart-pump standard concentration (institution-specific)
0.05 mcg/kg/min
To perfusion and age-based BP
0.05–0.3 mcg/kg/min
Pump rate (weight-based)
mL/hr = dose (mcg/kg/min) × weight (kg) × 60 ÷ concentration (mcg/mL). Example: 0.1 mcg/kg/min × 80 kg × 60 ÷ 16 mcg/mL = 30 mL/hr

Push-Dose Epinephrine Preparation (Adults)

  1. Use a prefilled 10 mcg/mL syringe if your system stocks one.
  2. Otherwise dilute: a 10 mL syringe with 9 mL 0.9% NaCl plus 1 mL (0.1 mg) from the 0.1 mg/mL syringe: 10 mL of 10 mcg/mL (100 mcg).
  3. Label at once: "EPINEPHrine 10 mcg/mL, push-dose", with time and initials.
  4. Give and read back in mcg and mL: 10–20 mcg = 1–2 mL IV; recheck BP before each repeat, and start an infusion if hypotension persists.
Push-dose error traps: Four traps: an adult dose given to a child, the whole 10 mL (100 mcg) pushed, the undiluted 0.1 mg/mL syringe (10 times the intended dose), or a mix from the 1 mg/mL vial without a protocol. A 2025 meta-analysis of 19 observational studies found adverse effects in about 14% of patients, serious in about 1.4%. Protocol use was linked to fewer adverse effects.

Preparation & Administration

  • Arrest push: the 0.1 mg/mL syringe undiluted as a rapid IV/IO push, then a saline flush; do not pause compressions.
  • Infusion dilution: premixed bag when available. Compounded dilutions use D5W or D5/0.9% NaCl (saline alone is not recommended for this compounded dilution). Discard pink, brown or cloudy solution.
  • Line: smart pump on a dedicated line. SSC 2026 (adults) suggests starting vasopressors peripherally rather than delaying for central access, with frequent site checks. Avoid leg veins in older adults and in vascular disease. Move to a central line for prolonged or high-dose infusions.
  • Weaning: taper gradually (label example: reduce every 30 min over 12–24 hr). Abrupt stops cause rebound hypotension.

Contraindications & Precautions

Contraindications

  • None absolute in cardiac arrest, neonatal resuscitation or life-threatening shock (the FDA label lists none).
  • Sulfite allergy (relative): the products contain sodium metabisulfite. That should not stop use in a life-threatening emergency.

Precautions

  • Coronary disease or cardiomyopathy: more arrhythmias and ischemia. Use the lowest effective dose.
  • Pre-existing tachyarrhythmia: may worsen the rate; consider an alternative vasopressor.
  • Aortic dissection or uncontrolled hypertension: avoid or use minimal doses outside cardiac arrest.
  • MAO inhibitors or tricyclic antidepressants: severe, prolonged hypertension; start low.
  • Hypothermic cardiac arrest: AHA 2025 Part 10 (2b, C-EO) says it may be reasonable to defer epinephrine until core temperature reaches ≥30 °C (86 °F), in adults and children.
  • Obstetrics and labor: inhibits contractions. Outside resuscitation, the label says to avoid it in the second stage of labor, and when maternal BP is above 130/80 mmHg.
  • Occlusive vascular disease: avoid leg veins (limb ischemia).

Hold / Reassess If

  • MAP above target on two readings: wean the infusion; do not stop abruptly.
  • New ventricular ectopy, VT, ischemic ST changes or chest pain: reduce or stop and reassess.
  • Tachycardia, tremor or pallor with normal or raised BP during an anaphylaxis infusion: excess epinephrine; reduce the rate.
  • Swelling, blanching or coolness at the site: stop that line, restart elsewhere, treat extravasation.
Pulse present? No 1 mg push: Feel for the pulse first. A 1 mg IV bolus of either concentration, given outside cardiac arrest, can cause severe hypertension, VF, myocardial infarction, pulmonary edema or stroke. Confirm there is no pulse before any arrest dose.

Adverse Effects & Toxicity

Common

  • Palpitations, tachycardia, anxiety, tremor, headache
  • Pallor, sweating, cool extremities; nausea and vomiting
  • Hyperglycemia, hypokalemia and rising lactate

Serious / Life-Threatening

  • Arrhythmias (including fatal VF): reduce or stop; correct K⁺, Mg²⁺ and hypoxia; ACLS.
  • Myocardial ischemia or infarction: lowest effective dose; 12-lead ECG; consider an alternative vasopressor.
  • Severe hypertension, cerebral hemorrhage: stop; short-acting vasodilator or α-blocker if needed; neuro assessment.
  • Pulmonary edema: stop or reduce; oxygen and ventilatory support.
  • Peripheral, digital or mesenteric ischemia; renal vasoconstriction: cold, mottled or dusky digits, abdominal pain, falling urine output. Infusions into ankle veins can end in gangrene. Use the lowest effective dose and reassess volume and output.
  • Extravasation necrosis: blanching, cold, hard, pale skin along the vein. Stop, restart elsewhere; phentolamine 5–10 mg in 10–15 mL 0.9% NaCl infiltrated through the area as soon as possible (within 12 hr).

Overdose & Toxicity Management

  • Signs: extreme hypertension, pulmonary edema, ventricular ectopy progressing to VT or VF, myocardial ischemia, lactic acidosis, renal failure.
  • Immediate: stop the drug. Epinephrine is inactivated within minutes, so care is supportive. There is no specific antidote.
  • Treat: phentolamine for pulmonary edema or hypertension; β-blocker (e.g. propranolol) for arrhythmias; another vasopressor if hypotension follows.

Monitoring
ParameterWhen / How OftenTarget / Act If
Clinical: rhythm (arrest)
Every 2-min rhythm check
Record dose times; after ROSC watch for tachyarrhythmia and hypertension
Clinical: ECG and blood pressure
Continuous ECG; BP every 2–5 min while titrating and before every push-dose
New VT, frequent ectopy or ST change: reduce or stop. Septic shock: MAP 65 mmHg (60–65 if ≥65 yr). Post-ROSC: MAP ≥65 mmHg
Clinical: perfusion
Hourly: mental status, capillary refill, skin, urine output
Urine <0.5 mL/kg/hr or dusky digits at goal MAP: suspect distal or gut ischemia; reassess output, volume and dose
Clinical: neonatal heart rate
Continuous ECG during compressions and after each dose
Still <60/min: repeat every 3–5 min, recheck ventilation
Laboratory: lactate, glucose, potassium
Baseline, and with ectopy or on prolonged infusion
Rising lactate with good perfusion may be a drug effect; hyperglycemia: treat per protocol; low K⁺: replace
Infusion safety: site
At least hourly and after every move
Blanching or swelling: stop, restart elsewhere, phentolamine

Interactions & Compatibility

Clinically Significant Interactions

Drug / ClassEffectWhat To Do
β-blockers (e.g. propranolol)
Unopposed α effect: severe hypertension and reflex bradycardia; poor response in anaphylaxis
Titrate cautiously. In anaphylaxis refractory to epinephrine and fluids on a β-blocker, consider glucagon (off-label: RCUK 2021 adult 1 mg IV; AHA 2025 Part 10, 2b, C-EO: 1–5 mg IV in adults, 20–30 mcg/kg IV up to 1 mg in children)
MAO inhibitors, tricyclic antidepressants
Severe, prolonged hypertension
Start low; arterial line if possible
Halogenated anesthetics, digoxin, quinidine, thyroid hormone, antihistamines
Increased arrhythmia risk
Continuous ECG; treat arrhythmias promptly
α-blockers, phenothiazines, vasodilators, ergot alkaloids, antihypertensives, diuretics
Blunted pressor effect
Expect higher dose needs; reassess the cause
Diuretics, corticosteroids, theophylline
Additive hypokalemia
Monitor and replace K⁺
Other vasopressors and inotropes, oxytocin, clonidine, doxapram, COMT inhibitors (e.g. entacapone)
Potentiated pressor effect
Titrate one drug at a time; track total vasopressor dose

IV Compatibility

  • Diluents: D5W or D5/0.9% NaCl for compounded infusions (label). Commercial premixes in 0.9% NaCl come as separately approved products.
  • Incompatible: sodium bicarbonate and other alkaline solutions, plus oxidizing agents. Blood or plasma goes through its own line.
  • Dedicated line or lumen for infusions. Verify against an institutional compatibility resource.

Special Populations
  • Pediatrics: Arrest and bradycardia doses are weight-based and capped at 1 mg. The label does not establish septic-shock use in children. See Pediatric Cardiac Arrest.
  • Neonates: Give only after effective ventilation and 60 seconds of compressions. The intravascular route is preferred.
  • Pregnancy: Human data are limited, and they show no established risk of birth defects or miscarriage. Don't hold back life-sustaining treatment. Epinephrine is part of maternal ACLS. It can cut uterine blood flow and slow labor.
  • Lactation: No data exist. Infant exposure is expected to be very low: poor oral bioavailability and a short half-life.
  • Older Adults: Start infusions at the low end of the range and avoid leg veins. Older patients carry a higher risk of ischemia, arrhythmia and hypertensive stroke.
  • Renal Impairment: No specific adjustment is established. Epinephrine constricts renal vessels and can cut urine output. Titrate to effect.
  • Hepatic Impairment: No specific adjustment is established. Titrate to effect.
  • Obesity / Dosing Weight: The adult arrest dose stays a fixed 1 mg. For infusions, pick one dosing weight per patient.

Field & Transport Considerations
  • Scope: cardiac-arrest doses: AEMT and above. The NHTSA model allows AEMT epinephrine during cardiac arrest. Push-dose epinephrine and infusions: Paramedic, RN and critical-care transport (CCT) only, under medical direction. Whoever mixes a push-dose syringe labels it right away and checks 10 mcg/mL with a second clinician where the agency requires it. Scope varies by state and agency protocol.
  • Storage & Stability: 20–25 °C (68–77 °F), protected from light; do not refrigerate or freeze. Discard pink, brown or cloudy solution.
  • Carried Concentration: 1 mg/mL (IM) and 0.1 mg/mL (IV syringe) sit side by side in drug boxes. Say the mg/mL out loud, store them apart and make a separately labeled push-dose syringe.
  • Infusions in Transport: pump with drug library on a dedicated line, bag volume for the trip plus delays, site check at every reassessment; verify concentration and dosing units at handoff.
  • Handoff Essentials: number and times of arrest doses and time of ROSC; push-dose total in mcg; infusion concentration, current rate (mcg/min or mcg/kg/min and dosing weight), last titration and response; any extravasation.

Clinical Pearls
What epinephrine does in arrest: It raises ROSC and survival to hospital admission. Whether it improves survival with good neurologic function is uncertain (Part 9). Fix the basics first: high-quality compressions and early defibrillation.
Exam discriminator, timing: Asystole or PEA: epinephrine as soon as feasible. VF or pVT: shock first. Epinephrine comes after initial defibrillation fails, or after 2 shocks in children. Never delay a shock for a drug.
Push-dose buys minutes, not stability: Most who need it end up on an infusion. Start mixing the drip with the first bolus.
Same drug, three strengths: 1 mg/mL (IM), 0.1 mg/mL (arrest) and 10 mcg/mL (push-dose). Each step is tenfold apart. Say the concentration and the dose, in mg or mcg, on every order and syringe.

Pharmacology

Nonselective α- and β-agonist. The α₁ effect is constriction. It raises diastolic and coronary perfusion pressure during CPR and SVR in shock. The β₁ effect raises contractility and heart rate, at the cost of oxygen demand and arrhythmia risk. IV/IO onset is under 5 min. The effect is gone within 20 min. Effective plasma half-life is under 5 min. MAO and COMT break it down, and it leaves no active metabolites. For the full pharmacology and a wider vasopressor comparison, see the Vasopressor and Inotrope Guide.

Names & Classification
Generic Name
Epinephrine (as epinephrine hydrochloride); adrenaline (international)
Brand Names
Adrenalin (vials and premixed bags); generic 0.1 mg/mL prefilled syringes and premixed bags
Controlled Substance
Not controlled
ISMP High-Alert
Yes: ISMP high-alert medication (adrenergic agonists, IV)
Look-Alike / Sound-Alike
EPINEPHrine / ePHEDrine (ISMP list); practical mix-up with norepinephrine and between the 1 mg/mL and 0.1 mg/mL strengths
Error-Prone Abbreviations to Avoid
Ratio strengths alone (1:1,000, 1:10,000) and "epi" on orders: write the drug name, mg/mL and the dose in mg or mcg

Related

References
  1. International Medication Systems, Ltd. (2024). Epinephrine injection USP 1 mg/10 mL (0.1 mg/mL), for intravenous use: prescribing information. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f2b5f15b-8541-466a-a27a-ee57bc4aac67
  2. Wigginton, J. G., Agarwal, S., Bartos, J. A., Coute, R. A., et al. (2025). Part 9: Adult advanced life support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 152(16 Suppl 2), S538–S577. https://doi.org/10.1161/CIR.0000000000001376
  3. Cao, D., Arens, A. M., Chow, S. L., Easter, S. R., et al. (2025). Part 10: Adult and pediatric special circumstances of resuscitation: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 152(16 Suppl 2), S578–S672. https://doi.org/10.1161/CIR.0000000000001380
  4. Lasa, J. J., Dhillon, G. S., Duff, J. P., Hayes, J., et al. (2025). Part 8: Pediatric advanced life support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 152(16 Suppl 2), S479–S537. https://doi.org/10.1161/CIR.0000000000001368
  5. Lee, H. C., Strand, M. L., Finan, E., Illuzzi, J., et al. (2025). Part 5: Neonatal resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 152(16 Suppl 2), S385–S423. https://doi.org/10.1161/CIR.0000000000001367
  6. Hirsch, K. G., Amorim, E., Coppler, P. J., Drennan, I. R., et al. (2025). Part 11: Post–cardiac arrest care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 152(suppl 2), S673–S718. https://doi.org/10.1161/CIR.0000000000001375
  7. Prescott, H. C., Antonelli, M., Alhazzani, W., Møller, M. H., et al. (2026). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2026. Critical Care Medicine. https://doi.org/10.1097/CCM.0000000000007075
  8. Resuscitation Council UK. (2021). Emergency treatment of anaphylaxis: Guidelines for healthcare providers (including refractory anaphylaxis). https://www.resus.org.uk/library/additional-guidance/guidance-anaphylaxis/emergency-treatment
  9. Sucena Rodrigues, B., Caldeira, D., Dantas, J., & Faria, R. (2025). Push-dose pressors outside the operating room: Systematic review and meta-analysis of observational studies. Journal of Emergency Medicine, 79, 260–279. https://doi.org/10.1016/j.jemermed.2025.04.021
  10. National Highway Traffic Safety Administration. (2021). National EMS Scope of Practice Model, 2019, including Change Notices 1.0 and 2.0 (DOT HS 813 151), Section V and footnote 5. https://mn.gov/oems/assets/National_EMS_Scope_of_Practice_Model_2021_%20%28002%29_tcm1221-744908.pdf
  11. National Association of State EMS Officials. (2022). National Model EMS Clinical Guidelines, Version 3.0, Shock (pp. 108–110). Copy hosted by Iowa HHS. https://hhs.iowa.gov/media/198/download
  12. Weiss, S., Peters, M. J., Oczkowski, S. J., et al. (2026). Surviving Sepsis Campaign international guidelines for the management of sepsis and septic shock in children 2026. Pediatric Critical Care Medicine, published March 23, 2026. DOI: https://doi.org/10.1097/PCC.0000000000003927. Verified text: SCCM guideline page ("insufficient evidence to issue a recommendation on the preferred use of epinephrine or norepinephrine").

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