Pediatric Advanced Life Support Review 2019 – A Link To “Pediatric Push Dose Epinephrine: Getting the Epi Dose Right During Pediatric Resuscitation”

This is an excellent article on the subject: Pediatric Push Dose Epinephrine: Getting the Epi Dose Right During Pediatric Resuscitation Sept 13, 2018 from RebelEM

I’m having a little trouble following the authors dosage calculations at the start of the article.

What follows is the Summary from the article:


  • In the rare instance of a crashing pediatric patient it is reasonable for emergency physicians to have a battle plan for how to give push dose pressors as a temporizing measure prior to a resuscitative procedure or the initiation of an infusion of a vasopressor.
  • Dosing epi at 1mcg/kg is an appropriate dose based on the guidelines, body of expert opinion, and single case series presented here.
  • The easiest way to accomplish this individualized dosing is to put the standard code dose (0.01mg/kg) of epinephrine into a 10cc syringe, and then dilute with normal saline to make a total of 10cc of fluid. This will mean each cc in the 10cc syringe has 1 mcg/kg of epinephrine for the specific patient it is prepared for.*
  • Push dose epinephrine is not a substitute for appropriate resuscitative efforts, and it is not appropriate for mild hypotension that has not responded to an appropriate fluid challenge.
  • A reasonable trigger for mixing Pediatric Push dose epinephrine is a blood pressure < 5th percentile (70 +(age x 2)) that is unresponsive to fluid resuscitation. It may be considered as an adjunct in dire circumstances while other resuscitative measures are being planned with the goal of preventing a cardiac arrest.
  • If the patient needs CPR then give the usual code dose of epinephrine and don’t worry about push dose epi. Push Dose epi could be used post resuscitation in the management of post arrest severe hypotension.

*I find this confusing and wonder why the usual concentration of push dose epinephrine in a 10 cc syringe could not be used – See Dr. Mellick’s YouTube video Pediatric Pulse Dose Pressor Administration for details.


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