Epinephrine

Provider Level

EMT/AEMT/RN/Paramedic

Class

Sympathomimetic, Adrenergic Agonist

Mechanism of Action

Endogenous catecholamine that directly stimulates alpha-1, beta-1, and beta-2 adrenergic receptors. Causes profound vasoconstriction, increased heart rate, increased myocardial contractility, and bronchial smooth muscle relaxation.

Indications

Anaphylaxis, severe allergic reactions, severe reactive airway disease, cardiac arrest (VF/Pulseless VT, Asystole, PEA), symptomatic bradycardia, and severe hypotension/shock.

Contraindications

None in true life-threatening emergencies. Relative contraindications include uncontrolled hypertension, myocardial ischemia, and hypovolemic shock without prior fluid resuscitation.

Routes

IM, SQ, IV, IO, ET

Onset / Duration

Onset: Immediate for IV/IO, 3 to 10 minutes for IM/SQ. Duration: 5 to 10 minutes for IV/IO, 20 to 30 minutes for IM/SQ.

Adverse Effects

Tachycardia, hypertension, palpitations, arrhythmias, myocardial ischemia, anxiety, headache, tremors, nausea, and vomiting.

Precautions & Interactions

May exacerbate ischemia in patients with underlying coronary artery disease. Ensure adequate oxygenation and tissue perfusion. Monitor IV sites closely as tissue necrosis can occur with extravasation.

Special Considerations

Requires continuous cardiac monitoring during IV/IO administration. Do not mix directly with alkaline solutions such as sodium bicarbonate as it may deactivate the medication. Authorized for EMT, AEMT, RN, and Paramedic depending on route and local protocol.