How to Mix Push-dose Epi: One out, one in — makes ten

Goal concentration: 10 mcg/mL

Step-by-Step Mixing:

1. Start with a 10 mL syringe of normal saline (NS)

• empty 1 mL to retain 9 mL of NS in the syringe.

2. Use the code cart 1:10,000 epi (100 mcg/mL)

• This is the standard “cardiac arrest epi” amp (usually 1 mg in 10 mL)…the 1:10,000 prefilled syringe used during ACLS

3. Withdraw 1 mL of the 1:10,000 epi (this gives you 100 mcg) using 3 mL syringe.

4. Inject that 1 mL (100 mcg) into your syringe of 9 mL NS.

• Now you have 10 mL of epinephrine at 10 mcg/mL — ready to use.

So what we just did is the mnemonic: One out, one in — makes ten

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• What’s the concentration of the code cart epi?

• How much do you withdraw?

• What do you inject it into?

• What’s the final concentration?

You should be able to say it out loud, now. If not — just repeat the podcast a couple of times to get it solid.

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How to Administer:

• Dose: 1–2 mL IV push every 1–5 minutes PRN hypotension

• That’s 5 to 20 micrograms per dose — meaning 0.5 to 2 mL of your push-dose epi, depending on the patient’s response.

• Titrate to clinical effect (aim for MAP >65 or ROSC support)