Folks always confuse 1:1,000 vs. 1:10,000 epinephrine, when you're supposed to use which, what the dosing is, etc
Here's what helps me remember/teach.
Thread 1/9
Here's what helps me remember/teach.
Thread 1/9
There's two main indications for epi - code blue and anaphylaxis.
1. Code blue is a 1mg IV dose of 1:10,000 epi
2. Anaphylaxis is 0.3mg IM dose of 1:1,000 epi
Shouldn't be that hard to remember... but it is.
2/
1. Code blue is a 1mg IV dose of 1:10,000 epi
2. Anaphylaxis is 0.3mg IM dose of 1:1,000 epi
Shouldn't be that hard to remember... but it is.
2/
There's the route, the dose, and the concentration.
The route is easiest. Think of epi being pushed IV during a code. Think of the epipen people jab into their thigh muscle for anaphylaxis.
1. Code β IV
2. Anaphylaxis - IM
Great, moving on.
3/
The route is easiest. Think of epi being pushed IV during a code. Think of the epipen people jab into their thigh muscle for anaphylaxis.
1. Code β IV
2. Anaphylaxis - IM
Great, moving on.
3/
Next the dose. Got a mnemonic for that too.
A code is worse than anaphylaxis so you need a bigger dose of epi.
1. Code - 1 mg
2. Anaphylaxis - 0.3 mg
Cool.
4/
A code is worse than anaphylaxis so you need a bigger dose of epi.
1. Code - 1 mg
2. Anaphylaxis - 0.3 mg
Cool.
4/
Now the formulation, which is the most confusing.
The secret is knowing what the 1:10,000 and 1:1,000 mean.
These units are mg (of epi) per MICROliter (of water).
Unfortunately we donβt think in microliters, we think in milliliters...
5/
The secret is knowing what the 1:10,000 and 1:1,000 mean.
These units are mg (of epi) per MICROliter (of water).
Unfortunately we donβt think in microliters, we think in milliliters...
5/
Luckily the conversion is easy. One mL is 1000 mcL. So just dropping three zeroes starts to make a lot of sense:
It's why 1:10,000 comes as a 10 mL stick, and 1:1,000 is a 1 mL ampule.
1.Code 1:10 mg:mL
2.Anaphylaxis 1:1 mg:mL
6/
It's why 1:10,000 comes as a 10 mL stick, and 1:1,000 is a 1 mL ampule.
1.Code 1:10 mg:mL
2.Anaphylaxis 1:1 mg:mL
6/
So for IV (code) itβs the more dilute solution, and for IM (anaphylaxis) itβs the more concentrated solution.
Which makes sense if you think about itβ¦ you donβt want to be injecting multiple mL of fluid into muscle, a big ole bubble of fluid won't absorb as well.
7/
Which makes sense if you think about itβ¦ you donβt want to be injecting multiple mL of fluid into muscle, a big ole bubble of fluid won't absorb as well.
7/
In summary:
1. Code: take the whole 10 mL stick of 1:10 mg/mL epi (1mg) and inject it IV
2. Anaphylaxis: draw up about 1/3 of the 1mL ampule of 1:1 mg/mL epi (0.3mg) and inject it IM
8/
1. Code: take the whole 10 mL stick of 1:10 mg/mL epi (1mg) and inject it IV
2. Anaphylaxis: draw up about 1/3 of the 1mL ampule of 1:1 mg/mL epi (0.3mg) and inject it IM
8/
When you forget, just ask:
1. Wait which one is IM? Epipen! Anaphylaxis
2. What does 1:1000 mean? Drop 0s. 1mg in 1mL... as opposed to in 10mL. So 1:1 more concentrated. Better for IM.
2. What's the dose for anaphylaxis? Not as bad as code, so less than 1mg. Oh it's 0.3!
9/9
1. Wait which one is IM? Epipen! Anaphylaxis
2. What does 1:1000 mean? Drop 0s. 1mg in 1mL... as opposed to in 10mL. So 1:1 more concentrated. Better for IM.
2. What's the dose for anaphylaxis? Not as bad as code, so less than 1mg. Oh it's 0.3!
9/9
Some people brought up dosing of 0.5 mg IM for anaphylaxis.
Newest guidelines (tinyurl.com) recommend 0.01 mg/kg up to 0.5 mg, so indeed 0.5 for adults >50kg.
Epipens are still 0.3 mg.
But agreed, if drawing up epi ourselves, 0.5 mg appropriate for most adults.
Newest guidelines (tinyurl.com) recommend 0.01 mg/kg up to 0.5 mg, so indeed 0.5 for adults >50kg.
Epipens are still 0.3 mg.
But agreed, if drawing up epi ourselves, 0.5 mg appropriate for most adults.
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