Procedure: Administration of Epinephrine by Medical Directive

Ensure that patient and health care provider safety standards are met during this procedure including:

  • Risk assessment and appropriate PPE
  • 4 Moments of Hand Hygiene
  • Procedural Safety Pause is performed
  • Two patient identification
  • Safe patient handling practices
  • Biomedical waste disposal policies


Epinephrine is a sympathomimetic which stimulates both alpha and beta adrenergic receptors. Alpha adrenergic receptors will cause peripheral vasoconstriction which leads to improved coronary and cerebral perfusion pressure. Beta effects will increase strength of myocardial contraction, increase automaticity and increase the electrical activity in the myocardium.
Administration of this drug can be performed by CCTC nursing staff who are approved in the administration of life saving drugs.

  1. Identify life-threatening rhythm
  2. Give Epinephrine per Medical Directive 
  3. Reassess Rhythm
  4. Notify Physician
  5. Monitor for Side Effects
  6. Document
  7. Order Requirements



Identify Life-Threatening Rhythm

The nurse identifies a life-threatening arrhythmia that would respond to epinephrine:

  • Ventricular Fibrillation (VF)
  • Pulseless Ventricular Tachycardia (VT) that is unresponsive to initial defibrillation attempts
  • Pulseless Electrical Activity or asystole during cardiac arrest procedure

Epinephrine stimulates vasoconstriction, increasing systemic vascular resistance which may improve coronary and cerebral perfusion pressure.


Give Epinephrine

A nurse may administer epinephrine 1 mg IV or Intraosseus (IO) direct by medical directive.  Give all doses of medications at the start of a CPR cycle.

For a shockable rhythm (VT/VF):

  • Administer first dose of epinephrine after the second defibrillation.

For a non-shockable rhythm (PEA, asystole):

  • Administer first dose at the onset of cardiac resuscitation

Continue to administer epinephrine 1 mg IV or IO or 2 mg ETT Q 3 - 5 minutes until Return of Circulation.

Epinephrine 1 mg provides alpha range dosing.

In the absence of vascular access, 2 mg of epinephrine can be administered via the ETT.


Reassess Rhythm

Reassess rhythms and if VF/VT present, continue to follow defibrillation procedure.
VF rarely converts without an application of direct current.


Notify Physician

Notify the critical care physician. Further treatment may be necessary.


Monitor for Side Effects

Monitor for side effects of epinephrine or reoccurrence of VT/VF.

Epinephrine increases myocardial oxygen consumption and can precipitate or worsen myocardial ischemia.



Document administration and effect of epinephrine in the clinical record and cardiac arrest record.


Order Requirement

The medical directive provides the authority to initiate the order. Enter the order in Power Chart and sign as by medical directive. 


American Heart Association. 2015 & 2018 Integrated ACLS Guidelines

American Heart Association. 2020 ACLS highlights. 

Developed by:

Last Update:March 24, 2010,  Reviewed January 22, 2022 (BM)