In adult anaphylactic shock, which statement describes the Push-Dose Epinephrine regimen?

• A. Push-Dose Epinephrine (1:100,000): 1 ml every 30 seconds (IO Preferred)
• B. Epinephrine 0.5 mg IM
• C. Albuterol 2.5 mg Nebulized
• D. Solu-Medrol 125 mg IV/IO/IM

Answer: (A)

Push-dose epinephrine is used in adult anaphylactic shock to rapidly support blood pressure and perfusion when hypotension persists despite initial therapy. This approach delivers small, highly controlled IV or intraosseous boluses of a dilute epinephrine solution, allowing the clinician to titrate the dose to the patient’s response in real time. Using a dilute concentration (about 1:100,000) means each milliliter contains a modest amount of epinephrine (roughly 10 micrograms), so giving 1 mL every 30 seconds provides a quick, repeatable dose that can be adjusted as the patient responds. If IV access isn’t immediately available, delivering via the intraosseous route ensures rapid drug delivery, hence the IO preference.

This strategy is distinct from the initial standard IM epinephrine dose, and from other meds like bronchodilators or steroids, which address different aspects of anaphylaxis. The push-dose regimen specifically targets rapid hemodynamic support during ongoing shock when a titratable IV/IO option is needed.