Adrenaline (epinephrine)

Airway/breathing/circulation compromise from suspected anaphylaxis, including pregnancy

IM into the anterolateral mid-thigh

Repeat after 5 min if airway/breathing/circulation problems persist

Continue emergency reassessment; refractory reaction after 2 appropriate IM doses needs expert IV-infusion/critical-care support · 1 mg/mL ampoule: 0.5 mL = 500 micrograms IM. Use mg/mL labels rather than ratio alone. NEVER give this IM-strength dose as an IV bolus

No fixed total IM-dose ceiling while life-threatening features persist; repeat every 5 min and escalate

Maternal cardiac arrest following the adult ALS algorithm

IV or IO

Every 3–5 min during CPR; immediately for non-shockable rhythm, after the third shock for shockable rhythm

During ongoing resuscitation, until ROSC or team decision · Use a 1 mg/10 mL (0.1 mg/mL) resuscitation syringe. If using 1 mg/mL stock, 1 mL diluted to FINAL 10 mL gives 0.1 mg/mL; independently check. Flush the IV/IO line and continue compressions

1 mg each scheduled dose; do not confuse with 0.5 mg IM anaphylaxis treatment

Persistent airway/breathing/circulation compromise after two appropriate IM doses; experienced critical-care/anaesthetic staff only

IV infusion pump

Continuous with immediate response-based titration

Until the reaction resolves and a supervised weaning/observation plan is established · Make 1 mg adrenaline up to FINAL 100 mL sodium chloride 0.9% =10 micrograms/mL. Use a dedicated labelled line and pump; do not piggyback where another infusion can cause an adrenaline bolus.

• At 70 kg, 0.5 mL/kg/hour =35 mL/hour =350 micrograms/hour (about 5.8 micrograms/min). The higher initial rate is chosen only by the experienced team.

No fixed universal rate ceiling; senior titration and invasive/continuous monitoring for refractory shock