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Scenario Question - Severe Allergic Reaction/EPI Admin/VSA

Question#: 593


ACP crew: If you have a patient in severe allergic reaction and you administer 0.5mg of EPI IM and then patient goes VSA, can you give a second dose of EPI IM in regards to your medical cardiac arrest medical directive or does your initial dose prior to being VSA count?


In this scenario it would be advisable to administer Epinephrine 1:10,000 IV or IO as per the Medical Cardiac Arrest Directive. Epinephrine 1:10,000 IV or IO will have the same beneficial effects (vasoconstriction which reduces hypotension, stabilizes cell membrane, bronchodilation and limiting histamine and other mediator release) but quicker onset as it would be administered directly into the central circulation and not in the periphery where blood flow is diminished due to the effects of histamine and other mediator release.

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28 March 2022



Please reference the MOST RECENT ALS PCS for updates and changes to these directives.