What is the typical EMS dose for epinephrine in adults with anaphylaxis (1:1000)?

• A. 0.15 mg IM
• B. 0.30 mg IM
• C. 0.50 mg IM
• D. 1.00 mg IM

Answer: (B)

In adults with anaphylaxis, the standard EMS dose of epinephrine at a 1:1000 concentration given intramuscularly is 0.3 mg. This concentration means 1 mg of epinephrine per mL of solution, so 0.3 mg corresponds to about 0.3 mL injected. The IM route in the thigh is chosen because it yields rapid absorption and quick onset, which is crucial to counter airway edema, bronchospasm, and hypotension. Using this dose provides strong enough alpha-adrenergic effects to reduce swelling and raise blood pressure, while the beta-adrenergic effects help open airways and support heart function. If symptoms persist, a second dose can be considered after 5–15 minutes. Doses much smaller may not reverse life-threatening symptoms in adults, while substantially larger single doses increase the risk of tachycardia and hypertension.