For a pediatric shock patient with a normal BgL and no IV access, what is the initial Push Dose Epinephrine dose (mcg/kg IV/IO) and its maximum allowed dose?

• A. 0.01 mcg/kg IV/IO, max dose 0.5 mcg; titrate to SBP >70 mmHg + 2 x age
• B. 0.05 mcg/kg IV/IO, max dose 3 mcg
• C. 0.1 mcg/kg IV/IO, max dose 5 mcg; titrate to SBP >70 mmHg + 2 x age
• D. 0.5 mcg/kg IV/IO, max dose 50 mcg

Answer: (C)

In pediatric shock without IV access, you give small, rapid boluses of epinephrine to quickly improve perfusion while you establish access. The correct approach uses a dose of 0.1 mcg/kg per bolus, with a maximum of 5 mcg per dose, and you repeat as needed until the patient’s systolic blood pressure is raised to a target: SBP > 70 plus 2 times the child’s age in years. This dosing balances efficacy with safety in children: it provides enough vasoconstriction and increased cardiac output to improve perfusion without pushing the heart too hard or causing excessive vasoconstriction. The target SBP gives a concrete goal to titrate toward, ensuring you aren’t overcorrecting or under-resuscitating.

Smaller per-dose options would often be insufficient to restore perfusion promptly, while a much larger per-dose could provoke tachycardia or ischemia. The max per-dose limit protects against overdose in larger children, and the age-based SBP target keeps resuscitation aligned with pediatric physiology.