Question: My question is in regards to the moderate to severe allergic reaction and medical cardiac arrest. With the new changes, the moderate to severe allergic reaction directive allows us to administer 2 doses of epinephrine q 5 minutes to a max of 2. If a patient were to go into cardiac arrest due to anaphylaxis (after already administering 2 doses of epinephrine), are we still able to administer another dose under the medical cardiac arrest directive? (Leading to a total of 3 doses).

Great question. Previous administration of epinephrine is not an exclusion from epinephrine in the cardiac arrest medical directive.  Therefore in the scenario described a paramedic could administer IM epinephrine to the anaphylactic patient who arrests. Given the failure of the 1^st two doses of epinephrine to relieve anaphylaxis, focus should be on high quality CPR and rapid transport. Do not delay these two key components of care in order to give the third dose of epinephrine.

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