**This is the least recommended approach as it commits a high volume of epinephrine to a large bag. If the patient’s vital signs (BP/MAP/HR) stabilize, the bag must be discontinued and the medic risks wasting some of his or her resources – “you can mix a drug in an IV bag, but you can’t take it out.”

Key point: If administering epinephrine infusion via a peripheral IV, monitor the IV site with every vital signs check for signs of redness, swelling or induration (firm, chord-like feeling of vessel above IV site). If any of these are present, epinephrine may be leaking out of the IV (“extravasating”) which can cause permanent scarring and damage to the vessel. Stop the infusion immediately and seek telemedicine consultation.

Use IV hydrocortisone, 100 mg every 8 hours, for at least 3 days in a military-aged male to treat septic shock in patients if adequate fluid resuscitation and vasopressor therapy are not able to restore hemodynamic stability. Due to the low volume and quality of evidence with this intervention, telemedicine is required before IV hydrocortisone is initiated as a treatment.3

References

1. Russell J, Gordon A, Walley K. Early may be better: early low-dose norepinephrine in septic shock. American Journal of Respiratory and Critical Care Medicine Vol. 199, No. 9 May 01, 2019; 1049–1051.
2. Farkas J. Epinephrine Challenge in Sepsis: An Empiric Approach to Catecholamines. EMCrit 2016. https://emcrit.org/pulmcrit/epi/ Accessed Oct 2020.
3. Gibbison B, López-López JA, Higgins JP, et al. Corticosteroids in septic shock: a systematic review and network meta-analysis. Crit Care. 2017 Mar 28;21(1):78.