Which route is used for epinephrine in anaphylaxis under ICEMA standing orders?

• A. Subcutaneous
• B. Inhaled
• C. Intravenous
• D. Intramuscular

Answer: (D)

During anaphylaxis, the preferred route for epinephrine is intramuscular injection because it delivers rapid, reliable systemic absorption in the prehospital setting. Injecting into the mid-outer thigh (vastus lateralis) provides quick onset, which is crucial to counteract airway swelling, bronchospasm, and hypotension. Subcutaneous administration can be slower and more variable when perfusion is compromised, making the response less predictable. Intravenous administration is typically reserved for hospital settings with careful monitoring and dosing, due to higher risks of rapid cardiovascular effects and the need for controlled titration. Inhaled epinephrine is not used for systemic anaphylaxis; it’s reserved for certain airway conditions like croup or bronchospasm in asthma. So the intramuscular route is the standard in ICEMA standing orders for anaphylaxis.