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Drugs, such as epinephrine, atropine, naloxone, and lidocaine can be given via the endotracheal route if IV access has not been obtained yet. The dose for epinephrine, rather than 1mg IV, should be 5mg endotracheally, followed by 5 to 10 mL of saline and several rapid breaths to aerosolize it into the lungs. ACLS currently recommends this approach, but there have been no studies showing benefit to this route of administration. I would recommend rapid IV access, and if no IV access if available within 90 seconds, placement if an intraosseous line should be attempted immediately afterwards and all medications given through that line. That is standard practice at many hospitals in this area as well as many EMS services.

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