Activated Charcoal (Aqua, Actidose, Liqui-char) 

Oral poisonings and drug overdose 

Adult: 1 to 2 g/kg PO, nasogastric tube, orogastric tube (larger dose if food present)

Ped (1-12yr): 15-30g

Infant (<1yr): 1g/kg 

Adenosine (Adenocard):

Stable PSVT:

Adult: 6mg/12mg/12mg Rapid IVP

Ped: 0.1mg/kg, 0.2mg/kg Rapid IVP (max 6mg, 12mg, 12mg)

Albuterol (Proventil) 

Bronchospasm in pts. with reversible obstructive airway disease, exercise induced bronchospasm

Adult: Metered dose inhaler 90mcg/spray, aerolisation 0.5% (5mg/ml), 0.083% (2.5mg in 3ml unit dose/nebulizer)

Ped: 0.01-0.03ml (0.05-0.15 mg)/kg max 0.50 ml/dose diluted in 2ml saline, every 20 mins 3 times.

Amiodarone (Cordarone):

Pulseless VT/VF:

Adult: 300mg/150mg IVP

Ped: 5mg/kg IVP, can repeat at 5mg/kg

 

Stable VT:

Adult: 150mg/100cc D5W over 10min

Ped: 5mg/kg IV over 20-60min (max single dose 300mg)

Amrinone (Inocor) 

Severe CHF refractory to diuretics, vasodilators, and conventional inotropic agents 

Adult: 0.75mg/kg IV over 2-3 mins followed by 5-15mcg/kg/min titrated to effect

Ped:  0.75-1mg/kg IV over 5 mins; may repeat twice (max 3mg/kg) followed by 5-10mcg/kg/min

Amyl Nitrate 

Cyanide poisoning (only until sodium nitrate can be given IV) 

Adult: 0.3ml glass ampule (inhale for 30-60 seconds) repeat up to 6 times from same ampule

Ped: same as adult 

Aspirin (A.S.A, Bayer, Ecotrin, St. Joseph) 

Mild pain, fever.

Adult: 325-650 mg PO q 4 hr

Ped: (over 12yr): 40-100 mg/kg/day in divided doses 

 

MI

Adult: 160-325 mg PO chewable

Atenolol (Tenormin) 

PSVT, Aflutter, Afib 

Adult: 5mg slow IV (over 5 mins),  wait 10 mins then give another 5mg.

Ped: not recommended

Atropine Sulfate:

Bradycardia:

Adult: 0.5 mg IVP q 3-5min max dose 3mg

Ped: 0.02mg/kg, 0.04mg/kg IVP (max 1mg child, 2mg adolescent) 

 

Asystole/PEA <60:

Adult: 1mg IVP

Ped: 0.02mg/kg, 0.04mg/kg IVP (max 1mg child, 2mg adolescent)

 

Organophosphate:

Adult: 1-2 mg IVP every 5 to 15 mins until effects are observed then every 1 to 4 hours for at least 24 hr.

Ped: 0.02-0.05 mg/kg/dose may be repeated every 10-20 mins until effects are observed then every 1 to 4 hours for at least 24 hr.

Calcium Chloride (10%):

Hypo Ca/Hyper K (except for digitalis toxicity), hypermagnesemia, to prevent hypotensive effects of calcium channel blockers (verapamil and diltiazem):

Adult: 8-16 mg/kg of 10% solution (slow IV - no more than 1 ml/min)  flush IV line between administration of sodium bicarbonate - to avoid precipitation

Ped: 20mg/kg IV/IO(of 10% solution)

Dexamethasone (Decadron, Hexadrol) 

Allergic state (onset 4 to 8 hr), chronic inflammation 

Adult: 4-24mg IV (or IM)

Ped: 0.25-0.5 mg/kg/doseIV (or IO) 

Dextrose 50%

Hypoglycemia, ALOC, Coma of unknown origin, seizure of unknown origin 

Adult: 12.5-25g slow IV

Ped: 5-10ml/kg D10W, 2-4ml/kg D25W, 1-2ml/kg D50W

Diazepam (Valium) 

Seizure

Adult: 5mg over 2 mins every 10-15min as needed (max 30mg)

Ped  (30 days to 5yr): 0.2-0.5mg slow IV every 2-5 min, max 5mg.

Ped: (>5yr): 1 mg every 2-5 min, max 10mg slow IV.

 

Prior to cardioversion or transcutaneous pacing 

Adult: 5-15mg IV 5-10mins before procedure 

Digoxin (Lanoxin) 

SVT, Aflutter, Afib, CHF, Cardiogenic shock 

Adult: 10-15mcg/kg 

Ped: not recommended pre-hospital 

Afib/Aflutter/PSVT:

Adult: 0.25mg/kg over 2min, 0.35mg/kg over 2min

Ped: safety not established 

Diphenhydramine (Benadryl) 

Moderate to severe allergic reactions, anaphylaxis 

Adult: 10-50mg IM, IV every 6-8hr. Max 400mg/day

Ped (>10kg): 1.25mg/kg/dose every 6 hrs (max 300mg/day)

Dobutamine (Dobutrex):

Hypotension: (BP 70-100 w/o signs of shock)

Adult: 2-20mcg/kg/min IV

Ped: 2-20mcg/kg/min IV/IO

Dopamine (Intropin):

Hypotension: (BP 70-100 with signs of shock)

Epinephrine Recemic (MicroNefrin, Adrenaline HCL):

Cardiac Arrest:

Adult: 1mg (1:10,000) q 3-5min no max

Ped: 0.01mg/kg (1:10,000) q 3-5min no max

Adult: 1mg (1mL/1:1,000) in 500cc D5W titrated to effect (2-10 mcg/min)

Ped: 0.01mg/kg (1:10,000) q 3-5min no max

 

(1:10,000) Higher doses up to 0.2mg/kg may be required

Etomidate (Amidate) 

Premedication for tracheal intubation or cardioversion 

Adult: 0.2-0.6mg/kg IV over 30-60 sec. 

Ped (over 10yr): 0.2-0.6mg/kg IV over 30-60 sec.

Fentanyl (Sublimaze) 

Pain control, RSI 

Adult: 0.05-0.1 mg IM every 1-2 hr as needed

Ped: (over 2yr): 0.02-0.03mg/9kg IM one time - rarely used pre-hospital.

Flumazenil (Romazicon)

Benzodiaz. OD:

Adult: 0.2mg IV over 15sec/ 0.3mg IV over 30 sec./ 0.5mg IV over 30 sec, max 3mg

Ped: Not recommended 

Furosemide (Lasix):

Pulm. Edema or HTN Emergencies:

Adult: 20-40mg (0.5-1.0mg/kg slow IV over 1-2min)

Ped: 1mg/kg/dose (max 6mg/kg) 

Glucagon (Gluca-Gen):

Hypoglycemia:

 

Beta-Blocker, Ca-Blocker OD, allergic reaction:

Adult: 1.0mg IM

Ped: Safety and efficacy not established

Adult: 1-5mg IV over 2-5 min

Haloperidol Lactate (Haldol) 

Acute psychotic episodes, emergency sedation of severely agitated or delirious patients 

Adult: 2-5mg IM every 4-8 hrs as needed 

Heparin Sodium 

Acute MI, thromboembolic disorders (eg: pulmonary emboli and DVT) 

Initial IV bolus 60 Int'l units/kg/hr (max 4000 IU) then maintain at 12 IU/kg/hr (max 4000 IU or 1000 IU/hr)

Hyralazine (Apresoline) 

Hypertensive crisis, hypertension associated with renal failure, preeclampsia,  eclampsia, primary pulmonary hypertension

Adult: 10-40mg IM or IV, repeat in 10 mins as needed.  Infusion 20 mg in 250ml NS or LR at 5-20mg/hr.

Ped: 0.1-0.2 mg/kg/dose every 4-6 hrs IM, IV, repeat as needed.  Infusion 0.75-3 mg/kg every 6-12 hrs.

Hydroxyzine (Atarax, Vistaril) 

To potentiate effects of analgesics, nausea and vomiting, anxiety reactions, motion sickness, pruritus 

Adult: 25-100mg deep IM

Ped: 1mg/kg/dose deep IM 

Ibutilide (Corvert) 

SVT dysrhythmias, conversion of Afib and Aflutter of brief durations 

Adult: 0.01mg/kg IV (up to 60kg) (1mg if over 60kg) over 10 mins IV

Ped: Not recommended 

Insulin (Regular, NPH, Ultralente) 

Used prehospital only on long transports

Adult: 10-25 units SQ, IM or IV followed by 0.1 units/kg/hr

Ped: 0.1-0.2 units/kg/hr IM

Ipratropium (Atrovent) 

Persistent bronchospasm, Chronic obstructive pulmonary disease exacerbation 

Adult: 1-2 18mcg aerosol actuation

Ped (over 12yrs): same as adult 

Isoproterenol (Isuprel):

Bradycardia:

 

Beta-Blocker OD:

 

Torsades (TdP):

Ped: Not recommended

Adult: 2-10mcg/min IV

Titrate to adequate heart rate

 

Titrate to increase heart rate until VT is supressed

Ketamine(Ketalar) 

Pain control, adjunct to nitrous oxide 

Adult: 1-2mg/kg IV over 1 min or 5-10mg IM 

Ped (over 2yrs): same as adult 

Ketorolac Tromethamine (Toradol) 

Short term management (<5 days) of moderate to severe pain 

Ped: Not recommended

Adult: IM:30-60mg, then 15-30mg every  6hr as needed up to 5 days (max dose 150mg in first 24hr)

IV: 30mg over 1 min (<65yrs), 15mg (>65 years or renal impairment)

Labetalol (Normodyne, Trandate) 

Hypertensive emergencies 

Adult: 10mg IV over 1-2 mins.  May repeat or double dosage after 10 mins (max 150mg)

Ped: Safety not established (initiate cautiously)

Lidocaine HCl (Xylocaine):

Pulseless VT/VF:

 

 

Post resuscitation: 

 

Stable VT or Ventricular Ectopy:

Adult: 1.0-1.5mg/kg IV/IO, may repeat in 3-5 mins. max total dose 3mg/kg

Ped: 1.0mg/kg IVP/IO (max 100mg)

Adult: 0.5-0.75mg/kg IV/IO, may double dose to 1.0-1.5mg/kg, repeat up to 3mg/kg

Ped: 1.0mg/kg IVP/IO (max 100mg)

Lorazepam (Ativan) 

Agitation requiring sedation, initial control of status epilepticus or severe recurrent seizures 

Adult: If given IV, then first dilute with equal volume or sterile water or saline.  If given IM, then do not dilute. 1-4mg slow IM/IV over 2-10 mins.  May be repeated in 15-20 mins (max 8mg) 

Ped: (not FDA approved) 0.05-0.15 mg/kg slow IV/IO/IM over2 min may be repeated once in 5-10 min max 4mg; 0.1-0.2mg/kg rectal dose

Magnesium Sulfate:

Cardiac Arrest, to include (TdP):

 

 

Torsades (TdP) with a pulse or life-threatening arrhythmias due to Digitalis toxicity:

 

Eclampsia:

Status Asthmaticus:

Adult: 1-2g IV/IO in 10cc D5W over 5-20 min

Ped: 25-50mg/kg (max 2g) over 10-20 mins 

 

Adult: 1-2g IV/IO in 100cc D5W over 5-60 min

 

2-4g

Ped: 25-50mg/kg IV/IO over 10-20 min (max 2g)

Mannitol (Osmitrol) 

Decrease cerebral edema and ICP caused by head injury or mass lesions (don't use if active intracranial bleeding) 

Adult: 0.5-1g/kg in a 20% solution over 5-10 mins

Ped: 0.2-0.5 g/kg/dose IV over 30-60 mins (max 1g/kg) every 4-6 hrs. 

Meperidine (Demerol) 

Moderate to severe pain 

Adult: 50-100mg IM every 3-4 hr as needed, 15-35mg IV per hr

Elderly: 25mg every 4 hr as needed

Ped: 1-2mg/kg/dose IM every 3-4 hrs as needed 

Metaproterenol (Alupent) 

Bronchial asthma, reversible brinchospasm (bronchitis, emphysema) 

Adult: Metered dose inhaler: (0.65mg/spray) 2-3 inhalations every 3-4 hr as needed (2 min between inhalations) (max 12 inhalations per day)

Ped (over 12yrs): same as adult 

Adult: Solution: 5-15 inhalations of 5% solution

Ped (over 6yrs): same as adult

Methylprednisolone (Solu-Medrol) 

Anaphylaxis, Bronchodilator: unresponsive asthma

 

 

Spinal cord injury (controversial) 

Adult: 40-125mg IV 

Ped: 1-2mg/kg/dose IV 

 

30mg/kg IV bolus, then 5.4mg/kg/hr

Metoprolol (Lopressor)

PSVT, Aflutter, Afib, acute MI 

Adult: 5mg slow IV at 5 min intervals (max 15mg)

Ped: Safety not established

Midazolam Hydrochloride (Versed) 

Premedication for tracheal intubation, cardioversion or other painful procedures

Adult: 1-2.5mg slow IV (over 2-3 mins) (may be repeated if necessary in small increments) (max 0.1mg/kg)

Elderly: 0.5mg slow IV (max 1.5mg in 2min)

Ped: 0.05-0.2 mg/kg then continue infusion 1-2 mcg/kg/min

Morphine Sulfate (Astramorph/PF)

 

Adult: 2-4mg IV over 1-5min q 3-5 min/may increase to 2-8mg IV q 5-15min

Ped: 0.1-0.2 mg/kg/dos IV (max total dose: 15mg) 

Nalmefene (Revex) 

Opiate OD: 

Adult: Green label 0.5-1mg/70kg (may repeat once in 2-5 min)

Ped: Safety not established

Naloxone HCl (Narcan):

Adult: 0.4-2.0mg IV/IO titrated to respiratory improvement

1-5mcg/kg IV/IO titrated to respiratory improvement

Nitroglycerin (Nitrostat):

Chest Pain, HTN Crisis:

Adult: CHF 0.3-0.4mg SL q 5min or 1 spray(0.4mg) q 5min, max 3 tabs or 3 sprays in 15 min

Ped: not recommended 

Nitropaste (Nitro-Bid):

Angina pectoris, chest pain associated with acute MI

Adult: 1-2 inches of paste over 2-4 inch area, cover with transparent wrap and secure with tape.

Ped: not recommended

Nitrous Oxide:Oxygen (50:50) (Nitronox) 

Moderate  to severe pain, anxiety, apprehension

Adult: Comes in blue and green tank that must be inverted several times Pt. must self administer by holding mask.

Ped: same as adult

Sodium Nitroprusside (Nipride):

HTN Crisis: Note: Drug is light-sensitive, and IV bag and tubing must be covered in opaque material.

Adult: 50-100mg in 250cc D5W, begin at 0.1 mcg/kg/min IV, titrate to effect

Norepinephrine (Levophed):

Cardiogenic shock, neurogenic shock

Adult: 4mg Norepinephrine in 250cc D5W, administer 0.5-1.0mcg/min (up to 30mcg/min) IV titrate to effect with BP <70

Ped: 0.1-2 mcg/kg/min IV/IO 

Oxygen 

Hypoxia, ischemic chest pain etc. 

Adult: 10-15L non-rebreather mask, 1-4L nasal cannula

Ped: same as adult 

Oxytocin (Pitocin) 

Postpartum  hemorrhage after infant and placental delivery

3-10 units IM

Pancuronium (Pavulon) 

Induction or maintenance of paralysis after intubation to assist ventilations 

Adult: 0.04-0.1mg/kg slow IV, repeat every 30-60 mins as needed

Ped: 0.04-0.1 mg/kg slow IV

Newborn 0.02 mg/kg/dose

Phenytoin (Dilantin) 

Major motor seizures (generalized grand mal,  simple partial and complex partial seizures).  Status epilepticus.

Adult: 1000mg or 15-20mg/kg slow IV (not to exceed 1g or 50mg/min); followed by 100-150mg/dose at 30min intervals (max 1500mg/24hrs)

Ped: 10-20 mg/kg slow IV (<0.5 mg/kg/min) 

Pralidoxime (2-PAM, Protopam) 

Organophosphate poisoning (after atropine) 

Adult: 600mg IM autoinjector or 1-2g IV over 15-30min

Ped: 20-50 mg/kg IV over 15-30 min 

Procainamide (Pronestyl):

Refractory VT/VF:

 

AFib/PSVT or Stable VT:

Adult: 20mg/min IV, max dose 17mg/kg

Ped: 15mg/min IV, over 30 - 60 min

Promethazine (Phenergan) 

Nausea and vomiting, motion sickness 

Adult: 12.5-25mg IV (over 1 min), deep IM (preferred route)

Ped: not recommended pre-hospital

Propranolol (Inderal) 

Hypertension, Angina pectoris. Vtach, Vfib, rapid SVT refractory to other therapies

Adult: 1-3mg IV over 2-5 mins (not to exceed 1mg/min)  May be repeated after 2 min.  (max 0.1mg/kg)

Ped: not recommended 

Reteplase (Retavase) 

Acute MI (confirmed by 12 lead) 

Adult: 10units IV over 2 min, then another 10units 30 mins later.

Ped: safety not established 

Sodium Bicarbonate:

Hyperkalemia, Metab. Acidosis, TCA/Cocaine OD,

Adult: 1mEq/kg IV bolus

Ped: same as adult

Streptokinase (Streptase) 

Acute MI, massive pulmonary emboli, arterial thrombosis and embolism 

1.5 million units diluted to 45ml IV over 1hr (use infusion pump) 

Succinylcholine (Anectine):

To facilitate intubation, terminate laryngospasm, muscle relaxation

Adult: 1-2mg/kg IV, 2-4 mg/kg IM

Ped: 1.0-1.5mg/kg IV, 2mg/kg for infants, IM dose is 2x IV dose

Syrup of Ipecac 

Acute oral drug or toxin OD in alert pts. 

Adult: 15-30ml PO followed by 3-4 glasses of water.  May repeat with 15ml once in 20 min if ineffective. 

Ped (1-12yrs): 5-15ml PO followed by 1.5-2 glasses of water. May repeat with 15ml once in 20 min if ineffective.

Tetracaine (Pontocaine) 

Short term relief from eye pain or irritation 

Adult: 1-2 drops

Ped: same as adult 

Thiamine (Betaxin) 

Coma of unknown origin, delirium tremens 

Adult: 100mg slow IV or IM

Ped: not recommended pre-hospital 

Tissue Plasminogen Activator (t-PA, Activase, Recombinant Alteplase) 

Acute MI, massive pulmonary emboli, arterial thrombosis and embolism

Adult: For acute MI: 15mg IV bolus, then 0.75mg/kg over next 30 mins (max 50mg) and then 0.5mg over next 60 mins (max 35mg)

Ped: safety not established 

Vasopressin (Pitressin):

Cardiac Arrest:

Adult: 40U IV/IO one time dose to replace first or second epinephrine

Ped: not recommended for child or infant 

Verapamil (Isoptin)

 

Adult: 2.5-5.0mg IV bolus over 2min/5.0-10.0mg every 15-30 min, max 20mg

Ped: not recommended 

Etomidate (Amidate):

Sedative

0.2-0.6mg/kg IVP

Fentanyl:

Sedative

2-10mcg/kg IVP

Ketamine:

Sedative

Sedative

0.07-0.3 mg/kg IVP

Sedative

2.0-2.5mg/kg IVP

Thiopental:

Sedative

3.0-5.0mg/kg IVP

Succinylcholine (Anectine):

NMBA

1-2mg/kg IV, 2-4 mg/kg IM

Vecuronium (Norcuron):

NMBA

Rocuronium (Zemuron):

NMBA

0.6-1.2mg/kg IV

Etomidate (Amidate):

Sedative

0.2-0.4mg/kg IV over 30-60sec, max 20mg

Fentanyl:

Sedative

2.0-4.0mcg/kg IVP

Ketamine:

Sedative

Sedative

0.1-0.2mg/kg IVP

Diazepam (Valium): 

Sedative

0.1-0.2mg/kg IVP

Sedative

2.0-3.0mg/kg IVP

Thiopental:

Sedative

2.0-5.0mg/kg IVP

Lidocaine:

Decrease ICP

1.0-2.0mg/kg IVP

Succinylcholine (Anectine):

NMBA

1.0-1.5mg/kg IV for children, 2mg/kg for infants, IM dose is 2x IV dose

Vecuronium (Norcuron):

NMBA

Rocuronium (Zemuron):

NMBA

0.6-1.2mg/kg IV