-
Atrovent / Ipratropium
Class
Indication
Dose
Anticholinergic (Parasympatholytic)
- Bronchial Asthma
- Reversible bronchospasm assoc with COPD & Emphysema
500 mcg/dose (typically with a B-agonist) via small volume nebulizer
-
Terbutaline / Brethine
Class
Indication
Dose
Sympathetic Agonist - B2 selective
- Reversible bronchospasm assoc with COPD
- Bronchial Asthma
- Preterm Labor
Labor: 0.25 mg subcutaneously (initial) may repeat in 30 - 60 minutes as needed
IV drip (labor): 5 mg in 500 mL Lactated Ringers or NS. 30 mL/hr (5 mcg/min). Slowly increase rate to max of 80 mcg/min as needed.
-
Albuteral / Proventil / Salbutamol / Ventolin
Class
Indication
Dose
Sympathomimetic - B2 selective
- Asthma
- Reversible bronchospasm assoc with COPD
2.5 - 5.0 mg in 2.5 mL NS over 5 - 15 minutes via small volume nebulizer
-
Glucagon / GlucaGen
Class
Indication
Dose
Hormone - Anti-hypoglycemic Agent
- Hypoglycemia
- Beta Blocker OD
- Calcium Channel Blocker OD
- 0.25 - 0.5 mg IV
- OR
- 1.0 mg IM
-
Thiamine / Vitamin B1
Class
Indication
Dose
Vitamin
- Coma of unknown origin - esp is ETOH may be involved
- Delirium Tremens (DT's)
100 mg IV or IM
-
Dextrose / D50W / D25W / D10W
Class
Indication
Dose
Carbohydrate
- Hypoglycemia
- Coma of unknown origin
- 25 g (50 mL) IV
- 2nd dose (same) may be given if 1st dose is ineffective
-
Propofol / Diprovan
Class
Indication
Dose
Sedative / Hypnotic
Induction and maintenance of sedation
2 mg/kg IV followed by 25 - 75 mcg/kg/min
-
Ketamine / Ketalar
Class
Indication
Dose
Sedative / Hypnotic / Analgesic
Induction agent for rapid sequence intubation
- 0.5 - 1.0 mg/kg IV over 30 - 60 seconds
- OR
- 2 - 4 mg/kg IM
-
Etomidate / Amidate
Class
Indication
Dose
Sedative / Hypnotic
Induction agent for rapid sequence intubation
0.1 - 0.3 mg/kg IV over 15 - 30 seconds
-
Lidocaine / Xylocaine
Sodium Channel Blocker / Antiarrhythmic
V-Tach
V-Fib refractory to Amiodarone
Cardiac Arrest
Initial - 1.0 - 1.5 mg/kg
Additional - 0.5 - 0.75 mg/kg every 5 - 10 minutes as needed until max dose of 3.0 mg/kg
*Reduce dose by 50% for Pts >70 yo or with liver disease
-
Procainamide / Pronestyl
Class
Indication
Dose
Sodium Channel Blocker / Antiarrhythmic
- V-Tach with a pulse
- Pre-excited A-Fib
20 - 50 mg/minute until arrhythmia suppressed
- D/C if:
- Arrhythmia suppressed
- Hypotension
- QRS widened by 50%
- Max dose of 17 mg/kg administered
-
Amiodarone / Cordarone
Class
Indication
Dose
- V-Tach
- V-Fib
- A-Fib
- Cardiac Arrest
- Stable narrow-complex tachycardia (to control ventricular rate)
V-Fib / Pulseless V-Tach: 300 mg IV or IO over 10 minutes. Repeat at 150 mg over 10 minutes.
A-Fib: 150 mg IV or IO over 10 minutes. Repeat as needed.
-
Adenosine / Adenocard
Class
Indication
Dose
Antiarrythmic
Tachyarrhythmias refractory to vagal maneuvers
- 1st Dose: 6 mg rapid IV or IO over 1 - 2 seconds followed by rapid saline flush
- 2nd Dose: 12 mg IV or IO over 1 - 2 seconds followed by rapid saline flush
-
Retavase / Reteplase Recominant
Class
Indication
Dose
Fibrinolytic
- Acute coronary syndrome
- Acute MI
- 10 units IV over 2 minutes
- Repeat in 30 minutes (20 units total)
-
Heparin
Class
Indication
Dose
Anticoagulant
- Acute coronary syndrome
- Pulmonary embolism
- Acute STEMI & unstable angina:
- 60 units/kg IV (max 4000 units) followed by 12 units/kg/hour
- NSTEMI & unstable angina:
- 60 - 70 units/kg IV (max 5000 units) followed by 12 - 15 units/kg/hour.
-
Plavix / Clopidogrel
Class
Indication
Dose
Platelet Aggregation Inhibitor
- Acute coronary syndrome
- Recent MI
- Stroke
- Peripheral vascular disease (PVD)
- Acute coronary syndrome & NSTEMI:
- 300 mg loading dose followed by 75 mg daily
-
Cardizem / Diltiazem
Class
Indication
Dose
Calcium Channel Blocker
Narrow-complex tachycardias (SVT, PSVT)
- 0.25 mg/kg IV over 2 minutes - initial dose
- 0.35 mg/kg IV over 2 minutes as needed
-
Verapamil / Isoptin / Calon
Class
Indication
Dose
Calcium Channel Blocker
Narrow-complex tachycardias
- 2.5 - 5 mg IV or IO over 2 minutes
- Repeat dose at 5 - 10 mg in 15 - 30 minutes if needed.
-
Aspirin / Bayer / St. Joseph's Baby Aspirin
Class
Indication
Dose
Antipyretic / Platelet Inhibitor / Anti-Inflammatory
- New CP suggestive of acute MI
- Active MI
160 - 325 mg orally - chewed
-
Atropine / Atropine Sulfate
Class
Indication
Dose
Parasympatholytic
- Symptomatic bradycardia
- Organophosphate Poisoning
0.5 mg IV every 3 - 5 minutes to max dose of 3.0 mg
-
Dobutamine / Dobutrex
Class
Indication
Dose
Sympathetic Agonist
Short term management of CHF when increased cardiac output without increased HR is desired
2 - 20 mcg/kg/min
- Dilute 250 mg in 500 mL D5W (0.5 mg/mL)
- OR
- 250 mg in 1L D5W (0.25 mg/mL)
-
Dopamine / Intropin
Class
Indication
Dose
Sympathetic Agonist
- Hemodynamically significant hypotension (systolic 70 - 100 mmHg) NOT resulting from hypovolemia.
- Cardiogenic Shock
- Symptomatic bradycardia
2 - 10 mcg/kg/minute. Increase until BP imporoves or mad dose of 20 mcg/kg/min
Dilute: 400 mg in 250 mL D5W= 1600 mcg/mL
-
Norepinephrine / Levophed
Class
Indication
Dose
Hypotension NOT due to hypovolemia
0.1 - 0.5 mcg/min per AHA, however higher doses may be needed to maintain BP.
- Dilute: 8 mg in 500 mL D5W = 16 mcg/mL
- OR
- 4 mg in 250 mL D5W = 16 mcg/mL
-
Epinephrine / Adrenalin
Class
Indication
Dose
Sympathetic Agonist
- 1:1000:
- Bronchial Asthma
- COPD exacerbation
- Allergic Reaction
0.3 - 0.5 mg
1:10 000:
- Cardiac Arrest = 1.0 mg every 3 - 5 minutes
- Anaphylaxis = 0.05 - 0.1 mg IV or IO
- Bradycardias refractory to Atropine = 2 - 10 mcg/min
-
Labatalol / Trandate / Normodyne
Class
Indication
Dose
Non selective Beta Blocker
Hypertensive emergency: markedly elevated BP with end-organ failure. (HA & anxiety with increased BP are NOT indications
20 mg slow IV over 10 minutes. Monitor BP prior and 5 - 10 minutes after administration.
Additional doses of 40 mg every 10 minutes until desired supine BP is reached
-
Sotolol / Sotacor / Betapace
Class
Indication
Dose
Non-selective Beta-Blocker, Antiarrhythmic
Hemodynamically stable monomorphic V-Tach (Stable V-Tach)
1.5 mg/kg infused over 5 minutes (slower is preferred)
-
Metoprolol / Lopressor
Class
Indication
Dose
Selective Beta-Blocker, Antiarrhythmic
- Suspected or aute MI who are also hypertensive
- Stable narrow-complex tachycardia if rhythm remains uncontrolled or unconverted by Adenosine or vagal maneuvers, or if SVT is recurrent.
5 mg slow IV every 2 - 5 minutes, to max of 3 doses. Reassess vitals in between and re-administer only if Pt remains stable.
-
Nitroglycerin / Nitro BID / Nitrostat
Class
Indication
Dose
Nitrate
0.4 mg sublingual spray or tablet every 3 - 5 minutes.
-
Oxygen
Class
Indication
Dose
Gas
Hypoxia
Cardiac arrest & critical Pt - 100%. Other titrate SpO2: 94 - 99%
- NC: 2 - 6 lpm 24 - 44%
- Simple: 8 - 10 lpm 40 - 60%
- Venturi: 4 - 12 lpm 24 - 50%
- Partial: 6 - 10 lpm 35 - 60 %
- NRB: 6 - 10 lpm 60 - 95%
- BVM: 10 - 15 lpm 40 - 90%
-
Vecuronium / Norcuron
Class
Indication
Dose
Nondepolarizing Neuromuscular Blocking Agent (Paralytic)
To achieve paralysis to facilitate endotracheal intubation when muscle tone or seizure activity prevents it.
0.08 - 0.1 mg/kg IV
-
Magnesium Sulfate
Class
Indication
Dose
Anticonvulsant / Antiarrhythmic
Torsade de pointes: 1 - 2 g (in 10 mL D5W)
Eclampsia: 2 - 4 g (in 10 mL D5W)
-
Sodium Bicarbonate
Class
Indication
Dose
Alkalinizing Agent
- Tricyclic antidepressant overdose.
- Severe acidosis refractory to hyperventilation.
1 mEq/kg initial followed by 0.5 mEq/kg every 10 minutes as indicated by blood gas studies
-
Calcium Chloride
Class
Indication
Dose
Calcium Supplement
- Hyperkalemia
- Hypocalcemia
- Calcium Channel Blocker Toxicity (Cardizem, Verapamil)
2 - 4 mg/kg IV every 10 minutes as needed
-
Morphine
Class
Indication
Dose
Narcotic (schedule II)
Severe pain with MI, kidney stones, etc.
- 2 - 10 mg IV - initial dose
- Additional doses of 2 mg every few minutes until pain is relieved or respiratory depression occurs.
-
Fentanyl / Sublimaze
Class
Indication
Dose
Narcotic
- Severe pain
- Adjunct to rapid sequence intubation (RSI)
- Maintenance of analgesia
25 - 100 mcg IV slowly over 1 - 3 minutes
-
Narcan / Naloxone
Class
Indication
Dose
Narcotic Antagonist
Narcotic overdoses including: morphine, hydromorphone (Dilaudid), Fentanyl, Demeral, Methadone, Heroin, Oxy, Percocet, etc.
1 - 2 mg IV or IO
-
Rocuronium / Zemuron
Class
Indication
Dose
Nondepolarizing Neuromuscular Blocker (Paralytic)
Induction of skeletal muscle paralysis
- 600 mcg/kg initial (0.6 mg/kg)
- followed by: 100 - 200 mcg/kg/min continuously (0.1 - 0.2 mg/kg/min)
-
Vasopressin / Patressin
Class
Indication
Dose
Vasopressor
- Cardiac arrest
- Organophosphate Poisoning
40 units IV or IO - may replace 1st or 2nd dose of Epi during cardiac arrest
-
Succinylcholine / Anectine
Class
Indication
Dose
Depolarizing Neuromuscular Blocking Agent (Paralytic)
To achieve paralysis to facilitate endotracheal intubation when muscle tone or seizure activity prevent it.
1.0 - 1.5 mg/kg IV
-
Phenobarbitol / Luminal
Class
Indication
Dose
Barbituate
- Major motor seizures
- Status epilepticus
- Acute anxiety state
Status epipecticus: 100 - 250 mg slow IV
-
Mannitol / Osmotrol
Class
Indication
Dose
Osmotic Diuretic
- Acute cerebral edema
- Blood transfusion reactions
1.5 - 2.0 g/kg slow IV bolus or infusion
-
Toradol / Ketorolac
Class
Indication
Dose
Non-Steroidal Anti-inflammatory Agent (NSAID)
Mild to moderate pain
- 30 mg IV
- OR
- 30 - 60 mg IM and then 1/2 original dose after 6 hours
* 1/2 dose in elderly Pts
-
Captopril / Capoten
Class
Indication
Dose
- Angiotensin-Converting Enzyme
- (ACE Inhibitor)
12.5 - 25 mg sublingually if BP is between 90 - 110 systolic
-
Enalapril / Vasotec / Enalaprilat
Class
Indication
Dose
- Angio-tensin Converting Enzyme
- ACE Inhibitor
1.25 - 5 mg (typically 1.25 mg) IV over 5 minutes. Can be repeated every 6 hours.
-
Decadron / Dexamethasone / Hexadrol
Class
Indication
Dose
Corticosteroid / Anti-Inflammatory
- Anaphylaxis (after Epi & Benadryl)
- Asthma
- COPD
Anaphylaxis: 4 - 10 mg IV - single dose prehospitally
4 - 24 mg IV
-
Benadryl / Diphenhydramine
Class
Indication
Dose
Anti-Histamine
- Allergic reactions
- Anaphylaxis
- Extrapyramidal symptoms
25 - 50 mg slow IV push or deep IM
-
Solu-Medrol / Methylprednisolone
Class
Indication
Dose
Corticosteroid / Anti-Inflammatory
- Severe anaphylaxis
- Asthma
- COPD
125 - 250 mg IV - single dose prehospitally
-
Zofran / Ondansetron
Class
Indication
Dose
Antiemetic
Nausea & Vomiting
4 - 8 mg IV
-
Phenergan / Promethazine
Class
Indication
Dose
Phenothiazine Antihistamine (H1 antagonist)
- Nausea & Vomiting
- Motion Sickness
- Sedation
- To potentiate the effects of analgesics
12.5 - 25 mg IV or deep IM
-
Reglan / Metoclopramide
Class
Indication
Dose
Phenothiazine Antiemetic
- Nausea & Vomiting
- Gastroesophageal reflux
- 10 mg slow IV push over 1 - 2 minutes
- or
- diluted in 50 mL NS over 15 minutes
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