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ADENOSINE (Adenocard)
o CLASS: Antidysrhythmic
o INDICATION: Narrow Complex SVT/PSVT
o CONTRAINDICATION: Hypersensitivity , 2nd & 3rd degree AV block, VT,
sick sinus syndrome, pt’s taking Tegretol. Asthma – Use with Caution.
o DOSAGE: 6 mg IV rapidly over 1-3 secs flush with 20 cc NS,
If no effect in 1-2 min give 12 mg
(PEDS: 0.1 mg/kg 1st dose, 0.2 mg/kg 2nd dose)
o * Half life is 6 sec. Push through large proximal vein & flush immediately.
o SIDE EFFECTS: Facial flushing ,chest pn, hypotension, headache, bronchospasm
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ALBUTEROL (Proventil, Ventolin)
o CLASS: Sympathomimetic bronchodilator
o INDICATIONS: Bronchospasm secondary to COPD, Asthma, Croup, RAD
o CONTRAINDICATIONS: Hypersensitivity, Tachydysrhythmias,
Known allergy to nuts
o DOSAGE: 2.5 mg in 3 ml saline in neb
(PEDS: Same as adult, Infants ≤ 3 months 1.25 mg)
o SIDE EFFECTS: Anxiety, n/v, tachydysrhythmias
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AMIODARONE (Cordarone)
o CLASS: Antidysrhythmic
o INDICATIONS: Life threatening recurrent ventricular &
supraventricular dysrhythmias, VF, pulseless VT before lidocaine
o CONTRAINDICATIONS: Hypersensitivity, cardiogenic shock,
severe sinus brady, advanced heart block
o DOSAGE: V-Fib: 300 mg IV/IO second dose of 150 mg in 3-5 min
(PEDS: 5 mg/kg, repeat up to 15 mg/kg)
o Stable Wide Complex Tachycardia: 150 mg IV/IO over 10 min
(PEDS: 5 mg/kg over 20 min, repeat up to 15 mg/kg)
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ASPIRIN (ASA)
o CLASS: Antiplatelet, Anti-inflammatory, Antipyretic, Analgesic
o INDICATIONS: Chest pain suggestive of an MI
o CONTRAINDICATIONS: Hypersensitivity, active ulcer disease, asthma
Precautions: Bleeding disorders, allergies to other NSAIDs
o DOSAGE: 160-325 mg PO (chewable)
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ATROPINE
o CLASS: Parasympatholytic
o INDICATIONS: Asystole, hemodynamically significant bradycardia,
organophosphate poisoning
o CONTRAINDICATIONS: None
o DOSAGE: Asystole, PEA: 1 mg IVP q 3-5 min; max 0.04 mg/kg
(PEDS: 0.02 mg/kg IV/IO)
ET TUBE: Adult: 2 mg; PEDS: 0.04 mg/kg
o Symptomatic bradycardia: 0.5-1 mg IVP (PEDS: 0.02 mg/kg up to 1mg)
o Organophosphate: 2-5 mg IV q 10-15 min (PEDS: 0.05 mg/kg)
o Asthma: 0.4-2 mg nebulized in 3 ml
* Remember, if given in a dose of < 0.1 mg, or if it is given too slowly,
a paradoxical (reflex) bradycardia may occur.
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CALCIUM CHLORIDE
o CLASS: Electrolyte
o INDICATIONS: Hyperkalemia, hypocalcemia, hypermagnesemia,
calcium channel blocker toxicity,
muscle spasm & pain from spider bites
o CONTRAINDICATIONS: V-Fib, hypercalcemia, and digitalis toxicity
o DOSAGE: 2-4 mg/kg IV (250-500 mg) of 10% solution/10 min
(PEDS: 20 mg/kg IV repeat at 10 min prn)
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DEXAMETHASONE (Decadron)
o CLASS: Steroid, Anti-inflammatory
o INDICATIONS: Anaphylaxis, asthma, COPD,
spinal cord trauma, cerebral edema
o CONTRAINDICATIONS: No absolute contraindication in the emergency setting
Relative: Uncontrolled infections, TB, varicella, ulcers
o DOSAGE: 4-24 mg IV
(PEDS: 0.5-1 mg/kg)
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DEXTROSE 50%
o CLASS: Antihypoglycemic, Carbohydrate
o INDICATIONS: Hypoglycemia
o CONTRAINDICATIONS: None in hypoglycemia,
intracerebral bleeding, hemorrhagic CVA
o DOSAGE: 25 gm (50 ml) IV/IO
(PEDS: 2-4 ml/kg (0.5 to 1 g/kg) of 25% solution)
(Infants: 1 y/o 0.5 to 1 g/kg of 10% solution)
o SIDE EFFECTS: Tissue necrosis (administer thru freely running IV)
* To convert D50W to D25W: Expel 25 ml from amp of D50W &
draw up 25 ml NS.
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DIAZEPAM (Valium)
o CLASS: Anticonvulsant, Sedative, Benzodiazepine
o INDICATIONS: Status epilepticus, sedation, anxiety,
skeletal muscle relaxation
o CONTRAINDICATIONS: Hypersensitivity, head injury, hypotension,
acute narrow angle glaucoma
o DOSAGE: Seizures: 5-10 mg IV Slowly (PEDS: 0.5-2 mg)
o Sedation: 5-15 mg IV Slowly (PEDS: 0.2 mg/kg IV, IO)
o Rectal 0.5 mg/kg via 2 in cath flush with 2-3 ml of air
o SIDE EFFECTS: Respiratory depression, decreased BP, drowsiness
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DIPHENHYDRAMINE (Benadryl)
o CLASS: Antihistamine, Anti-emetic, Anticholinergic
o INDICATIONS: Allergic reaction, anaphylaxis, dystonic reactions
o Dystonic reactions (Extrapyramidal Reactions) = Unusual posture, muscle tone,
drooling, or uncontrolled movements occasionally seen with
Haldol, Thorazine, Mellaril, Phenergan, Compazine, Reglan
o CONTRAINDICATIONS: Hypersensitivity, asthma & other lower respiratory diseases
o DOSAGE: 25-50 mg IV or deep IM
(PEDS: 0.5-1 mg/kg IV, IO slow, IM)
o SIDE EFFECTS: Sedation, blurred vision
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DILTIAZEM (Cardizem)
o CLASS: Calcium channel blocker
o INDICATIONS: Supraventricular tachydysrhythmias
(a-fib, a-flutter, and PSVT refractory to adenosine)
o CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome,
2nd or 3rd degree AV block, Systolic BP < 90, Diastolic BP < 60,
wide-complex tachycardia, and WPW
o DOSAGE: 0.25 mg/kg IV over 2 minutes,
may repeat in 15 min with 0.35 mg/kg,
followed by a drip of 5 to 10 mg/hr
Not to exceed 15 mg/hr over 24 hours.
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DOPAMINE (Intropin)
o CLASS: Sympathomimetic
o INDICATIONS: Nonhypovolemic hypotension, cardiogenic shock
o CONTRAINDICATIONS: Tachydysrhythmias, V-Fib, pheochromocytoma
o DOSAGE: 5-20 mcg/kg/min - AHA: 2-10 mcg/kg/min
(PEDS: 2-20 mcg/kg/min)
o Mix 800 mg/500 D5W or 400 mg/250 D5W for 1600 mcg/ml
o Renal Dose: 2-4 mcg/kg/min
o Beta Dose: 5-10 mcg/kg/min (Chronotropic, “Cardiac” Dose)
o Alpha Dose: 10-20 mcg/kg/min
o SIDE EFFECTS: VT, VF, HTN, N/V
*Remember - Dopamine is deactivated by Sodium bicarbonate.
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EPINEPHRINE (Adrenaline)
o CLASS: Sympathomimetic
o INDICATIONS: Cardiac arrest, anaphylaxis, allergic Reaction
o CONTRAINDICATIONS: Narrow angle glaucoma; hemorrhagic or
cardiogenic shock, pregnant women in active labor,
coronary insufficiency, organic brain or heart disease,
HTN, tachydysrhythmias
o DOSAGE: Cardiac arrest: 1 mg 1:10,000 IV q 3-5 min (PEDS 0.01 mg/kg 1:10,000)
o Allergic reaction: 0.3-0.5 mg SQ 1:1,000 (PEDS: 0.01 mg/kg. Max: 0.5 mg)
o Asthma: 0.3-0.5 mg SQ 1:1,000 (PEDS: 0.01 mg/kg. Max: 0.5 mg)
o Severe Anaphylaxis: 0.3-0.5 mg IV 1:10,000
o Bradycardia: drip 2-10 mcg/min IV - mix 1 mg in 250 ml D5W Clock method.
o (PEDS: 0.01 mg/kg. Max: 0.5mg; Drip 0.1-1 mcg/kg/min)
ET TUBE: Adult: 2-2.5 mg 1:1,000; PEDS: 0.1 mg/kg 1:1,000
o SIDE EFFECTS: VT, VF, angina, HTN
*To convert a 1:1,000 conc to 1:10,000 conc:
1 ml of 1:1,000 added to 9 ml of NS = 0.1 mg/ml
*Remember - Epinephrine is deactivated by Sodium bicarbonate.
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FLUMAZENIL (Romazicon)
o CLASS: Benzodiazipine antagonist
o INDICATIONS: Respiratory depression 2 to benzodiazepine use
Benzodiazepines: Valium, Versed, Ativan, Halcion,
Restoril, Ambien, Dalmane, Xanax
o CONTRAINDICATIONS: Hypersensitivity to benzodiazepines,
tricyclic antidepressant overdose,
Patients taking Flumazenil for seizures,
seizure prone patients during labor & delivery
o DOSAGE: 0.2 mg IV over 15 sec/min repeated at 0.3 mg over 30 sec,
then 0.5 mg over 30 sec every minute to affect or 3 mg
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FUROSEMIDE ( Lasix)
o CLASS: Diuretic
o INDICATIONS: CHF with pulmonary edema, HTN crisis
o CONTRAINDICATIONS: Hypersensitivity to furosemide or sulfonamides,
dehydration, hypokalemia, pregnancy
o DOSAGE: 40-120 mg (0.5 to 1 mg/kg) slow IV
(PEDS: 1 mg/kg slow IV, may repeat. Max: 2 mg/kg)
o SIDE EFFECTS: Orthostatic hypotension, dehydration
*Diuresis may take 20 min.
However, Lasix causes vasodilation w/in 3-5 min of administration
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GLUCAGON
o CLASS: Antihypoglycemic, Hormone
o INDICATIONS: Hypoglycemia without IV access & beta blocker overdose
o CONTRAINDICATIONS: Hypersensitivity
o DOSAGE: Hypoglycemia: 0.5-1 mg (unit) IM, SQ, IV, IO
(PEDS: 0.1-0.3 mg/kg IV, IO, IM, SQ )
 Beta Blocker Overdose: 3 mg IV over 1 min
 (PEDS: <20 kg 0.5 mg/kg may repeat X 1)
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IPRATROPIUM (Atrovent)
o CLASS: Anticholinergic, bronchodilator
o INDICATIONS: Bronchospasm associated with COPD, asthma, & inhaled irritants
o CONTRAINDICATIONS: Allergy to soy or peanuts & atropine or its derivatives, glaucoma
o DOSAGE: 0.5 mg in 2.5 – 3 ml NS nebulized with albuterol
(PEDS: 0.25 – 0.5 mg in 2.5 – 3 ml NS nebulized)
o Never give Atrovent by itself.
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LABETALOL (Trandate, Normodyne)
o CLASS: Beta Blocker
o INDICATIONS: Acute hypertensive crisis
o CONTRAINDICATIONS: Asthma, CHF, 2nd & 3rd degree heart block,
bradycardia, cardiogenic shock, hypersensitivity
o DOSAGE: 20 mg slow IV over 2 min. Can repeat at 10 min intervals.
o SIDE EFFECTS: Bradycardia, heart block, CHF, bronchospasms, postural hypotension
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LORAZEPAM (Ativan)
o CLASS: Sedative (Benzodiazepine)
o INDICATIONS: Sedation for cardioversion & status epilepticus
o CONTRAINDICATIONS: Hypersensitivity, renal failure,
severe hypotension, glaucoma, pts < 6 m/o)
o DOSAGE: Seizures: 1-2 mg IV/PR may repeat once
(PEDS: 0.05 to 0.01 mg/kg slow IV/PR)
 Sedation: 2 – 4 mg IM, 0.5- 2 mg IV
 (PEDS: 0.03-0.05 mg/kg IV/IM/PR up to 4 mg )
 May reduce by 50% in geriatrics.
o SIDE EFFECTS: resp depression, bradycardia, hypotension
*Ativan Injection is slightly viscid when cool.
To facilitate injection it may be diluted 1:1 with Normal Saline or Water
for Injection immediately before administration.
If given IM it should always be diluted.
Ativan Injection is presented as a 1ml solution in a 2 ml ampule to facilitate dilution.
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LIDOCAINE (Xylocaine)
o CLASS: Antidysrhythmic
o INDICATIONS: Pulseless Vtach, Vfib, Vtach w/pulse,
malignant PVC’s, pre-medication for RSI
o CONTRAINDICATIONS: Hypersensivity , supraventricular dysrthmias,
2nd/3rd degree heart block, bradycardia, Stokes-Adams Syndrome,
o DOSAGE: Cardiac Arrest: 1-1.5 mg/kg IV/IO repeated
at 0.5 to 0.75 every 5-10 min up to 3 mg/kg,
following cardioversion with a drip of 1-4 mg/min
*Max 3mg/kg
(PEDS: 1 mg/kg rapid IV/IO, to 100 mg, follow conversion with a drip of 20-50 mcg/kg/min.)
 V Tach with pulse: 0.5 – 1.5 mg/kg slow IV.
May repeat at ½ dose every 5 to 10 min up to 3 mg/kg.
Follow conversion with infusion of 1-4 mg/min.
 (PEDS: 1 mg/kg, followed by a drip at 20 – 50 mcg/kg/min)
 *Max dosage 300mg/hr
 Pre-medication for RSI: 0.5-1 mg/kg IV Bolus
 For Geriatrics (≥70 y/o): Reduce Dosage by 50%
o SIDE EFFECTS: Confusion, dizziness, drowsiness, headache, hypotension,
arrythmias, widening of the QRS, cardiac arrest, seizures.
o *Signs and symptoms of lidocaine toxicity are dose related & include
dizziness, nausea, drowsiness, speech disturbances,
periorbital numbness, muscle twitching, confusion,
vertigo, & tinnitus.
More serious signs of toxicity are difficulty breathing,
seizures, psychosis, & bradycardia.
o LIDOCAINE INFUSION (20% Solution):
4mg/ml = 1g in 250ml of D5W (or NS) OR 2g in 500ml of D5W (or NS)
 1mg/min = 15 gtts/min
 2mg/min = 30 gtts/min
 3mg/min = 45 gtts/min
 4mg/min = 60 gtts/min
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MAGNESIUM SULFATE 10%
o CLASS: Electrolyte, Antiarrhythmic
o INDICATIONS: Torsades de Pointes, eclamptic seizures, status asthmaticus
o CONTRAINDICATIONS: Heart block, hypocalcemia,
persistent hypertension, hypotension.
Use with caution in renal impairment
o DOSAGE: Torsades: 1-2 g in 50-100 ml IV/IO over 1-2 min
(PEDS: 25-50 mg/kg over 5-20 min. Max dose 2 g)
 Asthma: Same as Torsades
 Eclampsia: 2- 4 gm IV Slowly or IM
 (PEDS: TDP & Refractory VF/VT: 25-50 mg/kg IV/IO over several minutes,
to a max of 2 grams)
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MIDAZOLAM (Versed)
o CLASS: Sedative, Benzodiazepine
o INDICATIONS: To induce sedation before cardioversion or intubation
o CONTRAINDICATIONS: Hypersensitivity, narrow angle glaucoma, shock.
Use with caution in COPD, renal impairment, pregnant & nursing women
o DOSAGE: 1- 2.5 mg slow IV; 0.07-0.08 mg/kg IM (Usually 5 mg);
3 mg Intranasal
(PEDS: 0.025-0.5 mg/kg)
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MORPHINE SULFATE
o CLASS: Narcotic analgesic
o INDICATIONS: Moderate to severe pain, chest pain associated with ACS,
CHF, pulmonary edema
o CONTRAINDICATIONS: Hypersensitivity to opiates,
undiagnosed head or abdominal trauma,
hypotension, severe respiratory depression, shock,
o DOSAGE: Chest pain: 2-4 mg IV over 1-5 min Q 5-15 min
 Pain: 2.5 – 15 mg IV/Deep IM
 (PEDS: 0.05 – 0.1 mg/kg IV, 0.1 to 0.2 mg/kg IM, SQ)
*Consider Phenergen or Zofran for associated nausea.
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NALOXONE (Narcan)
o CLASS: Opioid antagonist
o INDICATIONS: Narcotic & synthetic narcotic overdose,
coma of unknown origin.
o CONTRAINDICATIONS: Hypersensitivity,
non-narcotic induced respiratory depression.
o DOSAGE: 0.4 – 2 mg IV/IO, repeated q 2-3 mins needed, up to 10 mg
(PEDS: 0.01 mg/kg up to 2 mg IV/IO)
ET TUBE: 2 – 2.5 times the dose ET
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NITROGLCERIN (Nitrostat, Nitrolingual Spray)
o CLASS: Nitrate, Antianginal agent
o INDICATIONS: Chest pain associated with angina & AMI,
acute pulmonary edema
o CONTRAINDICATIONS: Hypotension, hypovolemia, bleeds,
recent use (within 24 hr) of any medication for erectile dysfunction
o SIDE EFFECTS: Hypotension, syncope, flushing, tachycardia
o DOSAGE: Tablet: 0.4 mg SL repeat 3-5 min; Max 3 doses.
 Spray: 0.4 mg (1 spray) SL up to 3 sprays/25 min
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SODIUM BICARBONATE (NaHCO3)
o CLASS: Alkalizing agent
o INDICATIONS: Tricyclic antidepressant & barbiturate overdose,
refractory acidosis, or hyperkalemia
o CONTRAINDICATIONS: Alkalosis states
o DOSAGE: 1 mEq/kg IV/IO
(PEDS: 4.2% solution, 1 mEq/kg IV/IO)
*To make 4.2% soln = Expel 25 ml from 50 ml 8.4% amp &
Refill with 25 ml of normal saline
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VASOPRESSIN (Pitressin)
o CLASS: Hormone, Vasopressor
o INDICATIONS: To increase peripheral vascular resistance in arrest
o CONTRAINDICATIONS: None in cardiac arrest
o DOSAGE: 40 U IV/IO may replace 1st or 2nd dose of epinephrine