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Paramedic Drugs
| Drug | Class | Indications | Dosage | Name |
|---|---|---|---|---|
| Morphine Sulfate | Narcotic Analgesic | Moderate to severe pain and in MI and to reduce venous return in pulmonary edema | MI: 2-4 mg IV over 1-5 mins every 5-15 mins. Pain: 2.5-15 mg IV; 5-20 mg IM/SC. Ped: 0.05-0.1 mg/kg IV; 0.1-0.2 mg/kg IM/SC. AMI or PE: 1-2 mg/6-10 min. to response. | Morphine |
| Lorazepam | Sedative | Sedation for cardioversion and status epilepticus | Sedation: 2-4 mg IM, 0.5-2 mg IV. Ped: 0.03-0.5 mg/kg IV/IM/PR up to 4 mg. Status Epilepticus: 2 mg slow IV/PR (2 mg/min.). Ped: 0.1 mg/kg slow IV/PR (2-5 min.) | Ativan |
| Midazolam | Sedative | To induce sedation before cardioversion or intubation | 1-2.5 mg slow IV; 0.07-0.08 mg/kg I (usually 5 mg). Ped: 0.05-0.2 mg/kg IV; 0.1-0.15 mg/kg IM; 3 mg intranasal | Versed |
| Magnesium Sulfate | Electrolyte | Torsade de Pointes, eclamptic seizures. In children for status asthmaticus non-responsive to beta agents | Diluted in 100 mL, over 1-2 mins (in adults only). Peds: 25-50 mg/kg over 5-20 mins. Max dose 2 g. Asthma: same as for Torsades. Eclampsia: 2-4 g IV/IM | Magnesium |
| Oxygen | Oxidizing Agent | Hypoxia or anticipated hypoxia, or in any medical or trauma patient to improve respiratory efficiency | Hypoxia: 100% by inhalation or IPPV | Oxygen |
| Albuterol | Sympathomimetic Bronchodilator | Bronchospasm and asthma in COPD | Two inhalations (90 mcg) via metered-dose inhaler (2 sprays) or 2.5 mg in 2.5-3 mL NS via neb. repeat as needed. The duration of effect is 3-6 hours. Ped: 0.15 mg/kg in 2.5-3 mL NS via neb. repeat as needed. | Proventil, Ventolin |
| Vecuronium | Nondepolarizing Skeletal Muscle Relaxant | Facilitated Endotracheal Intubation | 0.08-0.1 mg/kg IV. Ped: same as adult | Norcuron |
| Succinylcholine | Depolarizing Neuromuscular Blocker | Facilitated endotracheal intubation | 1-1.5 mg/kg IV/IM; Ped: 1-2 mg/kg IV/IM | Anectine |
| Promethazine | Antiemetic | Nausea and vomiting, motion sickness, to enhance the effects of analgesics, and to induce sedation | 12.5-25 mg IV/IM/PR. Ped: 0.5 mg/kg IV/IM/PR | Phenergan |
| Prochlorperazine | Antiemetic | Severe nausea and vomiting or acute psychosis | 5-10 mg IV/IM Ped: 0.13 mg/kg IV/IM/PR if >10 kg or >2 yrs | Compazine |
| Nitroglycerin | Nitrate | Chest pain associated with angina and acute MI, and acute pulmonary edema | 1 tablet (0.4 mg) Sl. May be repeated/3-5 mins up to 3 tablets, or 1/2 -1 inch of topical ointment, or 0.4 mg (one spray) SL up to 3 sprays/25 mins. | Nitrostat |
| Nifedipine | Calcium Channel Blocker | Severe hypertension and angina | One 10-20 mg capsule SL/PO | Procardia, Adalat |
| Verapamil | Calcium Channel Blocker | PSVT refractory to adenosine, A. flutter, and A. fib with rapid ventricular response | 2.5-5 mg IV bolus over 2-3 mins, then 5-10 mg after 15-30 mins to a max of 20 mg. Ped: Newborn = 0.1-0.2 mg/kg (no to exceed 2 mg), age 1-15 = 0.1-0.3 mg/kg (not to exceed 5 mg) | Isoptin, Calan |
| Norepinephrine | Sympathomimetic Agent | Refractory hypotension and neurogenic shock | 0.5-30 mcg/min IV, titrated to BP. Ped:0.1-2 mcg/kg/min titrated to BP (rarely used) | Levophed |
| Sodium Bicarbonate | Alkalizing Agent | Tricyclic antidepressand and barbiturate overdose, refractory acidosis, or hyperkalemia | 1 mEq/kg IV/IO. Ped: same as an adult | NaHCO3 |
| Furosemide | Diuretic | CHF and pulmonary edema | 40-120 mg slow IV. Ped: 1mg/kg slow IV | Lasix |
| Activated Charcoal | Absorbent | Acute ingested poisoning | 1 g/kg mixed with at least 6-8 oz. of water, then PO or via and NG tube | Actidose |
| Thiamine | Vitamine | Coma of unknown origin, chronic alcoholism with associated coma, and delirium tremens | 50-100 mg IV/ IM. Ped: 10-25 mg IV/IM | Thiamine |
| Diphenhydramine | Antihistamine | Anaphylaxis, allergic reactions, and dystonic reactions | 25-50 mg IV/IM | Benadryl |
| Naloxone | Narcotic Antagonist | Narcotic and synthetic narcotic overdose, coma of unknown origin | 0.4-2 mg IV/IM repeated/2-3 mins. as needed up to 10 mg. Ped: 0.01 mg IV/IM repeated/2-3 mins. as needed up to 10 mg | Narcan |
| Diazepam | Antianxiety, Hypnotic, Anticonvulsant, Sedative | Major motor seizures, status epilepticus, premedication before cardioversion, muscle tremors due to injury, and acute anxiety | Seizures: 5-10 mg IV/IM. Ped: 0.5-2 mg IV/IM. Acute Anxiety: 2-5 mg IV/ IM. Ped: 0.5-2 mg IM | Valium |
| Racemic Epinephrine | Sympathomimetic Agonist | Croup (Laryngotracheobronchitis) | 0.25-0.75 mL of a 2.25% solution in 2 mL NS once by neb. Ped: Same as adult | microNefrin, Vaponefrin |
| Aspirin | Analgesic, Antipyretic, Platelet Inhibitor, Antiinflammatory | Chest pain suggestive of an MI | 160-325 mg PO (Chewable) | Acetylsalicylic Acid, Alka-Seltzer, Bayer, Empirin, St. Joseph Children's) |
| Oxytocin | Hormone | Severe postpartum hemorrhage | 3-10 units IM after delivery of the placenta. 10-20 units in 1,000 mL of D5W or NS IV titrated to effect | Pitocin |
| Glucagon | Hormone, Antihypoglycemic | Hypoglycemia without IV access and to reverse beta-blocker overdose | Hypoglycemia: 1 mg IM/SC repeated/5-20 mins. Ped: 0.1 mg/kg Beta Blocker Overdose: 3 mg IV over 1 min. Ped: 50-150 mg/kg IV over 1 min | GlucaGen |
| Dextrose 50% in Water | Carbohydrate | Hypoglycemia | 25 g D50W (50mL). Ped: 2-4 mL/kg of a 25% solution IV | D50W |
| Methylprednisolone | Corticosteroid/ Antiinflammatory | Spinal cord injury, asthma, severe anaphylaxis, COPD | Asthma/COPD/Anaphylaxis: 125-250 mg IV/IM. Ped: 1-2 mg/kg/dose IV/IM. Spinal Cord Injury: 30 mg/kg IV over 15 min. after 45 min an infusion of 5.4 mg/kg/hr. | Solu-Medrol |
| Procainamide | Antiarrhythmic | V. Fib and PVTach refractory to lidocaine | 20-50 mg/min IV drip up to 17 mg/kg to effect, then 1-4 mg/min. Ped: 15 mg/kg/IV/IO over 30-60 mins. | Pronestyl |
| Odansetron | Antiemetic | Nausea and vomiting | 4 mg over 1-5 mins. IV | Zofran |
| Meperidine | Narcotic Analgesic | Moderate to severe pain | 25-50 mg IV, 50-100 mg IM. Ped: 1 mg/kg IV/IM | Demerol |
| Lidocaine | Antidysrhythmic | Pulseless VTach, V.Fib., V. Tach (w/pulse) | Cardiac Arrest: 1-1.5 mg/kg IV/IO repeated at 0.5-0.75 every 5-10 mins up to 3 mg/kg follow conversion with a dirp of 1-4 mg/min. Ped: 1 mg/kg rapid IV/IO, to 100 mg, follow conversion with a drip of 20-50 mcg/kg/min. V. Tach w/pulse: 0.5-1.5 mg/kg | Xylocaine |
| Fentanyl | Narcotic Analgesic | Induce sedation for endotracheal intubation/moderate to severe pain | 25-100 mcg slow IV (2-3 mins.) Ped: 2 mcg/kg slow IV/IM | Sublimaze |
| Epinephrine | Sympathomimetic | To restore rhythm in cardiac arrest and severe allergic reactions | Arrest: 1 mg 1:10,000 IV (3-5 mins) Allergic Reactions: 0.3-0.5 mg 1:1,000 SQ/IM (5-15 mins.) | Adrenalin |
| Etomidate | Hypnotic | Induce sedation for rapid sequence intubation | 0.1-0.3 mg/kg IV over 15-30 sec. Ped: 0.2-0.4 mg/kg IV/IO over 30-60 sec. Max 20 mg. | Amidate |
| Flumazenil | Benzodiazepine Antagonist | Respiratory depression secondary to the benzodiazepines | 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. | Romazicon |
| Ipratropium | Anticholinergic | Bronchospasm associated with asthma, COPD, and inhaled irritants | 500 mcg in 2.5-3 mL NS via NEb or 2 sprays from MDI. Ped: 125-250 mcg | Atrovent |
| Labetelol | Beta Blocker | Acute hypertensive crisis | 10 mg slow IV, then 20-40 mg/10 mins as needed, up to 150 mg OR a bolus of 10 g, then continuous drip of 2-8 mg/min | Trandate, Normodyne |
| Haloperidol | Anti-psychotic | Acute psychotic episodes | 2-5 mg IM Ped: Children>3 years, 0.015-0.15 mg/kg/day PO in 2 or 3 divided doses | Haldol |
| Ipecac Syrup | Emetic | Poisoning and overdose | 30 mL PO, followed by 1-2 glasses of water, repeat in 20 mins as needed. Ped: 15 mL PO followed by 1-2 glasses of water, repeat in 20 mins. as needed | Ipecac Syrup |
| Ketorolac | NSAID | Mild or Moderate Pain | 30 mg IV/IM (15 mg>65 years or weighs <50kg | Toradol |
| Atropine | Parasympatholitic | Hemodynamically significant bradycardia, bradyasystolic arrest, and organophosphate poisoning | Asystole/PEA: 1 mg IV/IO ever 3-5 mins (max 3 doses) Sympathomatic Brady.: 0.5 mg IV Repeat 3-5 mins to 3 mg. Ped: 0.02 mg/kg IV Organophosphate Poisoning: 2-5 mg IV/IM/IO/10-15 mins. Ped: 0.05 mg/kg IV/IM/IO/10-15 mins. | Atropine |
| Calcium Chloride | Electrolyte | Hyperkalemia, hypocalcemia, hypermagnesmia, and calcium channel blocker toxicity | 2-4 mg/kg IV/10 mins. as needed. Ped: 60-100 mg/kg IV/IO repeat at 10 mins/ as needed | Calcium Chloride |
| Diltiazem | Calcium Channel Blocker | SVT dysrhythmias (A. Fib., A. Flutter, and PSVT refractory to adenosine) and to increase coronary artery perfusion in angina | 0.25 mg/kg IV over 2 mins., may repeat in 15 mins with 0.35 mg/kg followed by a drip of 5-10 mg/hr not to exceed 15 mg/hr over 24 hrs | Cardizem |
| Dexamethasone | Steroid | Anaphylaxis, asthma, COPD, spinal cord edema | 4-24 mg IV/IM Ped: 0.5-1 mg/kg | Decadron |
| Dopamine | Sympathomimetic | Nonhypovolemic hypotension (70-100 mmHg) and cardiogenic shock | 2-20 mcg/kg/min. titrated to effect. Ped: same as adult | Intropin |
| Bumetanide | Loop Diuretic | To promote diuresis in CHF and pulmonary edema | 0.5-1 mg IM/IV over 1-2 mins. repeat in 2-3 hours as needed | Bumex |
| Calcium Gluconate | Electrolyte | Hyperkalemia, hypermagnesemia, and calcium channel blocker toxicity | 5-10 mL of 10% solution, repeated as necessary at 10 min. intervals | Kalcinate |
| Amiodarone | Antidysrhythmic | Life threatening recurrent ventricular and supraventricular dysrhythmias that have not responded to other antidysrhythmic agents | 150-300 mg IV over 10 mins, then 1 mg/min over next 6 hours. Ped: 5 mg/kg IV/IO, then repeat up to 15 mg/kg | Cordarone, Pacerone |
| Alteplase Recombinant | Thrombolytic | To thrombolyse in AMI, Acute ischemic stroke, and pulmonary embolism | MI: 15 mg IV, then 0.75 mg/kg up to 50 mg over 30 mins, then 0.5 mg/kg up to 35 mg over 60 mins up to 100 mg. Stroke: 0.09 mg/kg over 1 min, then 0.91 mg/kg up to 90 mg over next 60 min. Pulmonary embolism: 100 mg IV infusion over 2 hours | tPA, Activase |
| Adenosine | Antidysrhythmic | Narrow, complex SVT refractory to vagal maneuvers | 6 mg rapidly (over 1-3 sec.) IV, then flush th eline rapidly with saline. If ineffective, 12 mg in 1-2 min, may be repeated. Ped: 0.1 mg/kg to a max of 6 mg. IV followed by rapid saline flush, then 0.2 mg/kg in 1-2 min to max 2nd dose of 12 mg | Adenocard |
| Dobutamine | Sympathomimetic | To increase cardiac output in CHF/cardiogenic shock | 2-20 mcg/kg/min IV. Ped: same as adult | Dobutrex |
| Nitrous Oxide | Analgesic (gas) | Musculoskeletal, burn, and ischemic chest pain and sever anxiety (including hyperventilation) | Self-Administered inhalation until the pain is relieved or the patient drops the mask | Nitronox |
| Ibuprofen | NSAID | Reduce fever and relieve minor to moderate pain | 200-400 mg PO/4-6 hours up to 1,200 mg/day. Ped:5-10 mg/kg PO/4-6 hours up to 40 mg/kg/day | Advil, Motrin, Nuprin, Excedrin IB |
| Acetaminophen | Analgesic, Antipyretic | For mild to moderate pain and fever when aspirin is otherwise not tolerated | 325 to 650 mg PO/4-6 hours. 650 mg PR/4-6 hours. | Tylenol, Anacin-3 |
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