Adult Dosages

Question 1

Glucagon for correction of hypoglycemia

Answer 1

• 0.5 - 1mg IM or SC

Question 2

Epinephrine for anaphylaxis

Answer 2

• 0.5 mg 1:1000 IM q 5 min x3 doses for anaphylaxis
• 5 ml nebulized 1/1000 EPINEPHrine in anaphylaxis, if critical angioedema affects airway management
• 50-100 µg 1:10,000 epinephrine IV or IO repeated as necessary for pre-arrest anaphylaxis or asthma

Question 3

Glucagon for anaphylaxis with persistent hypotension depsite fluids/epinephrine in patients on Beta-blockers

Answer 3

• 1-2mg IV q 5 mins.
• Also consider for Beta-blocker OD

Question 4

Magnesium Sulfate for asthma

Answer 4

• 2 g/250 cc N/S infused over 20 min
• Suggested administrations:
  
  • added to 50mL N/S bag, 10gtts/mL drip set, 1 gtt/2s
  • added to 150mL N/S bag, 10gtts/mL drip set, 2-3 gtts/s

Question 5

Epinephrine for peri-arrest patients (profoundly bradycardic and hemodynamically unstable)

Answer 5

​Infusion:

• 2-10 µg/min infusion - generally reserved for patients who are profoundly bradycardic and hemodynamically unstable

Slow push:

• 10 µg Slow IV/IO Q2 to 3 mins PRN
• Suggested Method
  
  • Take a pre-load of Epinephrine (1:10’000 - 1 mg in 10 mL), and empty 9 mL. You will have 100 µg remaining
  • Withdraw 9 mL Normal Saline from the luer lock of an IV line to obtain 100 µg in 10 mL - 10 µg per 1 mL
  • Can now administer 10 µg/1 mL aliquots

Question 6

Salbutamol (Ventolin) for acute bronchospasm in asthma/COPD or anaphylaxis

Answer 6

• 5 mg in 5 mL NS or H2O nebulized (with O2 at 6-8 L/min.) - repeat doses back to back prn - watch for signs of toxicity
• 4 x 100 mcg dose via MDI. Repeat as required prn. No max dose, watch for signs of toxicity

Question 7

Midazolam for sedation and seizures

Answer 7

• 5 to 10 mg IM
• 2 to 5 mg IV/IO incrementally to effect
• May be repeated as required in small increments

Question 8

Ketamine for excited delirium

Answer 8

• Intramuscular: 4-5 mg/kg bolus
• Maximum single/cumulative dose 500 mg. If appropriate sedation is not achieved, a call to Clinicall is required.
• Maximum volume of administration:
  
  • Deltoid: 2 mL
  • Lateral thigh: 4-5 mL
  • Gluteal: 5 mL

Question 9

Fentanyl by IM/IV/IO, loading and maintenance doses

Answer 9

• Loading Dose:0.5-1.0 mcg/kg IM/IV/IO
  
  • To a single maximum dose of 100 mcg every 5 minutes PRN to a total maximum dose of 300 mcg cumulative
• Maintenance dose for long transports:50 mcg IM/IV/IO every 10 minutes PRN
  
  • To a maximum of 250 mcg in one hour
• *Consider reducing doses by half for patients >65 y/o*
• *If pain not sufficiently relieved after 1-3 mcg/kg fentaNYL, consider ketamine*
• *If higher maintenance doses of fentaNYL are required, contact CliniCall*

Question 10

Epinephrine in cardiac arrest

Answer 10

• 1 mg IV/IO for cardiac arrest. Repeat q 3-5 minutes (current literature suggests maximum dose of 3-4 mg)

Question 11

Phenylephrine for peri-intubation hypotension

Answer 11

• 100 mcg Slow IV/IO Q2 to 5 mins PRN
  
  • MAX dose 500mcg

Question 12

Ketamine for induction and maintenance of anaesthesia

Answer 12

Induction

• Intravenous/Intraosseous: 2 mg/kg if shock index < 1
• Intravenous/Intraosseous: 1 mg/kg if shock index ≥ 1

Maintenance

• ½ of required induction dose every 10-15 minutes as required

Question 13

Fentanyl IN loading and maintenance

Answer 13

• Loading IN dose: 1.5-2.0 mcg/kg IN
  
  • To a maximum of 100 mcg
• Maintenance IN dose for long transports:50-100 mcg IN every 10 minutes PRN
  
  • To a maximum of 250 mcg in one hour
• *Consider reducing doses by half for patients >65 y/o*
• Safety alert: Remember to account for the 0.1 mL dead space in the mucosal atomizer device (MAD) to ensure the accurate dose is administered and documented*
• *If pain not sufficiently relieved after 1-3 mcg/kg fentaNYL, consider ketamine*
• *If higher maintenance doses of fentaNYL are required, contact CliniCall*

Question 14

Naloxone for reversal of opioid overdose

Answer 14

Escalating dosing strategy:

1. 0.4mg IM/IV
2. 0.4mg IM/IV
3. 0.8mg IM/IV
4. 2mg IM/IV
5. 4mg IM/IV
6. 10mg IM/IV (clinicall consult mandatory for 6th dose)

• total = 17.6mg cumulative.

In Cardiac Arrest

• 2mg IM/IV/IO

Question 15

Ketamine for analgesia

Answer 15

• Intranasal
  
  • 0.75 mg/kg initial dose (see intranasal ketamine dosing chart)
  • Maximum single dose 100 mg
  • May repeat 0.5 mg/kg after 20 minutes
• Intravenous/Intraosseous: 0.3 mg/kg slow push
  
  • May repeat 0.15 mg/kg after 5 minutes
  • Maximum cumulative dose 0.6 mg/kg in 45 minutes
• Intramuscular: 0.5 mg/kg
  
  • May repeat 0.3 mg/kg after 45 minutes

Question 16

Epinephrine for pre-arrest asthma/anaphylaxis

Answer 16

• 50-100 µg 1:10,000 epinephrine IV or IO repeated as necessary for pre-arrest anaphylaxis or asthma

Question 17

Ketamine for procedural sedation

Answer 17

• Intravenous/Intraosseous: 0.1 - 0.5 mg/kg slow push every 60 seconds to effect
  
  • Consider starting at 0.5 mg/kg; use subsequent doses of 0.25 mg/kg or less as needed
  • Titrate to effect

Question 18

Epinephrine for asthma

Answer 18

• 0.5 mg IM for asthma with failing respirations - repeat q 5 – 20 min
• 50-100 µg 1:10,000 epinephrine IV or IO repeated as necessary for pre-arrest anaphylaxis or asthma

Question 19

Magnesium Sulfate for torsades de pointes

Answer 19

• 2 g IV in 100 mL N/S over 15 min, followed by an infusion
• Cardiac Arrest: 4 g IV bolus

Question 20

Ipratropium (Atrovent) for severe bronchospasm in asthma/COPD

Answer 20

• MDI: 8 sprays x 20 mcg = 160 mcg total dose
• 0.5 mg via nebulizer

Question 21

Calcium Chloride (CaCl₂) dosage in cardiac arrest

Answer 21

• 1 g over 3 minutes repeat x1 in 10 minutes if indications still present

Question 22

Lidocaine dosage in cardiac arrest

Answer 22

• 1.0 - 1.5 mg/kg IV bolus or 2.0 mg/kg via ETT if IV not available in the arrested patient

Followed by 0.5 - 1.0 mg/kg bolus repeat prn to max of 3 mg/kg

Question 23

Magnesium sulfate dosage in cardiac arrest

Answer 23

• 4 g IV bolus in cardiac arrest with VF or pVT
• Note discrepancy from unstable or refractory TdP

Question 24

Naloxone dosage in cardiac arrest with suspected opioid overdose etiology

Answer 24

• May consider 2 mg IM or IV (IV preferable) with the possibility that the patient is not in cardiac arrest

Question 25

Sodium Bicarbonate dosage in cardiac arrest

Answer 25

• 1 mEq/kg slow IV push - repeat 0.5 mEq/kg q 10-15 min. prn

Question 26

Amiodarone dosage in cardiac arrest

Answer 26

• 300 mg IV bolus; may repeat 150 mg bolus in 10 min for ventricular fibrillation/pulseless VT.