Medications - Dosages

Question 1

Adenosine

Dosage

Answer 1

Adults: 12mg IV bolus, rapidly, followed by a normal saline flush.
Contact base for a second dose of 12mg IV bolus, Rapidly, followed by a normal saline flush after an interval of 1-2 minutes if the tachycardia persists.
Total maximum dose shouldn’t exceed 24mg.

Pediatrics: .1mg/kg, IV/IO bolus, rapidly, followed by a normal saline flush.
Additional dose of .2mg/kg rapid IV/IO bolus, followed by normal saline flush. Contact medical control for further considerations.

Question 2

Albuterol

Dosage

Answer 2

Adult:
Single Neb dose: Albuterol sulfate solution 0.083% (one unit dose bottle of 3.0mL), by nebulizer, at a flow rate (6-8 lpm) that will deliver the solution over 5 to 15 minutes. May be repeated twice (total of 3 doses).

Continuous Neb Dose: In more severe cases, place 3 premixed containers of albuterol (2.5mg/3mL) for a total dose of 7.5mg in 9mL, into an oxygen-powered nebulizer and run a continuous neb at 6-8 lpm.

Pediatric:
Single Neb dose: Albuterol sulfate 0.083% (one unit dose bottle of 3.0mL), by nebulizer, at a flow rate (6-8 lpm) that will deliver the solution over 5-15 minutes. May be repeated twice during transport (total of 3 times)

Question 3

Amiodarone

Dosage

Answer 3

Adult:
Pulseless Arrest (refractory VT/VF):
300 mg IV bolus. Repeat once 150mg IV bolus in 3-5 minutes.
Post arrest following successful conversion of VT/VF:
150 mg IV infused over 10 minutes.
Wide Complex tachycardia with poor perfusion (contact base):
150 mg IV infused over 10 minutes.

Pediatric:
Pulseless Arrest (refractory VT/VF):
5mg/kg IV over 3-5 minutes. (Contact base for additional doses).

Question 4

Aspirin

Dosage

Answer 4

324mg by mouth (4 tablets)

Question 5

Atropine

Dosage

Answer 5

Hemodynamically unstable bradycardia
Adult:
.5mg IV/IO bolus. Repeat if needed at 3-5 minute intervals to a maximum dose of 3 mg. (Stop at ventricular rate which provides adequate mentation and blood pressure).

Pediatric:
0.02 mg/kg IV/IO bolus. Minimum dose is .1mg, maximum single dose .5mg.

Stable bradycardia and poisoning/overdose:
Contact base

Question 6

Atrovent (Ipratropium Bromide)

Dosage

Answer 6

Adult:
Mod and severe bronchospasm:
Ipratropium (0.5 mg/2.5mL) along with albuterol in a nebulizer

Child (2-12 years)
Mod and severe bronchospasm:
Ipratropium (0.5 mg/2.5mL) along with albuterol in a nebulizer. Not indicated for repetitive dose or continuous neb use.

Question 7

Calcium Gluconate

Dosage

Answer 7

Adult:
Pulseless arrest assumed due to hyperkalemia: 1g slow IV push

Calcium channel blocker overdose:
Contact base for order. 3g slow IV/IO push over 2-3 minutes. Dose may be repeated every 10 minutes for a total of 3 doses.

Pediatric:
Calcium channel blocker overdose:
Contact base. 60mg/kg (0.6 mL/kg), not to exceed 1 gram slow, may repeat every 10 minutes for total of 3 doses

Question 8

Cyanokit

Dosage

Answer 8

Moderate exposure:
Exposure is considered to be a moderate level when: The patient has soot in the nose/mouth/oropharynx and the patient has altered mentation. Hypotension may or may not be present.

Adult:
5g IV push over 15 minutes.

Pediatric:
70mg/kg IV push

Severe exposure:
Exposure is considered to be severe when: The patient has soot in the nose/mouth/oropharynx and is in a coma/respiratory or cardiac arrest. Is hypotensive.

Adult:
5g IV push over 15 minutes, monitor for clinical response/need for second 5 gram dose.

Pediatric:
70mg/kg over 15 minutes, monitor for clinical response/need for second 70mg/kg dose.

Question 9

Dextrose 50%

Dosage

Answer 9

Adult:
25g (50mL of a 50% solution) IV/IO bolus

Pediatric:
1-12 years: 2-4 mL/kg of a 25% solution
<1 year: 2-4 mL/kg of a 10% solution

Question 10

Diazepam (Valium)

Dosage

Answer 10

Adult:
5 mg IV/IO bolus slowly

Pediatric:
0.3 mg/kg IV/IO bolus, slowly, over 2 minutes
Base contact is required for all situation except for status epileptics

Question 11

Diphenhydramine (Benadryl)

Dosage

Answer 11

Adult:
50 mg IV/IO/IM
Pediatrics:
1-2 mg/kg slow IV/IO/IM (not to exceed 50 mg)

Question 12

Dopamine (Intropin)

Dosage

Answer 12

Contact base for direct physician order
Mix: 400mg in 250mL NS or 800mg in 500mL NS to produce a concentration of 1600 mcg/mL

Adult IV/IO:
2-20 mcg/kg/min, Start at 5 mcg/kg/min, titrate dose up 5 mcg/kg/min every 5 minutes to a max dose of 20 mcg/kg/min to achieve desired effect.

Pediatrics IV/IO:
2-20 mcg/kg/min, Start at 5 mcg/kg/min, titrate dose up 5 mcg/kg/min every 5 minutes to a max dose of 20 mcg/kg/min to achieve desired effect.

Question 13

Droperidol (Inapsine)

Dosage

Answer 13

Adult:
Agitation/Combative
IV/IM: 5.0 mg slow IV/IM administration, after 10 minutes if desired effect is not achieved contact base to consider a second dose.

Pediatric: Under the age of 12 contact base

Antiemetic: Contact base for orders
Adult
IV/IM: 1.25mg slow push
Pediatric
IV/IM: 0.05 mg/kg slow push

Question 14

Epinephrine

Dosage

Answer 14

Adult:
Pulseless Arrest: 1mg (10mL of a 1:10,000 solution), IV/IO bolus. Repeat every 3-5 minutes.
Bradycardia/hypotension refractory to other interventions (Contact base):
Continuous infusion titrated to effect: 1 mg in 250 mL of NS, IV/IO infused at 2 mcg/min until desired BP of >90mmHg systolic achieved
Asthma:
0.3 mg (0.3mL of a 1:1,000 solution) IM. May repeat dose x1.
Systemic allergic reaction:
0.3 mg (0.3mL of a 1:1,000 solution) IM. May repeat dose x1.
Severe systemic allergic reaction refractory to IM epi (Contact Base):
Continuous infusion titrated to effect: 1 mg in 250 mL of NS, IV/IO infused at 2 mcg/min until desired BP of > 90 mmHg systolic achieved.

Pediatric:
Cardiac arrest:
0.01 mg/kg, IV/IO, (0.1 mL/kg of 1:10,000 solution). Subsequent doses repeated every 3-5 minutes.
Bradycardia (Contact base):
0.01 mg/kg, IV/IO, (0.1 mL/kg of 1:10,000 solution)
Asthma:
0.01 mg/kg (0.01 mL/kg of 1:1,000 solution) IM
Moderate to severe allergic reactions:
0.01 mg/kg (0.01 mL/kg of 1:1,000 solution) IM
Severe systemic allergic reaction refractory to IM epi (Contact base):
0.01 mg/kg (0.01 mL/kg of 1:10,000 solution) IV/IO

Question 15

Fentanyl (Sublimaze)

Dosage

Answer 15

Adult:
IV/IO: 1-2 mcg/kg, slow IV/IO bolus.
Dose may be repeated after 10 minutes and titrated to clinical effect to a maximum cumulative dose of 300mcg. Additional dosing requires base contact.

IN route:
1-2 mcg/kg IN single dose.
Repeat dosing only via IV route, and 10 minutes after initial IN dose up to a maximum cumulative dose of 300 mcg. Additional dose requires Base contract. Consider initial lower dose of 0.5-1 mcg/kg in elderly.

Pediatrics (1-12 years):
IV/IO route:
1 mcg/kg slow IV/IO bolus.
Dose may be repeated after 10 minutes and titrated to clinical effect to a maximum cumulative dose of 3 mcg/kg

IN route:
1 mcg/kg IN single dose. Repeat dosing only via IV route, and 10 minutes after initial IN dose up to a maximum cumulative dose of 3 mcg/kg.

*IN route requires base contact and approval for any patient <1 year: Contact base.

Question 16

Glucagon

Dosage

Answer 16

Adult:
Hypoglycemia: 1.0 mg, IM
Beta Blocker/Calcium Channel Blocker overdose: 2.0 mg IV bolus (contact base)

Pediatric:
Hypoglycemia: 0.1 mg/kg IM. Maximum dose 1.0 mg.
Beta Blocker/ Calcium Channel Blocker overdose: 2.0 mg IV bolus (contact base)

Question 17

Magnesium Sulfate

Dosage

Answer 17

Torsades de Pointes suspected cause by prolonged QT interval:
2g, IV bolus
Refractory Severe bronchospasm:
2g, IV bolus, over 2 minutes, contact base for order.
Eclampsia:
Mix 6g, IV drip, diluted in 50 mL of NS over 15-30 minutes. Contact base for order.

Question 18

Methylprednisolone (Solu-medrol)

Dosage

Answer 18

Adult:
125 mg, IV bolus, slowly, over 2 minutes

Pediatric:
2mg/kg, IV bolus, over 2 minutes

Question 19

Midazolam (Versed)

Dosage

Answer 19

Seizure:
Adult:
2.0 mg IV
5.0 mg IM/IN Contact base for additional dosing
Pediatric:
0.1 mg/kg, IV
0.2 mg/kg IM/IN Maximum dose is 4 mg.

Sedation of severely agitated or combative patient:
Adult:
2.0 mg IV or 5.0 mg IM/IN if no IV in place
Pediatric:
Contact base for dosing

Question 20

Morphine Sulfate

Dosage

Answer 20

Adult:
Initial dose 4mg IV/IM/IO. Repeat doses of 2.0mg, up to 10mg. Contact base for any single or cumulative dose >10mg.

Pediatric:
0.1 mg/kg IV/IM/IO Slowly. Maximum single dose is 5.0mg. Contact base for any single or cumulative dose >5mg.

Question 21

Naloxone (Narcan)

Dosage

Answer 21

Adult:
0.5 mg IV/IO/IM/IN and titrate to desired effect, up to 2mg total. In cases of severe respiratory compromise or arrest, 2mg bolus IV/IO/IM is appropriate, otherwise drug should be titrated.

Pediatrics:
0.5mg IV/IO/IM/IN and titrate to desired effect, up to 2mg total

Question 22

Nitroglycerine

Dosage

Answer 22

0.4 mg (1/150gr) sublingually every 5 minutes. PRN up to a total of 3 doses for persistent chest pain.

Nitropaste system specific

Question 23

Ondansetron (Zofran)

Dosage

Answer 23

Adult:
4mg IV/IM/. May repeat x1 dose as needed.

Pediatric, greater than 4 years old:
4mg IV

Pediatric, less than 4 years old:
2mg IV

Question 24

Oxygen

Dosage

Answer 24

1-2 lpm, minor medical/trauma
3-9 lpm, moderate medical/trauma
10-15 lpm, severe medical/trauma

Question 25

Phenylephrine (Intranasal)

Dosage

Answer 25

Administer two sprays in each naris prior to nasotracheal intubation.

Question 26

Racemic Epinephrine (Vaponephrine)
(Dosage)

Answer 26

0.5mL racemic epinephrine (acceptable dose for all ages) mixed in 2 mL saline, via nebulizer at 6-8lpm to create a fine mist.

Question 27

Sodium Bicarbonate

Dosage

Answer 27

Adults and Children (>10kg), 8.4%:
Tricyclic OD with hypotension or prolonged QRS >0.10 sec or suspected hyperkalemia-related pulseless arrest:
1.0 mEq/kg slow IV push.
Repeat if needed in 10 minutes.

Question 28

Topical Opthalmic Anesthetics

Dosage

Answer 28

Instill two drops into affected eye. Repeat only with base contact and physician consult.