EMS Protocols Quick Guide – Medication Formulary
Adenosine
- Indications: Stable PSVT.
- Dosage: 6 mg rapid IV push, followed by 12 mg if necessary.
Albuterol
- Indications: Asthma, COPD, allergic reaction, hyperkalemia, crush injury.
- Dosage:
- Hyperkalemia/Crush Injury: 15 mg nebulized.
- Allergic Reaction: 5 mg nebulized, repeat at 2.5 mg as needed.
- Respiratory Distress: 2.5 mg nebulized.
Amiodarone
- Indications: Ventricular fibrillation, pulseless ventricular tachycardia, wide complex tachycardia.
- Dosage:
- VF/pVT: 300 mg IV/IO, then 150 mg IV/IO.
- Wide Complex Tachycardia: 150 mg IV/IO over 10 minutes, repeat once if needed.
Aspirin
- Indications: Acute Coronary Syndrome (ACS).
- Dosage: 324 mg PO (chewed).
Atropine
- Indications: Symptomatic bradycardia, organophosphate poisoning.
- Dosage: 1 mg IV/IO every 4 minutes, max 3 doses.
Calcium Chloride
- Indications: Crush injury, hyperkalemia.
- Dosage: 1 g IV/IO.
Cefazolin
- Indications: Open fractures, gunshot wounds to extremities, severe soft tissue injury.
- Dosage: 2 g IV.
Dextrose
- Indications: Hypoglycemia (blood glucose < 70 mg/dL).
- Dosage: D10W 100 mL IV bolus, repeat up to 3 boluses at 50 mL increments (total 250 mL).
Diltiazem
- Indications: Atrial fibrillation/flutter with rapid ventricular response (> 150 bpm).
- Dosage: 0.25 mg/kg slow IV push over 2 minutes. If no improvement after 10 minutes, repeat at 0.35 mg/kg.
Diphenhydramine
- Indications: Allergic reactions.
- Dosage: 50 mg IV/IM over 2 minutes.
Epinephrine
- Indications:
- 1:1,000: Allergic reactions, severe asthma.
- 1:10,000: Cardiac arrest (VF/pVT/PEA/asystole), pediatric symptomatic bradycardia.
- 1:100,000 (push-dose): Symptomatic bradycardia not responding to atropine, refractory allergic reaction, septic shock.
- Dosage:
- 1:1,000: 0.3 mg IM for allergic reactions or severe asthma. May repeat once in 5 minutes.
- 1:10,000: 1 mg IV/IO for VF/pVT/PEA/asystole, or pediatric symptomatic bradycardia. Repeat every 4 minutes, max 3 doses.
- 1:100,000 (push-dose): 1 mL every minute (10 mcg/min) for symptomatic bradycardia, refractory allergic reaction, or septic shock. Max dose 30 mL.
Esmolol
- Indications: Refractory ventricular fibrillation/tachycardia.
- Dosage: 40 mg IV/IO bolus, then 60 mg IV/IO infusion over 10 minutes (mixed in 100 mL NS).
Etomidate
- Indications: Rapid Sequence Intubation (RSI).
- Dosage:
- Adult: 20 mg IV/IO if < 80 kg, 30 mg IV/IO if ≥ 80 kg.
- Pediatric: Refer to Handtevy™.
Fentanyl
- Indications: Pain management.
- Dosage:
- Adult: 50-100 mcg IV/IO/IM, based on frame size.
- Pediatric: Refer to Handtevy™.
Glucagon
- Indications: Hypoglycemia (blood glucose < 70 mg/dL) if IV access is unsuccessful and IO is not indicated.
- Dosage: 1 mg IM/IN.
Haloperidol
- Indications: Behavioral emergencies, hyperactive delirium with severe agitation.
- Dosage: 5 mg IM.
Hydroxocobalamin
- Indications: Known or suspected cyanide poisoning.
- Dosage: 5 g IV/IO.
Hydromorphone
- Indications: Pain management.
- Dosage: 1 mg IV/IM/IO every 10 minutes, max 3 doses.
Ipratropium
- Indications: Respiratory distress (COPD, asthma).
- Dosage: 0.5 mg nebulized.
Ketamine
- Indications: RSI, post-intubation sedation, procedural sedation, agitated delirium.
- Dosage:
- Adult: 150 mg IV/IO if < 80 kg, 200 mg IV/IO if ≥ 80 kg.
- Pediatric: Refer to Handtevy™.
Methylprednisolone
- Indications: Allergic reactions, respiratory distress (COPD, asthma).
- Dosage: 40 mg IV/IO/IM.
Midazolam
- Indications: Seizures, status epilepticus, agitated delirium, heat stroke (shivering), sedation for cardioversion, post-intubation sedation.
- Dosage:
- Seizures: 2.5 mg IV/IM/IN every 5 minutes, max 4 doses.
- Status Epilepticus/Repeated Seizures: 10 mg IM once.
- Heat Stroke (shivering): 2.5 mg IV/IO/IM/IN, repeat every 5 minutes (max 10 mg).
- Cardioversion: 2.5 mg IV/IO, repeat as needed (max 10 mg).
- Agitated Delirium: 5 mg IM/IN or 2.5 mg IV.
- Post-Intubation: 0.1 mg/kg IV/IO/IM/IN every 10 minutes, max 4 doses.
Naloxone
- Indications: Suspected opiate overdose.
- Dosage: 0.5 mg IV/IM/IO/IN every 2 minutes until desired effect (max 6 mg).
Nitroglycerin
- Indications: Acute Coronary Syndrome (ACS), Congestive Heart Failure (CHF).
- Dosage:
- ACS/CHF (SBP 90-160 mmHg): 0.4 mg SL every 5 minutes.
- CHF (SBP > 160 mmHg): 0.8 mg SL every 5 minutes.
Ondansetron
- Indications: Nausea/vomiting.
- Dosage: 4 mg IV/IO/IM/IN.
Prednisolone
- Indications: Mild allergic reactions (urticaria, angioedema) with NO respiratory or cardiovascular compromise.
- Dosage: 60 mg PO.
Rocuronium
- Indications: RSI.
- Dosage:
- Adult: 100 mg IV/IO if < 80 kg, 150 mg IV/IO if ≥ 80 kg.
- Pediatric: Refer to Handtevy™.
Sodium Bicarbonate
- Indications: Crush injury, hyperkalemia, TCA overdose.
- Dosage: 1 mEq/kg IV/IO (max 50 mEq).
Succinylcholine
- Indications: RSI.
- Dosage:
- Adult: 100 mg IV/IO if < 80 kg, 150 mg IV/IO if ≥ 80 kg.
- Pediatric: Refer to Handtevy™.
Terbutaline
- Indications: Bronchospasm.
- Dosage: 0.25 mg subcutaneous.
Tranexamic Acid
- Indications: Hemorrhagic shock.
- Dosage:
- Adult: 1 g IV/IO over 10 minutes (mixed in 100 mL NS).
- Pediatric: Refer to Handtevy™.