Quick cards
EMS Field Drugs
Prehospital drugs by use: scope, adult and pediatric doses, contraindications, cautions and the NREMT trap for each
Epinephrine, arrest and IV (Adrenalin)
| Scope | AEMT and paramedic for IV/IO epinephrine in arrest (2019 Scope of Practice Model); push-dose and drips are paramedic |
|---|---|
| Indications | Cardiac arrest in any rhythm; bradycardia or hypotension that persists after atropine or fluids (push-dose or drip) |
| Adult dose and route | Arrest: 1 mg (10 mL of 0.1 mg/mL) IV/IO every 3–5 min (AHA 2025). Push-dose: 10–20 mcg (1–2 mL of 10 mcg/mL, made from 1 mL of 0.1 mg/mL plus 9 mL saline) about every 2 min to MAP over 65. Drip: 0.02–0.2 mcg/kg/min for bradycardia, 0.05–0.3 for shock (NASEMSO) |
| Pediatric dose and route | Arrest: 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL) IV/IO, max 1 mg, every 3–5 min (PALS 2025). Push-dose: 0.1 mL/kg of the 10 mcg/mL mix (1 mcg/kg) every 3–5 min (NASEMSO) |
| Contraindications | None in cardiac arrest; the 0.1 mg/mL syringe label lists none |
| Key cautions | Three strengths cause mix-ups: 1 mg/mL is the IM strength, 0.1 mg/mL the arrest strength, 10 mcg/mL the push-dose mix. Arrhythmias, myocardial ischemia and necrosis if it leaks (label). Label and read back every push-dose syringe |
| NREMT trap | Timing: nonshockable rhythm, give it as soon as feasible; VF/pVT, give it after the initial shocks fail (AHA 2025). Never push 1 mg/mL IV into a patient with a pulse |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Amiodarone (Nexterone, Cordarone)
| Scope | Paramedic |
|---|---|
| Indications | VF/pVT that persists after CPR, shocks and epinephrine; stable regular wide-complex tachycardia (monomorphic VT); recurrent VF or unstable VT |
| Adult dose and route | Arrest: 300 mg IV/IO push, then 150 mg (AHA 2025 algorithm; NASEMSO 5 mg/kg, max 300 mg). With a pulse: 150 mg IV over 10 min (15 mg/min), may repeat once (NASEMSO); label then 1 mg/min for 6 h and 0.5 mg/min for 18 h |
| Pediatric dose and route | Arrest: 5 mg/kg IV/IO, max 300 mg, up to 3 doses with repeats max 150 mg (PALS 2025). Stable wide-complex tachycardia: 5 mg/kg over 10 min, max 150 mg (NASEMSO) |
| Contraindications | With a pulse: cardiogenic shock, marked sinus bradycardia, 2nd- or 3rd-degree AV block without a working pacemaker, iodine hypersensitivity (label) |
| Key cautions | Hypotension (slow the infusion first), bradycardia and AV block, QT prolongation (label); with a pulse it runs over 10 min, never as a push |
| NREMT trap | Arrest: 300 mg push, and the second dose is 150 mg, not another 300. A patient with a pulse gets 150 mg over 10 min |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Lidocaine (Xylocaine)
| Scope | Paramedic |
|---|---|
| Indications | Alternative to amiodarone for shock-refractory VF/pVT; stable monomorphic VT; IO infusion pain in an awake patient (NASEMSO) |
| Adult dose and route | Arrest: 1–1.5 mg/kg IV/IO, then 0.5–0.75 mg/kg (AHA 2025 algorithm; NASEMSO 1 mg/kg). With a pulse: 1–1.5 mg/kg, repeat every 5 min to a total of 3 mg/kg (NASEMSO); label bolus at 25–50 mg/min, infusion 1–4 mg/min |
| Pediatric dose and route | 1 mg/kg IV/IO for shock-refractory VF/pVT (PALS 2025); label infusion 20–50 mcg/kg/min after a 1 mg/kg bolus |
| Contraindications | Allergy to amide local anesthetics; Stokes-Adams syndrome, WPW, severe SA, AV or intraventricular block without a pacemaker (label) |
| Key cautions | CNS toxicity: tingling lips and tongue, tinnitus, drowsiness, seizures; the label ties CNS effects to plasma levels over 6 mcg/mL |
| NREMT trap | A slow, wide ventricular escape rhythm in complete heart block is not VT: lidocaine is contraindicated in severe AV block without a pacemaker (label) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Adenosine (Adenocard)
| Scope | Paramedic |
|---|---|
| Indications | Stable regular narrow-complex tachycardia (PSVT) after vagal maneuvers; regular monomorphic wide-complex tachycardia (NASEMSO) |
| Adult dose and route | 6 mg rapid IV push over 1–2 s into a proximal vein, then a 10 mL flush; if needed 12 mg, which may be repeated once (label; NASEMSO). Through a central line or after heart transplant 1 mg may be enough (AHA 2025) |
| Pediatric dose and route | 0.1 mg/kg rapid IV, max 6 mg, then 0.2 mg/kg, max 12 mg (NASEMSO; PALS 2025). Label under 50 kg: 0.05–0.1 mg/kg, rising to max 0.3 mg/kg |
| Contraindications | 2nd- or 3rd-degree AV block or sick sinus syndrome without a pacemaker; hypersensitivity (label). Asthma: severe bronchospasm, so AHA 2025 calls it contraindicated |
| Key cautions | Expect a few seconds of asystole, flushing, chest tightness and dread: warn the patient. Dipyridamole and carbamazepine strengthen it; caffeine and theophylline blunt it (label) |
| Onset and duration | Half-life under 10 s (label): push fast, close to the heart, flush at once |
| NREMT trap | Adenosine does not convert AF, flutter or VT (label). Unstable SVT gets synchronized cardioversion, not another drug |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Atropine (AtroPen)
| Scope | Paramedic IV; auto-injector antidotes for chemical exposure from EMR up (2019 model) |
|---|---|
| Indications | Symptomatic bradycardia (first drug); organophosphate, carbamate or nerve-agent poisoning; bradycardia from beta-blocker or CCB overdose |
| Adult dose and route | Bradycardia: 1 mg IV every 3–5 min, max 3 mg (NASEMSO; AHA 2023 0.5–1 mg). Organophosphates: 1–2 mg IV, doubled every 5 min until bronchial secretions dry (AHA 2023); severe nerve-agent exposure 6 mg IM at once (NASEMSO) |
| Pediatric dose and route | Bradycardia (vagal or cholinergic): 0.02 mg/kg, min 0.1 mg, max single 0.5 mg (PALS 2025; NASEMSO 0.01–0.02 mg/kg). Organophosphates: 0.02 mg/kg doubled every 5 min (AHA 2023); NASEMSO nerve-agent tables, infants: 0.05 mg/kg (mild to moderate) or 0.1 mg/kg (severe) IM |
| Contraindications | None (label). Relative: narrow-angle glaucoma, GI obstruction, bladder outlet obstruction, myasthenia gravis (NASEMSO) |
| Key cautions | Third-degree block and the denervated (transplanted) heart may not respond: go straight to epinephrine, dopamine or pacing (NASEMSO). Often ineffective in hypothermic bradycardia (NASEMSO) |
| NREMT trap | In organophosphate poisoning the endpoint is dry bronchial secretions and easier breathing, and severe cases can need more than 20 mg (NASEMSO), far beyond the 3 mg cardiac maximum |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Calcium chloride and calcium gluconate
| Scope | Paramedic |
|---|---|
| Indications | Hyperkalemia with ECG changes or arrest (dialysis patient); calcium channel blocker or beta-blocker poisoning; magnesium toxicity; hydrofluoric acid burns (NASEMSO) |
| Adult dose and route | Hyperkalemic arrest: calcium chloride 10% 1 g or calcium gluconate 10% 1 g IV over 2 min, gluconate may repeat (NASEMSO). CCB poisoning: chloride 2 g (20 mL) or gluconate 6 g (60 mL) (AHA 2023); NASEMSO chloride 0.5–1 g or gluconate 2–6 g over 10 min. Magnesium toxicity: gluconate 3 g or chloride 1 g (NASEMSO) |
| Pediatric dose and route | Chloride 20 mg/kg (0.2 mL/kg of 10%), max 1 g (NASEMSO; AHA 2023); gluconate 60 mg/kg (0.6 mL/kg) (AHA 2023; NASEMSO 100 mg/kg in hyperkalemic arrest) |
| Contraindications | Chloride label: ventricular fibrillation, asystole or PEA; newborns who need IV ceftriaxone. NASEMSO: hypercalcemia; caution with digoxin |
| Key cautions | 1 g of chloride carries about the calcium of 3 g of gluconate (AHA 2023: 2 g and 6 g are each 28 mEq). Chloride is a vesicant: large vein, never IM or SC; label maximum rate 1 mL/min (100 mg/min). Flush between it and bicarbonate, which precipitates with calcium |
| NREMT trap | Routine calcium in cardiac arrest is not recommended (AHA 2025): give it for suspected hyperkalemia (dialysis patient, peaked T waves) or a calcium channel blocker overdose |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Sodium bicarbonate 8.4%
| Scope | Paramedic |
|---|---|
| Indications | Tricyclic or other sodium-channel-blocker overdose with a wide QRS (100 ms or more, NASEMSO); hyperkalemia or dialysis patient in arrest; metabolic acidosis (label) |
| Adult dose and route | 1 mEq/kg IV for hyperkalemic or TCA arrest; TCA with a pulse and wide QRS 1–2 mEq/kg, repeated to narrow it (NASEMSO). Sodium-channel blockers: 50–150 mEq IV, then a 150 mEq/L drip (AHA 2023). Label arrest dosing: 44.6–100 mEq, then 50 mEq every 5–10 min guided by blood gases |
| Pediatric dose and route | 1 mEq/kg IV/IO (NASEMSO); 1–3 mEq/kg for sodium-channel blockers (AHA 2023). Under 2 years avoid rapid injection; 4.2% (0.5 mEq/mL) suits slow giving (label), and AHA 2023 uses 0.5 mEq/mL for children |
| Contraindications | Chloride loss from vomiting or GI suction; diuretic-induced hypochloremic alkalosis (label) |
| Key cautions | Necrosis if it leaks; precipitates with calcium; incompatible with norepinephrine and dobutamine (label). Watch for hypernatremia, alkalemia and hypokalemia (AHA 2023) |
| NREMT trap | Not routine in cardiac arrest (AHA 2025). The classic indications are a tricyclic overdose with a wide QRS and hyperkalemia |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Etomidate (Amidate)
| Scope | Paramedic RSI programs and critical care transport, where credentialed by medical direction |
|---|---|
| Indications | Induction for rapid sequence intubation (label: induction of general anesthesia) |
| Adult dose and route | 0.3 mg/kg IV over 30–60 s (label range 0.2–0.6 mg/kg) |
| Pediatric dose and route | Over 10 years: 0.3 mg/kg as for adults. Under 10: the label does not recommend it (too little data); use only as protocol directs |
| Contraindications | Known hypersensitivity (label) |
| Key cautions | Suppresses cortisol and aldosterone, so it is not for infusion (label); transient myoclonus can look like a seizure |
| Onset and duration | Hypnosis within 1 min, lasting 3–5 min after 0.3 mg/kg (label) |
| NREMT trap | It wears off in 3–5 min while rocuronium lasts 30–60 min or more: start post-intubation sedation and analgesia before the patient is awake and paralyzed |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Ketamine (Ketalar)
| Scope | Paramedic |
|---|---|
| Indications | RSI induction; severe agitation with high violence risk; moderate to severe pain at low dose |
| Adult dose and route | Induction: label 1–4.5 mg/kg IV (2 mg/kg is average) or 6.5–13 mg/kg IM. Agitation: 2 mg/kg IV or 4 mg/kg IM (NASEMSO). Pain: 0.25 mg/kg IV/IM/IO, max initial 25 mg, max total 100 mg (NASEMSO) |
| Pediatric dose and route | Agitation: 1 mg/kg IV or 3 mg/kg IM. Pain: 0.25 mg/kg, max initial 25 mg (NASEMSO). Label: safety under 16 not established |
| Contraindications | Patients in whom a significant rise in blood pressure would be a serious hazard; hypersensitivity (label). NASEMSO relative: head trauma or intracranial bleeding, hypertension, angina, stroke, psychiatric disorder |
| Key cautions | Emergence delirium in about 12% (label); raises BP and heart rate; hypersalivation, laryngospasm and airway obstruction (label) |
| Onset and duration | IV: anesthesia within 30 s, lasting 5–10 min after 2 mg/kg. IM: 3–4 min, lasting 12–25 min (label) |
| NREMT trap | Unlike propofol, ketamine tends to raise BP and heart rate (label). Laryngospasm, not apnea, is the airway problem to expect |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Propofol (Diprivan)
| Scope | Critical care transport (FP-C, CCP-C) and paramedic programs where medical direction credentials it |
|---|---|
| Indications | Induction of anesthesia; continuous sedation of intubated, ventilated patients (label) |
| Adult dose and route | Induction: 2–2.5 mg/kg under 65 (ASA I–II); 1–1.5 mg/kg if elderly, debilitated or ASA III–IV. Sedation: start 5 mcg/kg/min, titrate within 5–50 mcg/kg/min (label) |
| Pediatric dose and route | Induction 2.5–3.5 mg/kg for ages 3–16 (label); not labeled for pediatric ICU sedation |
| Contraindications | Hypersensitivity to propofol or its components; the label also lists anaphylaxis to eggs, egg products, soybeans or soy products |
| Key cautions | Hypotension and apnea; propofol infusion syndrome with long, high-dose infusions; strict asepsis, finish within 12 h of opening a vial, one patient per vial (label) |
| NREMT trap | Propofol drops blood pressure: in shock lower the dose or choose ketamine or etomidate |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Succinylcholine (Anectine, Quelicin)
| Scope | Paramedic RSI programs and critical care transport, where credentialed |
|---|---|
| Indications | Neuromuscular blockade for rapid sequence intubation |
| Adult dose and route | Label: 0.6 mg/kg IV on average (range 0.3–1.1 mg/kg); emergency RSI commonly uses 1–1.5 mg/kg (Radkowski 2025 review). IM if no vein: up to 3–4 mg/kg, max 150 mg (label) |
| Pediatric dose and route | Label IV: 2 mg/kg for infants and small children, 1 mg/kg for older children and adolescents; reserve for emergency airways (boxed warning) |
| Contraindications | Personal or family risk of malignant hyperthermia; skeletal muscle myopathies; after the acute phase of major burns, multiple trauma, extensive denervation or upper motor neuron injury (hyperkalemia); hypersensitivity (label) |
| Key cautions | Boxed warning: hyperkalemic cardiac arrest in children with undiagnosed myopathy (usually boys 8 or younger, Duchenne). Bradycardia; prolonged block with low plasma cholinesterase; raises intraocular and intracranial pressure (review) |
| Onset and duration | IV: within 60 s, lasting under 10 min (review); IM onset 2–3 min (label) |
| NREMT trap | Burns, crush and denervation are dangerous after the acute phase of injury (label), not in the first minutes at the scene. Known hyperkalemia (dialysis, renal failure) is another reason to choose rocuronium |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Rocuronium (Zemuron)
| Scope | Paramedic RSI programs and critical care transport, where credentialed |
|---|---|
| Indications | Rapid sequence and routine intubation; paralysis for ventilation |
| Adult dose and route | RSI: 0.6–1.2 mg/kg IV; routine intubation 0.6 mg/kg (label) |
| Pediatric dose and route | Intubation 0.6 mg/kg (0.45 mg/kg possible); the label does not recommend it for pediatric RSI |
| Contraindications | Hypersensitivity, including anaphylaxis, to rocuronium or other neuromuscular blockers (label) |
| Key cautions | No sedative or analgesic effect; give only where intubation, ventilation, oxygen and a reversal agent are ready; anaphylaxis; residual paralysis; confirm the vial, since accidental paralysis kills (label) |
| Onset and duration | Time to 80% block median 1 min at 0.6 mg/kg and 0.7 min at 1.2 mg/kg; clinical duration median 31 min (range 15–85) and 67 min (range 38–160) (label) |
| NREMT trap | Paralysis outlasts every induction drug: a paralyzed patient cannot show awareness, so keep giving sedation and analgesia |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Midazolam (Versed)
| Scope | Paramedic |
|---|---|
| Indications | Status seizures (IM or IN when there is no IV); agitation; sedation for pacing, cardioversion or after intubation |
| Adult dose and route | Seizure: 0.2 mg/kg IM or IN, max 10 mg (IM preferred), or 0.1 mg/kg IV/IO, max 4 mg (NASEMSO). Agitation: 5 mg IV, IM or IN (NASEMSO). Procedural sedation: no more than 2.5 mg IV over at least 2 min, 1.5 mg if 60 or older or debilitated (label) |
| Pediatric dose and route | Seizure: 0.2 mg/kg IM or IN, max 10 mg, or 0.1 mg/kg IV/IO, max 4 mg. Agitation: 0.05–0.1 mg/kg IV, 0.1–0.15 mg/kg IM or 0.3 mg/kg IN, each max 5 mg (NASEMSO) |
| Contraindications | Hypersensitivity; acute narrow-angle glaucoma (label). NASEMSO adds severe respiratory depression and sleep apnea |
| Key cautions | Boxed warning: respiratory depression and arrest, worse with opioids; use with continuous monitoring; no rapid IV injection in neonates (label). Flumazenil can provoke seizures in benzodiazepine-dependent patients (AHA 2023) |
| Onset and duration | IV 3–5 min; IM 10–15 min; IN 3–5 min (NASEMSO) |
| NREMT trap | Seizing without an IV: give IM (or IN) midazolam now; IM midazolam is at least as safe and effective as IV lorazepam (NASEMSO). More than 2 benzodiazepine doses carry a high risk of airway compromise (NASEMSO) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Fentanyl (Sublimaze)
| Scope | Paramedic; AEMT parenteral analgesia where the state allows (2019 model) |
|---|---|
| Indications | Moderate to severe pain; analgesia after intubation |
| Adult dose and route | 1 mcg/kg IV, IO, IM or IN, max initial 100 mcg; repeat after 5 min if vital signs allow (NASEMSO). Label: 50–100 mcg IM or slow IV over 1–2 min |
| Pediatric dose and route | 1 mcg/kg IN, IV, IO or IM, max initial 100 mcg; IN is preferred when IV access is hard (NASEMSO). Label: 2–3 mcg/kg in children 2–12 |
| Contraindications | Hypersensitivity (label); MAO inhibitor in the last 14 days (NASEMSO, all opioids) |
| Key cautions | Respiratory depression, worse with benzodiazepines or alcohol (boxed warning); chest wall rigidity with large or fast IV doses (label); use capnography (NASEMSO) |
| Onset and duration | IV almost immediate, analgesia 30–60 min after up to 100 mcg; IM onset 7–8 min, lasting 1–2 h (label) |
| NREMT trap | Fentanyl is dosed in micrograms, morphine in milligrams: 100 mcg is 0.1 mg. A rigid chest after a fast push can make bagging nearly impossible |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Morphine sulfate
| Scope | Paramedic; AEMT parenteral analgesia where the state allows (2019 model) |
|---|---|
| Indications | Moderate to severe pain; ischemic chest pain not relieved by nitrates (NASEMSO) |
| Adult dose and route | 0.1 mg/kg IV, IO or IM, max initial 10 mg; repeat after 5 min if vital signs allow (NASEMSO). Label: 0.1–0.2 mg/kg IV every 4 h, injected slowly |
| Pediatric dose and route | 0.1 mg/kg IV, IO or IM, max initial 10 mg (NASEMSO); label: safety under 18 not established |
| Contraindications | Significant respiratory depression; acute or severe asthma without monitoring; GI obstruction or paralytic ileus; MAO inhibitor in the last 14 days; hypersensitivity (label) |
| Key cautions | Severe hypotension, so avoid in circulatory shock; avoid with impaired consciousness or coma (label). Use with caution in unstable angina or NSTEMI, where it is linked to higher mortality (NASEMSO) |
| Onset and duration | Peak CNS effect, including respiratory depression, about 30 min after IV (label) |
| NREMT trap | Breathing is most depressed about 30 min after an IV dose (label), after the pain has eased: keep reassessing and keep capnography on |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Ketorolac (Toradol)
| Scope | Paramedic |
|---|---|
| Indications | Moderately severe acute pain, short term (NASEMSO; label) |
| Adult dose and route | 30 mg IM or 15 mg IV (NASEMSO). Label single dose: 60 mg IM or 30 mg IV under 65; 30 mg IM or 15 mg IV if 65 or older, under 50 kg or with renal impairment |
| Pediatric dose and route | 0.5 mg/kg IM or IV for ages 2–16, max 30 mg IM or 15 mg IV (NASEMSO); the label does not cover patients under 17 |
| Contraindications | Aspirin or NSAID allergy (including aspirin-sensitive asthma); active or past GI bleeding or ulcer; advanced kidney disease or volume depletion; labor and delivery; suspected cerebrovascular bleeding or high bleeding risk; current aspirin or NSAID use; CABG (label) |
| Key cautions | Avoid in hypotension (renal toxicity) and pregnancy (NASEMSO); total use no longer than 5 days (label) |
| NREMT trap | IV does not make it safer: it is still an NSAID, wrong for a bleeding trauma patient or a possible head bleed (label contraindications) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Acetaminophen (Tylenol, Ofirmev)
| Scope | Oral: EMT (OTC analgesic in the 2019 model). IV: paramedic |
|---|---|
| Indications | Mild to moderate pain or as an opioid-sparing adjunct; fever |
| Adult dose and route | 15 mg/kg PO or IV, max 1 g (NASEMSO). Label IV, 50 kg or more: 1 g every 6 h or 650 mg every 4 h, max 4 g/day, infused over 15 min |
| Pediatric dose and route | 15 mg/kg PO or IV, max 1 g (NASEMSO). Label IV for ages 2–12 or under 50 kg: 15 mg/kg every 6 h, max 75 mg/kg/day; infants 15 mg/kg, max 60 mg/kg/day |
| Contraindications | Severe hepatic impairment or severe active liver disease; hypersensitivity (label) |
| Key cautions | Boxed warning: dosing errors and hepatotoxicity; ask what acetaminophen the patient already took today |
| NREMT trap | IV dosing errors (mg mistaken for mL) have caused fatal overdoses (boxed warning): check the weight-based dose and the daily maximum |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Ondansetron (Zofran)
| Scope | AEMT (IV antiemetic in the 2019 model) and paramedic |
|---|---|
| Indications | Nausea and vomiting |
| Adult dose and route | 4 mg IV, PO or SL; ODT 4 or 8 mg (NASEMSO). Label: 4 mg IV undiluted over at least 30 s, preferably 2–5 min |
| Pediatric dose and route | 0.15 mg/kg IV or PO, max 4 mg, ages 6 months–14 years; ODT 2 mg at 1–5 years, 4 mg from 6 (NASEMSO). Label (1 month–12 years): 0.1 mg/kg IV up to 40 kg, 4 mg over 40 kg |
| Contraindications | Hypersensitivity; apomorphine (profound hypotension and loss of consciousness) (label); known long QT (NASEMSO) |
| Key cautions | Dose-related QT prolongation and torsades: monitor the ECG with electrolyte problems, heart failure, bradyarrhythmias or other QT drugs; serotonin syndrome (label). Can sedate very young children (NASEMSO) |
| NREMT trap | No dopamine blockade, so no extrapyramidal reactions (NASEMSO). Dystonia after metoclopramide or prochlorperazine is treated with diphenhydramine |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Oxygen (O₂)
| Scope | EMR and EMT and above |
|---|---|
| Indications | Hypoxemia, respiratory distress, shock; cardiac arrest; ACS only when dyspneic, hypoxemic or in heart failure (NASEMSO) |
| Adult dose and route | Titrate to SpO₂ 94–98% (NASEMSO). Chronic COPD: an SpO₂ of about 90% may be enough (NASEMSO). Arrest: highest available flow, then back to 94–98% after ROSC (NASEMSO) |
| Pediatric dose and route | Same 94–98% target; step up from nasal cannula to mask to non-rebreather (NASEMSO croup guideline) |
| Contraindications | None for a hypoxemic patient |
| Key cautions | Do not carry 100% oxygen into the post-ROSC phase (NASEMSO). No open flame or smoking near oxygen |
| NREMT trap | Never withhold oxygen from a hypoxemic COPD patient: titrate to target and watch breathing and EtCO₂. High-flow oxygen for chest pain with a normal SpO₂ is the wrong answer |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Albuterol (Proventil, Ventolin)
| Scope | EMT and above (inhaled beta agonist in the 2019 model) |
|---|---|
| Indications | Bronchospasm: asthma, COPD, anaphylaxis with wheeze; adjunct for hyperkalemia (NASEMSO) |
| Adult dose and route | 2.5 mg nebulized for mild wheeze; 5 mg nebulized (or 6 MDI puffs) for respiratory distress, repeated with no frequency limit while distress continues (NASEMSO) |
| Pediatric dose and route | NASEMSO uses the same 2.5–5 mg nebulized doses. The 0.63 or 1.25 mg label (ages 2–12) was not studied in acute attacks and says 2.5 mg may suit them better, especially from age 6 |
| Contraindications | Hypersensitivity (label); tachycardia from a heart condition (NASEMSO) |
| Key cautions | Tachycardia, tremor, palpitations, low potassium; paradoxical bronchospasm, which can be life-threatening (label) |
| Onset and duration | Effect measurable by 30 min, peak 30–60 min (label) |
| NREMT trap | A quiet chest in a struggling asthmatic is not improvement: little air is moving. A normal EtCO₂ with fast breathing signals impending failure (NASEMSO) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Ipratropium (Atrovent)
| Scope | EMT and above (inhaled anticholinergic in the 2019 model) |
|---|---|
| Indications | Bronchospasm in asthma or COPD, given with albuterol |
| Adult dose and route | 0.5 mg (500 mcg) nebulized with albuterol, up to 3 doses (NASEMSO) |
| Pediatric dose and route | NASEMSO gives the same 0.5 mg with albuterol; label: safety under 12 not established |
| Contraindications | Hypersensitivity to ipratropium, atropine or its derivatives (label) |
| Key cautions | Narrow-angle glaucoma (keep mist out of the eyes), prostatic enlargement or bladder-neck obstruction (label) |
| Onset and duration | Starts in 15–30 min, peaks at 1–2 h, lasts 4–5 h (label) |
| NREMT trap | It is the add-on, not the rescue drug: its slower onset is why albuterol goes first. An atropine allergy rules it out (label) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Epinephrine, IM for anaphylaxis (EpiPen, Adrenalin 1 mg/mL)
| Scope | EMT: agency-carried auto-injector; IM from a vial only with medical-director-approved training (2019 model). Paramedic: all routes |
|---|---|
| Indications | Anaphylaxis (first drug); stridor or wheeze in anaphylaxis (nebulized); severe asthma near respiratory failure as an adjunct (NASEMSO) |
| Adult dose and route | 0.3 mg IM in the anterolateral thigh (NASEMSO, 25 kg or more); label 0.3–0.5 mg (0.3–0.5 mL of 1 mg/mL) for 30 kg or more. Repeat every 5–15 min (NASEMSO; label 5–10 min). Stridor or wheeze: 5 mL of 1 mg/mL nebulized (NASEMSO) |
| Pediatric dose and route | 0.01 mg/kg IM (0.01 mL/kg of 1 mg/mL), max 0.3 mg (label, under 30 kg); NASEMSO 0.15 mg if under 25 kg. Croup with stridor at rest: 5 mL of 1 mg/mL nebulized (NASEMSO) |
| Contraindications | None in anaphylaxis (label) |
| Key cautions | Expect tachycardia, tremor, anxiety and pallor. Never inject the buttock, fingers, hands or feet (label). Patients on beta-blockers may respond poorly (NASEMSO) |
| NREMT trap | IM epinephrine in the thigh comes first; diphenhydramine and steroids never replace it. 1 mg/mL is the IM strength, never an IV push |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Diphenhydramine (Benadryl)
| Scope | Paramedic |
|---|---|
| Indications | Hives and itching in allergic reactions, after epinephrine when there is anaphylaxis; dystonic reactions and akathisia from antiemetics or antipsychotics (NASEMSO) |
| Adult dose and route | 25–50 mg IV, IM or PO (NASEMSO; allergy 1 mg/kg, max 50 mg). Label: 10–50 mg IV or deep IM, up to 100 mg, max 400 mg/day; IV no faster than 25 mg/min |
| Pediatric dose and route | 1 mg/kg IV, IM or PO, max 50 mg for allergy (NASEMSO; max 25 mg in its agitation guideline). Label: 5 mg/kg/day in 4 doses, max 300 mg/day |
| Contraindications | Neonates and premature infants; breastfeeding mothers; use as a local anesthetic; hypersensitivity (label) |
| Key cautions | Sedation, dizziness and low BP in the elderly; excitation, hallucinations or seizures in children in overdose; anticholinergic effects in narrow-angle glaucoma and urinary obstruction (label) |
| NREMT trap | An antihistamine treats hives, not airway swelling or shock: in anaphylaxis it is a second-line add-on after epinephrine |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Methylprednisolone (Solu-Medrol)
| Scope | Paramedic |
|---|---|
| Indications | Asthma or COPD exacerbation; adrenal insufficiency or fluid-refractory shock (NASEMSO); allergic reactions as an adjunct |
| Adult dose and route | 2 mg/kg IV/IM, max 125 mg (NASEMSO). Label: 10–40 mg initial for most conditions; doses over 0.5 g pushed in under 10 min have caused arrhythmias and arrest |
| Pediatric dose and route | 2 mg/kg IV/IM, max 125 mg (NASEMSO); label minimum 0.5 mg/kg per 24 h |
| Contraindications | Systemic fungal infection; intrathecal use; the 40 mg vial in cow’s milk allergy, since it contains lactose from milk (label) |
| Key cautions | Give slowly; avoid high doses in traumatic brain injury (NASEMSO) |
| NREMT trap | Steroids add to bronchodilators and epinephrine, they never replace them. The 40 mg vial is off limits with a cow’s milk allergy (label) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Dexamethasone (Decadron)
| Scope | Paramedic |
|---|---|
| Indications | Croup; asthma or COPD exacerbation (PO or IV); adrenal insufficiency or refractory shock; high-altitude cerebral edema (NASEMSO) |
| Adult dose and route | 0.6 mg/kg PO, IV or IM, max 16 mg (NASEMSO; the IV solution can be swallowed). HACE: 8 mg IM, IV or PO, then 4 mg every 6 h (NASEMSO) |
| Pediatric dose and route | Croup or asthma: 0.6 mg/kg PO, IV or IM, max 16 mg (NASEMSO) |
| Contraindications | Systemic fungal infection (label); cerebral malaria (NASEMSO) |
| Key cautions | In children use the smallest effective dose, preferably by mouth (label) |
| NREMT trap | Croup with stridor at rest: nebulized epinephrine (5 mL of 1 mg/mL) plus dexamethasone, and every child given inhaled epinephrine is transported. Mist therapy is not indicated (NASEMSO) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Aspirin (ASA)
| Scope | EMT and above (oral aspirin for chest pain in the 2019 model) |
|---|---|
| Indications | Chest pain of suspected ischemic origin (acute coronary syndrome) |
| Adult dose and route | 162–325 mg chewed, non-enteric-coated preferred (NASEMSO): for example four 81 mg chewable tablets |
| Pediatric dose and route | No pediatric ACS use. The OTC label warns against aspirin for children and teens with chickenpox or flu-like illness (Reye syndrome) |
| Contraindications | Aspirin or NSAID allergy (including aspirin-induced asthma or hives), bleeding GI ulcer; bleeding disorders such as hemophilia or thrombocytopenia (NASEMSO; OTC label) |
| Key cautions | Stomach bleeding risk is higher over 60, with past ulcers, or with anticoagulants or steroids (OTC label) |
| NREMT trap | Chewed, non-enteric-coated aspirin is the preferred form (NASEMSO): have the patient chew it rather than swallow it whole |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Nitroglycerin (Nitrostat, Nitrolingual)
| Scope | EMT: assist with the patient’s own prescribed SL nitroglycerin. AEMT and paramedic: administer (2019 model) |
|---|---|
| Indications | Ischemic chest pain; acute pulmonary edema from heart failure with adequate or high BP |
| Adult dose and route | Chest pain: 0.4 mg SL every 3–5 min while SBP over 100 (NASEMSO); label every 5 min, no more than 3 tablets in 15 min. Pulmonary edema: 0.4 mg SL if SBP under 160, 0.8 mg if 160 or more (or MAP over 120), every 5 min while SBP over 100 (NASEMSO) |
| Pediatric dose and route | No pediatric use; the label says safety and effectiveness in children are not established |
| Contraindications | PDE-5 inhibitors (avanafil, sildenafil, tadalafil, vardenafil) or sGC stimulators; severe anemia; raised intracranial pressure; circulatory failure or shock; hypersensitivity (label). NASEMSO: any PDE-5 inhibitor in 48 h, IV epoprostenol or treprostinil, SBP under 90 or 30 below baseline, HR under 50 |
| Key cautions | Hypotension, headache, reflex tachycardia; hypertrophic obstructive cardiomyopathy (label). RV infarct: NASEMSO’s ACS text says it does not rule out nitrates if you watch BP closely, while its drug appendix lists it as a contraindication |
| NREMT trap | Ask about erectile dysfunction and pulmonary hypertension drugs before every dose. Know your BP floor: NASEMSO repeats nitro only with SBP over 100 |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Diltiazem (Cardizem)
| Scope | Paramedic |
|---|---|
| Indications | Rate control of stable atrial fibrillation or flutter with rapid ventricular response; stable narrow-complex SVT (NASEMSO; label) |
| Adult dose and route | 0.25 mg/kg IV over 2 min (about 20 mg); after 15 min, 0.35 mg/kg (about 25 mg) if needed; infusion 5–15 mg/h (label; NASEMSO). Over 65: first dose max 10 mg, second max 20 mg (NASEMSO) |
| Pediatric dose and route | Not established (label) |
| Contraindications | Sick sinus syndrome or 2nd- or 3rd-degree AV block without a pacemaker; severe hypotension or cardiogenic shock; IV beta-blocker within a few hours; AF or flutter with WPW; ventricular tachycardia (label) |
| Key cautions | Hypotension and bradycardia, worse with beta-blockers (NASEMSO); avoid with suspected systolic heart failure (AHA 2025) |
| NREMT trap | Wide, irregular, very fast AF suggests WPW: AV nodal blockers (diltiazem, adenosine, beta-blockers) are wrong. Use procainamide or cardiovert (NASEMSO) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Norepinephrine (Levophed)
| Scope | Paramedic and critical care transport |
|---|---|
| Indications | Shock that persists after fluids: preferred in septic and neurogenic shock; also cardiogenic shock (NASEMSO) |
| Adult dose and route | 0.05–0.5 mcg/kg/min titrated to MAP 65 or more (NASEMSO shock; 0.02–0.4 for bradycardia). Label: 4 mg in 1,000 mL D5W (4 mcg/mL), start 8–12 mcg/min, maintain 2–4 mcg/min |
| Pediatric dose and route | Weight-based infusion per protocol (NASEMSO shock dosing is in mcg/kg/min); label: pediatric safety not established |
| Contraindications | None (label). NASEMSO: hypotension from an uncorrected volume deficit |
| Key cautions | Vesicant: large vein, watch the site; for extravasation infiltrate phentolamine 5–10 mg in 10–15 mL saline (label). Stopping abruptly drops BP; arrhythmias (label). Inactivated by alkaline solutions such as bicarbonate in the same line (NASEMSO) |
| NREMT trap | Norepinephrine, not dopamine, is the preferred pressor in septic shock (NASEMSO: lower mortality, fewer arrhythmias); correct hypovolemia first |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Dopamine (Intropin)
| Scope | Paramedic and critical care transport |
|---|---|
| Indications | Bradycardia that does not respond to atropine, with epinephrine or pacing as alternatives (AHA 2025); shock when norepinephrine or epinephrine is not available (NASEMSO) |
| Adult dose and route | 2–20 mcg/kg/min (NASEMSO shock). Label: start 2–5 mcg/kg/min, titrate in 5–10 mcg/kg/min steps, max 50 |
| Pediatric dose and route | Label: used from birth through adolescence at similar mcg/kg/min doses. NASEMSO: not indicated for pediatric bradycardia |
| Contraindications | Pheochromocytoma (label); NASEMSO adds uncorrected tachyarrhythmias and VF |
| Key cautions | Tachyarrhythmias. Vesicant: for extravasation infiltrate phentolamine, adults 5–10 mg, children 0.1–0.2 mg/kg, max 10 mg (label) |
| NREMT trap | Dose bands (label): under 5 mcg/kg/min dilates renal and mesenteric vessels, 5–10 adds beta-1 rate and contractility, over 10 adds alpha-1 vasoconstriction |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Lorazepam (Ativan)
| Scope | Paramedic |
|---|---|
| Indications | Status epilepticus; agitation; anxiety |
| Adult dose and route | Seizure: 0.1 mg/kg IV/IO, max 4 mg (NASEMSO); label 4 mg IV at 2 mg/min, repeat once after 10–15 min. Agitation: 2 mg IV or 4 mg IM (NASEMSO) |
| Pediatric dose and route | Seizure: 0.1 mg/kg IV/IO, max 4 mg (NASEMSO); label: not established for pediatric status epilepticus. Agitation: 0.05 mg/kg IV or IM, max 2 mg (NASEMSO) |
| Contraindications | Hypersensitivity to benzodiazepines or the vehicle (polyethylene glycol, propylene glycol, benzyl alcohol); acute narrow-angle glaucoma; sleep apnea; severe respiratory insufficiency unless ventilated; intra-arterial use; premature infants (label) |
| Key cautions | Respiratory depression, worse with opioids (boxed warning). Dilute with an equal volume and push no faster than 2 mg/min; intra-arterial injection can cause gangrene (label) |
| Onset and duration | IV 2–5 min, IM 15–30 min (NASEMSO agitation guideline); effects last 6–8 h (label) |
| NREMT trap | IM lorazepam is slow (15–30 min). Without an IV, IM or IN midazolam is the benzodiazepine of choice for seizures (NASEMSO) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Diazepam (Valium, Diastat)
| Scope | Paramedic; the CANA 10 mg auto-injector is part of nerve-agent antidote kits (NASEMSO) |
|---|---|
| Indications | Seizures (IV, or rectal when no other route); agitation; nerve-agent seizures |
| Adult dose and route | Seizure: 0.2 mg/kg IV/IO, max 10 mg (NASEMSO); label 5–10 mg IV, repeat every 10–15 min to 30 mg, at least 1 min per 5 mg. Rectal: 0.2 mg/kg PR, max 20 mg (NASEMSO). Agitation: 5 mg IV or 10 mg IM (NASEMSO) |
| Pediatric dose and route | Seizure: 0.2 mg/kg IV/IO, max 10 mg, or 0.2 mg/kg PR, max 20 mg (NASEMSO). Label IV, 3 months–17 years: 0.2 mg/kg (max 8 mg), then 0.1 mg/kg (max 4 mg) after 5 min |
| Contraindications | Hypersensitivity; acute narrow-angle glaucoma; open-angle glaucoma without treatment (label); severe respiratory depression (NASEMSO) |
| Key cautions | Respiratory depression and hypotension, worse with opioids (boxed warning); inject slowly |
| Onset and duration | IV 2–5 min; IM 15–30 min (NASEMSO agitation guideline) |
| NREMT trap | Route order for seizures (NASEMSO): IM or IN midazolam first, IV/IO when a line is in, rectal diazepam only when no other route exists |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Naloxone (Narcan)
| Scope | EMR and EMT: intranasal or auto-injector. AEMT and paramedic: also IV, IO and IM (2019 model) |
|---|---|
| Indications | Suspected opioid overdose with respiratory depression |
| Adult dose and route | 0.4–2 mg IV or IM, or up to 4 mg IN (one 4 mg spray in one nostril), titrated to breathing; 5 mg by ETT only in extremis (NASEMSO). AHA 2023: 0.2–2 mg IV/IO/IM or 2–4 mg IN, repeat every 2–3 min |
| Pediatric dose and route | 0.1 mg/kg IV, IM, IN or ETT, max 2 mg IV/IM/ETT or 4 mg IN (NASEMSO; AHA 2023) |
| Contraindications | Hypersensitivity (label; NASEMSO) |
| Key cautions | Sudden withdrawal: agitation, vomiting, tachycardia, pulmonary edema; seizures in neonates (NASEMSO; label). The opioid can outlast naloxone; buprenorphine may need higher or repeated doses (label) |
| Onset and duration | Nasal spray: repeat every 2–3 min, alternating nostrils, if there is no response (label) |
| NREMT trap | Airway and BVM come first (NASEMSO); the goal is adequate breathing, not a fully awake, combative patient. Anyone who wakes still needs care and observation because sedation can return (label) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Atropine and pralidoxime (DuoDote, ATNAA)
| Scope | EMR and above: auto-injector antidotes for chemical exposure (2019 model). Label: trained providers; a provider with mild symptoms may self-inject one |
|---|---|
| Indications | Organophosphorus nerve agent or insecticide poisoning with cholinergic signs (secretions, bronchospasm, small pupils, bradycardia, twitching) |
| Adult dose and route | Each auto-injector: atropine 2.1 mg plus pralidoxime 600 mg IM, mid-lateral thigh. Two or more mild symptoms: 1; if severe symptoms follow, 2 more in rapid succession. Severe: 3 at once (label). Further atropine as plain atropine, not more DuoDote (NASEMSO) |
| Pediatric dose and route | Label: established only over 41 kg; at 41 kg or less use pediatric atropine auto-injectors and weight-based pralidoxime. NASEMSO tables, infants: mild to moderate atropine 0.05 mg/kg with pralidoxime 15 mg/kg; severe atropine 0.1 mg/kg with pralidoxime 45 mg/kg IM |
| Contraindications | None (label) |
| Key cautions | Protect yourself and decontaminate first. Treat seizures with a benzodiazepine (diazepam 10 mg CANA auto-injector or midazolam) (NASEMSO) |
| NREMT trap | Atropine blocks the muscarinic effects (secretions, bronchospasm); pralidoxime reactivates acetylcholinesterase (NASEMSO). Keep giving atropine until secretions dry; severe cases may need more than 20 mg |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Hydroxocobalamin (Cyanokit)
| Scope | Paramedic |
|---|---|
| Indications | Known or suspected cyanide poisoning, judged from history and signs since there is no rapid blood test (NASEMSO; label) |
| Adult dose and route | 5 g IV over 15 min (one vial reconstituted with 200 mL saline, 25 mg/mL); a second 5 g over 15 min to 2 h, total 10 g (label) |
| Pediatric dose and route | 70 mg/kg IV, max single dose 5 g (NASEMSO; AHA 2023; label clinical experience) |
| Contraindications | None (label) |
| Key cautions | Its own IV line (label). Turns skin and urine red and interferes with pulse oximetry and lab tests: draw blood first if you can (NASEMSO). BP rise; kidney injury (label) |
| NREMT trap | Preferred over nitrites in smoke inhalation: nitrites make methemoglobin and worsen oxygen delivery alongside carbon monoxide (NASEMSO). It is also the only cyanide antidote NASEMSO calls safe in pregnancy |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Activated charcoal (Actidose-Aqua)
| Scope | Per state protocol and medical direction (oral route from EMT up in the 2019 model) |
|---|---|
| Indications | Selected oral poisonings within 1 h of ingestion when the airway is protected, especially before a long transport (NASEMSO) |
| Adult dose and route | 1 g/kg PO without sorbitol (NASEMSO). Actidose-Aqua: 25 g in 120 mL |
| Pediatric dose and route | 1 g/kg PO without sorbitol (NASEMSO) |
| Contraindications | Unprotected airway or falling mental status, caustic ingestion, bowel obstruction (NASEMSO); not fully conscious, corrosives, petroleum distillates (label) |
| Key cautions | Vomiting and aspiration |
| NREMT trap | Never give it to a patient who may soon lose the airway, such as after a sedating or seizure-causing co-ingestion (NASEMSO) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Magnesium sulfate
| Scope | Paramedic |
|---|---|
| Indications | Seizures in eclampsia (more than 20 weeks or postpartum) and severe pre-eclampsia; torsades de pointes; severe asthma with impending failure (NASEMSO) |
| Adult dose and route | Pre-eclampsia: 4 g IV over 20–30 min (prophylaxis) or 4 g over 5–10 min, then 2 g/h. Seizing: 6 g IV over 5–10 min, or 8 g IM (4 g in each buttock) (NASEMSO); label total initial 10–14 g, max 30–40 g/24 h. Torsades: 2 g IV over 1–2 min in arrest, 1–2 g over 10 min with a pulse. Asthma: 2 g IV over 10–15 min, 1 g in older adults (NASEMSO) |
| Pediatric dose and route | Asthma: 40 mg/kg IV over 10–15 min, max 2 g. Torsades: 25–50 mg/kg (NASEMSO) |
| Contraindications | Heart block or myocardial damage (label); hypermagnesemia (NASEMSO) |
| Key cautions | Toxicity in order: hypotension, lost patellar reflexes, drowsiness and slurred speech, respiratory paralysis, cardiac arrest. Antidote: calcium gluconate 3 g or calcium chloride 1 g IV (NASEMSO). Dilute 50% to 20% or less for IV; usually no faster than 150 mg/min except in eclamptic seizures (label) |
| NREMT trap | Lost patellar reflex is the early warning of toxicity (label): check reflexes and breathing before each dose. In VF arrest magnesium is not routine (AHA 2025); it is for torsades |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Oxytocin (Pitocin)
| Scope | Paramedic |
|---|---|
| Indications | Postpartum bleeding from uterine atony, after delivery of the placenta (label; NASEMSO) |
| Adult dose and route | 10 units IM after the placenta delivers; or 10–40 units in 1,000 mL of IV fluid (max 40 units per 1,000 mL), rate adjusted to keep the uterus firm and control bleeding (label) |
| Pediatric dose and route | No pediatric indication |
| Contraindications | Hypersensitivity. Not for use before delivery in the field: the label’s antepartum contraindications include cephalopelvic disproportion, unfavorable presentation, fetal distress without imminent delivery and a hypertonic uterus |
| Key cautions | Water intoxication with long infusions; uterine hypertonicity or rupture with excess doses (label). Pair with fundal massage; NASEMSO also lists TXA for postpartum hemorrhage |
| NREMT trap | Give it after the placenta delivers, and check for a second baby first |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Labetalol (Trandate)
| Scope | Paramedic and critical care transport |
|---|---|
| Indications | Severe hypertension with pre-eclampsia symptoms: SBP over 160 or DBP over 110 lasting more than 15 min (NASEMSO) |
| Adult dose and route | 20 mg IV over 2 min; repeat every 10 min for 2 more doses if still severe; lower MAP 20–25% at first, aiming near 140/90; check HR over 60 before each dose (NASEMSO) |
| Pediatric dose and route | No prehospital pediatric dose in NASEMSO |
| Contraindications | Asthma or obstructive airway disease, severe or sinus bradycardia, 2nd- or 3rd-degree block or sick sinus without a pacemaker, cardiogenic shock, uncompensated heart failure (NASEMSO appendix) |
| Key cautions | Hypotension; patients on beta-blockers may respond poorly to epinephrine in anaphylaxis; caution with calcium channel blockers (NASEMSO) |
| NREMT trap | Lower the BP, but not too far: about 140/90 keeps the uterus perfused (NASEMSO). Asthma rules labetalol out; hydralazine 5 mg IV or oral nifedipine are the alternatives (NASEMSO) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Dextrose (D10, D25, D50)
| Scope | AEMT and paramedic (IV dextrose in the 2019 model) |
|---|---|
| Indications | Hypoglycemia (glucose 60 mg/dL or less with symptoms, NASEMSO) in a patient who cannot safely swallow |
| Adult dose and route | Up to 25 g IV in increments until mental status improves: 250 mL of D10 (preferred), 100 mL of D25 or 50 mL of D50 (NASEMSO). D50 label: 10–25 g (20–50 mL), given slowly |
| Pediatric dose and route | 0.5–1 g/kg IV/IO: D10 5–10 mL/kg (newborns 2 mL/kg), or D25 2–4 mL/kg over 8 years (NASEMSO). Under 8 years no stronger than D25; under 1 month no stronger than D10–12.5 (NASEMSO) |
| Dose rule | Rule of 50: concentration (%) × mL/kg = 50 gives 0.5 g/kg, so D10 5 mL/kg and D25 2 mL/kg (NASEMSO) |
| Contraindications | Hyperglycemia; intracranial or intraspinal hemorrhage; anuria; dehydrated patients with delirium (NASEMSO appendix) |
| Key cautions | D50 that leaks damages tissue: large vein, check patency (NASEMSO; label); fast infusion causes hyperglycemia (label). D10 works as well and is safer (NASEMSO) |
| NREMT trap | Recheck glucose after each dose. Sulfonylureas have 12–60 h half-lives, so hypoglycemia recurs: transport (NASEMSO) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Oral glucose (Insta-Glucose, glucose gel)
| Scope | EMT and above (2019 model) |
|---|---|
| Indications | Suspected hypoglycemia in a patient who is awake with an intact airway and can swallow |
| Adult dose and route | 25 g PO as tablets, gel or cake icing (NASEMSO) |
| Pediatric dose and route | 0.5–1 g/kg PO (NASEMSO) |
| Contraindications | Cannot swallow, protect the airway or follow commands |
| Key cautions | Recheck glucose; NASEMSO treat-and-release criteria include a repeat glucose over 80 mg/dL |
| NREMT trap | Never put oral glucose in a patient who cannot swallow or protect the airway: that patient needs IV dextrose or glucagon |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Glucagon (GlucaGen, Gvoke, Baqsimi)
| Scope | AEMT and paramedic (glucagon in the 2019 model) |
|---|---|
| Indications | Hypoglycemia when IV access cannot be obtained; symptomatic beta-blocker (and CCB) overdose (NASEMSO; AHA 2023) |
| Adult dose and route | Hypoglycemia: 1 mg IM, SC or IV (label) or IN; 3 mg nasal powder (NASEMSO); one repeat after 15 min if no response (label). Beta-blocker overdose: 5 mg IV, repeat once in 5–10 min (NASEMSO); AHA 2023 2–10 mg, then 1–15 mg/h |
| Pediatric dose and route | Hypoglycemia: 0.5 mg under 20 kg, 1 mg at 20 kg or more (label; NASEMSO also by age, under or over 5 years). Overdose: 0.05–0.15 mg/kg (AHA 2023); NASEMSO 0.5 mg under 25 kg, 1 mg at 25–40 kg, every 5 min |
| Contraindications | Pheochromocytoma, insulinoma, hypersensitivity (label) |
| Key cautions | Nausea and vomiting are common: protect the airway (label; AHA 2023). Needs liver glycogen, so it may fail in starvation, adrenal insufficiency or chronic hypoglycemia (label) |
| Onset and duration | Glucose starts to rise about 10 min after an SC dose (label), slower than IV dextrose |
| NREMT trap | Glucagon fails without glycogen: a starving or chronically hypoglycemic patient may need IV dextrose instead (label) |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Tranexamic acid (Cyklokapron)
| Scope | Paramedic |
|---|---|
| Indications | Adult trauma with clinical signs of hemorrhagic shock (a common trigger is SBP under 90 and/or HR over 110), within 3 h of injury, after life-saving interventions (NAEMSP/ACEP/ACS-COT 2025). Postpartum hemorrhage (NASEMSO: consider) |
| Adult dose and route | Either 1 g IV/IO followed by a 1 g hospital infusion over 8 h, or a single 2 g IV/IO dose as an infusion or slow push (2025 joint statement). Label: no faster than 1 mL/min (100 mg/min) to avoid hypotension |
| Pediatric dose and route | No standard dose and an unclear role; if used, within 3 h of injury (2025 joint statement) |
| Contraindications | Intrathecal or epidural injection, subarachnoid hemorrhage, active intravascular clotting, hypersensitivity (label) |
| Key cautions | Thrombosis, seizures, visual changes (label). Wrong-route intrathecal errors have been fatal: check the vial (label). Hand off the dose and time to prevent a duplicate dose (2025 statement) |
| NREMT trap | Never after 3 hours, where no benefit has been shown (2025 statement), and it never replaces stopping the bleeding |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
Pediatric dosing rules
| Weight | Weigh or estimate in kilograms; use a length-based tape or similar tool for doses and equipment, and record weight in kg and the tape color. Obese children: dose by ideal body weight (NASEMSO) |
|---|---|
| Who is pediatric | Generally up to 40 kg or 14 years, whichever comes first; states vary (NASEMSO) |
| Maximum | A weight-based dose should not exceed the maximum adult dose unless a guideline says so (NASEMSO) |
| Arrest drugs | Epinephrine 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL), max 1 mg, every 3–5 min, as early as possible in nonshockable rhythms; amiodarone 5 mg/kg (max 300 mg) or lidocaine 1 mg/kg (PALS 2025) |
| Energy | Defibrillation 2 J/kg, then 4 J/kg, later 4 or more, max 10 J/kg or the adult dose; synchronized cardioversion 0.5–1 J/kg, then 2 J/kg (PALS 2025; NASEMSO) |
| Fluids | 20 mL/kg isotonic boluses, reassessing after each, up to 60 mL/kg; 10 mL/kg boluses in cardiogenic shock (NASEMSO) |
| Glucose | Rule of 50: % × mL/kg = 50 gives 0.5 g/kg (D10 5 mL/kg, D25 2 mL/kg); D10 preferred; no stronger than D25 under 8 years (NASEMSO) |
| Common doses | Atropine 0.02 mg/kg (min 0.1 mg, max single 0.5 mg); adenosine 0.1 then 0.2 mg/kg (max 6 then 12 mg); naloxone 0.1 mg/kg (max 2 mg IV/IM, 4 mg IN); midazolam 0.2 mg/kg IM or IN (max 10 mg); IM epinephrine 0.01 mg/kg (max 0.3 mg); fentanyl 1 mcg/kg (max 100 mcg) |
| Routes | IN and IM first for seizures and pain when IV access is hard; place an IO if an IV fails after 2 attempts or 90 s in shock (NASEMSO) |
| NREMT trap | Weight in pounds is the classic trap: convert first (kg = lb ÷ 2.2), then check the dose against the adult maximum |
Local protocols and medical direction govern every dose and route; these are national exam-study references from the sources named.
More quick cards
- Checklists
- Push and Emergency Meds
- 12-Lead ECG
- Scales and Staging
- Tubes, Lines and Equipment
- Equivalents and Conversions
- IV Fluids
- Empiric Antibiotics
- ICU Bundles
- Renal Dosing
Practice free in your browser2,450+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.
For education and exam preparation only. Follow your institution’s protocols. Typical adult values for study. Follow your local protocols and medical direction.