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Push and Emergency Meds
IV bolus doses for codes, rhythms, pressure, airway, seizures and reversal
Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app
On this page Cardiac arrest Rhythm control Blood pressure boluses Airway and RSI Seizures and neuro Metabolic and electrolyte boluses Reversal and antidotes Other common pushes Antiemetics Cardiac arrest ACLS drug doses
Epinephrine 1 mg IV/IO every 3–5 min Amiodarone 300 mg IV/IO, then 150 mg (VF/pVT refractory to shocks) Lidocaine 1–1.5 mg/kg, then 0.5–0.75 mg/kg every 5–10 min (max 3 mg/kg) Magnesium 1–2 g IV/IO over 5–20 min for torsades Calcium chloride 1 g (10 mL of 10%) for hyperkalemia or calcium channel blocker overdose Sodium bicarbonate 1 mEq/kg for hyperkalemia or TCA overdose; not routine Naloxone 0.4–2 mg IV/IM/IN for suspected opioid overdose with a pulse
Safety Compressions and early defibrillation matter more than any drug. Flush each IV/IO dose with 20 mL and raise the arm.Rhythm control Bradycardia, SVT, AF and VT with a pulse
Bradycardia Atropine 1 mg IV every 3–5 min, max 3 mg Epinephrine infusion 2–10 mcg/min Dopamine infusion 5–20 mcg/kg/min
SVT Adenosine 6 mg rapid push with 20 mL flush, then 12 mg; use 3 mg through a central line or with dipyridamole or carbamazepine Metoprolol 2.5–5 mg IV over 2 min, repeat every 5 min to 15 mg Diltiazem 0.25 mg/kg (about 15–20 mg) over 2 min; repeat 0.35 mg/kg after 15 min; then 5–15 mg/h
Wide complex with a pulse Amiodarone 150 mg over 10 min, repeat; then 1 mg/min for 6 h, 0.5 mg/min for 18 h Procainamide 20–50 mg/min until the rhythm converts, hypotension, QRS widens over 50% or 17 mg/kg; then 1–4 mg/min Lidocaine 1–1.5 mg/kg; then 1–4 mg/min Magnesium 2 g over 15 min for polymorphic VT
Safety Unstable: synchronized cardioversion before drugs. Avoid AV nodal blockers (adenosine , diltiazem , beta-blockers, digoxin ) in AF with pre-excitation (WPW).Blood pressure boluses Hypertensive emergency and brief hypotension
Lower Labetalol 10–20 mg IV over 2 min; 20–80 mg every 10 min to 300 mg Hydralazine 5–10 mg IV every 20–30 min (unpredictable; used in pregnancy) Metoprolol 5 mg IV every 5 min up to 15 mg Enalaprilat 1.25 mg IV every 6 h
Raise (push-dose pressors) Phenylephrine 50–100 mcg (0.5–1 mL of 100 mcg/mL) every 1–2 min Epinephrine 10–20 mcg (1–2 mL of 10 mcg/mL) every 2–5 min Ephedrine 5–10 mg IV every 5–10 min (anesthesia)
Safety Push-dose epinephrine is micrograms, not the 1 mg arrest dose. Use labeled prefilled syringes and a second check.Airway and RSI Induction, paralysis and post-intubation boluses
Induction Etomidate 0.3 mg/kg (adrenal suppression after one dose is small but real) Ketamine 1–2 mg/kg (0.5–1 in shock); bronchodilates; keeps BP Propofol 1–2 mg/kg (lower in shock); drops BP Midazolam 0.1–0.3 mg/kg (slow onset; hypotension)
Paralysis Succinylcholine 1–1.5 mg/kg; avoid in hyperkalemia, burns or crush over 24–72 h old, neuromuscular disease, malignant hyperthermia history Rocuronium 1–1.2 mg/kg for RSI (0.6 for routine); reverse with sugammadex 16 mg/kg Vecuronium 0.1 mg/kg (slower onset than rocuronium; lasts 25–40 min)
After the tube Fentanyl bolus 25–100 mcg IV Propofol bolus 10–20 mg IV, then infusion Lidocaine (pre-RSI, raised ICP) 1.5 mg/kg 3 min before laryngoscopy; evidence is weak
Seizures and neuro Status epilepticus, raised ICP and agitation
Status epilepticus Lorazepam 0.1 mg/kg IV (max 4 mg per dose), repeat once in 5–10 min Midazolam 10 mg IM (over 40 kg) when no IV Diazepam 0.15–0.2 mg/kg IV (max 10 mg), repeat once Levetiracetam 60 mg/kg (max 4,500 mg) over 10 min Fosphenytoin 20 mg PE/kg (max 1,500 mg PE) at up to 150 mg PE/min; watch BP and rhythm Valproate 40 mg/kg (max 3,000 mg) over 10 min
Raised ICP Mannitol 0.5–1 g/kg of 20% over 10–20 min; hold if osmolality over 320 or osmolar gap over 20 Hypertonic saline 3% 150–250 mL bolus over 10–20 min; 23.4%: 30 mL via central line
Agitation Haloperidol 2–5 mg IV/IM; check QTc Olanzapine 5–10 mg IM Lorazepam 0.5–2 mg IV/IM (alcohol withdrawal, stimulant toxicity) Ketamine 1 mg/kg IV or 4–5 mg/kg IM for severe agitation (EMS)
Reversal and antidotes The bolus doses; full toxicology is on its cheat sheet
Naloxone 0.04–0.4 mg IV titrated to breathing (2 mg if apneic); repeat or infuse (two-thirds of the effective dose per hour) Flumazenil 0.2 mg IV over 15 s, repeat to 1 mg; avoid in chronic benzodiazepine use or TCA overdose (seizures) Protamine 1 mg per 100 units of heparin in the last 2–3 h, max 50 mg, slowly 4F-PCC (Kcentra) 25–50 units/kg by INR (max 5,000 units) with vitamin K 10 mg Idarucizumab (Praxbind) 5 g IV (two 2.5 g vials) for dabigatran Andexanet alfa Off the US market since December 2025 (thrombosis in ANNEXA-I); for apixaban or rivaroxaban bleeding give 4F-PCC 50 units/kg Sugammadex 2–4 mg/kg routine; 16 mg/kg right after rocuronium Glucagon 3–10 mg IV for beta-blocker or calcium channel blocker overdose, then infusion Hydroxocobalamin 5 g IV over 15 min for cyanide Acetylcysteine 150 mg/kg over 1 h, then 50 mg/kg over 4 h, then 100 mg/kg over 16 h
Other common pushes Analgesia, antiemetics, steroids, diuretics, TXA
Morphine 2–4 mg IV every 5–15 min; histamine release, hypotension Hydromorphone 0.2–0.5 mg IV every 5–15 min (about 7 times morphine) Fentanyl 25–50 mcg IV every 5 min; fast, short, no histamine Ketamine (analgesia) 0.1–0.3 mg/kg IV over 10 min Ondansetron 4 mg IV; QT caution Metoclopramide 10 mg IV Methylprednisolone 125 mg IV (asthma, anaphylaxis adjunct); 1 g for spinal cord injury is no longer recommended Hydrocortisone 100 mg IV (adrenal crisis), then 200 mg/day Dexamethasone 6–10 mg IV Furosemide 40–80 mg IV over 1–2 min (double the home oral dose); high doses as an infusion no faster than 4 mg/min (label) Tranexamic acid 1 g IV over 10 min within 3 h of trauma, then 1 g over 8 h Diphenhydramine 25–50 mg IV Famotidine 20 mg IV Epinephrine (anaphylaxis) 0.3–0.5 mg IM (1 mg/mL) mid-outer thigh, repeat every 5–15 min
Antiemetics Class, typical adult dose and the caution that matters
Serotonin and NK₁ blockers Ondansetron 5-HT₃ antagonist. 4 mg IV over 2–5 min or IM (PONV, end of surgery); chemo 8 mg or 0.15 mg/kg, max 16 mg IV; QT, constipation Granisetron 5-HT₃ antagonist. 1 mg IV over 30 s (PONV); chemo 10 mcg/kg IV, 2 mg PO or a 3.1 mg/24 h patch worn up to 7 days; QT, constipation Aprepitant or fosaprepitant NK₁ antagonist. Fosaprepitant 150 mg IV over 20–30 min (chemo day 1); aprepitant 40 mg PO or 32 mg IV (PONV); CYP3A4: halve dexamethasone
Dopamine blockers Metoclopramide D₂ antagonist, prokinetic. 10 mg IV over 1–2 min (fast push: restlessness); akathisia, dystonia, tardive dyskinesia; no bowel obstruction Prochlorperazine Phenothiazine (D₂). 2.5–10 mg IV no faster than 5 mg/min, or IM; max 40 mg/day; 25 mg PR; akathisia, dystonia, hypotension Droperidol Butyrophenone (D₂). 0.625–1.25 mg IV at end of surgery (PONV 2025); boxed QT warning: ECG first, monitor 2–3 h; akathisia, sedation Haloperidol (low dose) Butyrophenone (D₂). 0.5–2 mg IV or IM for PONV (PONV 2025; IV use is off-label); QT, extrapyramidal effects Olanzapine Atypical antipsychotic. 5–10 mg PO, often at bedtime, days 1–4 with chemo (ASCO 2020) or for breakthrough; sedation, orthostasis
Steroid, antihistamine, anticholinergic Dexamethasone Corticosteroid. 4–8 mg IV at induction (PONV 2025); 12 mg with an NK₁ antagonist for chemo (ASCO); hyperglycemia, perineal burning on fast push Promethazine Phenothiazine antihistamine. 6.25–12.5 mg (PONV 2025), deep IM preferred; IV only at 1 mg/mL or less over 20–40 min (FDA 2023); sedation Scopolamine patch Anticholinergic. 1 mg/3-day patch behind the ear the night before surgery, off 24 h after; delirium in older adults, urine retention, MRI burns
Choosing Rescue with a class not yet given; repeating the same class within 6 h adds nothing (PONV 2025) Parkinson disease or Lewy body dementia: avoid D₂ blockers and phenothiazines; use ondansetron (not with apomorphine) QTc over 500 ms or low K⁺ or Mg²⁺: avoid stacking ondansetron, droperidol and haloperidol ; get an ECG Dystonia or akathisia after a D₂ blocker: diphenhydramine 25–50 mg IV (or benztropine) Safety Promethazine has a boxed warning for gangrene after extravasation or intra-arterial injection: deep IM preferred; IV only diluted (1 mg/mL or less) over 20–40 min into a large vein, never hand or wrist.For education and exam preparation only. Follow your institution’s protocols. Typical adult values for study. Follow your local protocols and medical direction.