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Common EMS Medications
Class, use, typical adult dose and key cautions for 21 prehospital drugs, with EMT-scope drugs marked
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Typical adult exam doses; follow your protocols. (EMT) marks national EMT scope; others are paramedic (some AEMT); states vary. EMTs also give oral glucose if the patient can swallow: NASEMSO 25 g adult, 0.5-1 g/kg child (the ADA 15-15 self-treatment rule is 15 g); follow your protocol.
Chest pain and breathing
| Drug (class) | Use | Dose | Cautions |
|---|---|---|---|
| Aspirin (EMT), antiplatelet | Suspected ACS | 162–325 mg chewed, non-enteric | Aspirin/NSAID allergy, active GI bleed |
| Nitroglycerin (EMT: own Rx), nitrate | Ischemic chest pain, pulmonary edema | 0.4 mg SL q5 min, up to 3 doses | SBP <90 (<100 in many protocols), RV infarct |
| Oxygen (EMT) | Hypoxemia, respiratory distress | SpO₂ 94–98%; COPD 88–92% | Routine use in ACS with SpO₂ ≥90% |
| Albuterol (EMT), beta-2 agonist | Bronchospasm | 2.5–5 mg nebulized, repeat | Allergy; tachydysrhythmias |
| Ipratropium (EMT), anticholinergic | Asthma, COPD, with albuterol | 0.5 mg nebulized, up to 3 doses | Allergy to it or atropine |
Epinephrine (alpha/beta agonist): four doses
| Use | Strength | Adult dose |
|---|---|---|
| Anaphylaxis (EMT: auto-injector) | 1 mg/mL (1:1,000) | 0.3–0.5 mg IM, anterolateral thigh; repeat q5–15 min |
| Cardiac arrest | 0.1 mg/mL (1:10,000) | 1 mg IV/IO q3–5 min |
| Push-dose (hypotension, bradycardia) | 10 mcg/mL (mixed) | 10–20 mcg (1–2 mL) about q2 min |
| Bradycardia infusion | Diluted drip | 2–10 mcg/min |
No absolute contraindication in anaphylaxis. Push-dose mix: 1 mL of 0.1 mg/mL + 9 mL saline = 10 mcg/mL.
Arrest and rhythm drugs
| Drug (class) | Use | Dose | Cautions |
|---|---|---|---|
| Amiodarone, class III | Shock-refractory VF/pVT; stable VT | Arrest 300 mg, then 150 mg; VT 150 mg over 10 min | If pulse: 2nd/3rd-degree block, cardiogenic shock |
| Lidocaine, class Ib | VF/pVT (amiodarone alternative) | 1–1.5 mg/kg, then 0.5–0.75 mg/kg | High-grade block without pacer; amide allergy |
| Adenosine, AV nodal blocker | Stable regular narrow-complex tachycardia | 6 mg rapid push + flush, then 12 mg | AV block, sick sinus, asthma, irregular wide QRS |
| Atropine, anticholinergic | Symptomatic bradycardia; organophosphates | 1 mg q3–5 min, max 3 mg | Heart transplant; weak in hypothermia, wide-QRS block |
| Magnesium sulfate, electrolyte | Torsades, severe asthma, eclampsia | Torsades 1–2 g; asthma 2 g; eclampsia 4–6 g (IV) | Fast push drops BP; toxicity: lost reflexes, apnea |
Bradycardia: HR usually <50 with symptoms; pace if atropine fails. Organophosphates: atropine 1–2 mg, doubled q5 min until secretions dry.
Glucose, overdose and electrolytes
| Drug (class) | Use | Dose | Cautions |
|---|---|---|---|
| Naloxone (EMT: IN, auto-injector), opioid antagonist | Opioid respiratory depression | 0.4–2 mg IV/IM, 4 mg IN; repeat q2–3 min | Withdrawal, pulmonary edema; re-sedation |
| Dextrose 10%, carbohydrate | Glucose <60 (or <70) mg/dL, cannot swallow | Titrate IV, max 25 g (250 mL) | Check glucose first |
| Glucagon, hormone | Low glucose, no IV; beta-blocker OD (CCB unclear) | 1 mg IM (3 mg nasal); OD 2–10 mg IV | Pheochromocytoma; weak if glycogen depleted |
| Calcium chloride 10%, electrolyte | High K with ECG changes, CCB OD, Mg toxicity | 1 g over 5 min (= 3 g gluconate); CCB 2 g | Digoxin toxicity, hypercalcemia; necrosis if it leaks |
| Sodium bicarbonate, alkalinizer | TCA OD with wide QRS; hyperkalemia | 1 mEq/kg IV (TCA 50–150 mEq) | Alkalosis; flush between it and calcium |
Pain, sedation, nausea and bleeding
| Drug (class) | Use | Dose | Cautions |
|---|---|---|---|
| Fentanyl, opioid | Moderate to severe pain | 1 mcg/kg, first dose ≤100 mcg; IV/IO/IN/IM | Hypotension, hypoventilation, MAOI in 14 days |
| Ketamine, dissociative (NMDA) | Pain; severe agitation | Pain 0.25 mg/kg (max 25 mg); agitation 4 mg/kg IM | Dangerous BP rise; laryngospasm, emergence |
| Midazolam, benzodiazepine | Seizures; agitation | Seizure 0.2 mg/kg IM/IN, max 10 mg; agitation 5 mg IV/IM/IN | Severe respiratory depression |
| Ondansetron, 5-HT3 antagonist | Nausea, vomiting | 4 mg IV/IM or ODT | Long QT, apomorphine use |
| TXA, antifibrinolytic | Trauma with hemorrhagic shock | 1 g IV over 10 min, or 2 g IV/IO | >3 h since injury |
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Calculators for this topic
Sources
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- National Association of State EMS Officials (NASEMSO) Medical Directors Council. National Model EMS Clinical Guidelines, Version 3.0. March 2022. Link
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- Adrenalin (epinephrine injection) 1 mg/mL prescribing information. Par Health USA; revised 6/2026. DailyMed. Link
- Glucagon for injection kit prescribing information. Amphastar Pharmaceuticals; revised 3/2025 (DailyMed version updated August 11, 2026). DailyMed. Link
- Sodium Bicarbonate Injection, USP 8.4% prescribing information. Civica, Inc. / Long Grove Pharmaceuticals; revised 01/2026. DailyMed. Link
- Ketalar (ketamine hydrochloride injection) prescribing information. Par Health USA; 2026. DailyMed. Link