EMT Drugs List: Medications EMTs Can Give

In depth

The one-page summary above is what the PDF prints. These sections go further.

Oxygen and oral glucose

Oxygen is a drug with a target: an SpO2 of 94 to 98% in most patients. It treats low oxygen, not slow breathing; a patient breathing too slowly needs a bag-valve mask. Oral glucose is for a patient with low blood sugar who is awake enough to swallow and protect the airway. National guidance gives 25 g for adults and 0.5 to 1 g/kg for children; the 15 g figure you may see is the self-treatment rule for people with diabetes. Recheck the glucose and mental status after.

Aspirin and nitroglycerin

• Aspirin blocks platelets in a suspected acute coronary syndrome. Chewable, not enteric-coated, 162 to 325 mg.
• Do not give aspirin with a true aspirin or NSAID allergy (hives, asthma attacks), active GI bleeding or a bleeding disorder.
• Nitroglycerin relaxes blood vessels and eases cardiac chest pain. One 0.4 mg tablet or spray under the tongue every 5 minutes, up to 3, if the systolic stays over 100.
• Other nitroglycerin contraindications on the label: severe anemia, suspected raised pressure in the head, shock.
• Recheck blood pressure before every nitro dose.

Epinephrine auto-injector

• For anaphylaxis: allergic signs plus trouble breathing, low blood pressure or airway swelling.
• Dose: 0.3 mg for adults and larger children; 0.15 mg for small children (NASEMSO uses 25 kg as the cut-off, the EpiPen label 30 kg).
• Into the outer thigh, through clothing if needed; never into a vein, buttock, hand or foot.
• Repeat in 5 to 15 minutes if symptoms persist. There is no absolute contraindication in anaphylaxis.
• Expect a fast heart rate, shakiness and pale skin afterward. Transport even if the patient improves.

Albuterol, ipratropium and naloxone

• Albuterol relaxes the airways: 2.5 mg for mild wheeze, 5 mg nebulized (or 6 puffs by inhaler) for distress, repeated as needed.
• Ipratropium 0.5 mg nebulized, up to 3 doses, with albuterol for asthma or COPD.
• Naloxone reverses opioids. Support the airway and ventilate first; then naloxone nasal spray 4 mg, repeating every 2 to 3 minutes if breathing stays slow.
• Children: naloxone 0.1 mg/kg, up to 4 mg intranasal. Use the device your agency carries.
• After naloxone, expect withdrawal (agitation, vomiting, sweating), and watch for re-sedation as it wears off.

Exam pearls

• The exam tests indications and contraindications more than exact numbers.
• Hypotension rules out nitro; inability to swallow rules out oral glucose; adequate breathing makes naloxone unnecessary.
• Epinephrine is the first drug for anaphylaxis; antihistamines are not a substitute.
• Always reassess and document after any medication.