Epinephrine
Sympathomimetic (Catecholamine)
Indication: Anaphylaxis, cardiac arrestAdult Dose: 0.3-0.5 mg IM (1:1000) for anaphylaxis; 1 mg IV/IO (1:10,000) for cardiac arrestRoute: IM (anaphylaxis), IV/IO (cardiac arrest)Onset: ImmediateSide Effects: Tachycardia, hypertension, anxiety, cardiac arrhythmiasContraindications: None in life-threatening anaphylaxis; caution with hypertension, CAD
CRITICALAspirin
Antiplatelet / NSAID
Indication: Suspected acute coronary syndrome (MI)Adult Dose: 162-324 mg PO (chewable)Route: PO (oral, chewable)Onset: 20-30 minutesSide Effects: GI upset, bleeding risk, allergic reactionContraindications: Active bleeding, known allergy, asthma, children (Reye syndrome)
NREMTNitroglycerin
Vasodilator (Nitrate)
Indication: Chest pain from angina or ACSAdult Dose: 0.4 mg SL every 5 min, up to 3 dosesRoute: SL (sublingual tablet or spray)Onset: 1-3 minutesSide Effects: Headache, hypotension, dizziness, reflex tachycardiaContraindications: Hypotension (SBP below 90-100), recent PDE-5 inhibitor use (Viagra, Cialis within 24-48h), right ventricular infarction
NREMTNaloxone (Narcan)
Opioid Antagonist
Indication: Opioid overdose with respiratory depressionAdult Dose: 2 mg IN initially, or 0.4-2 mg IV/IO/IM; may repeatRoute: IN (intranasal), IM, IV, IOOnset: 2-5 minutes IN/IM, immediate IVSide Effects: Opioid withdrawal symptoms (agitation, vomiting, diarrhea), tachycardiaContraindications: None in overdose; caution in opioid-dependent patients
CRITICALOxygen
Medical Gas
Indication: Hypoxia, respiratory distress, shock, trauma, cardiac arrestAdult Dose: 1-6 L/min via nasal cannula (24-44%); 10-15 L/min via NRB (up to 90%)Route: Inhalation via NC, NRB, or BVMOnset: ImmediateSide Effects: Drying of mucous membranesContraindications: None in emergencies; caution in COPD (oxygen-induced hypoventilation, titrate to 88-92% SpO2)
COMMONAlbuterol
Beta-2 Agonist (Bronchodilator)
Indication: Asthma exacerbation, COPD with bronchospasmAdult Dose: 2.5 mg (0.5 mL of 0.5% solution) in 3 mL NS via nebulizer; may repeatRoute: Nebulized inhalationOnset: 5-15 minutesSide Effects: Tachycardia, tremors, nervousness, headacheContraindications: Known hypersensitivity; caution with cardiac arrhythmias
NREMTGlucose (Oral)
Carbohydrate / Hyperglycemic
Indication: Conscious patient with hypoglycemiaAdult Dose: 15-30 grams PO (one tube of oral glucose gel)Route: PO (oral, between cheek and gums)Onset: 5-10 minutesSide Effects: Aspiration risk if patient has altered mental statusContraindications: Unconscious patient or unable to swallow safely (use IV dextrose or IM glucagon instead)
COMMONDextrose (IV)
Hyperglycemic
Indication: Severe hypoglycemia with altered mental statusAdult Dose: 25 g IV (50 mL of D50)Route: IV (preferred) or IOOnset: 1-3 minutesSide Effects: Tissue necrosis if extravasation occurs (hypertonic solution), hyperglycemiaContraindications: Intracranial hemorrhage, known CVA
CRITICALGlucagon
Hyperglycemic Agent
Indication: Severe hypoglycemia when IV access is not availableAdult Dose: 1 mg IM or SQRoute: IM (preferred), SQ, IN, IVOnset: 5-15 minutes IMSide Effects: Nausea, vomiting, dizzinessContraindications: Pheochromocytoma, insulinoma; caution in known sulfonylurea overdose
NREMTActivated Charcoal
Adsorbent
Indication: Recent ingestion (within 1 hour) of certain toxinsAdult Dose: 25-50 g PO (single dose)Route: PO (oral or via NG tube)Onset: Immediate binding in GI tractSide Effects: Black stools, vomiting, aspiration risk, constipationContraindications: Unconscious patient without protected airway, ingestion of caustics, acids, or alkali, hydrocarbons, non-adsorbable toxins (alcohol, iron, lithium, lead)
NREMTSodium Bicarbonate
Alkalizing Agent
Indication: Severe metabolic acidosis (prolonged cardiac arrest, tricyclic overdose, DKA)Adult Dose: 1 mEq/kg IV/IO, then 0.5 mEq/kg every 10 minutesRoute: IV, IOOnset: RapidSide Effects: Hypernatremia, metabolic alkalosis, reduced ionized calciumContraindications: Hypothermia, hypercarbic acidosis (COPD), known alkalosis
CRITICALAmiodarone
Antiarrhythmic (Class III)
Indication: Shock-resistant VF/VT, stable wide-complex tachycardiaAdult Dose: 300 mg IV/IO push for cardiac arrest; 150 mg IV over 10 min for stable VTRoute: IV, IOOnset: MinutesSide Effects: Hypotension, bradycardia, prolonged QTContraindications: Cardiogenic shock, severe sinus node dysfunction, marked bradycardia
CRITICALLidocaine
Antiarrhythmic (Class IB)
Indication: Ventricular arrhythmias, alternative to amiodaroneAdult Dose: 1-1.5 mg/kg IV/IO push for cardiac arrestRoute: IV, IOOnset: 1-2 minutesSide Effects: Drowsiness, confusion, seizures, respiratory depressionContraindications: Severe heart block, known hypersensitivity
NREMTAtropine
Anticholinergic / Vagolytic
Indication: Symptomatic bradycardia, organophosphate poisoningAdult Dose: 0.5 mg IV/IO every 3-5 min, max 3 mg (bradycardia); higher for OP poisoningRoute: IV, IOOnset: 2-3 minutesSide Effects: Tachycardia, dry mouth, blurred vision, urinary retentionContraindications: Hypothermic bradycardia, cardiac transplant patients (use transcutaneous pacing)
NREMTFentanyl
Opioid Analgesic
Indication: Moderate to severe painAdult Dose: 50-100 mcg IV/IO/IM; may repeat after 2-5 minRoute: IV, IO, IM, INOnset: 1-2 minutes IV, 5-10 minutes IMSide Effects: Respiratory depression, hypotension, bradycardia, chest wall rigidityContraindications: Hypotension, respiratory depression, known hypersensitivity
NREMTMorphine Sulfate
Opioid Analgesic
Indication: Moderate to severe pain, acute pulmonary edemaAdult Dose: 2-5 mg IV/IO/IM every 5-15 minRoute: IV, IO, IMOnset: 5-10 minutes IVSide Effects: Respiratory depression, hypotension, nausea/vomiting, histamine releaseContraindications: Hypotension, respiratory depression, head injury with increased ICP, known hypersensitivity
NREMTMidazolam (Versed)
Benzodiazepine
Indication: Seizures, anxiety, procedural sedationAdult Dose: 5 mg IM or 2 mg IV/IO for seizures; may repeatRoute: IV, IO, IM, INOnset: 1-2 minutes IV, 5-15 minutes IMSide Effects: Respiratory depression, hypotension, amnesia, paradoxical excitationContraindications: Hypotension, acute narrow-angle glaucoma, known hypersensitivity
NREMTDiazepam (Valium)
Benzodiazepine
Indication: Seizures (status epilepticus), anxiety, alcohol withdrawalAdult Dose: 5-10 mg IV/IO; may repeat every 5-10 min, max 30 mgRoute: IV, IO, PR (rectal gel for children)Onset: 1-3 minutes IVSide Effects: Respiratory depression, hypotension, sedation, phlebitis at IV siteContraindications: Severe respiratory depression, acute narrow-angle glaucoma
COMMONMagnesium Sulfate
Electrolyte / Anticonvulsant
Indication: Eclampsia, torsades de pointes, severe asthma (refractory)Adult Dose: 1-2 g IV/IO over 1-2 min (torsades); 4 g IV over 5-10 min (eclampsia); 2 g IV over 20 min (asthma)Route: IV, IOOnset: MinutesSide Effects: Flushing, hypotension, respiratory depression, loss of deep tendon reflexesContraindications: Heart block, severe renal impairment, known hypersensitivity
CRITICALDopamine
Sympathomimetic (Pressor)
Indication: Hypotension refractory to fluid resuscitation (cardiogenic shock)Adult Dose: 2-20 mcg/kg/min IV drip, titrated to BPRoute: IV infusionOnset: 2-5 minutesSide Effects: Tachycardia, hypertension, arrhythmias, vasoconstriction, extravasation injuryContraindications: Hypovolemic shock (correct volume first), pheochromocytoma, VF/VT
NREMT