Mass Paramedic Drug Dosages

Front 1

ACTIVATED CHARCOAL

Back 1

Dosage and Administration
Note, if not in Pre-mixed slurry, dilute with 1-part charcoal/ 4 parts water.
Adult: 1-2 gm/kg PO or via NGT
Pediatric: 1-2 gm/kg PO or via NGT

Front 2

ADENOSINE

Back 2

Dosage and Administration
Adult: 6 mg over 1-3 seconds; If no response after 1-2 minutes, administer 12 mg over 1-3 seconds, Maximum total dose = 30 mgs.
Pediatric: 0.1 - 0.2 mg/kg rapid IV; maximum single dose = 12 mgs.

Front 3

ALBUTEROL

Back 3

Dosage and Administration
Adult: Administer 2.5 mg. Dilute 0.5 ml of 0.5% solution for inhalation with 2.5 ml normal saline in nebulizer and administer over 10-15 minutes.
MDI: 1-2 inhalations (90-180 mcg). Five minutes between inhalations

Front 4

AMINOPHYLLINE

Back 4

Loading dose (Adult): 5-6 mg / kg in 60-100 ml of diluent over 30 min. IV infusion not to exceed 20 mg/min.;
Loading dose (Pediatric): 5-6 mg / kg in 50-100 ml; diluent IV infusion.
Maintenance infusion
Adult: First 12 hours: 0.5-0.7 mg/kg/hour (lower doses for elderly, CHF, liver disease). Subsequent: 0.1-0.5 mg/kg/hour (based on serum aminophylline levels)
Pediatric: 1.0 mg/kg/hour.

Front 5

AMIODARONE

Back 5

Adult: 300 mg slow IV Push over 1-2 minutes in 10 ml Normal Saline, (For ACLS VF/ Pulseless VT)

IV Drip 0.5-1mg per minute. (For malignant ventricular arrhythmias) per ordering physician.

Front 6

AMYL NITRITE, SODIUM NITRITE, SODIUM THIOSULFATE
(CYANIDE ANTIDOTE KIT)

Back 6

Dosage and administration
Adult: Amyl nitrite: breathe 30 seconds out of every minute. Sodium Thiosulfate and sodium nitrite: IV per antidote kit directions.
Pediatric: Same as adult

Front 7

ASPIRIN

Back 7

Dosage and Administration:
160 mg or 325 mg PO.

Front 8

ATROPINE SULFATE

Back 8

Dosage and Administration:
Adult:

- Bradydysrhythymias: 0.5 - 1.0 mg IV every 3-5 minutes as needed to maximum total dose of 0 .0 4 mg / kg.

- Asystole: 1.0 mg IV push every 3-5 minutes as needed to maximum total dose of 0.04 mg / kg

Pediatric:

- Bradydysrhythmias: 0.02 mg / kg IV / IO (minimum single dose 0.1 mg, maximum single dose 1.0 mg).

- Asystole: Same as for Bradydysrhythmias: minimum dose 0.1 mg; maximum dose 0.5 mg for a child and 1.0 mg for adolescent.

Front 9

CALCIUM CHLORIDE / CALCIUM GLUCONATE

Back 9

Dosage and Administration
Adult: 2-4 mg/kg of 10% solution slowly IV over 5 minutes; may repeat in 10 minutes. (maximum: 1 gm dose)
Pediatric: 20 mg/kg/dose of 10% solution slow IV/ IO (maximum: 1 gm dose); (may repeat in 10 minutes.)

Front 10

DEXAMETHASONE SODIUM PHOSPHATE

Back 10

Dosage and Administration
Adult: 10-100 mg IV (1 mg/kg slow IV bolus). (considerable variance through Medical Control).
Pediatric: 0.25-1.0 mg/kg/dose IV, IO, IM

Front 11

DEXTROSE

Back 11

Dosage and Administration
Adult: 12.5-25 gram slow IV; may be repeated as necessary.
Pediatric: 0.5-1 gm/kg/dose slow IV; may be repeated as necessary

Front 12

DIAZEPAM

Back 12

Dosage and Administration
Seizure activity: Adult: 5-10 mg IV q 10-15 minutes prn (5 mg over 5 min.)(maximum dose = 30 mgs.)

Seizure activity: Pediatric: 0.2-0.3 mg/kg/dose IV every 15-30 minutes (no faster than 3 mg over 5 minutes) (max. = 10 mg).
Rectal diazepam: 0.5 mg/kg via 2” rectal catheter and flush with 2-3 ml air after administration.
Sedation for cardioversion: 5- 15 mg IV over 5-10 minutes prior to cardioversion.

Front 13

DIAZOXIDE

Back 13

Dosage and Administration
Adult: 5 mg/kg IV push over 10-30 seconds.
Pediatric: 5 mg/kg IV push over 10-30 seconds

Front 14

DILTIAZEM HCL

Back 14

Dosage and Administration:
Adult: Initial bolus: 0.25 mg/ kg (average dose 20 mg) IV over two (2) minutes. If inadequate response, may re-bolus in 15 minutes: 0.35 mg / kg IV over two (2) minutes. Maintenance infusion of 5-15 mg / hour.
Pediatric: not recommended.

Front 15

DIPHENHYDRAMINE

Back 15

Dosage and Administration
Adult: 25 - 50 mg IM or IV or P.O.
Pediatric: 1-2 mg/kg IV, IO slowly or IM. If given PO: 5 mg./ kg./ 24 hours

Front 16

DOPAMINE

Back 16

Dosage and Administration
Adult: 2- 20 mcg / kg / min. (Rate determined by physician).
Pediatric: 2 - 20 mcg / kg / min. (Rate determined by physician).

Front 17

EPINEPHRINE

Back 17

Dosage and Administration

Adult
Allergic reactions and asthma: 0.3 - 0.5 mg (0.3 - 0.5 ml 1:1000) IM
Anaphylaxis: 0.3 - 0.5 mg (3- 5 ml 1:10,000) IV

Cardiac: (asystole, PEA, VF)
1 mg IV push (1:10,000) every 3- 5 minutes

Epinephrine Infusion 1-10 mcg/minute. Mix Epinephrine (1:1000) 1 mg in 250 mL
Normal Saline. (15 micro drops/minute = 1 mcg / min.)


Pediatric
Allergic reactions and asthma: 0.01 mg/kg (0.01 mL/kg 1:1000) IM to maximum of 0.5 mg.
Cardiac: (asystole, PEA, VF)
IV, IO: Standard initial dose: 0.01 mg/kg (1:10,000, 0.1mL/kg)

Severe croup: 5 mg. as 5 ml. of 1:1000 solution administered via nebulization; may repeat every 30 minutes.
Racemic epinephrine 11.25mg via nebulization

Front 18

FENTANYL CITRATE

Back 18

Dosage and Administration
Adult: 1 mcg/kg. to max. 150 mcg. slow IV push.

Pediatric: The safety and efficacy of fentanyl citrate in pediatric patients under two years of age has not been established.

Nasal administration may be permitted by the State Treatment Protocols in certain cases.

Front 19

FUROSEMIDE

Back 19

Dosage and Administration
Adult: 0.5-1.0 mg / kg injected slowly IV.
Pediatric: 1 mg / kg / dose IV, IO.

Front 20

GLUCAGON

Back 20

Dosage and Administration
Adult: 0.5 - 1 mg IM, SC, or slow IV; may repeat q 20 minutes PRN.
Pediatric: 0.03 - 0.1 mg / kg / dose (not to exceed 1 mg) q 20 min. IM, IO, SC, slow IV.
Nasal administration may be permitted by the State Treatment Protocols in certain cases.

Front 21

GLUCOSE - ORAL

Back 21

Dosage and Administration
Adult: Should be sipped slowly by patient until clinical improvement noted.
Pediatric: Same as adult.

Front 22

GLYCOPROTEIN IIb / IIIa INHIBITORS

Back 22

Dosage and Administration
Variable depending upon Brand utilized

Front 23

HEPARIN SODIUM

Back 23

Dosage and Administration
Adult: Loading dose: 80 units / kg IV; maintenance dose: 18 units / kg / hour IV.
Pediatric: Loading dose: 50 u / kg IV; maintenance dose: 7.5 units / kg / hour IV.

Front 24

HYDROCORTISONE/METHYLPREDNISOLONE

Back 24

Dosage and Administration
Hydrocortisone, 2 mg./kg. IV bolus to maximum of 100 mg.; 100 mg. in adult.
Methylprednisolone 2 mg./kg/ IV bolus to maximum of 125 mg.; 125 mg. in adult

Front 25

HYDROXOCOBALAMIN (Vitamin B 12)

Back 25

Dosage and Administration:
The starting dose of hydroxocobalamin for adults is 5 g (i.e., both 2.5g vials) administered as an intravenous (IV) infusion over 15 minutes (approximately 15 mL/min), i.e., 7.5 minutes/vial. Depending upon the severity of the poisoning and the clinical response, a second dose of 5 g may be administered by IV infusion for a total dose of 10 g. The rate of infusion for the second dose may range from 15 minutes (for patients in extremis) to two hours, as clinically indicated.

The pediatric dose is 70 mg/kg. This dose should be given over 15 minutes

Front 26

INSULIN

Back 26

Dosage and Administration
Dosage adjusted relative to blood sugar levels.
May be given SC, IM or IV.
Standard doses for diabetic coma
Adult: 10-25 units Regular insulin IV, followed by infusion of 0.1 units / kg / hour.
Pediatric: 0.1 - 0.2 units / kg / hour IV or IM followed by infusion: 50 units of regular insulin mixed in 250 ml of NS (0.2 units / ml), at a rate of 0.1 - 0.2 units / kg / hour.

Front 27

IPRATROPIUM BROMIDE

Back 27

Dosage and Administration:

Adult: 2-3 puffs via metered dose inhaler (MDI) tid-qid; maximum 12 puffs/day.
ALT: 500mcg NEB q 6-8hrs (may mix neb solution with Albuterol if used within 1 hour)

Pediatric: < 12 yo: 1-2 puffs (MDI) tid-qid; max: 8 puffs
ALT: 250mcg NEB q 6-8hrs (may mix neb solution with Albuterol if used within 1 hour)

Front 28

LABETALOL

Back 28

Dosage and Administration:
Adult: (Systolic <90 mmHg) Infuse wide open until systolic pressure of 100mmHg is obtained.
(Systolic 100mmHg or >) Infuse at a rate of 100 ml/hr.

Pedi: 20 ml/kg repeated as required based on hemodynamic response

Front 29

LACTATED RINGERS Solution

Back 29

Dosage and Administration:
Adult: (Systolic <90 mmHg) Infuse wide open until systolic pressure of 100mmHg is obtained.
(Systolic 100mmHg or >) Infuse at a rate of 100 ml/hr.

Pedi: 20 ml/kg repeated as required based on hemodynamic response

Front 30

LIDOCAINE HCL (2%)

Back 30

Dosage and Administration
Adult:
Cardiac arrest VT/ VF: 1.5 mg / kg IV push; repeat q 3-5 minutes to maximum dose of 3 mg/kg. After conversion to NSR, begin drip at 2-4 mg / min.
VT with pulse: 1-1.5 mg / kg IV Push; then 0.50 - 0.75 mg / kg q 5-10 min. to max. of 3 mg/kg. Start drip at 2-4 mg/min. ASAP.
PVCs with pulse: 0.5-1.5 mg/kg IV Push; additional boluses of 0.5-1.5 mg/kg q 5-10 min. to max. of 3 mg/kg. Start drip at 2-4 mg/ min. ASAP.
VF prophylaxis: 0.5 mg/kg IV Push; additional boluses 0.5 mg/kg in 8-10 minutes up to 2 mg/kg. Start drip at 2-4 mg/min. ASAP.
IM dose: 300 mg (4 mg/kg) of 10% solution.
Pediatric:
VF or Pulseless V-tach: 1 mg/kg IV / IO per dose. Infusion: 20-50 mcg/kg/min.
PVCs with pulse: 1 mg/kg IV / IO per dose. Infusion: 20-50 mcg/kg/min.

Front 31

LORAZEPAM

Back 31

Dosage and Administration
Note: When given IV or IO, must dilute with equal volume of sterile water or sterile saline; When given IM, Lorazepam is not to be diluted.
Adult: 2-4 mg slow IV at 2 mg / min. or IM; may repeat in 15-20 minutes to maximum dose of 8 mg. For sedation: 0.05 mg / kg up to 4 mg IM.
Pediatric: 0.05 - 0.20 mg / kg slow IV, IO slowly over 2 minutes or IM; may repeat in 15-20 minutes to maximum dose of 0.2 mg / kg.

Front 32

MAGNESIUM SULFATE

Back 32

Dosage and Administration
Adult: Seizure activity associated with pregnancy: 1-4 gm IV over 10 minutes. For Torsades de Pointes or Refractory VF/VT: 1-2 grams IV over 1-2 minutes.
Pediatric: Asthma/bronchospasm, severe: 25 mg./kg. over 10 minutes IV.
Usually mixed in 50-100 CC of NS to be given IV.

Front 33

MANNITOL 20%

Back 33

Dosage and Administration
Adult: 0.50g - 2 g / kg IV infusion over 15-30 minutes; may repeat after 5 minutes if no effect.
Pediatric: 0.5 - 1g / kg / dose IV, IO infusion over 30-60 minutes; may repeat after 30 minutes if no effect.

Front 34

MEPERIDINE

Back 34

Dosage and Administration
Adult: 50-100 mg IM, SC or 25 - 50 mg slowly IV.
Pediatric: 1-2 mg / kg / dose IV, IO, IM, SC.

Front 35

METOPROLOL

Back 35

Dosage and Administration:
Adults: I.V.
Hypertension: Has been given in dosages 1.25-5 mg every 6-12 hours in patients unable to take oral medications

Myocardial infarction (acute): I.V. 5 mg every 5-10 minutes up to 3 doses in early treatment of myocardial infarction.

Front 36

MIDAZOLAM

Back 36

Dosage and Administration
Adult: 0.5 - 2.5 mg slow IV push;
(may be repeated to total maximum: 0.1 mg / kg).

Pediatric: To facilitate intubation: Medical control may order:
(6 months- 5 years) Use of Midazolam 0.05-0.1 mg/kg IV maximum dose of 5 mg.
(6-12 year old) Use of Midazolam 0.1 mg/kg IV maximum dose of 8 mg.

WMD: (See APPENDIX Dosing Table)
Nasal administration may be permitted by the State Treatment Protocols in certain cases.

Front 37

MORPHINE SULFATE

Back 37

Dosage and Administration
Adult: 1-3 mg IV/IM/SC/IO every 5 minutes titrated to maximum of 10 mg.
Adult: Morphine 0.1mg/kg to a maximum of 10mg IV/IM/SC/IO
~
Pediatric: 0.1 - 0.2 mg / kg / dose IV, IO, IM, SC every 5 minutes titrated to max. of 5 mg.

Front 38

NALOXONE

Back 38

Dosage and Administration
Adult: 0.4 - 2.0 mg IV, IM, SC, Nasal via atomizer; min. recommended = 2.0 mg repeat at 5 minute intervals to 10 mg maximum dose. (Medical Control may request higher amounts). Infusion: 2 mg in 500 ml of D5W (4 mcg/ml), infuse at 0.4 mg / hr (100 ml/hour).

Pediatric: 0.1 mg / kg / dose IV, IM, SC; maximum of 0.8 mg; if no response in 10 minutes, administer an additional 0.1 mg / kg /dose.

Front 39

NITROGLYCERIN

Back 39

Dosage and Administration
Adult:
Tablets: 0.3 - 0.4 mg SL; may repeat in 3-5 minutes to maximum of 3 doses.
NTG spray: 0.4 mg under the tongue; 1-2 sprays.
NTG IV infusion: 5 ug / min.; increase by 5-10 ug / min. every 5 minutes until desired effect.
Pediatric: not recommended.

Front 40

NITROPASTE

Back 40

Dosage and Administration
Adult: For CHF/PE; HTN
Paste: Apply 1 inch, cover with plastic wrap and secure with tape.

Pediatric: not recommended

Front 41

OCTREOTIDE

Back 41

Dosage and Administration

Adult: as per infusion orders.

Front 42

ONDANSETRON

Back 42

Dosage and Administration:
Children:
For child under or up to 30 kg. 1 mg. IV/IM;
For a child over 30 kg., 2 mg. IV/IM.

Adults:
Adult: 4 mg. IV/IM.

Front 43

OXYGEN

Back 43

Dosage and Administration
Adult:
Cardiac arrest and Carbon Monoxide poisoning: 100%.
Hypoxemia: 10-15 L/ min. via non-rebreather.
COPD: 0-2 L/ min. via nasal cannula or 28-35% venturi mask. Be prepared
to provide ventilatory support if higher concentrations of oxygen needed.
Pediatric: Same as for adult with exception of premature infant.

Front 44

PRALIDOXIME CHLORIDE

Back 44

Dosage and Administration
NOTE: If Protopam is to be used, it should be administered almost simultaneously with atropine.
Adult: Initial dose of 1-2 grams as an IV infusion with 100 ml saline over 15-30 minutes.
Pediatric: 20-40 mg / kg as IV infusion over 15-30 minutes.
Doses may be repeated every 1 (one) hour if muscle weakness persists.
If IV administration is not feasible, IM or SC injection may be utilized.
For Autoinjectors: (See Nerve Agent Antidote)

Front 45

PROCAINAMIDE

Back 45

Dosage and Administration
Adult: 20-30 mg / min.; maximum total dose is 17 mg / kg. Maintenance infusion: 1-4 mg / min.
Pediatric: 2-6 mg / kg IV, IO at less than 20 mg / min.; maximum dose is 17 mg / kg. Maintenance infusion: 20-80 micrograms/kg/min.

Front 46

SODIUM BICARBONATE 8.4%

Back 46

Dosage and Administration
Adult: 1 mEq / kg IV; may repeat with 0.5 mEq / kg every 10 minutes.
Pediatric: same as for adult.

Adult infusion: 1 – 4 amps in 1 liter D5W or NS, rate determined by sending physician.
Pediatric infusion: same as for adult.

Front 47

STREPTOKINASE

Back 47

Dosage and Administration
NOTE: Reconstitute by slowly adding 5 ml sodium chloride or D5W, directing stream to side of vial instead of into powder. Gently roll and tilt vial for reconstitution; Dilute slowly to 45 ml total.
Adult: 500,000 - 1,500,000 IU diluted to 45 ml IV over one (1) hour.
Pediatric: safety not established.

Front 48

TETRACAINE

Back 48

Dosage and Administration

Adult: Ophthalmic Solution: Instill 1-2 drops

Pediatric: Safety and efficacy have not been established.

Front 49

THIAMINE

Back 49

Dosage and Administration
Adult: 100 slow IV or IM.
Pediatric: 10-25 mg slow IV or IM.

Front 50

TISSUE PLASMINOGEN ACTIVATOR (tPA)

Back 50

Dosage and Administration
Adult: 10 mg bolus IV over 2 minutes; then 50 mg over one hour, then 20 mg over the second hour and 20 mg over the third hour for a total dose of 100 mg. (other doses may be prescribed through Medical Direction.
Pediatric: safety not established.

Front 51

VASOPRESSIN (Pitressin)

Back 51

Dosage and Administration
Adult: 40 units (as a single dose only) IV or IO to replace the first or second dose of epinephrine in cardiac arrest