IV Push Medication Administration Rates for Adults
For emergency cardiovascular medications, follow the specific push rates outlined in the 2010 AHA ACLS guidelines, which provide the most authoritative dosing and administration timing for life-threatening situations.
Emergency Cardiovascular Medications
Adenosine 1
- 6 mg IV rapid push followed immediately by 20 mL saline flush
- If no response: 12 mg IV rapid push
- Must be given as rapid bolus to be effective due to extremely short half-life
Epinephrine in Cardiac Arrest 1, 2
- 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) IV/IO push
- Maximum single dose: 1 mg
- Repeat every 3-5 minutes during resuscitation
- For continuous infusion in refractory shock: 0.1-1.0 mcg/kg/min 3
Calcium Chloride 10% 2
- 20 mg/kg (0.2 mL/kg) IV/IO slowly
- Maximum single dose: 2 g
- Must be administered slowly to avoid cardiac arrhythmias
Atropine 2
- 0.02 mg/kg IV/IO
- Minimum dose: 0.1 mg
- Maximum single dose: 0.5 mg
- May repeat once if needed
Amiodarone 1, 2
- 5 mg/kg IV/IO for cardiac arrest (rapid push with flush)
- For perfusing rhythms: administer over 20-60 minutes
- Maximum single dose: 300 mg
- Monitor ECG and blood pressure; adjust rate based on clinical urgency
Lidocaine 2
- Bolus: 1 mg/kg IV/IO
- Can be given as rapid push in cardiac arrest
- Followed by infusion: 20-50 mcg/kg/minute
Sodium Bicarbonate 2
- 1 mEq/kg per dose IV/IO slowly
- Must be given slowly after adequate ventilation established
Antiarrhythmic Medications
Diltiazem 1
- Initial: 15-20 mg (0.25 mg/kg) IV over 2 minutes
- Additional dose: 20-25 mg (0.35 mg/kg) IV in 15 minutes if needed
- For rate control in atrial fibrillation/flutter
Verapamil 1
- Initial: 2.5-5 mg IV over 2 minutes
- May repeat 5-10 mg every 15-30 minutes to total 20-30 mg
- Only for narrow-complex tachycardias
Metoprolol 1
- 5 mg over 1-2 minutes
- Repeat every 5 minutes as needed to maximum 15 mg
Esmolol 1
- Loading: 500-1000 mcg/kg over 1 minute
- Followed by 50 mcg/kg/min infusion
- Short half-life (2-9 minutes) allows rapid titration
Procainamide 1, 3, 2
- Adult: 20 mg/min IV infusion to maximum 17 mg/kg
- Pediatric: 15 mg/kg IV/IO over 30-60 minutes
- Stop if hypotension or QRS widens by 50%
- Requires expert consultation and ECG monitoring
Hypertensive Emergency Medications
Labetalol 4, 5
- Initial: 0.3-1.0 mg/kg (maximum 20 mg) slow IV injection every 10 minutes
- Alternative: 0.4-1.0 mg/kg/h IV infusion up to 3 mg/kg/h
- Maximum cumulative dose: 300 mg
Hydralazine 4, 5
- Initial: 10 mg via slow IV infusion (maximum initial 20 mg)
- Repeat every 4-6 hours as needed
- Unpredictable response makes it less desirable as first-line
Enalaprilat 4, 5
- Initial: 1.25 mg over 5 minutes
- May increase up to 5 mg every 6 hours
Phentolamine 4, 5
- 5 mg IV bolus
- Additional boluses every 10 minutes as needed
Anaphylaxis Management
Epinephrine for Anaphylaxis 6
- IM route preferred: 0.3 mg (0.3 mL of 1:1000) into anterolateral thigh
- Repeat every 5 minutes as necessary
- IV epinephrine only for profoundly hypotensive patients who fail IM doses and volume resuscitation
- IV infusion: 1-4 mcg/min (maximum 10 mcg/min) with continuous hemodynamic monitoring 6
Diphenhydramine 6
- 25-50 mg IV/IM (1-2 mg/kg)
Ranitidine 6
- 1 mg/kg diluted in D5W to 20 mL, injected IV over 5 minutes
- Superior to diphenhydramine alone when combined
Seizure Management
Phenytoin 3
- 20 mg/kg IV (maximum 1000 mg initial dose)
- Infusion rate: not to exceed 1 mg/kg/min (recommended 10-20 minutes total)
- Must dilute in normal saline (incompatible with glucose solutions)
- Monitor heart rate; reduce rate if heart rate decreases by 10 bpm
- May cause hypotension and arrhythmias with rapid infusion
Phenobarbital 3
- 20 mg/kg IV over 10 minutes
- May repeat once after 15 minutes (maximum total 40 mg/kg)
- Monitor for apnea; be prepared for respiratory support
Infusion Reaction Management
Hydrocortisone 7
- 100-500 mg IV for moderate reactions
- 200 mg IV for symptom-directed treatment
Ondansetron 7
- 4-8 mg IV for nausea
Critical Pitfalls to Avoid
Never administer first-generation antihistamines (diphenhydramine) for hypotensive infusion reactions - they can exacerbate hypotension and convert minor reactions into hemodynamically significant events 7.
Avoid IV epinephrine in anaphylaxis unless patient is profoundly hypotensive and has failed multiple IM doses with volume resuscitation - risk of lethal arrhythmias 6.
Do not give calcium channel blockers or beta-blockers to patients with wide-complex tachycardia - may precipitate cardiovascular collapse if rhythm is ventricular in origin 1.
Adenosine must be given as rapid push followed immediately by saline flush - slower administration renders it ineffective due to rapid metabolism 1.
Reduce procainamide dose or stop infusion if QRS widens by 50% or hypotension develops - indicates toxicity 1, 3.
Sodium nitroprusside requires intra-arterial BP monitoring and cyanide toxicity precautions for infusions ≥4-10 mcg/kg/min or duration >30 minutes 4, 5.