What are the common emergency medications and their dosages?

Common Emergency Medications and Dosages

The most essential emergency medications include epinephrine, naloxone, flumazenil, atropine, glucose, and benzodiazepines, with specific dosing protocols for each based on the clinical scenario and patient age. 1

Resuscitation Medications

Epinephrine

• Cardiac Arrest/CPR:

  • Newborns: 0.01-0.03 mg/kg of 1:10,000 solution IV/IO 1
  • Infants/Children: 0.01 mg/kg of 1:10,000 solution (maximum: 1 mg), repeated every 3-5 minutes IV/IO 1
  • Endotracheal route: 0.1 mg/kg of 1:1000 solution for older infants/children (maximum: 10 mg) 1

• Anaphylaxis:

  • IM/SC: 0.01 mg/kg of 1:1000 solution (maximum: 0.3-0.5 mg), repeated every 5-20 minutes 1
  • Note: IM route is preferred for anaphylaxis 1

• Shock after volume resuscitation:

  • IV infusion: 0.1-1.0 μg/kg/min, titrated to effect (doses up to 5 μg/kg/min sometimes necessary) 1

Atropine

• For bradycardia, organophosphate poisoning:
  • 0.02 mg/kg IV/IO, doubled every 5 minutes as needed 1
  • For organophosphates: Titrate to reversal of bronchorrhea, bronchospasm, bradycardia, and hypotension 1

Sedatives and Anticonvulsants

Diazepam (Benzodiazepine)

• Seizures/Status Epilepticus:

  • Adults: 5-10 mg IV/IM initially, then 5-10 mg in 3-4 hours if necessary 2
  • Children >5 years: 5-10 mg IV/IM repeated every 3-4 hours as needed 2
  • Infants >30 days: 1-2 mg IV/IM slowly, repeated every 3-4 hours as needed 2

• Muscle Spasm/Tetanus:

  • Adults: 5-10 mg IV/IM initially, then 5-10 mg in 3-4 hours if necessary 2
  • Children >5 years: 5-10 mg IV/IM repeated every 3-4 hours as needed 2
  • Infants >30 days: 1-2 mg IV/IM slowly, repeated every 3-4 hours as needed 2

• Anxiety:

  • Adults: 2-5 mg IV/IM, repeated in 3-4 hours if necessary 2

Midazolam

• Sedation for Rapid Sequence Intubation (RSI):
  • 0.2-0.4 mg/kg IV/IO (maximum: 20 mg) 1

Antidotes

Naloxone (Opioid Antagonist)

• Opioid Overdose:
  • Children: 0.1 mg/kg IV/IO/IM 1, 3
  • Adults: 0.2-2 mg IV/IO/IM 1
  • Titrate to reversal of respiratory depression and restoration of protective airway reflexes 3
  • Note: For suspected combined opioid and benzodiazepine poisoning, administer naloxone first 3

Flumazenil (Benzodiazepine Antagonist)

• Benzodiazepine Overdose:
  • IV: 0.01-0.02 mg/kg (maximum: 0.2 mg); repeat at 1-minute intervals to maximum cumulative dose of 0.05 mg/kg or 1 mg, whichever is lower 1
  • Adults: 0.2 mg, titrated up to 1 mg 1
  • CAUTION: Contraindicated in benzodiazepine dependence, seizure disorders, or suspected tricyclic antidepressant co-ingestion 1, 3

Cardiovascular Medications

Dopamine

• Cardiogenic/Distributive Shock:
  • IV infusion: 2-20 μg/kg/min, titrated to desired clinical effect 1
  • Effects are dose-dependent: low-dose (1-5 μg/kg/min) stimulates dopaminergic and β-adrenergic receptors; α-adrenergic effects predominate at higher doses 1

Labetalol

• Hypertensive Emergencies:
  • First-line treatment for malignant hypertension, hypertensive encephalopathy, acute stroke with severe hypertension 1
  • Target is usually MAP reduction of 15-25% depending on condition 1

Calcium Chloride

• Calcium Channel Blocker Overdose:
  • 20 mg/kg IV (0.2 mL/kg of 10% solution) 1
  • Maintenance: 20-40 mg/kg/h 1

Metabolic Emergency Medications

Glucose (Dextrose)

• Hypoglycemia:
  • D10W: 0.5-1.0 g/kg (5-10 mL/kg) 1
  • D25W: 0.5-1.0 g/kg (2-4 mL/kg) 1
  • D50W: 0.5-1.0 g/kg (1-2 mL/kg) 1
  • Note: D50W is irritating to veins; dilution to 25% dextrose is desirable 1

Glucagon

• Hypoglycemia (as adjunct to glucose):
  • IV/IM/SC: 0.03 mg/kg up to maximum of 1 mg; repeat every 15 min up to 3 doses if needed 1
  • For β-blocker or calcium channel blocker overdose: 0.05-0.15 mg/kg 1

Alternative Administration Routes

• Intranasal (IN) Route: Viable alternative for medications like midazolam, lorazepam, ketamine, fentanyl, and naloxone when IV access is challenging 4

• Endotracheal (ET) Route: Can be used for epinephrine, atropine, and naloxone (memory aid: LEAN) when IV/IO access is unavailable 1, 5

  • Follow ET administration with saline flush or dilute in isotonic saline (1-5 mL) based on patient size 1

• Autoinjector Devices: Useful for rapid administration in emergency situations, particularly for atropine, epinephrine, and diazepam 6

Important Considerations

• Always ensure appropriate monitoring when administering emergency medications, particularly for respiratory and cardiovascular effects 1

• For vasoactive medications (epinephrine, dopamine), monitor for extravasation which can cause severe skin injury; phentolamine (0.1-0.2 mg/kg up to 10 mg diluted in 10 mL of 0.9% sodium chloride) injected intradermally at extravasation site may help counteract dermal vasoconstriction 1

• Dosing of medications should be weight-based in pediatric patients, with careful attention to appropriate concentration selection 1