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Medication

Epinephrine
Adrenaline
  • Cardiac arrest
  • Anaphylaxis
  • Severe asthma
  • 1mg IV/IO every 3-5 min (cardiac arrest)
  • 0.3-0.5mg IM (anaphylaxis)

None

  • 0.01mg/kg IV/IO (max 1mg), 0.01mg/kg IM (max 0.5mg)
  • Tachycardia
  • Hypertension
  • Anxiety
Atropine
Sulfate
  • Anti-vagal effects
  • Organophosphate Poisoning
  • bradycardia
  • Anti-vagal: 0.5 mg to 1 mg every 1 to 2 hours
  • Organophosphate 2 mg to 3 mg every 20 to 30 minutes
  • Bradycardia: 1 mg every 3 to 5 minutes (3 mg max)

Atropine does not carry an FDA-issued box warning or any absolute contraindications

  • Pediatric: 0.01 mg/kg to 0.03 mg/kg every 3 to 5 minutes. The pediatric minimum dose is 0.1 mg, the maximum dose is 0.5 mg (child) and 1.0 mg (adolescent), and the maximum cumulative dose is 1 mg (child) and 2 mg (adolescent).
  • Blurred vision.
  • change in color vision.
  • difficulty seeing at night.
  • eye pain or stinging.
  • fast, pounding, or irregular heartbeat or pulse.
  • increased sensitivity of the eyes to sunlight.
 
Amiodarone
Cordarone
  • VF/VT cardiac arrest
  • Wide-complex tachycardia
  • 300mg IV/IO bolus (cardiac arrest)
  • 150mg over 10 min (stable VT)
  • Cardiogenic shock
  • Bradycardia
  • AV block

  • 5mg/kg IV/IO bolus (max 300mg)

  • Hypotension
  • Bradycardia
  • QT prolongation
Naloxone
Narcan
  • Opioid overdose
  • Respiratory depression from opioids

  • 0.4-2mg IV/IM/IN, repeat every 2-3 min as needed

  • None in life-threatening situations

  • 0.1mg/kg IV/IM/IN (max 2mg)

  • Withdrawal symptoms
  • Agitation
  • Hypertension
Dopamine
vasopressor - inotrope
  • Bradycardia
  • systolic BP <100 mm Hg with signs of shock
  • 2 to 20 mcg/kg/minute infusion titrated to response
  • Pregnancy and breastfeeding.
  • High blood pressure (hypertension).
  • Risk of fibrosis-type conditions. 
  • Kidney or liver disease.
  • Taking certain medications.
  • History of psychosis-related conditions or symptoms.
  •  2–20 mcg/kg/min
  • Headache
  • Dyspnea
  • Palpitations, PVCs, SVT, VT
  • Nausea/ vomiting
  • Acute renal failure
Magnesium Sulfate
Electrolyte - bronchodilator
  • Torsades de pointes
  • hypomagnesemia
  • digitalis toxicity

Cardiac arrest due to hypomagnesemia or torsades: 1-2 gram IV bolus

Torsades with a pulse: 1-2 gram IV over 5-60 minutes followed by infusion at 0.5-1 gram per hour IV

  • Atrioventricular heart block or myocardial damage/cardiac ischemia.
  • Myasthenia gravis (risk of precipitating myasthenic crisis). 
  • Severe renal failure or anuria (risk of accumulation/toxicity). 
  • Hypocalcemia or existing hypermagnesemia.

25–50 mg/kg IV/IO over 10–20 minutes, faster in torsades de pointes Maximum dose 2 g

  • Confusion
  • sedation
  • weakness
  • respiratory depression
  • hypotension
  • heart block
  • bradycardia
  • cardiac arrest
  • nausea
  • vomiting
  • muscle cramping
  • flushing
  • sweating
Lidocaine
Antiarrhythmic
  • Cardiac arrest from VF or VT
  • Wide complex tachycardia
  • Cardiac Arrest: 1-1.5 mg/kg IV bolus; may repeat twice at half dose in 5-10 minutes to total of 3 mg/kg; followed with infusion of 1-4 mg per minute infusion
  • Wide complex tachycardia with pulse: 0.5-1.5 mg/kg IV; may repeat twice at half dose in 5-10 minutes to total of 3 mg/kg; followed with infusion of 1-4 mg per minute infusion

  • Hypersensitivity to lidocaine or other amide-type local anesthetics.

  • Adams–Stokes syndrome.

  • Severe sinoatrial, atrioventricular, or intraventricular block (in the absence of a functioning pacemaker).

  • Wolff–Parkinson–White (WPW) syndrome or severe conduction disturbances with ventricular arrhythmias.
    Untreated severe shock (e.g., hypovolemic or cardiogenic shock).

Bolus: 1 mg/kg IV/IO Infusion: 20–50 mcg/kg/minute

  • Seizures
  • heart block
  • bradycardia
  • dyspnea
  • respiratory depression
  • nausea, vomiting
  • headache, dizziness
  • tremor, drowsiness
  • tinnitus
  • blurred vision
  • hypotension
  • rash
Adenosine
Antiarrhythmic
  • Supraventricular tachycardia (SVT)
  • Wide complex ventricular tachycardia (VT)

  • 1st dose = 6 mg rapid IV push followed by saline bolus

  • 2nd dose = 12 mg rapid IV push in

  • Second- or third-degree AV block (unless the patient has a functioning pacemaker)

  • Sick sinus syndrome without a pacemaker

  • Known hypersensitivity to adenosine

  • 0.1 mg/kg (maximum 6 mg) Second dose: 0.2 mg/kg (maximum 12 mg)

  • Headache
  • dizziness
  • metallic taste
  • dyspnea
  • hypotension
  • bradycardia or palpitations
  • nausea, flushing, sweating
Solu-Medrol
Synthetic glucocorticoid
  • inflammatory and allergic conditions.
  • 40 mg to 125 mg
  • Systemic Fungal Infections: 
  • Hypersensitivity:
  • Premature Infants: 
  • Cerebral Malaria: 
  • Typical Dosing: Initial doses may range from 0.5 to 2 mg/kg per dose.
  • For status asthmaticus: Dosing might be 1 to 2 mg/kg per dose (maximum 60 mg/day).
  •  Euphoria, depression, mood swings, insomnia.
  • Fluid retention, hypertension (high blood pressure), hypokalemia (low potassium).
  •  Nausea, vomiting, increased appetite.
  • Hyperglycemia (high blood sugar), which is especially important to monitor in diabetic patients.
Sotalol
Antiarrhythmic
  • ventricular tachycardia (VT)
  • highly symptomatic atrial fibrillation or atrial flutter

75 mg IV infused over 5 hour

  • Atrioventricular heart block or myocardial damage/cardiac ischemia.
  • Myasthenia gravis (risk of precipitating myasthenic crisis). 
  • Severe renal failure or anuria (risk of accumulation/toxicity). 
  • Hypocalcemia or existing hypermagnesemia.

  • Neonates: Doses often start much lower and are titrated slowly (e.g., 0.5-1 mg/kg/dose infused over 1-2 hours).

  • Children: Initial doses may be in the range of 0.5 to 2 mg/kg per dose, infused slowly (e.g., over 1-4 hours)

  • Bradycardia (slow heart rate)
  • Hypotension (low blood pressure)
  • Dizziness, lightheadedness
  • Fatigue
  • Nausea, vomiting
  • Dyspnea (shortness of breath)
  • Headache
Sodium bicarbonate
Alkalinizing Agent

  • Known Pre-existing Metabolic Acidosis

  • Hyperkalemia

  • Tricyclic Antidepressant (TCA) Overdose

  • Prolonged Cardiac Arrest

1 mEq/kg

  • Routine Cardiac Arrest
  • Metabolic or Respiratory Alkalosis
  • Hypocalcemia
  • Hypernatremia
  • Fluid or Sodium Overload
  • Chloride Loss

1 mEq/kg per dose Max 50 mEq

  • Metabolic Alkalosis
  • Hypernatremia and Hyperosmolarity
  • Intracellular Acidosis
  • Hypokalemia
  • Worsening Coronary Perfusion
  • Tissue Necrosis
  • Incompatibility with other drugs
Procainamide
Antiarrhythmic
  • Wide QRS Tachycardia
  • Preferred for VT with pulse (stable)
  • 20 to 50 mg/min IV until rhythm improves, hypotension occurs, QRS widens by 50%, or MAX dose is given
  • MAX dose: 17 mg/kg
  • Drip = 1 to 2 gm in 250 to 500 mL at 1 to 4 mg/min
  • Cardiac and BP monitoring
  • Caution with acute MI
  • May reduce dose with renal failure
  • Do not give with amiodarone
  • Do not use in prolonged QT or CHF
  • Infants, Children, and Adolescents: Typically 10 to 15 mg/kg per dose, administered over 30 to 60 minutes. The maximum single dose is often 1000 mg.
  • Neonates (less than 1 month): Some data suggest a loading dose of 7 to 10 mg/kg infused over 60 minutes.
  • Headache
  • dizziness
  • metallic taste
  • dyspnea
  • hypotension
  • bradycardia or palpitations
  • nausea, flushing, sweating