PARAMEDIC II MEDICATIONS/DOSAGES
Acute Bronchospasm (Asthma, Allergic reactions, COPD ect.)
Albuterol (Proventil) 2.5 mg/3 ml and Ipratropium Bromide 0.02% (Atrovent) 0.5 mg/2.5 ml
via nebulizer. May repeat Albuterol (Proventil)/Ipratropium Bromide (Atrovent) X 2 if
wheezing persists
Methylprednisolone (Solumedrol) 125 mg IV if wheezing persists after 1st nebulizer
Magnesium Sulfate 2 grams IV in 100 ml NS over 10-15 minutes
Epinephrine 1:1,000 0.3 mg IM (severe respiratory distress)
Acute Pulmonary Edema
Nitroglycerin 0.4 mg spray SL every 5 minutes
Albuterol (Proventil) 2.5 mg/3 ml and Ipratropium Bromide 0.02% (Atrovent) 0.5
mg/2.5 ml via nebulizer: Repeat Albuterol (Proventil)/Ipratropium Bromide (Atrovent) X 2
if wheezing persists.
Dopamine infusion at 5-20 mcg/kg/min titrated to maintain systolic BP > 90 mm Hg
Allergic Reactions
Mild Reaction
Diphenhydramine (Benadryl) 1 mg/kg IV (Maximum 50 mg)
Moderate Reaction
Albuterol (Proventil) 2.5 mg/3 ml and Ipratropium Bromide 0.02% (Atrovent) 0.5 mg/2.5 ml
via nebulizer: repeat Albuterol (Proventil)/Ipratropium Bromide (Atrovent) X 2 if wheezing
persists
Diphenhydramine (Benadryl) 1 mg/kg IV (Maximum 50 mg)
Allergic Reactions
Severe Reaction
Epinephrine 1:1,000 0.3 mg IM
Albuterol (Proventil) 2.5 mg/3 ml and Ipratropium Bromide 0.02% (Atrovent) 0.5 mg/2.5 ml
via nebulizer: repeat Albuterol (Proventil)/Ipratropium Bromide (Atrovent) X 2 if wheezing
persists
Diphenhydramine (Benadryl) 1 mg/kg IV (Maximum 50 mg)
Methylprednisolone (Solumedrol) 125 mg IV
Cardiac Arrest due to Allergic Reaction
Epinephrine 1:10,000 0.5 mg IV (instead of 1:1,000 IM)
For cardiac arrest, refer to the appropriate algorhythm based on presenting rhythm
In the setting of cardiac arrest, the following items should be performed in the post
resuscitative phase, when time allows:
Albuterol (Proventil) 2.5 mg/3 ml and Ipratropium Bromide 0.02% (Atrovent) 0.5
mg/2.5 ml via nebulizer, repeat Albuterol (Proventil)/Ipratropium Bromide (Atrovent) X 2 if
wheezing persists
Diphenhydramine (Benadryl) 1 mg/kg IV (Maximum 50 mg)
Methylprednisolone (Solumedrol) 125 mg IV
Altered Mental Status
If hypoglycemic (Blood glucose < 70 mg/dL [<50mg/dL if stroke]):
Dextrose 50% 25 gm slow IV
Thiamine 100 mg IV (malnourished/Alcoholism)
If no IV available:
Glucose paste or other oral glucose containing agent (e.g. orange juice) if patient
alert enough to self administer oral agent
Glucagon 1 mg IM
If Opioid overdose suspected (significantly altered mental status or respiratory
depression):
Naloxone (Narcan) 2 mg IV (start at 0.4 mg for patients over 65 years old)
Naloxone (Narcan) can be given in 0.4 mg increments, titrated to mental status and
respiratory drive (monitor respiratory status with continuous capnography)
If respiratory depression persists, repeat every 3 minutes to a maximum of 8 mg
Arrhythmias
Adenosine Phosphate (Adenocard) 6 mg rapid IV over 1-3 seconds (Tachycardia)
If no response in 2 minutes, 12 mg rapid IV over 1-3 seconds
If no response in 2 minutes, repeat 12 mg IV over 1-3 seconds
Amiodarone 150 mg followed by 150 mg during 2nd round of medications
(Ventricular arrhythmias)
Behavioral Emergencies
Severe agitation compromising patient care or patient/crew safety, or for
patients who continue to struggle against physical restraints
Haloperidol (Haldol) 5mg IM if < 60 kg and 10mg IM if > 60 kg
Avoid if history of recent MAO inhibitor use (e.g. Phenelzine, Tranylcypromine)
Lorazepam (Ativan) 1 mg IM (can be combined in same syringe as Haloperidol)
If cocaine/sympathomimetic toxicity strongly suspected:
Lorazepam (Ativan) 1 mg IV/IM
Repeat Lorazepam (Ativan) 1 mg IV/IM if adequate sedation not achieved initially
Bites and Envenomations
For hypotension (systolic BP < 90 mmHg) not improved by fluid boluses, or when fluid
boluses are contraindicated
Dopamine infusion at 5-20 mcg/kg/min titrated to maintain systolic BP > 90 mm Hg
For Black Widow spider or Scorpion envenomations with severe muscle spasms
Lorazepam (Ativan) 1 mg slow IV or IM
For patients with severe pain if systolic blood pressure > 120 mmHg:
Morphine Sulfate 2 mg slow IV; repeat every 2 minutes as needed (Maximum 10mg)
Cardiac Arrest Medications
Epinephrine 1 mg every 3-5 mins (all forms of arrest)
Amiodarone 300 mg followed by 150 mg during 2nd round of medications
(Ventricular arrhythmias)
Magnesium Sulfate 2 grams (Torsades)
Sodium Bicarbonate 1 mEq/Kg (hyperkalemia, renal disease)
Calcium Chloride 1 gram
Dopamine infusion at 5-20 mcg/kg/min titrated to maintain systolic BP > 90 mm Hg
(post arrest)
Chest Pain
Aspirin 324 mg PO, chewed if patient is able to swallow
Aspirin is contraindicated if allergic or taking Warfarin (Coumadin)
Nitroglycerin 0.4 mg spray SL, every 5 minutes as needed for chest pain
Contraindicated if systolic BP < 90 mm Hg
Contraindicated if use of a Phosphodiesterase-5 (PDE5) inhibitor within last 24
hours (Viagra or Levitra); 48 hours for Cialis
Morphine Sulfate 2 mg slow IV; repeat every 5 minutes as needed (Maximum 10 mg)
if no chest pain relief after 3rd Nitroglycerin dose
If runs of Ventricular Tachycardia occur:
Amiodarone 150 mg IV Piggyback over 10 minutes
Isolated PVC’s do not require treatment
For patients with severe nausea or vomiting:
Ondansetron (Zofran), 4 mg slow IV
Cyanide poisoning
Hydroxocobalamin (Cyanokit) 5 grams (two 2.5 grams vials) IV/IO over 15 minutes
Dehydration
Normal Saline 250 ml followed by a second infusion of 250 ml if necessary.
Drug overdoses
Glucagon 3 mg IV/IO for calcium channel and B blocker OD
Calcium Chloride 1 gram IV/IO for calcium channel blocker OD
Sodium Bicarbonate 1 mEq/kg IV/IO for Tricyclic antidepressant OD
Naloxone (Narcan) 2 mg IV repeat every 3-5 minutes (Maximum 8 mg)
Hypoglycemia (Blood glucose < 70 mg/dL [<50mg/dL if stroke])
Dextrose 50% 25 gm slow IV
Thiamine 100 mg IV (If the patient appears malnourished/alcoholic)
If no IV available:
Glucose paste or other oral glucose containing agent (e.g. orange juice) if patient
alert enough to self administer oral agent
If unable to take oral glucose administer Glucagon 1 mg IM
Nausea and Vomiting
Ondansetron (Zofran), 4 mg slow IV
Pain Control (Chest pain, fractures, kidney stones ect.)
Morphine Sulfate 2 mg every 2 minutes maximum dose 10 mg unless medical control
increases maximum dose.
Seizures
For active seizures administer Lorazepam (Ativan) 1 mg, slow IV; can be given IM if no IV
Available, If seizures continue or re-occur repeat Lorazepam (Ativan) 1 mg IV or IM; wait
at least 5 minutes from initial dose.