Emergency Medications and Doses

Cardiac Arrest Medications

• The American Heart Association recommends epinephrine 1 mg IV/IO every 3-5 minutes during cardiac arrest 1
• The American Heart Association recommends atropine 0.5-1.0 mg IV every 3-5 minutes up to 3 mg total for bradycardia or organophosphate poisoning 1, 2
• The American Heart Association recommends continuing epinephrine dosing every 3-5 minutes throughout resuscitation efforts 1

Overdose/Toxicology Antidotes

• The American College of Medical Toxicology recommends naloxone 0.2-2 mg IV/IO/IM for opioid overdose 1, 2
• The American College of Medical Toxicology recommends titrating naloxone to reversal of respiratory depression, not full consciousness 2, 3
• The American College of Medical Toxicology recommends flumazenil 0.2 mg IV, titrated up to 1 mg maximum, for benzodiazepine reversal 1, 2
• The American College of Medical Toxicology recommends atropine 1-2 mg IV, doubled every 5 minutes, for organophosphate or carbamate poisoning 1, 2

Anaphylaxis

• The American Academy of Allergy, Asthma, and Immunology recommends epinephrine 0.3-0.5 mg IM (1:1000 concentration) into anterolateral thigh as first-line treatment for anaphylaxis 4
• The American Academy of Allergy, Asthma, and Immunology recommends diphenhydramine 25-50 mg IV/IM and famotidine 20 mg IV as adjunctive medications after epinephrine 4

Respiratory Emergency Medications

• The American Academy of Pediatrics recommends albuterol 2.5-5 mg in 3 mL normal saline via nebulizer for bronchospasm 5
• The American Academy of Pediatrics recommends ipratropium bromide 0.5 mg combined with albuterol via nebulizer 5

Seizure Management

• The American Academy of Neurology recommends midazolam 5 mg IM as a first-line treatment for seizures 6
• The American Academy of Neurology recommends lorazepam 2-4 mg IV as a first-line treatment for seizures 6

Metabolic Emergencies

• The American Diabetes Association recommends 50% dextrose 25-50 mL (12.5-25 g) IV push for hypoglycemia 5
• The American Academy of Pediatrics recommends sodium bicarbonate 1 mEq/kg IV for severe metabolic acidosis or tricyclic antidepressant overdose 5
• The American Heart Association recommends magnesium sulfate 1-2 g IV over 5-15 minutes for torsades de pointes or severe asthma 5

Critical Pitfalls to Avoid

• The American College of Medical Toxicology recommends never delaying epinephrine for antihistamines in anaphylaxis 4
• The American College of Medical Toxicology recommends never giving flumazenil without screening for contraindications 1, 3
• The American Heart Association recommends never giving calcium through peripheral IV in children 1
• The American College of Medical Toxicology recommends always giving naloxone first in suspected combined opioid-benzodiazepine overdose 1, 3

Emergency Department Medication Guidelines (Cited Evidence)

Analgesic Opioid Management

• Initiate acute pain treatment with short‑acting oral opioids at the lowest effective dose; hydrocodone/acetaminophen 5–10 mg or oxycodone 5–10 mg every 4–6 hours PRN are first‑line options. 7, 8
• Recommended dosing ranges for oral opioids in the ED:
  
  • Hydrocodone/acetaminophen 5–15 mg PO q4‑6 h PRN (Schedule III). 7, 8
  • Oxycodone/acetaminophen 5–15 mg PO q4‑6 h PRN (Schedule II). 7, 8
  • Morphine 15–30 mg PO q4‑6 h PRN (Schedule II). 7, 8
  • Hydromorphone 2–4 mg PO q4‑6 h PRN (Schedule II). 7, 8
  • Codeine/acetaminophen 30–60 mg PO q4‑6 h PRN (Schedule III). 7, 8
• Critical pitfall: Long‑acting or extended‑release opioids (e.g., OxyContin, MS Contin, fentanyl patches) should not be used for acute pain; they are reserved for opioid‑tolerant patients with chronic pain. 7, 8

Anticoagulation for Unstable Angina/NSTEMI

• Enoxaparin 1 mg/kg subcutaneously every 12 hours (minimum 48 hours) is preferred over unfractionated heparin because it yields superior clinical outcomes. 9, 10
• Unfractionated heparin regimen: 60–70 units/kg IV bolus (max 5,000 units), followed by an infusion of 12–15 units/kg/hour. 9, 10

Acute Agitation Management

• For undifferentiated, acutely agitated patients, either a benzodiazepine (lorazepam or midazolam) or a conventional antipsychotic (droperidol or haloperidol) can be used as effective monotherapy. 11
• Lorazepam 2–4 mg IV is recommended as first‑line therapy for seizures or agitation. 11
• Haloperidol 5 mg IM (often combined with lorazepam 2 mg) is an effective antipsychotic option. 11
• Droperidol is preferred over haloperidol when rapid sedation is required. 11
• In cooperative agitated patients, a combination of oral lorazepam and oral risperidone provides synergistic calming effects. 11

Essential Emergency Medication Dosing and Stocking Guidelines

Antidotes for Toxic Ingestion

• Acetylcysteine for acetaminophen overdose – Administer a 150 mg/kg loading dose over 1 hour, followed by 50 mg/kg over 4 hours and 100 mg/kg over 16 hours (total ≈ 22 g for a 100 kg adult). This regimen is recommended for preventing hepatic injury. 12
• Acetylcysteine for acute hepatic failure – Give intravenously as the primary antidote for drug‑induced liver injury. 12

Cardiovascular Emergency Agents

• Adenosine for supraventricular tachycardia – Give 6 mg rapid IV push; if no conversion, give 12 mg rapid push, repeat up to a second 12 mg dose as needed. Each dose must be followed immediately by a saline flush. 12

Metabolic Emergency Medications

• Dextrose 50 % for severe hypoglycemia – Administer 25–50 mL (≈ 12.5–25 g) IV push; may be followed by additional dextrose at lower concentrations as needed. 12
• Glucagon for β‑blocker or calcium‑channel‑blocker overdose – Give a total of 90–250 mg intravenously (dose may be divided). 12
• Sodium bicarbonate for severe metabolic acidosis or tricyclic antidepressant overdose – Initial dose 1 mEq/kg IV; for a 100 kg adult, 63–84 g may be required over 8–24 hours. 12

Calcium Preparations

• Calcium chloride in calcium‑channel‑blocker toxicity – Avoid peripheral IV administration in children; use a central venous line when possible, and never give subcutaneously. 12
• Calcium gluconate for hyperkalemia, hypocalcemia, or hydrofluoric acid exposure – Administer 30 g (for a 100 kg adult) over 8–24 hours; can be given intravenously or subcutaneously. 12

Anticoagulation Reversal

• Digoxin‑specific immune Fab for digoxin toxicity – Dose 15 vials for a 100 kg patient. 12
• Protamine sulfate for heparin reversal – Administer 400 mg to 1.2 g for a 100 kg patient, depending on the amount of heparin to be neutralized. 12

Stocking and Availability Recommendations

• Essential antidote inventory – Emergency departments should maintain at least an 8‑hour supply of all core antidotes, with a 24‑hour supply preferred for high‑risk facilities. 12