All emergency medicine name with adult dose per kg and indication classical
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Emergency Medicines - Adult Doses & Classical Indications
Sources: Tintinalli's Emergency Medicine, Rosen's Emergency Medicine, Miller's Anesthesia, Barash's Clinical Anesthesia
CARDIAC ARREST & RESUSCITATION
| Drug | Adult Dose | Indication |
|---|---|---|
| Epinephrine (Adrenaline) | 1 mg IV every 3-5 min | Cardiac arrest (VF, pulseless VT, asystole, PEA) - first-line vasopressor |
| Amiodarone | 300 mg IV bolus (first dose); 150 mg (second dose) | Shock-refractory VF / pulseless VT; also SVT, stable VT |
| Lidocaine | 1-1.5 mg/kg IV bolus | VF / pulseless VT (alternative to amiodarone); wide-complex tachycardia |
| Atropine | 0.5-1 mg IV every 3-5 min (max 3 mg) | Symptomatic bradycardia; NOT routine in PEA/asystole |
| Sodium bicarbonate | 1 mEq/kg IV | TCA overdose, hyperkalemia; NOT routine in arrest |
| Calcium chloride | 1 g (10 mL of 10%) IV slow push | Hyperkalemia, hypocalcemia, calcium channel blocker overdose |
| Magnesium sulfate | 1-2 g IV over 15 min | Torsades de pointes, hypomagnesemia, eclampsia |
| Vasopressin | 40 units IV (single dose) | Previously used in cardiac arrest; removed from 2015/2020 ACLS algorithm |
CARDIAC ARRHYTHMIAS
| Drug | Adult Dose | Indication |
|---|---|---|
| Adenosine | 6 mg rapid IV push; if no response: 12 mg (repeat once) | SVT (first-line); diagnostic in wide-complex tachycardia |
| Amiodarone | 150 mg IV over 10 min (loading); then 1 mg/min x 6 h | Hemodynamically stable VT, AF rate control |
| Metoprolol | 5 mg IV every 5 min (x3 doses) | Rate control in AF/flutter, SVT |
| Diltiazem | 0.25 mg/kg IV over 2 min | Rate control in AF/flutter |
| Digoxin | 0.5 mg IV, then 0.25 mg q4-6h (total 1-1.5 mg) | AF rate control in heart failure |
| Procainamide | 20-50 mg/min IV (max 17 mg/kg) | SVT refractory to adenosine, stable VT, AF with WPW |
| Ibutilide | 1 mg IV over 10 min | AF/flutter cardioversion |
ACUTE CORONARY SYNDROME (ACS/STEMI)
| Drug | Adult Dose | Indication |
|---|---|---|
| Aspirin | 162-325 mg PO (chewed) | ACS - first-line antiplatelet |
| Clopidogrel | 600 mg loading PO, then 75 mg daily | ACS/PCI - P2Y12 inhibitor |
| Ticagrelor | 180 mg loading PO, then 90 mg twice daily | ACS - preferred P2Y12 inhibitor |
| Prasugrel | 60 mg loading PO, then 10 mg daily (post-PCI) | ACS with PCI |
| Heparin (UFH) | 60 units/kg IV bolus (max 4,000 units), then 12 units/kg/h infusion | ACS/STEMI antithrombotic |
| Enoxaparin | 30 mg IV bolus + 1 mg/kg SC every 12 h | STEMI/ACS LMWH |
| Nitroglycerin | 0.4 mg SL every 5 min x3; IV: start 10 mcg/min, titrate | Chest pain, ACS, hypertensive emergency, pulmonary edema |
| Morphine | 2-5 mg IV every 5-15 min PRN | Pain in ACS (use selectively - may worsen outcomes) |
| Alteplase (tPA) | 15 mg IV bolus, then 0.75 mg/kg over 30 min, then 0.5 mg/kg over 60 min (max 100 mg) | STEMI fibrinolysis; ischemic stroke (0.9 mg/kg, max 90 mg) |
| Streptokinase | 1.5 million units IV over 60 min | STEMI fibrinolysis (where alteplase unavailable) |
| Tenecteplase | Weight-based: 30-50 mg IV bolus (see table) | STEMI fibrinolysis - single bolus |
VASOPRESSORS & INOTROPES (SHOCK)
| Drug | Adult Dose | Indication |
|---|---|---|
| Norepinephrine | 0.01-3 mcg/kg/min IV infusion | Septic shock (first-line), distributive shock |
| Epinephrine | 0.01-0.5 mcg/kg/min IV infusion | Anaphylactic shock, cardiogenic shock, refractory septic shock |
| Dopamine | 5-20 mcg/kg/min IV infusion | Cardiogenic shock with bradycardia (no longer preferred for sepsis) |
| Dobutamine | 2-20 mcg/kg/min IV infusion | Cardiogenic shock, low CO states |
| Phenylephrine | 50-200 mcg/min IV infusion | Hypotension (vasodilatory); not recommended in septic shock |
| Vasopressin | 0.03-0.04 units/min IV infusion | Adjunct in septic shock refractory to catecholamines |
RESPIRATORY EMERGENCIES
| Drug | Adult Dose | Indication |
|---|---|---|
| Epinephrine | 0.3-0.5 mg IM (anterolateral thigh) | Anaphylaxis (first-line), severe asthma, croup |
| Salbutamol (Albuterol) | 2.5-5 mg nebulized every 20 min x3 | Acute asthma, COPD exacerbation, hyperkalemia |
| Ipratropium | 0.5 mg nebulized with salbutamol | Acute asthma/COPD (additive bronchodilation) |
| Methylprednisolone | 125 mg IV (or 1-2 mg/kg) | Severe asthma, anaphylaxis, COPD exacerbation |
| Dexamethasone | 10 mg IV/IM | Asthma, croup, cerebral edema, meningitis, antiemesis |
| Magnesium sulfate | 2 g IV over 20 min | Severe refractory asthma |
| Heliox | 70:30 (He:O2) inhaled | Severe upper airway obstruction, refractory asthma |
RAPID SEQUENCE INTUBATION (RSI)
| Drug | Adult Dose | Indication |
|---|---|---|
| Succinylcholine | 1.5 mg/kg IV | RSI paralytic (depolarizing) - first-line, fastest onset |
| Rocuronium | 1.2-1.6 mg/kg IV | RSI paralytic (non-depolarizing) - preferred when succinylcholine contraindicated |
| Ketamine | 1-2 mg/kg IV | RSI induction - dissociative, maintains airway reflexes; bronchospasm; haemodynamically stable |
| Propofol | 1-2 mg/kg IV | RSI/procedural sedation induction - caution in hypotension |
| Etomidate | 0.3 mg/kg IV | RSI induction - haemodynamically neutral, preferred in shock |
| Midazolam | 0.1-0.3 mg/kg IV | Procedural sedation, RSI co-induction, status epilepticus |
| Fentanyl | 1-3 mcg/kg IV | Pre-RSI blunting of intubation response; procedural analgesia |
NEUROLOGICAL EMERGENCIES
| Drug | Adult Dose | Indication |
|---|---|---|
| Lorazepam | 0.1 mg/kg IV (up to 4 mg) | Status epilepticus - first-line benzodiazepine |
| Diazepam | 0.15-0.2 mg/kg IV (or 10 mg PR) | Status epilepticus |
| Phenytoin/Fosphenytoin | 20 mg/kg IV (max 1 g) at ≤50 mg/min | Second-line status epilepticus, seizure prophylaxis |
| Levetiracetam | 60 mg/kg IV (max 4.5 g) | Second-line status epilepticus (alternative to phenytoin) |
| Sodium valproate | 40 mg/kg IV | Second-line status epilepticus |
| Phenobarbital | 15-20 mg/kg IV | Refractory status epilepticus |
| Propofol | 1-2 mg/kg IV then 1-10 mg/kg/h | RSE (refractory status epilepticus) - ICU |
| Mannitol | 0.5-1 g/kg IV over 20-30 min | Raised ICP, cerebral edema |
| Hypertonic saline (3%) | 1-3 mL/kg IV bolus | Raised ICP (alternative/adjunct to mannitol), hyponatremia with symptoms |
| Alteplase (tPA) | 0.9 mg/kg IV (max 90 mg; 10% as bolus, rest over 60 min) | Acute ischemic stroke (within 3-4.5 h of onset) |
TOXICOLOGY / ANTIDOTES
| Drug | Adult Dose | Indication |
|---|---|---|
| Naloxone | 0.4-2 mg IV/IM/IN; repeat every 2-3 min PRN (max ~10 mg) | Opioid overdose reversal |
| Flumazenil | 0.2 mg IV over 30 sec; repeat 0.1 mg every 60 sec (max 1 mg) | Benzodiazepine reversal (use cautiously - may precipitate seizures) |
| N-acetylcysteine (NAC) | 150 mg/kg IV over 1 h, then 50 mg/kg over 4 h, then 100 mg/kg over 16 h | Paracetamol (acetaminophen) overdose |
| Atropine | 1-3 mg IV every 5-10 min (large doses possible in severe poisoning) | Organophosphate/nerve agent poisoning, cholinergic toxidrome |
| Pralidoxime (2-PAM) | 1-2 g IV over 15-30 min | Organophosphate poisoning (reactivates AChE) |
| Sodium bicarbonate | 1-2 mEq/kg IV bolus | TCA overdose (QRS widening), salicylate poisoning, cocaine toxicity |
| Digoxin-specific Fab | Based on body load (typically 10 vials empirically) | Digoxin toxicity |
| Glucagon | 1-5 mg IV (up to 10 mg) | Beta-blocker overdose, calcium channel blocker overdose |
| Calcium gluconate | 2-3 g IV (10-30 mL of 10%) | Calcium channel blocker OD, HF poisoning, hyperkalemia |
| Hydroxocobalamin | 5 g IV over 15 min | Cyanide poisoning (first-line) |
| Phentolamine | 5-15 mg IV | Hypertensive crisis from sympathomimetic/MAOI |
HYPERTENSIVE EMERGENCIES
| Drug | Adult Dose | Indication |
|---|---|---|
| Labetalol | 20 mg IV over 2 min; repeat 20-80 mg every 10 min (max 300 mg) | Hypertensive emergency, aortic dissection, eclampsia |
| Nicardipine | 5-15 mg/h IV infusion | Hypertensive emergency (titratable) |
| Esmolol | 500 mcg/kg IV bolus, then 50-300 mcg/kg/min | Aortic dissection, perioperative hypertension, SVT |
| Hydralazine | 5-20 mg IV every 20-30 min | Hypertensive emergency, eclampsia |
| Sodium nitroprusside | 0.3-10 mcg/kg/min IV infusion | Hypertensive emergency (most potent, ICU use) |
| Phentolamine | 5-15 mg IV | Pheochromocytoma crisis |
| Nitroglycerin | 5-200 mcg/min IV infusion | Hypertensive emergency with ACS or pulmonary edema |
METABOLIC / ENDOCRINE EMERGENCIES
| Drug | Adult Dose | Indication |
|---|---|---|
| Dextrose 50% (D50W) | 50 mL (25 g) IV | Symptomatic hypoglycemia |
| Glucagon | 1 mg IM/SC/IV | Hypoglycemia when IV access unavailable |
| Insulin (Regular) | 10 units IV | Hyperkalemia (with dextrose), DKA |
| Hydrocortisone | 100-200 mg IV | Adrenal crisis, severe asthma, anaphylaxis, septic shock |
| Sodium bicarbonate | 150 mEq (3 x 50 mEq amps) in 1 L D5W | DKA with severe acidosis (pH <6.9); salicylate poisoning |
| Thiamine | 100 mg IV before dextrose | Wernicke's encephalopathy, alcohol withdrawal, coma of unknown cause |
ANAPHYLAXIS PROTOCOL
| Drug | Adult Dose | Indication |
|---|---|---|
| Epinephrine | 0.3-0.5 mg IM (1:1000); 0.1 mg IV (1:10,000) if cardiovascular collapse | Anaphylaxis - FIRST-LINE, given before all others |
| Diphenhydramine | 25-50 mg IV/IM | Anaphylaxis (H1 blocker - adjunct) |
| Ranitidine/Famotidine | 50 mg IV (ranitidine) or 20 mg IV (famotidine) | Anaphylaxis (H2 blocker - adjunct) |
| Methylprednisolone | 125 mg IV | Anaphylaxis (prevents biphasic reaction) |
OBSTETRIC EMERGENCIES
| Drug | Adult Dose | Indication |
|---|---|---|
| Magnesium sulfate | 4-6 g IV loading over 15-20 min, then 1-2 g/h | Eclampsia (seizure prophylaxis and treatment) |
| Labetalol | 20-80 mg IV | Hypertensive emergency in pregnancy |
| Hydralazine | 5-10 mg IV every 20 min | Hypertensive emergency in pregnancy |
| Oxytocin | 10-40 units in 500 mL NS IV infusion (titrated) | Postpartum hemorrhage |
Key Clinical Pearls:
- Epinephrine is the most universal emergency drug - it treats cardiac arrest (IV), anaphylaxis (IM), and is used as a vasopressor (infusion)
- In cardiac arrest, give epinephrine every 3-5 minutes; give amiodarone for shock-refractory VF/pulseless VT
- Atropine is no longer recommended for asystole or PEA - only for symptomatic bradycardia
- Always give thiamine before dextrose in alcoholic or malnourished patients to prevent precipitating Wernicke's
- Succinylcholine (1.5 mg/kg) remains first-line RSI paralytic; use rocuronium (1.2 mg/kg) when succinylcholine is contraindicated (hyperkalemia, burns, crush injuries >24-48 h, denervation injury)
- For SVT with stable hemodynamics: adenosine 6 mg rapid IV push is first-line; for unstable SVT: synchronized cardioversion
(Sources: Tintinalli's Emergency Medicine 9e; Rosen's Emergency Medicine 9e; Miller's Anesthesia 10e; Barash's Clinical Anesthesia 9e)
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