This study guide focuses on medications and dosages relevant to paramedics, aligned with the National Registry of Emergency Medical Technicians (NREMT) scope of practice, American Heart Association (AHA) Basic Life Support (BLS) guidelines, and Advanced Cardiovascular Life Support (ACLS) guidelines for 2025 (current as of 2026). Information is compiled from official AHA sources and national EMS standards. Note that NREMT testing emphasizes national scope, which includes administration of various medications via multiple routes, but specific dosages may vary by local protocols. Always refer to local EMS protocols and the latest AHA updates for clinical use. The guide is organized into sections for BLS, ACLS, and additional paramedic-level medications commonly included in NREMT preparation. Dosages are for adults unless specified; pediatric dosages require weight-based calculations (e.g., via length-based tape). For closed-ended math questions (e.g., dosage calculations), reasoning is provided transparently.
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BLS focuses on basic interventions, including limited medications for lay rescuers and EMS providers. Paramedics may administer these at ALS levels (e.g., IV routes). Updates emphasize early access and integration with CPR.
| Medication | Class | Indications | Dosages | Notes/2025 Updates |
|---|---|---|---|---|
| Aspirin | Antiplatelet | Suspected acute coronary syndrome (ACS) with chest pain. | 162-325 mg chewed (non-enteric-coated), adult loading dose. | Give the loading dose even if the patient already takes daily aspirin (2025 ACC/AHA ACS guideline). Confirm no contraindications (e.g., true allergy, active bleeding). |
| Epinephrine (Auto-Injector) | Vasopressor/Adrenergic Agonist | Severe anaphylaxis or allergic reaction. | 0.3 mg IM (adult); 0.15 mg IM (pediatric <30 kg). | For BLS, auto-injector preferred; paramedics may use IV/IO in advanced scenarios. No major 2025 changes. |
| Naloxone | Opioid Antagonist | Suspected opioid overdose with respiratory or cardiac arrest. | 2-4 mg IN (intranasal) or IM; repeat as needed without delaying CPR. | New 2025: Recommended for lay rescuers and EMS in suspected overdose; distribute via public programs. No harm if not opioid-related; prioritize CPR. |
| Oral Glucose | Carbohydrate | Hypoglycemia (blood glucose <70 mg/dL) in conscious patients. | 15-20 g PO (e.g., gel or tablets). | For BLS; paramedics may use IV dextrose if unconscious. No 2025 changes. |
ACLS includes advanced interventions for cardiac arrest, arrhythmias, and peri-arrest conditions. Key updates: Prioritize IV/IO access; epinephrine timing refined; uncertain benefit for some antiarrhythmics. Dosages from adult cardiac arrest algorithm and guidelines.
| Medication | Class | Indications | Dosages | Notes/2025 Updates |
|---|---|---|---|---|
| Epinephrine | Vasopressor | Cardiac arrest (all rhythms); symptomatic bradycardia/hypotension if atropine fails. | Cardiac arrest: 1 mg IV/IO every 3-5 min. Bradycardia: 2-10 mcg/min infusion or push-dose (10-20 mcg IV boluses). | 2025: For shockable rhythms, give after initial defibrillation fails; for non-shockable, as soon as possible. Improves ROSC but not long-term outcomes. No high-dose routine use. |
| Amiodarone | Antiarrhythmic | Refractory VF/pVT; stable wide-complex tachycardia (e.g., VT). | VF/pVT: 300 mg IV/IO bolus (first); 150 mg (second). Stable VT: 150 mg IV over 10 min, repeat if VT recurs, then 1 mg/min for the first 6 h. | AHA 2025: amiodarone or lidocaine may be considered for shock-refractory VF/pVT; neither is preferred. |
| Lidocaine | Antiarrhythmic | Refractory VF/pVT (alternative to amiodarone); stable monomorphic VT. | VF/pVT: 1-1.5 mg/kg IV/IO (first); 0.5-0.75 mg/kg (second). Stable VT: 1-1.5 mg/kg IV. | 2025: Similar to amiodarone for short-term survival; less effective for stable VT. Max total 3 mg/kg. |
| Atropine | Anticholinergic | Symptomatic bradycardia (first-line). | 1 mg IV/IO every 3-5 min (max 3 mg). | AHA 2025 bradycardia algorithm dose is 1 mg (older guidelines used 0.5 mg). If ineffective: transcutaneous pacing or an epinephrine (2-10 mcg/min) or dopamine (5-20 mcg/kg/min) infusion. |
| Adenosine | Antiarrhythmic | Stable narrow-complex SVT; diagnostic for wide-complex tachycardia. | 6 mg rapid IV push; second dose 12 mg if needed (AHA 2025). | Follow each dose with a rapid saline flush. For regular narrow-complex tachycardia; in stable wide-complex tachycardia only if regular and monomorphic. Never for irregular or polymorphic wide-complex rhythms. |
| Dopamine | Vasopressor/Inotrope | Symptomatic bradycardia/hypotension (second-line after atropine). | 5-20 mcg/kg/min IV infusion. | Titrate to effect; no major 2025 changes. |
| Magnesium Sulfate | Electrolyte/Antiarrhythmic | Torsades de pointes (polymorphic VT with long QT). | 1-2 g IV over 5-60 min. | 2025: For torsades; correct electrolytes. No routine use in arrest. |
| Calcium (e.g., Calcium Chloride) | Electrolyte | Hyperkalemia-induced arrest; calcium channel blocker overdose. | 1 g IV/IO (10% solution). | 2025: Not routine in arrest; indicated for special circumstances (e.g., hyperkalemia). Trend toward harm in general use. |
| Sodium Bicarbonate | Buffer | Hyperkalemia, metabolic acidosis in prolonged arrest; tricyclic overdose. | 1 mEq/kg IV/IO. | 2025: Not routine; potential benefit in PEA/asystole but needs trials. For special cases. |
| Procainamide | Antiarrhythmic | Stable monomorphic VT; refractory SVT (pediatric). | 20-50 mg/min IV until the arrhythmia is suppressed, hypotension occurs, QRS widens >50%, or 17 mg/kg is reached; then 1-4 mg/min. Avoid with prolonged QT or CHF (AHA 2025). | 2025: Uncertain benefit in VF/pVT; reasonable for stable VT. Infuse slowly to avoid hypotension. |
| Sotalol | Antiarrhythmic | Stable monomorphic VT; refractory SVT (pediatric). | 1.5 mg/kg IV over 5 min. | Not in the AHA 2025 adult tachycardia algorithm (removed); use only per local protocol. Avoid with prolonged QT. |
| Diltiazem | Calcium Channel Blocker | Rate control in AF/flutter or stable NCT. | 0.25 mg/kg IV bolus over 2 min; then 5-10 mg/h infusion. | AHA 2025: a beta-blocker or calcium channel blocker for stable narrow-complex tachycardia (no preference stated). Avoid in decompensated heart failure, hypotension and pre-excited AF (WPW). |
| Verapamil | Calcium Channel Blocker | Rate control in stable NCT. | 0.075-0.15 mg/kg IV over 2 min. | 2025: Similar to diltiazem; avoid in wide-complex or heart failure. |
| Beta-Blockers (e.g., Metoprolol, Esmolol) | Beta-Adrenergic Blocker | Rate control in AF/flutter; polymorphic VT (non-long QT). | Metoprolol: 2.5-5 mg IV (up to 3 doses). Esmolol: 500 mcg/kg bolus, then 50-300 mcg/kg/min. | 2025: Uncertain benefit in VF/pVT; for acute coronary syndromes. |
| Digoxin | Cardiac Glycoside | Rate control in AF/flutter (adjunctive). | 0.25 mg IV (repeat to max 1.5 mg/24 h). | 2025: Slow onset; caution in renal impairment. |
Per National EMS Scope of Practice Model (2019 with 2021 changes) and Education Standards, paramedics administer a broad range of medications for emergencies (e.g., pain, seizures, respiratory). List based on common NREMT-tested meds from sources like REMSA and quizlet; dosages are general (adult) and may require local adjustment. Focus on acute use.
| Medication | Class | Indications | Dosages | Notes |
|---|---|---|---|---|
| Acetaminophen | Analgesic/Antipyretic | Mild-moderate pain, fever. | 1 g IV/PO (adult); 15 mg/kg (pediatric). | Contraindications: Liver failure. Max 4 g/24 h. |
| Albuterol | Bronchodilator | Asthma/COPD exacerbation. | 2.5 mg nebulized; repeat prn. | Often combined with ipratropium. |
| Activated Charcoal | Adsorbent | Poisoning/overdose (non-caustic). | 50 g PO (adult); 1 g/kg (pediatric). | Shake well; risk of aspiration. |
| Dextrose | Carbohydrate | Hypoglycemia (unconscious). | 25 g IV (50% solution, adult); 0.5-1 g/kg (pediatric). | Use 10% for pediatrics to avoid hypertonicity. |
| Diazepam | Benzodiazepine | Seizures; sedation. | 5-10 mg IV/IM (adult); 0.2-0.5 mg/kg (pediatric). | For status epilepticus. |
| Diphenhydramine | Antihistamine | Allergic reactions; dystonia. | 25-50 mg IV/IM/PO (adult). | |
| Fentanyl | Opioid Analgesic | Severe pain. | 50-100 mcg IV/IM/IN (adult); 1-2 mcg/kg (pediatric). | Monitor respiration. |
| Glucagon | Hormone | Hypoglycemia (no IV access); beta-blocker overdose. | 1 mg IM (adult). | |
| Ipratropium | Anticholinergic Bronchodilator | Asthma/COPD (with albuterol). | 0.5 mg nebulized. | |
| Ketamine | Dissociative Anesthetic | Pain; sedation; excited delirium. | 1-2 mg/kg IV (analgesia); 4-5 mg/kg IM (sedation). | Emerging for agitation. |
| Lorazepam | Benzodiazepine | Seizures; anxiety. | 2-4 mg IV/IM (adult). | Alternative to diazepam. |
| Midazolam | Benzodiazepine | Seizures; sedation. | 2-5 mg IV/IM/IN (adult); 0.1-0.2 mg/kg (pediatric). | Versatile routes. |
| Morphine | Opioid Analgesic | Severe pain; ACS. | 2-5 mg IV (adult). | Titrate; monitor BP. |
| Nitroglycerin | Vasodilator | ACS chest pain; hypertension. | 0.4 mg SL every 5 min (max 3); paste 1-2 inches topical. | Contraindications: SBP <90 mmHg, suspected RV infarct, sildenafil or vardenafil within 24 h, tadalafil within 48 h. |
| Ondansetron | Antiemetic | Nausea/vomiting. | 4 mg IV/IM/ODT (adult). | |
| Oxygen | Gas | Hypoxemia or respiratory distress; cardiac arrest and immediately after ROSC. Not routine for every emergency. | Titrate device and flow to the target (nasal cannula through NRB/BVM). | ACS: only if SpO2 <90% (2025 ACC/AHA). Post-ROSC: 100% until SpO2 is reliable, then 90-98% (AHA 2025). Other conditions: follow your local protocol target. |
| Thiamine | Vitamin | Wernicke's encephalopathy (alcoholics with altered mental status). | 100 mg IV/IM. | |
| Tranexamic Acid (TXA) | Antifibrinolytic | Massive hemorrhage (trauma). | 1 g IV over 10 min. | Within 3 hours of injury. |
Question: Calculate epinephrine dose for a 70 kg pediatric patient in bradycardia (infusion rate: 0.1 mcg/kg/min).
Solution: First, convert to mcg/min: 0.1 mcg/kg/min × 70 kg = 7 mcg/min. To arrive: Multiply rate by weight (0.1 × 70 = 7). For infusion setup (e.g., 1 mg in 250 mL = 4 mcg/mL), rate = 7 mcg/min ÷ 4 mcg/mL × 60 min/h = 105 mL/h (drip rate).