Emergency Drug Card - Adult

Authors: Rob Bryant, MD, Amie Hatch, PharmD, BCPS, Jeremy Bair, PharmD
Updated: 9/11/2013

Emergency Drug Card (Adult)

Rapid Sequence Intubation

Drug Dose
Etomidate 0.3mg/kg (~20mg) IV push over 30-60 sec; onset 10-20 sec
Lidocaine 2% 1-2mg/kg (~100mg) IV push over 1min (20mg=1mL)
Rocuronium 0.6-1.2 mg/kg (~70mg) IV push; onset 1-2 min
Succinylcholine IV: 1-1.5 mg/kg (~100 mg) IV push over 10-30 sec; onset 30-60 sec
IM: 3-4 mg/kg (max 150 mg); onset 1-4 min
Vecuronium 0.08-0.1 mg/kg (~10mg) IV push; onset 2-3 min

Cardiac

Drug Dose
Amiodarone Cardiac Arrest (pulseless):300 mg IV push, may repeat 150 mg IV push in 3-5 min
Wide complex tachycardia (stable): 150 mg IV over 10 min, then 1 mg/min infusion x 6 hours, then 0.5 mg/min infusion x 18 hrs
Diltiazem Bolus: 0.25 mg/kg (~20mg) IV bolus over 2 min, may repeat in 15 min, 0.35 mg/kg (~25mg) IV over 2 min
Infusion: 5-15 mg/hr IV
Esmolol Bolus: 500 mcg/kg IV push over 1 min
Infusion: 50-300 mcg/kg/min IV
Labetalol Bolus: 20 mg IV push over 2 min; may administer 40-80 mg at 10 min intervals; MAX 300mg cumulative
Infusion: 2 mg/min IV, titrate to response; usual effective dose 50-200 mg; MAX 300 mg cumulative
Nicardipine Infusion: 2.5-15 mg/hr IV, increase by 2.5 mg/hr every 5-15 min
Procainamide ACLS: 20-50 mg/min IV until arrhythmia resolved, hypotension occurs, or QRS prolonged by 50% or total cumulative dose of 17mg/kg is given
Loading Dose: 1 gm (or 17 mg/kg) IV over 30 min
Infusion: 1-4 mg/min IV

Sedation & Analgesia

Drug Dose
Fentanyl Bolus: 1 mcg/kg IV
Infusion: 25-150 mcg/hr IV, titrate to goal
Ketamine IV: 0.5-2 mg/kg IV push over 1 min, may repeat with half dose every 5-10 min PRN
IM: 3-8 mg/kg IM
PO: 6-10 mg/kg (mix with cola, give 30 min prior to procedure)
Infusion: 2-80 mcg/kg/min IV
Propofol Bolus: (Procedural sedation) 0.5-1 mg/kg IV push, may repeat with 0.5 mg/kg every 3-5 min PRN
Infusion: (Sedation) 10-80 mcg/kg/min IV

Electrolytes

Drug Indication / Dose
Calcium Gluconate Hyperkalemia: 1-3 grams IV push over 3-5 minutes
Magnesium Sulfate Asthma: 2 grams IV over 15-30 min
Pre-eclampsia: 4-6 gm IV over 15-20 min, followed by infusion of 1-2 gm/hr IV
ACLS/torsades de pointes: Pulseless 1-2 gm IV push over 1 min, with pulse give dose over 15 min

Vasopressors & Inotropes

Drug Dose
Dobutamine 5-20 mcg/kg/min IV infusion
Dopamine 5-20 mcg/kg/min IV infusion
Epinephrine ACLS: 1 mg IV push every 3-5 min
ETT: 2-2.5 mg diluted in 10 ml of NS
Infusion: 0.02-0.5 mcg/kg/min IV
Norepinephrine 0.01-0.3 mcg/kg/min IV infusion
Phenylephrine 10-200 mcg/min IV infusion
Vasopressin ACLS: 40 Units IV push x1
Infusion: sepsis 0.01-0.04 units/min IV (0.6-2.4 units/hr)

Push Dose Pressors

Drug Dose
Epinephrine
  1. Take a 10 ml syringe
  2. Draw up 9 ml NS
  3. Draw up 1 ml of epinephrine 1:10,000 (0.1mg/ml) - this is the syringe used in ACLS
  4. Label the syringe 10 mcg/ml Dose: 5-20 mcg (0.5-2 ml) IV every 5-10 min Duration: 5-10 min
Phenylephrine
  1. Take a 10 ml syringe
  2. Draw up 1 ml phenylephrine (10 mg/ml)
  3. Inject into a 100 ml bag NS - this bag now contains phenylephrine 100 mcg/ml
  4. Draw up into a 10 ml syringe and label 100 mcg/ml
  5. THROW away the 100 ml NS bag
Dose: 50-200 mcg (0.5-2ml) every 2-5 min
Duration: 2-5min

Overdose / Unresponsive

Drug Dose
N-acetylcysteine 1st dose: 150 mg/kg IV over 1 hour
2nd dose: 50 mg/kg IV over 4 hours
3rd dose: 100 mg/kg IV over 16 hours
Dextrose 25-50 g slow IV push (Dextrose 50%)
Fomepizole Loading dose: 15 mg/kg IV over 30 min
Lipid Emulsion Bolus: 1.5 ml/kg IV push over 1 min (may be repeated 1 to 2 times if persistent asystole)
Infusion: 0.25-0.5 ml/kg/min IV for 30-60 min
Naloxone Bolus: 0.04-2 mg IV/IO/IM/SC/IN every 2 minutes to effect
Infusion: 2/3 effective bolus dose per hour
Digoxin Immune Fab Cardiac glycoside overdose: (life threatening arrhythmias or hyperkalemia)
  • Empiric dosing (unknown level and severe toxicity): 10-20 vials
  • Acute ingestion, known quantity: vials = (0.8) x mg of digoxin ingested / (0.5)
  • Known digoxin level: vials = digoxin level (ng/ml) x weight (kg) / 100
  • Chronic toxicity: ~6 vials

Vasodilators

Drug Dose
Nitroglycerin 10-300 mcg/min IV, increase by 5-10 mcg/min every 3-5 min
Nitroprusside 0.2-8 mcg/kg/min IV, increase by 0.5 mcg/kg/min every 3-5 min

OBSTETRICS

Drug Indication / Dose
Methergine Post abortal hemorrhage due to uterine atony: 0.2 mg IM
Misoprostol Post abortal hemorrhage due to uterine atony: routes include PO, SL, buccal, vaginal, and rectal. Dose varies ~200-800 mcg. Consult OB/GYN for institution specific dosing
RhoGAM Threatened termination of pregnancy:
>13 weeks gestation: 300 mcg IM
<13 weeks gestation: 50 mcg IM (300 mcg ok if 50 mcg not available)

Psychiatric

Drug Dose
Haloperidol 2-10 mg IV/IM every 30 min
Olanzapine 5-10 mg IM may repeat in 2 hours x 2 doses (max 30 mg/day)
Ziprasidone 10-20 mg IM may repeat 10 mg dose in 2 hours or 20 mg dose in 4 hours (max 40 mg/day)

Miscellaneous

Drug Dose
Alteplase (rtPA) Stroke: 0.9 mg/kg (not to exceed 90 mg), give 10% of dose as IV bolus followed by 90% over 1 hour
PE (acute massive with pulses): 100 mg IV infusion over 2 hours
PE (cardiac arrest only): 50 mg IV push, repeat with 50 mg IV push in 15 minutes if no ROSC
Desmopressin (DDAVP) Reversal of platelet dysfunction in patients on aspirin: 0.3 mcg/kg IV
Dilute in 50 ml NS and give over 15-30 minutes
Factor VII 20-80 mcg/kg IV push over 3-5 min (use ideal body weight, dose depends on indication)
Unfractionated Heparin Venous thromboembolism: Bolus 80 U/kg IV, infusion 18 U/kg/h IV
ACS: Bolus 60 U/kg IV (max 4000 U), infusion 12 U/kg/h (max 1000 U/h)
Octreotide Bolus: 25-50 mcg IV push over 3 min
Infusion: 25-50 mcg/hr IV
Tenecteplase Single weight based bolus dose for STEMI
  • <60 kg = 30 mg IV bolus over 5seconds
  • 60-69 kg = 35 mg IV bolus over 5 seconds
  • 70-79 kg = 40 mg IV bolus over 5 seconds
  • 80-89 kg = 45 mg IV bolus over 5 seconds
  • ≥90 kg = 50 mg IV bolus over 5 seconds
Tranexamic Acid (TXA) Trauma hemorrhage: 1 gram IV load over 10 mins followed by 1 gram IV infusion over the next 8 hours

Acknowledgements

Prepared by: Amie Hatch, PharmD, BCPS and Jeremy Bair, PharmD,BCPS. Updated AUG2013.

This document presents an evidence-based approach that is appropriate for most patients. It should be adapted to meet the needs of individual patients and situations, and should not replace clinical judgment.

References