EMERGENCY

DRUG CARD - ADULT EMERGENCY DRUG CARD - ADULT EMERGENCY DRUG CARD - ADULT
RSI VASOPRESSORS AND INOTROPES OBSTETRICS
Etomidate Dobutamine Methergine
0.3 mg/kg (~20 mg) IV push over 30-60 sec; onset 10-20 sec 5-20 mcg/kg/min IV infusion Postabortal hemorrhage due to uterine atony: 0.2 mg IM
(Amidate) (Dobutrex) (Methylergonovine):
Lidocaine 2% Dopamine Postabortal hemorrhage due to uterine atony: routes include PO, SL,
1-2 mg/kg (~ 100 mg) IV push over 1 min (20mg=1mL) 5-20 mcg/kg/min IV infusion Misoprostol
(Xylocaine) (Intropin) buccal, vaginal, and rectal. Dose varies ~200-800 mcg. Consult OB/GYN
(Cytotec)
Rocuronium ACLS: 1 mg IV push every 3-5 min for institution specific dosing.
0.6-1.2 mg/kg (~70 mg) IV push; onset 1-2 min Epinephrine
(Zemuron) ETT: 2-2.5mg diluted in 10 ml of NS Threatened termination of pregnancy:
(Adrenalin) RhoGAM
Succinylcholine IV: 1-1.5 mg/kg (~100 mg) IV push over 10-30 sec; onset 30-60 sec Infusion: 0.02-0.5 mcg/kg/min IV > 13 weeks gestation: 300 mcg IM
(from Blood Bank)
(Anectine) IM: 3-4 mg/kg (max 150mg); onset 1-4 min < 13 weeks gestation: 50 mcg IM (300 mcg ok if 50 mcg not available)
Norepinephrine
Vecuronium
0.08-0.1 mg/kg (~10 mg) IV push; onset 2-3 min (Levophed)
0.01-0.3 mcg/kg/min IV infusion PSYCHIATRIC
(Norcuron) Haloperidol
Phenylephrine 2-10 mg IV/IM every 30 min
CARDIAC 10-200 mcg/min IV infusion (Haldol)
Cardiac Arrest (pulseless): 300 mg IV push, may repeat 150 mg IV push (Neo-Synephrine) Olanzapine 5-10 mg IM may repeat in 2 hours x 2 doses
Amiodarone in 3-5 min Vasopressin ACLS: 40 U IV push x 1 (Zyprexa) (max 30 mg/day)
(Cordarone) Wide complex tachycardia (stable): 150 mg IV over 10 min, then (Pitressin) Infusion: sepsis 0.01-0.04 units/min IV (0.6-2.4 units/hr) Ziprasidone 10-20 mg IM may repeat 10 mg dose in 2 hours or 20 mg dose in 4
1 mg/min infusion x 6 hours, then 0.5 mg/min infusion x 18 hrs (Geodon) hours (max 40 mg/day)
PUSH DOSE PRESSORS
Bolus: 0.25 mg/kg (~20 mg) IV bolus over 2 min, may repeat in 15 min MISCELLANEOUS
Diltiazem (1) Take a 10 ml syringe (2) Draw up 9 ml NS (3) Draw up 1 ml of
0.35 mg/kg (~25 mg) IV over 2 min Stroke: 0.9 mg/kg (not to exceed 90 mg), give 10% of dose as IV bolus
(Cardizem) epinephrine 1:10,000 (0.1 mg/ml)- this is the syringe used in ACLS
Infusion: 5-15 mg/hr IV Epinephrine followed by 90% over 1 hour
Esmolol Bolus: 500 mcg/kg IV push over 1 min (4) Label the syringe 10 mcg/ml Alteplase (rtPA)
10 mcg/ml PE (acute massive with pulses): 100 mg IV infusion over 2 hours
(Brevibloc) Infusion: 50-300 mcg/kg/min IV Dose: 5-20 mcg (0.5-2 ml) IV every 5-10 min (Activase)
PE (cardiac arrest only):
Bolus: 20 mg IV push over 2 min; may administer 40-80 mg at 10 min Duration: 5-10 min
50 mg IV push, repeat with 50 mg IV push in 15 minutes if no ROSC
Labetalol intervals; MAX 300 mg cumulative (1) Take a 10 ml syringe (2) Draw up 1 ml phenylephrine (10 mg/ml) Desmopressin Reversal of platelet dysfunction in patients on aspirin: 0.3 mcg/kg IV.
(Trandate) Infusion: 2 mg/min IV, titrate to response; Phenylephrine (2) Inject into a 100 ml bag NS- this bag now contains phenylephrine (DDAVP) Dilute in 50 ml NS and give over 15-30 minutes.
usual effective dose 50-200 mg; MAX 300 mg cumulative 100 mcg/ml 100 mcg/ml (3) Draw up into a 10 ml syringe (4) label 100 mcg/ml Factor VII 20-80 mcg/kg IV push over 3-5 min
Nicardipine Infusion: 2.5-15 mg/hr IV, increase by 2.5 mg/hr every (5) THROW away the 100 ml NS bag (NovoSeven) (use ideal body weight, dose depends on indication)
(Cardene) 5-15 min Dose: 50-200 mcg (0.5-2 ml) every 2-5 min
Heparin VTE: Bolus 80 U/kg IV, infusion 18 U/kg/h IV
ACLS: 20-50 mg/min IV until arrhythmia resolved, hypotension occurs, Duration: 2-5 min
(unfractionated) ACS: Bolus 60 U/kg IV (max 4000 U),infusion 12 U/kg/h (max 1000 U/h)
or QRS prolonged by 50% or total cumulative dose of 17 mg/kg is OVERDOSE/UNRESPONSIVE Octreotide Bolus: 25-50 mcg IV push over 3 min
Procainamide st
given 1 dose: 150 mg/kg IV over 1 hour (Sandostatin) Infusion: 25-50 mcg/hr IV
(Pronestyl) N-acetylcysteine nd
Loading Dose: 1 gram (or 17 mg/kg) IV over 30 min 2 dose: 50 mg/kg IV over 4 hours PCC
(Acetadote) rd Warfarin or new oral anticoagulant associated life-threatening bleeding:
Infusion: 1-4 mg/min IV 3 dose: 100 mg/kg IV over 16 hours (prothrombin - Profilnine or Bebulin (3 factor PCC): 25-50 unit/kg IV (IBW)
SEDATION AND ANALGESIA Dextrose 25-50 g slow IV push (Dextrose 50%) complex - FEIBA (Factor VIII Inhibitor Bypassing Activity/ activated PCC)
Bolus: 1mcg/kg IV Fomepizole concentrate) 25-50 units/kg; max rate 2 units/kg/min
Fentanyl Loading dose: 15 mg/kg IV over 30 min
Infusion: 25-150 mcg/hr IV, titrate to goal (Antizol) ***Check with - KCentra (4 factor PCC): max rate 200 units/min
IV: 0.5-2 mg/kg IV push over 1 min, may repeat with of dose every Lipid Emulsion pharmacy to see
Bolus: 1.5 ml/kg IV push over 1 min (may be repeated 1 to 2 times if Pre-treatment INR 2 - <4 4 6 >6
5-10 min PRN (Intralipid 20%) which products are
Ketamine persistent asystole) Dose (units/kg) 25 35 50
IM: 3-8 mg/kg IM ***Contact Poison available***
(Ketalar) Infusion: 0.25-0.5 ml/kg/min IV for 30-60 min Max dose (units) 2500 3500 5000
PO: 6-10 mg/kg (mix with cola, give 30 min. prior to procedure) Control Center***

Infusion: 2-80 mcg/kg/min IV Naloxone Bolus: 0.04-2 mg IV/IO/IM/SC/IN every 2 minutes to effect Single weight based bolus dose for STEMI
Bolus (Procedural sedation): (Narcan) IV Infusion: 2/3 effective bolus dose per hour <60 kg = 30 mg IV bolus over 5 seconds
Propofol 0.5-1 mg/kg IV push, may repeat with 0.5 mg/kg Tenecteplase 60-69 kg = 35 mg IV bolus over 5 seconds
Cardiac glycoside OD: (life threatening arrhythmias or hyperkalemia)
(Diprivan) every 3-5 min PRN (TNKase) 70-79 kg = 40 mg IV bolus over 5 seconds
- Empiric dosing (unknown level and severe toxicity): 10-20 vials
Infusion (sedation): 10-80 mcg/kg/min IV Digoxin Immune Fab 80-89 kg = 45 mg IV bolus over 5 seconds
- Acute ingestion, known quantity:
(DigiFab or Digibind) 90 kg = 50 mg IV bolus over 5 seconds
ELECTROLYTES vials = (0.8) x mg of digoxin ingested/(0.5)
Trauma hemorrhage: 1000 mg IV load over 10 mins followed by
Calcium gluconate Hyperkalemia: 1-3 grams IV push over 3-5 minutes - Known digoxin level: vials = digoxin level (ng/ml) x weight (kg)/100 Tranexamic acid
- Chronic toxicity: ~6 vials 1000 mg IV infusion over the next 8 hours
(peripheral IV) *** 3 gm calcium gluconate = 1 gm calcium chloride***
Prepared by: Amie Hatch, PharmD, BCPS and Jeremy Bair, PharmD, BCPS. Updated AUG 2013.
VASODILATORS This document presents an evidence-based approach that is appropriate for m ost patients. It should
Asthma: 2 g IV over 15-30 min
Nitroglycerin 10-300 mcg/min IV, increase by 5-10 mcg/min every 3-5 min be adapted to m eet the needs of individual patients and situations, and should not replace clinical judgment.
Pre-eclampsia: 4-6 g IV over 15-20 min, followed by infusion 1-2 g/h IV
Magnesium Sulfate
ACLS/torsades de pointes: pulseless 1-2 g IV push over 1 min, with Nitroprusside
pulse give dose over 15 min 0.2-8 mcg/kg/min IV, Increase by 0.5 mcg/kg/min every 3-5 min
(Nipride)
 EMERGENCY DRUG CARD - PEDIATRIC EMERGENCY DRUG CARD PEDIATRIC EMERGENCY DRUG CARD - PEDIATRIC
PALS VASOPRESSORS AND INOTROPES SEDATION AND ANALGESIA
Dobutamine IV: I mcg/kg IV
Adenosine Pediatric tachycardia with a pulse and poor perfusion: 0.1 mg/kg IV 5-20 mcg/kg/min IV
(Dobutrex) Fentanyl Intranasal: 1-2 mcg/kg (max 100 mcg) using the 50 mcg/ml
(Adenocard) rapid bolus (max 6 mg), second dose 0.2 mg/kg (max 12 mg) Dopamine concentration (no more than 1 ml/nare)
5-20 mcg/kg/min IV
(Intropin) Procedural sedation: 0.5-2 mg/kg IV push over 1 min, may repeat with
Cardiac Arrest (pulseless): 5 mg/kg IV/IO (max 300 mg), repeat twice
Amiodarone to a max of 15 mg/kg/day Epinephrine Ketamine of dose every 5-10 min PRN
0.05-1 mcg/kg/min IV
(Cordarone) Wide complex tachycardia (stable): 5 mg/kg IV over 20-60 minutes (Adrenalin) (Ketalar) IM: 3-8 mg/kg IM
(max 300 mg), may repeat to a max of 15 mg/kg/day Norepinephrine PO: 6-10 mg/kg (mix with cola, give 30 min. prior to procedure)
0.1-2 mcg/kg/min IV
(Levophed) Lorazepam
Pediatric bradycardia with pulse and poor perfusion: IV: 0.05-0.1 mg/kg IV
Atropine Phenylephrine Bolus: 5-20 mcg/kg/dose IV every 10-15 min (Ativan)
0.02 mg/kg (max dose 0.5 mg); May repeat once.
(Neo-Synephrine) Infusion: 0.1-0.5 mcg/kg/min IV Midazolam IV: 0.1 mg/kg IV
(Versed) Intranasal: 0.4 mg/kg (max 10 mg) using the 5 mg/ml concentration
20 mg/kg IV/IO (0.2 ml/kg) (max dose 2 g) Vasopressin
Calcium Chloride 10% Limited data Morphine IV: 0.1 mg/kg IV
For non-cardiac arrest, use calcium gluconate, push slowly (Pitressin)
Propofol Bolus (Procedural sedation):
SEIZURE (Diprivan) 0.5-1 mg/kg IV push, may repeat with 0.5 mg/kg every 3-5 min PRN
Diazepam rectal
0.5-1 g/kg (2-4 ml/kg) slow IV/IO push 0.2-0.5 mg/kg PR (may use IV solution PR) OVERDOSE/UNRESPONSIVE
Dextrose 25% (Valium)
(for newborns, use dextrose 10% 5-10 ml/kg) st
1 dose: 150 mg/kg IV over 1 hour
Fosphenytoin N-acetylcysteine nd
20 mg/kg IV over 20 minutes (no faster than 150 mg/min) 2 dose: 50 mg/kg IV over 4 hour
(Cerebyx) (Acetadote) rd
Epinephrine 1:10,000 Cardiac Arrest (pulseless): 0.01 mg/kg (0.1 ml/kg of 1:10,000 3 dose: 100 mg/kg IV over 16 hour
Levetiracetam
(Adrenalin) concentration) IV/IO every 3-5 min (max 1 mg) 20 mg/kg IV over 20 minutes Infants 6 months:
(Keppra)
0.25-0.5 g/kg/dose slow IV push
Lorazepam IV
0.1 mg/kg IV (max 2-4 mg max) (1-2 ml/kg/dose of D25 or 2.5-5 ml/kg/dose of D10)
Pulseless VT with torsades de pointes: 25-50 mg/kg (max 2 g) IV/IO (Ativan) Dextrose
Infants > 6 months and children:
Magnesium Sulfate Torsades de pointes with a pulse: 25-50 mg/kg IV, push slowly Midazolam intranasal 0.5-1 g/kg/dose slow IV push
0.2mg/kg IN (max 12 mg) using the 5 mg/ml concentration
Asthma: 25-50 mg/kg IV over 10-20 minutes (max single dose 2 g) (Versed) (2-4 ml/kg/dose of D25, 5-10 ml/kg/dose D10)
Benzodiazepine reversal: 0.01 mg/kg (up to 0.2 mg) IV over 15 seconds.
Pediatric tachycardia with a pulse and poor perfusion: 10-20 mg/kg IV (max dose 800 mg) IV over 20-60 min Flumazenil
Procainamide Phenobarbital May repeat 0.01 mg/kg (up to 0.2 mg) every min to max cumulative dose
15 mg/kg IV/IO over 30-60 minutes (see pharmacist for dilution recommendations) (Romazicon)
(Pronestyl) of 0.05 mg/kg or 1 mg.
Infusion: 20-80 mcg/kg/min VASODILATORS Fomepizole
Loading dose: 15 mg/kg IV over 30 min
1 mEq/kg slow IV/IO 0.25-0.5 mcg/kg/min, increase by 0.5-1 mcg/kg/min q 3-5 min (Antizol)
Sodium Bicarbonate Nitroglycerin Total reversal required: 0.1 mg/kg IV/IO/IM/SC/IN every 2 min PRN (max
(Use 4.2% concentration if < 5 kg) (max 20 mcg/kg/min) Naloxone
2 mg)
Nitroprusside (Narcan)
RSI 0.2-8 mcg/kg/min Infusion: 0.002-0.16 mg/kg/hr IV
(Nipride) MISCELLANEOUS
Etomidate
(Amidate)
0.3 mg/kg IV push over 30-60 sec; onset 10-20 sec ALLERGIC REACTIONS Alprostadil
Patent ductus arteriosus: 0.05-0.1 mcg/kg/min; once therapeutic
Dexamethasone (prostaglandin E1)
Lidocaine 2% IV or oral: 0.6 mg/kg (max 12 mg) (may use IV solution PO) response is achieved reduce rate to lowest effective dose. (i.e.reduce
1-2 mg/kg IV push over 1 min (20mg=1mL) (Decadron) (Prostin VR
(Xylocaine) dose from 0.1 to 0.05 to 0.025, etc.)
Pediatric)
Rocuronium Minor bleeding: 10-15 IU/kg IV push over 3-5 min
0.6-1.2 mg/kg IV push; onset 1-2 min Diphenhydramine
(Zemuron) 1-1.25 mg/kg IV (max 50 mg) Factor VIII Moderate bleeding: 10-30 IU/kg IV push over 3-5 min
(Benadryl)
Life-threatening bleeding: 30-50 IU/kg IV push over 3-5 min
Infants: 2 mg/kg IV push over 10-30 sec; onset 30-60 sec (Consider IM: 0.01 mg/kg (max 0.3 mg) every 5-15 minutes as needed
Succinylcholine atropine) Heparin
Epinephrine (1:1,000 concentration) VTE: Bolus 75 U/kg given over 10 min, infusion 15-20 U/kg/h
(Anectine) Children: 1-1.5 mg/kg IV push over 10-30 sec ( Consider atropine) (unfractionated)
Continuous infusion: 0.1-1 mcg/kg/min IV
IM: 3-4 mg/kg (max 150 mg); onset 1-4 min Ondansetron
Famotidine IV or oral: 0.15 mg/kg (max 4 mg)
0.25 mg/kg IV (Zofran)
Vecuronium (Pepcid)
0.1 mg/kg IV push; onset 2-3 min Prepared by: Amie Hatch, PharmD, BCPS and Jeremy Bair, PharmD, BCPS. Updated AUG 2013.
(Norcuron)
This document presents an evidence-based approach that is appropriate for m ost patients. It should
PSYCHIATRIC Methylprednisolone
IV: 1-2 mg/kg IV (max 125 mg) be adapted to m eet the needs of individual patients and situations, and should not replace clinical judgment.
(Solumedrol)

Haloperidol
(Haldol)
0.025-0.05 mg/kg per dose IV/IM Ranitidine
Oral: 2 mg/kg PO (max 150 mg)
(Zantac) IV: 0.5-1 mg/kg IV (max 50 mg)