All Emergencies - Basic life support principles:

  1. Maintain an airway
  2. Assess breathing
  3. Monitor circulation
Monitor and record all vital signs.
Drugs & Dosages

Romazicon (Flumazenil)
Adults (for reversal of sedation):
Initial dose – administer 0.2 mg.  
     For IV – administer over 15 seconds
     For sublingual – administer slowly
Repeat doses (maximum 4 doses):
     If desired level of consciousness is not achieved, 0.2 mg may be repeated at 1- minute intervals IV
Usual dose:  0.6 – 1.0 mg.
Onset:   80% response within 3 minutes, peak effect 6-10 minutes
Duration of action:  Approximately one hour. Reversal effects normally wear off before effects of benzodiazepine
In the event of re-sedation, repeat doses may be given at 20 minute intervals, with a  maximum of 1 mg/dose and 3 mg/hour.


Epinephrine 1:10,000
For anaphylaxis, pulseless arrest
For IV use: Administer entire syringe (1 mg)
For PEA: 1 mg IV push, repeat q3-5 min (or better - use Vasopressin)
For anaphylaxis: I.V. administration only in severe reactions
(true anaphylaxis): 3-5 mL 1:10,000 solution I.V.
May repeat in 10-20 minutes, if necessary


Epinephrine 1:1,000
For anaphylaxis, pulseless arrest
For sub-Q use, administer entire ampule
If used IV, must dilute 1:10 with saline
Avoid using epinephrine in a patient with uncontrolled hyperthyroid


Spray in nostril before inserting nasal airway


Bronchodilator - for asthma, Bronchospasm:
2-4 puffs initially; may be repeated in 10-20 minutes


For bronchial asthma, congestive heart failure
IV 250-500 mg slowly over 20-30 minutes
IM 500 mg


Amyl Nitrate
For angina
Crush, have patient inhale. Provides vasodilation within about 10 seconds.
Shelf life of amyl nitrate is longer than nitroglycerin tablets, but the duration of action is shorter
Sides effects occur with all vasodilators, but are more likely with amyl nitrate than nitroglycerin


Atropine Sulfate
For bradycardia, avoid w/glaucoma
Administer only if patient has hypotension and bradycardia
Usual adult dose 1 mg, maximum dose 3 mg
IV, IM or Sub-Q


If myocardial infarction is suspected
Chew and Swallow
Avoid if allergic to aspirin, bleeding disorder, stomach problems


Benadryl (Diphenhydramine)
For anaphylaxis: use epinephrine first
10 - 50 mg IV or deep IM, 100 mg. if required.
Max. dose is 400 mg.


Dextrose 50%
For hypoglycemia. Administer 30 ml bolus if patient unconscious
Stock 1-2 vials 30 ml


Vasopressor - Ephedrine
Note: Sedation dentists should have a second vasopressor in their drug kit besides epinephrine. Ephedrine & Phenylephrine will both work, and included here together for your choice
For bronchial asthma (won't raise blood pressure like epinephrine), acute bronchospasm, or for hypotension related to sedation/analgesia
IM or Sub-Q: 25-50 mg, parenteral adult dose should not exceed 150 mg in 24 hours
IV: 5-25 mg/dose, slow IV push, repeat q5-10 minute as needed, then q3-4h. Do not exceed 150 mg/24 hours.


Have patient swallow
Repeat in 10 minutes if no response


Lidocaine 2% HCL
Administer entire ampule IV in pulseless arrest algorithm


For seizures – Vial is 5 mg/1ml
Adults:  1 mg titrated slowly to effect
Up to 1 mg/minute, until seizure activity ceases.
Note: Only professionals specifically trained in managing apneic patients should administer anticonvulsants. EMS personnel are trained to administer these drugs.


Narcotic reversal agent. 0.4 mg/ml - small ampules 1 ml, Large vial 10 ml.
I.V.: 0.4 - 2.0 mg; may be repeated at 2- to 3-minute intervals up to 10 mg;
I.M. or S.C. administration may be used if I.V. administration is not possible, but response may be delayed
If required, be prepared to support breathing for patient.
Large doses may precipitate hypertension, severe pain, arrhythmias or pulmonary edema.


Nitro-Quik Tabs - 0.4 mg/tab
Administer sub-lingually. When tablets have proper potency, a bitter taste and sting will be present.
Dose may be repeated every 5 minutes, for up to 3 doses in 15 minutes.
Discard bottle 12 weeks after bottle is opened.
Alternative: Amyl nitrite inhalant


Nitro-Stat Spray
Spray directly on the tongue, do not inhale the spray. Do not shake the spray before or during use.
Have the patient close their mouth immediately after the spray.
Dose is typically 1 spray every 5 minutes, up to 3 times.
Angina pain should be alleviated within 2 minutes with nitroglycerin


Ondansetron (brand name Zofran)
For nausea/vomiting, and as preventive agent to avoid nausea and vomiting – Vial is 2 mg/ml, 20 ml vial .
Adults: For rescue:  1 mg
For prevention:  4 mg pre-op. (oral or IV)


Phenergan Injection
For nausea, administer IM or IV
I.M., I.V.: 25 mg, may repeat in 2 hours when necessary;
Switch to oral route as soon as feasible


For shock, adrenal insufficiency
Use IV in emergency, administer entire vial,
Inject over a period of one or more minutes.