Meds & Pharma

This is not a milligram book. It is how to think about EMS drugs: rights, concentration traps, and high-risk agents — atropine vs pacing, calcium for hyperK ECG toxicity, bicarb that is not routine, glucagon when there is no IV, TXA, oxytocin — with protocol and medical direction owning the dose.

Lessons

Suggested order

Twenty-nine modules in this path. Progress is saved on this device after you pass a quiz.

1
Medication Rights & Safety CultureClosed-loop habits that catch errors.
2
Weight-Based Dosing Safetykg → mg/kg → concentration → volume.
3
Fentanyl for Pain ManagementLife threats first, monitor breathing.
4
Epinephrine: Anaphylaxis & ArrestIndication, concentration, route.
5
Naloxone: Smart UseRestore ventilation — not maximal agitation.
6
Ketamine in the FieldProtocol-only potent tool with airway vigilance.
7
Push-Dose PressorsTemporary bridge only when authorized.
8
Aspirin in ACSACS picture, no dissection/bleed/allergy — aspirin per protocol, chewed.
9
Nitroglycerin CautionsNitro only with a BP, a 12-lead when you can, and no PDE5 / RV-infarct caution.
10
Benzodiazepines in the FieldRight indication, ready airway, protocol dose only — benzos are not universal sedation candy.
11
Albuterol & BronchodilatorsAsthma/COPD bronchodilation. Not for stridor. HyperK shift is a second, protocol-only use.
12
Dextrose: D10 FramingOral if they can swallow. IV D10 titration beats a D50 slam. Recheck glucose and mentation.
13
Magnesium: Three Field UsesEclampsia first-line. Torsades. Some severe asthma. Not a universal VT drug. Watch breathing.
14
Tranexamic Acid in TraumaAfter life-saving interventions. Clinical hemorrhagic shock. No later than 3 hours. Protocol owns dose.
15
Amiodarone & Lidocaine in ArrestAfter shocks fail in VF/pVT. Amio or lido — AHA does not prefer one. Not a PEA drug.
16
Atropine in the FieldBradycardia atropine ≠ nerve-agent atropine. Do not delay TCP in complete block.
17
Calcium for HyperK ECG ToxicityCalcium for ECG toxicity. Shift/remove per protocol. Not for every peaked T.
18
Sodium Bicarbonate FramingRoutine arrest bicarb is out. TCA wide-complex and selected hyperK remain protocol uses.
19
Glucagon When There Is No IVGlucagon is plan B for hypo without IV. Alcoholic/empty glycogen may not respond. Recheck.
20
Ipratropium With AlbuterolIpratropium is an add-on neb for severe bronchospasm. Not a solo anaphylaxis plan.
21
Ondansetron in the FieldAntiemetic after the red-flag screen. QT caution. Protocol owns the dose and route.
22
Oral Analgesics in the FieldOral analgesics are not a consolation prize. They are not for the vomiting hypotensive trauma patient.
23
Activated Charcoal FramingCharcoal is optional, time-sensitive, airway-dependent. Poison center / protocol.
24
Oxytocin in Postpartum HemorrhagePPH atony: massage ± oxytocin per protocol. Ectopic/undelivered bleeding is not an oxytocin call.
25
Diphenhydramine CautionsNot first-line anaphylaxis. Anticholinergic load. Beers-list caution in older adults.
26
Hydroxocobalamin for Smoke CyanideClosed-space smoke + coma/shock/arrest: O₂, airway, hydroxocobalamin per protocol. Not a CO-oximeter substitute.
27
Dexamethasone & Field SteroidsCroup, asthma/COPD, adrenal: steroid per protocol. Never instead of epinephrine.
28
Diltiazem in AF with RVRStable narrow irregular: diltiazem per protocol. Unstable: cardiovert. Wide irregular: never.
29
Droperidol & Haloperidol in the FieldSevere agitation: glucose, airway plan, then the protocol antipsychotic. Watch QT. Do not stack blindly.