Knowing Your Dosages — Top 10 Most Common Dosages You Absolutely Have to Know on the National Registry Exam, Plus 3 Frequently Forgotten Dosages

Host 1: Welcome back. Today is all about dosages. The top ten most common dosages you absolutely have to know for the National Registry exam, plus three that people frequently forget.

Host 2: By EMT Tutor, sponsored by Forrest Munden and EMT Tutor. I train people for the National Registry exam.

Host 1: This is education, not medical direction. Follow your local protocols.

Host 2: And that matters more today than any other episode, because doses are exactly where your local protocol can be different from the textbook. So here's how we're doing it. When we say AHA, that's the 2025 American Heart Association guidelines, ACLS and PALS. When AHA doesn't give a dose, we'll fall back on the National Model EMS Clinical Guidelines or standard National Registry level teaching, and we'll tell you when we're doing that.

Host 1: Perfect. Let's go. Number one. Epinephrine in adult cardiac arrest.

Host 2: AHA says one milligram IV or IO, every three to five minutes. That's the one milligram per ten milliliter concentration, point one milligrams per mL.

Host 1: And the timing question. For a non-shockable rhythm, asystole or P E A, AHA says give epi as soon as possible. For a shockable rhythm, V fib or pulseless V tach, you prioritize defibrillation, and epi comes after the initial shocks haven't worked.

Host 2: And the trap here is concentration. Your arrest epi is the point one milligram per mL. The one milligram per mL concentration is what you use for IM in anaphylaxis. Mixing those up is a dangerous error, and the exam knows it.

Host 1: Number two. Amiodarone in arrest.

Host 2: AHA says first dose three hundred milligrams IV or IO bolus. Second dose one-fifty.

Host 1: And that's for V fib or pulseless V tach that doesn't respond to defibrillation. Not asystole. Not P E A.

Host 2: And while we're on amiodarone, the stable wide complex tachycardia dose is different. AHA says one-fifty milligrams over ten minutes, repeat as needed if V tach recurs. So three hundred is the arrest dose, one-fifty slow is the pulse dose.

Host 1: Number three. Adenosine.

Host 2: AHA says six milligrams rapid IV push, follow it with a normal saline flush. If that doesn't work, twelve milligrams.

Host 1: And the technique is part of the question. Rapid push, as close to the heart as you can get, usually an antecubital vein, followed immediately by a flush. Adenosine has a very short half-life, so if you push it slowly, it's gone before it gets there.

Host 2: And warn your patient. That feeling of impending doom for a few seconds is normal. And remember from the stumpers episode, adenosine is for regular, narrow complex rhythms, and for a regular monomorphic wide rhythm. Not for an irregular, wide, very fast rhythm that could be pre-excited A fib.

Host 1: Number four. Atropine for symptomatic bradycardia.

Host 2: AHA says first dose one milligram IV bolus. Repeat every three to five minutes, maximum total dose three milligrams.

Host 1: And that's a change people miss. Older materials said point five milligrams. The current AHA dose is one milligram.

Host 2: And atropine might not work in some patients, like heart transplant patients or high-degree blocks. If it doesn't work, AHA says move to transcutaneous pacing or an infusion, which we'll hit in the forgotten section.

Host 1: Number five. Epinephrine for anaphylaxis.

Host 2: This is IM, into the lateral thigh, using the one milligram per mL concentration. The standard weight-based dose is point zero one milligrams per kilogram. Maximum single dose is point five milligrams for an adult, and point three milligrams for a child. That dosing comes from standard anaphylaxis guidance like the National Model EMS Clinical Guidelines.

Host 1: And the auto-injectors are point three milligrams for adults and point one-five for smaller children.

Host 2: And if the patient isn't improving, the dose can be repeated, commonly in about five to fifteen minutes, per your protocol. Don't hold epi in anaphylaxis because you're worried about the heart rate. It's the first-line drug.

Host 1: Number six. Aspirin for suspected acute coronary syndrome.

Host 2: AHA says one-sixty-two to three-twenty-five milligrams, non-enteric coated, chewed. A lot of systems use four baby aspirin, which is three-twenty-four milligrams.

Host 1: And the reason for chewing is speed. It gets absorbed faster. The contraindications to watch for are a true aspirin allergy and active bleeding, per your protocol.

Host 2: Number seven. Nitroglycerin.

Host 1: Point four milligrams sublingual, tablet or spray. Repeat every five minutes, up to three doses, if the pain continues and the pressure holds.

Host 2: And the holds are the real test question. Systolic under ninety, or a big drop from baseline, commonly thirty or more below. A suspected right ventricular infarct. And phosphodiesterase inhibitors. Sildenafil or vardenafil in the last twenty-four hours, tadalafil in the last forty-eight.

Host 1: Number eight. Glucose and dextrose for hypoglycemia.

Host 2: For a patient who's awake and can swallow, AHA first aid guidance says about fifteen to twenty grams of oral glucose.

Host 1: And for the patient who can't swallow safely, it's IV dextrose. The AHA doesn't print a prehospital dextrose dose, so this is protocol territory. A very common adult dose is twenty-five grams, which is fifty mL of D fifty, or two-fifty mL of D ten, often given in smaller increments and rechecked.

Host 2: Recheck the glucose after you treat it. And watch that IV site. Dextrose that leaks out of the vein can damage tissue, which is one reason a lot of systems moved to D ten.

Host 1: Number nine. Naloxone.

Host 2: AHA doesn't give an exact naloxone dose either, so here we lean on the National Model EMS Clinical Guidelines. Point four to two milligrams IV, IM, or intranasal, and the intranasal devices are commonly four milligrams.

Host 1: And the goal is the part that gets tested. You titrate to adequate breathing. Not to waking them up swinging.

Host 2: And BLS before ALS again. If they're not breathing well, you bag them first. AHA says for suspected opioid overdose with a pulse but abnormal breathing, support ventilation, and naloxone is reasonable. If they're in cardiac arrest, high quality CPR comes first, and naloxone does not replace it.

Host 1: Number ten. Pediatric cardiac arrest drugs.

Host 2: AHA PALS says epinephrine point zero one milligrams per kilogram IV or IO. That's point one mL per kilogram of the point one milligram per mL concentration. Maximum single dose one milligram. Every three to five minutes.

Host 1: And amiodarone for shock-refractory V fib or pulseless V tach in kids is five milligrams per kilogram bolus, and it can be repeated up to three total doses. Lidocaine is the alternative, one milligram per kilogram.

Host 2: And the energy, even though it's not a drug, always comes up with these. AHA says first shock two joules per kilogram, second shock four joules per kilogram, and subsequent shocks four or more, up to ten joules per kilogram or the adult dose.

Host 1: Okay. The three frequently forgotten dosages. Forgotten number one. Lidocaine in adult arrest.

Host 2: People memorize amiodarone and forget lidocaine is right there in the same AHA box as the alternative. First dose one to one and a half milligrams per kilogram. Second dose point five to point seven-five milligrams per kilogram.

Host 1: Forgotten number two. Pediatric adenosine.

Host 2: AHA says point one milligram per kilogram rapid push, maximum first dose six milligrams. Second dose point two milligrams per kilogram, maximum twelve. Same rapid push and flush technique.

Host 1: And notice the maximums are just the adult doses. That's an easy way to remember it.

Host 2: Forgotten number three. The bradycardia infusions. When atropine fails.

Host 1: AHA says dopamine at five to twenty micrograms per kilogram per minute, or epinephrine at two to ten micrograms per minute. Titrate to the patient's response.

Host 2: And the trick is the units. Dopamine is weight based. Micrograms per kilogram per minute. Epi infusion for bradycardia is not weight based in adults. It's just micrograms per minute. The exam loves to swap those.

Host 1: Alright, let's run it back fast. Arrest epi, one milligram every three to five. Amio, three hundred then one-fifty. Adenosine, six then twelve. Atropine, one milligram, max three. Anaphylaxis epi, point zero one per kilo IM, max point five adult. Aspirin, one-sixty-two to three-twenty-five chewed. Nitro, point four every five, up to three. Oral glucose fifteen to twenty grams. Naloxone, titrate to breathing. And peds epi, point zero one per kilo.

Host 2: Plus lidocaine, peds adenosine, and the bradycardia infusions.

Host 1: And one last time. Your local protocols and your medical director decide what you actually give in the field. Know the AHA numbers for the test, and know your protocol book for the street.

Host 2: By EMT Tutor, sponsored by Forrest Munden and EMT Tutor. I train people for the National Registry exam.

Host 1: This is education, not medical direction. Follow your local protocols. See you next time.