You’re staring at a patient. They’re gray. Their breathing sounds like a bag of potato chips being crushed in a dark room. Your preceptor is looking at you, waitng. This is where the textbook meets the pavement. When people search for emt drugs and doses, they usually want a tidy list to memorize for the NREMT, but the reality of the streets is a lot messier. You aren’t just memorizing numbers; you’re managing chaos with a limited toolkit.
Most people think EMTs carry a pharmacy. We don't. At the Basic level, your options are narrow, but they’re high-impact. It’s basically a game of "can I stop this person from crashing before we hit the ER doors?" Honestly, the "dose" part is often the easy bit—it's the "when" and "why" that trips people up. If you give a vasodilator to someone who is already bottoming out their blood pressure, you're not helping. You're accelerating a disaster.
The Big Six: EMT Drugs and Doses You'll Actually Give
Let's talk about Oxygen first. People forget it’s a drug. It is. We used to slap a non-rebreather mask on everyone like it was a welcoming gift. Now, the American Heart Association and most state protocols, like those in New York or California, tell us to chill out. If their pulse ox is 94% or higher, they probably don't need it. But if they're struggling? Start low with a nasal cannula at 2 to 6 liters per minute. If they look like they’re drowning, crank that NRB up to 15 liters. Just don't over-oxygenate your stroke patients; high O2 levels can actually cause vasoconstriction in the brain, which is the last thing you want when a clot is already causing trouble.
Then there’s Oral Glucose. It’s basically cake frosting in a tube. You give the whole tube, which is usually 15 grams. But here’s the catch: they have to be able to swallow. If they’re unconscious and you squeeze that into their mouth, you’ve just created an airway obstruction. Not a good look.
Aspirin is the unsung hero of the chest pain call. We give 324 milligrams. That’s four "baby" aspirins at 81mg each. You tell them to chew it. Don't let them swallow it whole with water. Chewing gets it into the bloodstream faster to stop platelets from sticking together. It’s not about the pain; it’s about stopping a clot from getting bigger.
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Why Epinephrine is the Scariest Five Seconds of Your Shift
Epi is the heavy hitter. For an adult in anaphylaxis, the dose is 0.3mg. For a kid, it’s 0.15mg. We use the 1:1,000 concentration. It feels like magic. One minute they’re closing up, the next they’re breathing. But your heart rate will be just as high as theirs because you’re basically injecting liquid adrenaline.
Check the lateral thigh. Keep it away from veins. Hold it for ten seconds—or whatever your specific autoinjector brand says. Some of the newer ones only need three seconds. Read the labels. It matters.
The Nitroglycerin Nuance
Nitro is tricky. Most EMT-Basics can only assist with a patient’s own prescribed Nitro. The dose is 0.4mg, usually a sublingual spray or a tiny tablet that dissolves under the tongue. You can repeat it every 5 minutes, up to three times total.
But you have to check the BP. If that systolic pressure is under 100 (or 120 in some picky jurisdictions), Nitro is a no-go. And please, for the love of everything, ask them if they’ve taken Viagra or Cialis in the last 24 to 48 hours. If they have, and you give them Nitro, their blood pressure will fall off a cliff. You can't fix that in the back of an ambulance.
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Albuterol and the "Shake and Bake"
Asthma calls are bread and butter for EMS. You’re looking at a Small Volume Nebulizer (SVN) or a Metered Dose Inhaler (MDI). The standard dose is 2.5mg of Albuterol in 3ml of saline. Set the O2 flow to 6-8 liters to get a good mist. If the patient is shaking afterward, that's normal. Albuterol is a "sympathomimetic." It mimics the sympathetic nervous system. It opens the lungs but also makes the heart race.
Narcan: The Drug Everyone Asks About
Naloxone has changed the game. In many places, EMTs carry the 4mg intranasal spray. It’s simple. Stick it up a nostril and push. But don't be a hero and give too much too fast. You want them breathing, not necessarily jumping off the stretcher ready to fight you. Chronic users who get slammed with 4mg of Narcan go into instant, violent withdrawal. Start with one nostril. Give it a minute. If they start taking deep breaths, you’ve won. You don't need them awake and screaming; you just need them not dead.
Real World Limitations
It's important to realize that protocols change. What works in a rural volunteer squad in Maine might be totally different from what a high-volume medic unit in Chicago does. Always defer to your local Medical Director. They’re the ones whose license you’re technically using.
Also, documentation is your shield. If you gave 324mg of Aspirin, you better write down the exact time. "Administered 324mg ASA PO per protocol at 14:02." If you didn't write it, you didn't do it. That’s the rule in court, and it’s the rule in the QA office.
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- Aspirin: 324mg (4 x 81mg tablets), chewed.
- Oral Glucose: 1 tube (approx 15g), patient must be conscious.
- Nitroglycerin: 0.4mg sublingual, every 5 mins (max 3 doses), BP must be >100 systolic.
- Epinephrine: 0.3mg for adults, 0.15mg for peds (IM injection).
- Naloxone: 2mg to 4mg intranasal.
- Albuterol: 2.5mg via nebulizer.
Actionable Steps for Mastering EMT Pharmacology
First, stop trying to memorize a giant spreadsheet. Instead, group these drugs by what they actually do to the body. Understand that Aspirin is an anti-platelet, not a painkiller in this context. Know that Epinephrine works on both Alpha and Beta receptors—it squeezes blood vessels and opens airways.
Second, practice the physical act of administration. If you’re using an autoinjector, practice the "swing and firm push" motion until it’s muscle memory. If you're assisting with Nitro, practice checking a blood pressure manually in a loud, moving vehicle. If you can't get an accurate BP, you can't safely give the drug.
Third, keep a "cheat sheet" in your pocket or on the back of your clipboard. Even the pros do it. When the adrenaline hits during a pediatric arrest or a massive anaphylactic reaction, your brain will dump half of what you learned in class. Having the emt drugs and doses written down in plain sight prevents math errors that could cost a life.
Finally, always do a "cross-check" with your partner. "I’m giving 0.3mg of Epi 1:1,000 for systemic anaphylaxis, do you agree?" It takes two seconds. It prevents 100% of "oops" moments. Use your partner. Use your protocols. Stay calm. The drugs work if you give the right amount at the right time.