EMT Medication Administration
EMTs have a limited but critical medication formulary. The NREMT expects you to know the indications, contraindications, dosages, routes, and side effects for every medication in the EMT scope of practice. Medication questions frequently appear as scenario-based problems requiring you to choose the correct drug, dose, and route based on patient presentation.
Aspirin (ASA)
Indication: Suspected acute coronary syndrome (chest pain of suspected cardiac origin)
Dose: 324 mg (four 81 mg chewable tablets) administered orally. Instruct the patient to chew, not swallow whole.
Contraindications: Known aspirin allergy, active GI bleeding, recent surgery with risk of bleeding. Do not administer if the patient has already taken aspirin.
Mechanism: Aspirin inhibits platelet aggregation, reducing clot formation in coronary arteries. It does not dissolve existing clots but prevents them from growing.
Epinephrine Auto-Injector
Indication: Severe allergic reaction (anaphylaxis) with signs of respiratory distress or cardiovascular compromise
Dose: Adult: 0.3 mg IM via auto-injector in the lateral thigh. Pediatric (under 66 pounds): 0.15 mg IM via pediatric auto-injector
Contraindications: None in a true anaphylactic emergency. The benefit always outweighs the risk.
Side effects: Tachycardia, palpitations, anxiety, tremor, headache, nausea. These are expected and not a reason to withhold the medication.
Mechanism: Epinephrine is a sympathomimetic that causes bronchodilation, vasoconstriction, and increased cardiac output, directly counteracting the pathophysiology of anaphylaxis.
Nitroglycerin
Indication: Chest pain of suspected cardiac origin in patients who have been prescribed nitroglycerin
Dose: 0.4 mg sublingual tablet or spray. May repeat every 5 minutes up to 3 doses total (including any doses the patient took before EMS arrival).
Contraindications: Systolic blood pressure below 100 mmHg, heart rate below 50 or above 100, suspected right ventricular infarction, phosphodiesterase inhibitor use within 24-72 hours (sildenafil, tadalafil, vardenafil), head injury with increased ICP
Side effects: Hypotension, headache, tachycardia. Monitor blood pressure before each dose.
Oral Glucose
Indication: Altered mental status with a history of diabetes and suspected hypoglycemia
Dose: One tube (approximately 15-25 g) administered orally between the cheek and gum
Contraindications: Inability to swallow, unconsciousness (aspiration risk), inability to protect airway
Key point: The patient must be able to swallow and have an intact gag reflex. If the patient is unresponsive, do not administer oral glucose.
Naloxone (Narcan)
Indication: Known or suspected opioid overdose with respiratory depression
Dose: 2 mg intranasal (1 mg per nostril) or 0.4 mg IM/IN depending on protocol
Contraindications: Known hypersensitivity (extremely rare)
Key points: Naloxone may precipitate acute withdrawal in opioid-dependent patients, potentially causing agitation, vomiting, and combative behavior. Titrate to respiratory effort rather than full consciousness when possible. Duration of action is shorter than most opioids, so reassess frequently for recurrent respiratory depression.
Assisted Medications
EMTs may also assist patients with their own prescribed medications including metered-dose inhalers (albuterol for asthma/COPD) and epinephrine auto-injectors. Always verify the medication is prescribed to the patient, check the expiration date, and confirm the dose before assisting with administration.