Reference — Emergency Respiratory Care
Respiratory Emergency Medications
The drugs an RT administers or assists with in a respiratory emergency — intramuscular epinephrine for anaphylaxis, nebulized epinephrine for airway edema, bronchodilators and magnesium for severe bronchospasm, naloxone for opioid-induced hypoventilation, and the inhaled and code agents to know — with their indication and key cautions.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Overview
This is a quick reference to the emergency medications most relevant to respiratory care, with the indication, the typical adult route, and the key RT caution. Doses follow institutional protocol and current guidelines; this table is for orientation, not for order-writing. Real emergencies are run against current ACLS and departmental protocols under physician orders — this page orients you to the agents, it does not replace them.
Emergency Medications
| Drug | Emergency Indication | Route / Note | Key Caution |
|---|---|---|---|
| Epinephrine (1 mg/mL) | Anaphylaxis (first-line) | IM anterolateral thigh, 0.3–0.5 mg, repeat every 5–15 min | Give immediately; no absolute contraindication in true anaphylaxis. |
| Nebulized epinephrine (racemic or 1 mg/mL) | Laryngeal edema, croup, post-extubation stridor | Nebulized | Watch for rebound; observe after dosing; tachycardia. |
| Albuterol (SABA) | Acute bronchospasm (asthma, COPD, anaphylaxis) | Nebulized or MDI; continuous in severe asthma | Tachycardia, tremor, hypokalemia. |
| Ipratropium (SAMA) | Severe bronchospasm (added to a SABA) | Nebulized with albuterol | Adjunct in acute severe asthma and COPD. |
| Magnesium sulfate | Severe or refractory asthma | IV (per orders) | Hypotension; an adjunct, not first-line. |
| Systemic corticosteroids | Asthma/COPD exacerbation, anaphylaxis (adjunct) | IV or PO | Slow onset (hours); does not treat the acute airway. |
| Naloxone | Opioid-induced respiratory depression | IV/IM/IN | Short duration - may need redosing; support ventilation first. |
| Oxygen (100%) | Hypoxemia, CO poisoning, any code | Non-rebreather or ETT | In chronic hypercapnia, titrate to SpO₂ 88–92%. |
| Epinephrine (IV/IO, code) | Cardiac arrest (ACLS) | IV/IO 1 mg every 3–5 min | Per the ACLS algorithm. |
| Amiodarone | Shock-refractory VF/pulseless VT | IV/IO (per ACLS) | Antiarrhythmic; recognize it in the code. |
Clinical Notes
- Anaphylaxis is an epinephrine emergency. In anaphylaxis, intramuscular epinephrine is the immediate life-saving drug; antihistamines and steroids are adjuncts that act too slowly for the airway.
- Naloxone wears off before the opioid does. Naloxone reverses opioid respiratory depression but is short-acting — keep ventilating and watch for re-sedation.
- Expect rebound after nebulized epinephrine. Nebulized (racemic) epinephrine reduces mucosal edema by vasoconstriction; observe for rebound after the effect wears off.
- Verify every dose against protocol and weight. Always confirm doses against current protocol and the patient’s weight (especially in pediatrics).
Related Resources
Sources
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. Emergency pharmacology and respiratory drugs chapters.
- Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S366-S468.