ALS Medication: Buprenorphine-Naloxone, Calcium Chloride

• Medications detailed here are for ALS (Advanced Life Support) unless stated otherwise.

Buprenorphine-Naloxone (Suboxone ®) - Adult

• Used for opioid withdrawal when the Clinical Opioid Withdrawal Scale score is ≥ 8.
• Initial dose: 16 mg/4mg sublingual.
• Repeat dose: 8 mg/2mg sublingual after 10 minutes if the patient remains symptomatic.
• Maximum total dose: 24 mg/6mg.

Calcium Chloride - Adult (Base Hospital Order Only)

• Indications include Calcium Channel Blocker Poisonings and cardiac arrest
• Cardiac arrest with suspected hypocalcemia, hyperkalemia, hypermagnesemia, or calcium channel blocker poisoning is to be treated.
• Also indicated for End-Stage Renal Disease (ESRD) patients on dialysis with suspected hyperkalemia and hemodynamic instability presenting with documented sinus bradycardia, 3rd degree AV Block, 2nd degree Type II AV Block, slow junctional and ventricular escape rhythms, or slow atrial fibrillation.
• Dosage: 1 gm (10 ml of a 10% solution) IV/IO.

Calcium Chloride - Pediatric (Base Hospital Order Only)

• Indication: Calcium Channel Blocker Poisonings.
• Dosage: 20 mg/kg IV/IO over 5 minutes.

Dextrose - Adult (LALS, ALS)

• Indication: Hypoglycemia in adults with blood glucose less than 80 mg/dL.
• Dosage: Dextrose 10% /250 ml (D10W 25 gm) IV/IO bolus.

Dextrose - Pediatric (LALS, ALS)

• Indication: Hypoglycemia in neonates (0 - 4 weeks) with blood glucose less than 35 mg/dL, or pediatric patients (more than 4 weeks) with glucose less than 60 mg/dL.
• Dosage: Dextrose 10%/250 ml (D10W 25 gm) 0.5 gm/kg (5 ml/kg) IV/IO.

Diazepam - Pediatric (ALS)

• Only when midazolam is not commercially available.
• Indication: Seizures.
• Dosage: 0.1mg/kg IV/IO, single dose only, not to exceed adult dose of 5mg.
• Dosage: 0.2mg/kg IM, single dose only, not to exceed adult dose of 10mg.

Diphenhydramine - Adult (ALS)

• Dosage: 25 mg IV/IO.
• Dosage: 50 mg IM.

Diphenhydramine - Pediatric (ALS)

• Indication: Allergic reaction in patients 2 years to 14 years.
• Dosage: 1 mg/kg slow IV/IO, not to exceed adult dose of 25 mg, or
• Dosage: 2 mg/kg IM not to exceed adult dose of 50 mg IM.

Guidance for Buprenorphine-Naloxone use in opioid withdrawal based on COWS score. Calcium Chloride indications cover poisonings, cardiac arrest, and specific conditions in ESRD patients on dialysis.