QV/07.06Reference

Drugs

Every drug in ACM by who may give it - self aid, the lifesaver, the medic - what it does, and what not to mix.

G1ReferenceSkill levels

Each level may give its own drugs and every drug below it.

Level	Who	Drugs
1	Self aid and buddy aid	Paracetamol
2	CLS	Penthrox, naloxone, ammonia, ATNA, midazolam
3	Medic	All vials, fentanyl lozenge, epinephrine autoinjector
Not issued		Morphine autoinjector

G2ReferenceLevel 1: Self aid and buddy aid

Level 1 gives paracetamol and nothing else.

Paracetamol

Drug	Dose	Onset	Peak	Lasts	Strength
Paracetamol	1 to 2 pills	Under 4 min	About 15 min	About 50 min	Weak

10 pills per pack.
No effect on heart rate, blood pressure or breathing.
Tell CLS how many you took or gave.

G3ReferenceLevel 2: CLS

Level 2 adds everything that is pre-dosed: inhalers, sprays and autoinjectors.

Penthrox inhaler Naloxone spray Ammonia inhalant ATNA autoinjector Midazolam autoinjector

Drug	Uses	Dose	Onset	Peak	Lasts	Heart rate	Blood pressure
Penthrox inhaler	8	1 to 5 uses	Under 3 s	Under 90 s	About 4 min	Down
Naloxone spray	1	1 to 2 uses	Under 3 s	About 2 min	About 6 min
Ammonia inhalant	8	1 use	Under 3 s	Under 6 s	Under 40 s	Up	Up strongly
ATNA autoinjector	1	2 to 3 injections to start	Under 15 s	About 10 min	About 15 min	Up strongly	Up
Midazolam autoinjector	1	1 injection	Under 30 s	About 15 min	About 20 min	Down	Down

Penthrox:

Moderate pain relief. The only step up from paracetamol at this level.
Do not use it with a chest injury, slow breathing, low blood volume or altered mental status.

Naloxone:

Give it to any casualty in cardiac arrest or with falling saturation who has had morphine or fentanyl.
It wears off in about 6 minutes. Opioids last 15 to 30. Watch and re-dose.

Ammonia inhalant:

Only for an unconscious casualty with stable vitals. It does not fix the reason they are out.

ATNA and midazolam:

ATNA treats nerve agent. Midazolam stops the seizures. See the CBRN guide.

QV/07.06/G4Level 3: Medic

BX-4.1ReferenceDrawing and giving

Vial drugs are drawn into a syringe, then given IV or IM. Volume to draw is dose divided by concentration.

5 ml syringe

Epinephrine Amiodarone Lidocaine TXA Calcium chloride Morphine Fentanyl Ketamine Ondansetron Ertapenem Atropine Esmolol Adenosine

Syringes come in 1, 3, 5 and 10 ml.
IV drugs need an IV or IO in place first. IM drugs need no access.
IV acts faster than IM for every drug that offers both.
Dose by patient weight. Weight is fixed per player in multiplayer and random on AI.
More than the dose range adds side effects, not benefit.

Fixed doses:

Drug	Dose	Concentration	Draw
Epinephrine	1 mg	1 mg/ml	1 ml
Amiodarone	300 mg	50 mg/ml	6 ml, two vials
Lidocaine, IV or IM	100 mg	20 mg/ml	5 ml
TXA	1 g	100 mg/ml	10 ml
Calcium chloride	1 g	100 mg/ml	10 ml
Ertapenem	1 g	312.5 mg/ml	3.2 ml
Ondansetron	4 mg	2 mg/ml	2 ml
Atropine, nerve agent	2 mg	1 mg/ml	2 ml, two vials
Adenosine	6 mg	3 mg/ml	2 ml

Weight doses, worked for an 80 kg patient:

Drug	Route	Range per kg	Dose at 80 kg	Draw
Morphine	IV	0.05 to 0.1 mg	4 to 8 mg	0.8 to 1.6 ml
Morphine	IM	0.07 to 0.1 mg	5.6 to 8 mg	1.1 to 1.6 ml
Fentanyl	IV	0.5 to 1 mcg	40 to 80 mcg	0.8 to 1.6 ml
Fentanyl	IM	0.7 to 1 mcg	56 to 80 mcg	1.1 to 1.6 ml
Ketamine	IV	0.1 to 0.2 mg	8 to 16 mg	0.16 to 0.32 ml
Ketamine	IM	0.4 to 0.8 mg	32 to 64 mg	0.64 to 1.28 ml
Lidocaine	IV	1 mg, max 3 mg	80 mg, max 240 mg	4 ml, max 12 ml
Esmolol	IV	0.25 to 0.5 mg	20 to 40 mg	2 to 4 ml

BX-4.2ReferencePain

Ketamine if breathing is impaired or the chest is injured, otherwise morphine or fentanyl.

Drug	Vial	Onset IV / IM	Peak IV / IM	Lasts IV / IM	Strength	Vitals
Morphine	10 mg / 2 ml	Under 25 s / under 2 min	15 / 20 min	21 / 30 min	Strong	Lowers heart rate, blood pressure, breathing
Fentanyl	100 mcg / 2 ml	Under 10 s / under 30 s	14 / 15 min	16 / 20 min	Very strong	Lowers heart rate, blood pressure, breathing
Ketamine	500 mg / 10 ml	Under 5 s / under 20 s	9 / 10 min	11 / 15 min	Strong	None
Fentanyl lozenge	1 lozenge	Under 2 min	10 min	15 min	Very strong	Lowers breathing most

Fentanyl lozenge: the casualty must be conscious and lying down.
Consider ondansetron 4 mg after ketamine.
IM lidocaine 50 to 100 mg before fracture realignment or thoracostomy.

BX-4.3ReferenceCardiac

Epinephrine for every arrest, plus amiodarone or lidocaine when the rhythm is shockable.

Drug	Route	Vial	Dose	Onset	Peak	Lasts	Vitals
Epinephrine	IV, IM	1 mg / 1 ml	1 mg	Under 5 s IV, under 30 s IM	4 min	6 to 7 min	Raises heart rate, blood pressure, breathing
Amiodarone	IV	150 mg / 3 ml	300 mg, max 2200 mg	Under 10 s	8 min	12 min	Lowers heart rate, blood pressure
Lidocaine	IV	100 mg / 5 ml	1 mg/kg, max 3 mg/kg	Under 5 s	6 min	10 min	Lowers heart rate, blood pressure
Atropine	IV, IM	1 mg / 1 ml	1 mg for slow heart rate	Under 5 s IV, under 15 s IM	10 min	15 min	Raises heart rate
Esmolol	IV	100 mg / 10 ml	0.25 to 0.5 mg/kg	Under 20 s	4 min	5 min	Lowers heart rate
Adenosine	IV	12 mg / 4 ml	6 mg	Under 1 min	25 s	Under 2 min	Lowers heart rate

From the cardiac arrest study:

Treatment	Average time to pulse
CPR only, asystole	1:37
Epinephrine 1 mg, asystole	0:47
Morphine 5 mg on board, asystole	3:57
Amiodarone 300 mg, VF, shocked	0:52
Lidocaine 100 mg, VF, shocked	0:57

Epinephrine is the only drug that helps in asystole.
Amiodarone only works at 300 mg.
Lidocaine is one vial and one 5 ml syringe, so it is faster to give than amiodarone.
Atropine corrects a slow heart rate after amiodarone.

BX-4.4ReferenceBleeding, blood and the rest

Drug	Route	Vial	Dose	Onset	Lasts	When
TXA	IV	1 g / 10 ml	1 to 2 g	Under 15 s	15 min	Severe bleeding, bruising, bleeding hemothorax
Calcium chloride	IV	1 g / 10 ml	1 g	Under 15 s	10 min	After the first unit of blood, then after every 4 units
Ondansetron	IV, IM	4 mg / 2 ml	4 mg, max 8 mg	Under 15 s IV, under 45 s IM	12 to 15 min	Nausea and vomiting, after ketamine
Ertapenem	IV, IM	1 g / 3.2 ml	1 g	Under 5 s IV, under 30 s IM	15 to 20 min	Wound infection. Before casualty conversion if the mission requires it
Atropine	IV, IM	1 mg / 1 ml	2 to 4 mg to start	Under 5 s IV, under 15 s IM	15 min	Nerve agent

TXA strengthens clots, inside and out. It lowers blood pressure slightly.
A unit of blood is 500 ml. Skipping calcium ends in a casualty who cannot clot.
Epinephrine autoinjector: 1 use, IM, lasts about 7 minutes, raises heart rate, blood pressure and breathing. The wiki lists no use for it. The unit medication notes list anaphylaxis.

G5ReferenceDo not mix

Rule	Why
No amiodarone and lidocaine within 5 to 10 minutes of each other	Heart rate drops to the 40s, with hypoxia
No second amiodarone dose within 5 to 10 minutes	Same
No opioids with low blood volume, slow heart rate, slow breathing, chest injury or altered mental status	They lower all three vitals
Naloxone for any arrest with opioids on board	Opioids more than double time to pulse
No Penthrox with a chest injury or slow breathing	Lowers heart rate
Calcium chloride never IM	Unit medication notes
No calcium chloride in ventricular fibrillation	Unit medication notes
No epinephrine with a very fast heart rate or high blood pressure	It raises both
No esmolol, adenosine, amiodarone or midazolam with a slow heart rate	They lower it further
Morphine autoinjector not issued	Unit medication notes: 10 mg is the lethal dose in ACM. The wiki lists it as a 5 mg equivalent

The wiki and the unit medication notes disagree on some doses. This guide uses the wiki's numbers. Where the notes differ: fentanyl IM 2 mcg/kg, morphine 5 to 8 mg, epinephrine lasting 16 to 20 minutes.

The Quiver

Drugs

QV/07.06/G4Level 3: Medic