2006-2007 San Diego County Als Drugs

Front 1

Normal Saline - Class

Back 1

Electrolyte / Isotonic Crystalloid

Front 2

Normal Saline - Actions

Back 2

Electrolyte solution which is equivalent osmotically to blood.

Increases the circulating volume of the vascular system. (2/3 of infused volume leaves vascular space within 1 hour)

Front 3

Normal Saline - Indications

Back 3

Definitive therapy or anticipated
___________________________

Shock Hypovolemia

Shock Normovolemia: anaphylactic, neurogenic

Suspected intra-abdominal catastrophe or aortic aneurysm

Anaphalaxis
___________________________

Shock: Cardiogenic or Septic

Dysrhythmias
___________________________

Crush injury with extended entrapment = or > 2 hrs or extremity or torso
___________________________

Burn patients with = or > 20% 2nd degree or = or > 5% 3rd degree
___________________________

Respiratory distress with croup-like cough

Front 4

Normal Saline - Dosage / Route

for

Definitive therapy or anticipated

Back 4

ADULT & PEDS:

IV SO; adjust prn

Front 5

Normal Saline - Dosage / Route

for

Shock Hypovolemia

Shock Normovolemia: anaphylactic, neurogenic

Suspected intra-abdominal catastrophe or aortic aneurysm

Anaphalaxis

Back 5

ADULT:

IV 500ml bolus; MR to maintain BP 90 systolic

PEDS "non-cardiogenic":

IV/IO per drug chart; MR to maintain BP = or > [70+(2xAge)]

Front 6

Normal Saline - Dosage / Route

for

Shock: Cardiogenic or Septic

Dysrhythmias

Back 6

ADULT:

IV bolus to max 250ml with clear lungs; MR to maintain BP 90 systolic

PEDS"cardiogenic":

IV/IO per drug chart with clear lungs; MR x1 to maintain BP = or > [70+(2xAge)]

Front 7

Normal Saline - Dosage / Route

for

Crush injury with extended entrapment = or > 2 hrs or extremity or torso

Back 7

ADULT:

IV 1000ml bolus when extremity released - BHO

PEDS:

IV per drug chart when extremity released - BHO

Front 8

Normal Saline - Dosage / Route

for

Burn patients with = or > 20% 2nd degree or = or > 5% 3rd degree

Back 8

ADULT:

= or > 15 y/o - 500ml/hr then TKO

PEDS:

5-14 y/o - 250ml/hr then TKO
<5 y/o - 150ml/hr then TKO

Front 9

Normal Saline - Dosage / Route

for

Respiratory distress with croup-like cough

Back 9

ADULT & PEDS:

5ml via nebulizer

Front 10

Normal Saline - Contras

Back 10

Rales for fluid boluses

Front 11

Normal Saline - Side Effects

Back 11

None

Front 12

Normal Saline - Concentration

Back 12

1000ml - 10gtts/ml

or

250ml - 60gtts/ml

Front 13

Normal Saline - Special Information

Back 13

Contents of 0.9% solution:

- 154MEQ NA/Liter
- 154MEQ CL/Liter
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Flow Rates:

- 18G=80ml/min wide open (maxi tubing)
- 14G=160ml/min wide open (maxi tubing)
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TKO:

- MAXI - 1gtt/12sec OR 5gtts/min
- MINI - 1gtt/2sec OR 30gtts/min

Front 14

Albuterol - Alternative Names

Back 14

Proventil, Ventolin

Front 15

Albuterol - Class

Back 15

Sympathomimetic

Front 16

Albuterol - Actions

Back 16

Activates the beta-2 adrenergic receptors to relax bronchial smooth muscles.

Bronchodilation, relieves bronchospasms, and reduces airway resistance.

ONSET - 5 min
PEAK - 1 hour
DURATION - 3-4 hours

Front 17

Albuterol - Indications

Back 17

Respiratory distress with Bronchospasms:
- Respiratory origin
- Allergic reaction
- Burns

Front 18

Albuterol - Dosage / Route

Back 18

ADULT:

6ml (0.083%) via nebulizer; MR

PEDS:

Per drug chart via nebulizer; MR

Front 19

Albuterol - Contras

Back 19

None

Front 20

Albuterol - Side Effects

Back 20

Tachycardia / Palpitations
Dizziness / Headache
Tremors / Nervousness

Front 21

Albuterol - Concentration

Back 21

2.5mg / 3ml

Front 22

Albuterol - Special Information

Back 22

Handheld mouthpiece - 4-6L O2

Mask or ET Tube - 6-10L O2

Use with caution in pregnancy

Check lung sounds, o2 sat and resp rate before and after administration.

Front 23

Atrovent - Alternative Names

Back 23

Ipratropium Bromide

Front 24

Atrovent - Class

Back 24

Anticholinergic

Front 25

Atrovent - Actions

Back 25

Antagonizes the action of acetylcholine preventing the interacton with muscarinic receptors in bronchial smooth muscle causing bronchodilation.

Bronchodilation, site specific (in lung - not systemic)

ONSET - 15-30 min
PEAK - 1-2 hrs
DURATION - 4-5 hrs

Front 26

Atrovent - Indications

Back 26

Respiratory distress with Bronchospasms:
- Respiratory origin
- Allergic reaction
- Burns

Front 27

Atrovent - Dosage / Route

Back 27

ADULT:

2.5 (0.02%) via nebulizer added to first dose Albuterol

PEDS:

Per drug chart via nebulizer added to first dose of Albuterol

Front 28

Atrovent - Contras

Back 28

None

Front 29

Atrovent - Side Effects

Back 29

Nausea
GI Distress
Nervous / Dizzyness
Headache
Palpitations
Blurred Vision / Eye irritation (with direct contact of mist)

Front 30

Atrovent - Concentration

Back 30

0.5mg / 2.5ml (0.02% unit dose vial)

Front 31

Atrovent - Special Information

Back 31

Handheld mouthpiece - 4-6L O2
Mask / ET Tube - 6-10 O2

Avoid direct contact with eyes, consider using mouthpiece instead of mask.

Administer even with patient self-administration prior to medic arrival.

Check lung sounds, o2 sat and resp rate before and after administration.

Front 32

Versed - Alternate Names

Back 32

Midazolam

Front 33

Versed - Class

Back 33

Benzodiazepine

Front 34

Versed - Actions

Back 34

CNS Depressant

Produces retrograde amnesia, then sedation

Stops and prevents seizures

ONSET - IV=2-5min IM=15mins
DURATION - 1-4hrs

Front 35

Versed - Indications

Back 35

Seizures
- Generalized seizures lasting = or > 5mins
- Focal seizures with respiratory compromise
- Recurrent seizures without lucid interval
- Eclamptic seizures of any duration
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Precardioversion
- Conscious VT - Adult only
- SVT - Adult and Peds
- A-fib/flutter if rhythm refractory to Rx or symptoms are severe
___________________________

Pacemaker insertion with capture

Front 36

Versed - Dosage / Route

For

Seizures

Back 36

ADULT
0.1mg/kg slow IVP (1mg/min) to max of 5mg - SO
MR x1 in 10" - SO

If no IV
IM - Double the IV Dose

PEDS
Per Drug Chart IV/IM

Front 37

Versed - Dosage / Route

For

Precardioversion
- Conscious VT

Back 37

ADULT ONLY
1-5mg slow IVP (1mg/min) - SO
(if age = or > 60 consider lower dose with attention to age and hydration status)

Front 38

Versed - Dosage / Route

For

Precardioversion
- SVT

Back 38

ADULT
1-5mg slow IVP (1mg/min) - BHO (if age = or > 60 consider lower dose with attention to age and hydration status)

PEDS
Per drug chart slow IVP (1mg/min) - BHPO

Front 39

Versed - Dosage / Route

For

Precardioversion
- A-Fib/Flutter (if rhythm refractory to Rx or symptoms are severe

Pacemaker insertion with capture

Back 39

ADULT ONLY
1-5mg slow IVP (1mg/min) - BHPO
(if age = or > 60 consider lower dose with attention to age and hydration status)

Front 40

Versed - Contras

Back 40

None

Front 41

Versed - Side Effects

Back 41

Respiratory depression / Apnea
Drowsiness / Confusion
Hypotension

Front 42

Versed - Concentration

Back 42

5mg/1ml OR 10mg/2ml

Front 43

Versed - Special Information

Back 43

Give at 1mg/min rate for IVP

No pinching tube, give with TKO rate

Discontinue if seizure stops

Some patients respond to as little as 1mg

Monitor respiratory rate and O2 sat, especially with ETOH or other sedatives, CNS depressants.

Used for amnesia effect not sedation

Controlled substance