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35 Cards in this Set

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Activated Charcoal
INDICATIONS:
Management of poisoning or overdose of many substances.

CONTRAINDICATIONS:
A. Patients with altered mental status or the inability to maintain their own airway.
B. Patients who have aspirated or with a potential for aspiration.
POISONING OR OVERDOSE: 1.0 g/kg PO or NG

PEDIATRIC: Same as adult
Adenosine (Adenocard®)
INDICATIONS:
PSVT (To convert PSVT to a normal sinus rhythm)

CONTRAINDICATIONS:
A. Second or third degree heart block.
B. Sick Sinus Syndrome
C. Known hypersensitivity
D. Atrial fibrillation
PSVT: 6 mg followed by 12 mg X 2 if needed, RAPID IV

PEDIATRIC: 1.0 mg/kg followed by 2.0 mg/kg if needed, RAPID IV
Albuterol (Ventolin®)
INDICATIONS:
A. Bronchial asthma and reversible bronchial spasm that occurs with chronic
obstructive pulmonary disease.
B. Hyperkalemia.

CONTRAINDICATIONS:
None in the prehosptial setting.
RESPIRATORY DISTRESS: 2.5 mg Nebulized, repeat as needed

HYPERKALEMIA: 10 mg Nebulized

PEDIATRIC: Same as adult
Amiodarone (Cordarone®)
INDICATIONS:
A. V-FIB, Pulseless V-Tach.
B. Ventricular tachycardia with pulses.

CONTRAINDICATIONS:
None in cardiac arrest.
V-FIB / PULSELESS V-TACH: 300 mg, repeat once at 150 mg, IV/IO

V-TACH w PULSE: 150 mg IV/IO

PEDIATRIC: 5.O mg/kg and 2.5 mg/kg, IV/IO
Aspirin
INDICATIONS:
Unstable angina and acute myocardial infarction
(indicated in patients with suspected ischemic chest pain.)

CONTRAINDICATIONS:
A. Allergy to aspirin or aspirin induced asthma.
B. History of bleeding disorder (i.e. hemophilia)
C. Current ulcer or GI bleeding.
D. Suspected aortic dissection.
CARDIAC CHEST PAIN (AMI): 324 mg, PO

PEDIATRIC: NOT INDICATED FOR PEDIATRIC PTS!
Atropine Sulfate
INDICATIONS:
A. Bradycardia (increase heart rate)
B. Second and third degree heart block (improve conduction)
C. PEA / Asystole
D. Insecticide exposures (e.g. anti-cholinesterases, organophosphates)
and nerve gas exposure.
E. For bradycardia not due to hypoxia when using Succinylcholine.

CONTRAINDICATIONS:
A. Atrial fibrillation and atrial flutter (increased conduction may speed
ventricular rate excessively.)
B. Not used in neonatal resuscitation.
BRADYCARDIA: 0.5 mg - 1.0 mg, IV/IO
(every 3-5 min. Max -3 mg IV)

PEA /ASYSTOLE: 1.0 mg IV/IO, 2.0 mg ET,
(every 3-5 min. Max -3 mg IV, 4 mg ET)

ORGANOPHOSPHATES: 1.0 - 2.0 mg, IV/IO

PEDIATRIC: 0.02 mg/kg, do not exceed adult dosing
(Min dose 0.1 mg)
Calcium Gluconate
INDICATIONS:
A. Suspected Calcium Channel Blocker overdose.
B. Hyperkalemia.
*also: treatment of Hydrogen Fluoride exposure

CONTRAINDICATIONS:
A. Hypercalcemia and hypercalciuria (hyperthyroidism, Vitamin D overdose, bone
metastases).
B. Patients on Digoxin
HYPERKALEMIA / CALCIUM CH. BLOCKER O.D: 10 ml, slow IV over 5-10 min

PEDIATRIC: 0.5 ml/kg, slow IV over 5-10 min ( max dose 10 ml)
Dexamethasone (Decadron®)
INDICATIONS:
A. Moderate to severe asthma/COPD
B. Severe allergic reaction.
C. Croup

CONTRAINDICATIONS:
Do not use in patients with known hypersensitivity to corticosteroids.
RESP. DISTRESS, SEVERE ALLERGIC RXN / ANAPHYLAXIS: 10 mg IV/IO, IM, or PO.

PEDIATRIC: 0.3 mg/kg IV, IO, IM or PO.
Dextrose 50%
INDICATIONS:
A. Hypoglycemia
B. Unconscious patient when history is unobtainable.

CONTRAINDICATIONS:
None
HYPOGLYCEMIA (ALTERED MENTAL STATUS): 25 g (50 cc) slow IV

PEDIATRIC DOSING * (may repeat once)
Patients greater than 10 kg: 1 ml / kg of D50% (max of 50 ml.)

Patients less than 10 kg: 2 ml / kg of D25%
Diphenhydramine (Benedryl ®)
INDICATIONS:
A. The second-line drug in anaphylaxis and severe allergic reactions (after epinephrine).
B. To counteract acute dystonic and dysphoric reactions to anti-psychotic drugs.

CONTRAINDICATIONS:
None
ANAPHYLAXIS / EPS: 1 mg / kg to a max of 50 mg, IV or deep IM

PEDIATRIC: Same as adult
Dopamine (Intropin®)
INDICATIONS:
A. Primary indication is cardiogenic shock.
B. May be useful in other forms of shock, except hypovolemic.
CONTRAINDICATIONS:
Hypovolemic shock
SHOCK (NonHypovolemic): 5 mcg/kg/min IV drip.

Increase by 5 mcg/kg/min every 5 minutes to max of 20
mcg/kg/min or until desired effect is achieved.

PEDIATRIC: Same as adult
Droperidol (Inapsine®)
INDICATIONS:
A. Sedation of combative patients to facilitate restraint.
B. Nausea and vomiting not responsive to ondansetron (Zofran).

CONTRAINDICATIONS:
Unless directed by OLMC, do not administer Droperidol in the following situations:
A. Systolic BP < 90.
B. Known allergy or prior reaction to Droperidol.
C. Pregancy.
D. Patients < 14 years old
PATIENT RESTRAINT: 2.5 mg IV or 5 mg IM.
(May repeat once in 10 minutes.)

NAUSEA / VOMITING (Not responsive to Zofran): 0.625 mg IV
( = 0.25 cc based on a 5 mg/ 2 ml package)

PEDIATRIC: Contact OLMC
Epinephrine
INDICATIONS:
A. ventricular fibrillation, asystole, PEA
B. Systemic allergic reactions, asthma in patients < 40,
C. Children 6 months - 6 years with audible stridor at rest.

CONTRAINDICATIONS: None
V-FIB / ASYSTOLE/ PEA: *1:10,000
I mg IV/IO (or2 mg in 10 ml NS, ET) q 3-5 minutes

ANAPHYLAXIS / ASTHMA:
0.3 mg 1:1000 SQ / IM or
0.3 mg 1:10,000 IV/IO

PEDIATRIC:
V-FIB / ASYSTOLE/ PEA: 0.01 mg/kg 1:10,000 IV/IO
(or 0.1mg/kg 1:1000 in 4 ml NS ET)

ANAPHYLAXIS / ASTHMA: 0.01 mg/kg 1:1000 SQ or IM to a
max single dose of 0.3 mg

RESPIRATORY DISTRESS: 5 ml of 1:1000 via nebulizer
(audible stridor at rest 6 mo to 6 yrs)
Etomidate (Amidate®)
INDICATIONS:
As an induction agent for use in rapid sequence intubation.

CONTRAINDICATIONS:
Etomidate is contraindicated in patients who have a known hypersensitivity to the drug.
RSI INDUCTION: 0.3 mg / kg, IV/IO, injected over 10 seconds
Fentanyl (Sublimaze®)
INDICATIONS:
A. Pain due to musculoskeletal injury or burn.
B. Suspected ischemic chest pain unresponsive to nitroglycerin.

CONTRAINDICATIONS:
A. Respiratory distress or O2 saturation of < 90%
B. Known allergy to fentanyl
C. Altered mental status
D. Systolic blood pressure of < 100 mm/Hg
PAIN: 50 mcg IV/IM,
repeat 25-50 mcg q 3-5 min as needed to a max of 200 mcg

PEDIATRIC: 1 mcg / kg, IV/IM, repeat with 0.5-1 mcg/kg q 3-5 min as
needed to a max of 4 mcg/kg. Do not exceed adult dosing.
Furosemide (Lasix®)
INDICATIONS:
Acute pulmonary edema
(to decrease the extracellular volume and reduce pressure on the
lungs in cardiac failure.)

CONTRAINDICATIONS:
A. Hypovolemia or hypotension.
B. Pregnancy
PULMONARY EDEMA: 20 mg IV (If patient is not currently taking furosemide)
*If the patient is taking furosemide, give 40 mg IV.

PEDIATRIC: Not indicated
Glucagon
INDICATIONS:
A. Known hypoglycemia (preferably demonstrated by blood glucose determination) when
patient is confused or comatose and dextrose is not available or an IV cannot be started.
B. Possible Beta blocker overdose.

CONTRAINDICATIONS:
None
HYPOGLYCEMIA: 1mg IM

BETA-BLOCKER OVERDOSE: contact OLMC
Glucose (Oral)
INDICATIONS:
hypoglycemia in conscious patient

CONTRAINDICATIONS:
Do not give to patients who cannot adequately protect their own airway.
HYPOGLYCEMIA: 15 g PO
Hydrocobalamin (Cyano-Kit®)
INDICATIONS:
Cyanide poisoning or smoke inhalation with suspected cyanide poisoning due to the presence of coma, persistent hypotension or cardiorespiratory arrest.

CONTRAINDICATIONS:
Do not administer Hydroxocobalamin and Sodium Thiosulfate to the same patient.
CYANIDE POISONING: 5 grams IV or IO over 15 minutes.
Contact OLMC regarding second 5 gram dose.

*Each 2.5 gram vial should be reconstituted with 100 ml of Normal Saline.

PEDIATRIC: 70 mg/kg IV or IO over 15 minutes.
Ipratroprium Bromide
INDICATIONS:
As a supplement to Albuterol in patients with asthma and COPD.

CONTRAINDICATIONS:
Do not use in patients with severe glaucoma.
ASTHMA/COPD: 0.5 mg, Nebulized

*Combine with 2nd and 3rd dose of Albuterol

PEDIATRIC: Same as adult
Lidocaine
INDICATIONS:
A. Recurrent ventricular fibrillation
B. Stable ventricular tachycardia or recurrent ventricular tachycardia if clinical condition is not
rapidly deteriorating.
C. Following successful defibrillation or cardioversion from ventricular fibrillation or ventricular
tachycardia.
D. PVC’s in a suspected ischemic event.

CONTRAINDICATIONS:
Lidocaine is contraindicated in perfusing pts in the following situations without OLMC
approval.
A. Systolic BP is less than 90 mmHg.
B. Heart rate is less than 50 beats per minute.
C. Periods of sinus arrest are present.
D. Second or Third degree heart block are present.
RECURRENT VF, STABLE VT, PVC’s:
Bolus:1.5 mg/kg IV/IO/ET (to a max of 3 mg/kg)
Maintenace: 0.75mg/kg q 10 min

*Double dose for ET

PEDIATRIC: Same as Adult
Magnesium Sulfate
INDICATIONS:
A. In cardiac arrest after defibrillation, Epinephrine, Lidocaine and Amiodarone in the treatment of ventricular fibrillation and pulseless ventricular tachycardia.
B. Pre-eclampsia/eclampsia seizures.
C. Severe asthma as a smooth muscle relaxant and inhibitor of histamines

CONTRAINDICATIONS:
None
VF / VT: 2 grams over 1-2 minutes, IV / IO

ECLAMPSIA: 4 g IV infusion, followed by 1-2 g/hr continuous infusion

ASTHMA: 2 grams IV over 20 min
Midazolam (Versed®)
INDICATIONS:
A. Status seizure (any seizure that has lasted longer than 2 minutes or two consecutive
seizures without regaining consciousness)
B. Cardioversion, TCP, or RSI (to relieve anxiety, and produce amnesia)
C. Chemical restraint
D. Sedation for Induced Hypothermia

CONTRAINDICATIONS:
In seizures, do not give unless patient is actively seizing.
SEIZURE, TCP: 2.5 mg IV or 5 mg IM

CHEM RESTRAINT: 2.5 – 5 mg IV or 5 mg IM

RSI SEDATION: 2.5 mg IV.
*May repeat once as long as systolic BP is > 100 mmHg.

INDUCED HYPOTHERMIA: 5 mg IV.
*May repeat to a maximum of 10 mg as long as
systolic BP is > 100 mmHg.

PEDIATRIC:

SEIZURE, TCP: 0.1 mg / kg IV to a max of 2.5 mg
0.2 mg / kg IM to a max of 5 mg

SEDATION AFTER INTBATION: 0.1 mg/kg IV to a max of 2.5 mg
Morphine Sulfate
INDICATIONS:
A. Suspected ischemic chest pain unresponsive to nitroglycerin.
B. Pain due to burns or musculoskeletal injury.

CONTRAINDICATIONS:
A. Known allergy to morphine or sulfates (Sulfa drugs are not sulfates)
B. Blood pressure less than 100 mmHg systolic.
C. Trauma or pain of the head or abdomen.
D. Respiratory rate less than 14 breaths per minute or oxygen saturation less than 90%.
*For pediatric patients, vital signs should be maintained within the normal age appropriate
range.
MUSCULOSKELETAL INJURY, BURNS, CHEST PAINS: 2-5 mg IV.
(Repeat to max of 20 mg)

PEDIATRIC: 0.1 mg / kg IV. (Repeat as needed.)
Naloxone (Narcan®)
INDICATIONS:
A. Reversal of respiratory depression due to opiods

B. Diagnostically in coma of unknown etiology to rule out or reverse opioid depression.

CONTRAINDICATIONS: Do not use in neonates.
OPIOD REVERSAL: 0.5 mg IV,
(repeat q 2 minutes up to 2 mg titrating to respirations. )
*If no IV, give 2 mg IM.

If no response to initial dose, may repeat at 2 mg q 5 min (IV or
IM) up to a maximum of 8 mg.

PEDIATRIC: 0.1 mg / kg IV or IM up to 2 mg. May repeat q 3-5 minutes up
to 2 mg / dose. Do not exceed adult dosing. Do not use in
neonates.
Nitroglycerin
INDICATIONS:
A. Chest pain thought to be related to cardiac ischemia.
B. Pulmonary edema.

CONTRAINDICATIONS:
A. Blood pressure less than 100 mmHg systolic.
B. Patients who have taken Viagra® (sildenafil citrate) or Levitra® (vardenafil HCl) within 24 hours, or who have taken Cilais® (tadalafil) within 48 hours. Contact OLMC for
direction.
CHEST PAIN, PULMONARY EDEMA: 0.4 mg SL q 5 minutes, as long as systolic BP is greater than 100 mmHg.

PEDIATRIC: Contact OLMC
Ondansetron (Zofran®)
INDICATIONS:
Prevention and control of uncomplicated nausea and vomiting.

CONTRAINDICATIONS:
Known hypersensitivity to Zofran or similar medications.
NAUSEA/VOMITING: 4 mg IV,IM (Give over 2 min IV)
8 mg Oral tablet

PEDIATRIC: 0.1 mg/kg IV, IM
4 mg Oral tablet
Oxygen
INDICATIONS:
A. Suspected hypoxemia or respiratory distress from any cause.
B. Acute chest pain in which cardiac ischemia or myocardial infarction is suspected.
C. Shock from any cause.
D. Major trauma.
E. Carbon monoxide poisoning.

CONTRAINDICATIONS:
None
FLOW INSPIRED O2
NASAL CANNULA: 2-8 Lpm 24-40%

FACE MASK: 6 Lpm 40-60%

REBREATHER MASK: 10-12 Lpm 90%

BVM: 12 Lpm 40%
*w reservoir 90+%
Pralidoxime (2-Pam®)
INDICATIONS:
A. As an antidote in the treatment of poisoning due to organophosphate pesticides and
chemicals.
B. Control of overdose by anticholinesterase drugs (e.g. treatment of myasthenia gravis).
CONTRAINDICATIONS:
None in the emergency setting.
Moderate symptoms⎯1,200 mg (two 600 mg Mark 1 injectors or one Duodote)

Severe symptoms⎯1,800 mg (three 600mg Mark 1 injectors or three Duodote injectors)

CAUTION: When administering 2-PAM intravenously, administer at rate of less than 200 mg/minute, (4 mg/minute for children).
Proparacaine
INDICATIONS:
Superficial foreign bodies or chemical burns to the eye.

CONTRAINDICATIONS:
Known hypersensitivity to any component of the solution.
Instill one drop in the affected eye. If there is no effect within
one minute, three additional drops may be instilled at oneminute
intervals.

(For transports longer than 15 minutes, if eye
pain returns, 1-4 additional drops may be instilled to continue
anesthetic effect.)
Sodium Bicarbonate
INDICATIONS:
A. Cyclic antidepressant overdose or hyperkalemia. (To control arrythmias or asystole)
B. Acidosis caused by prolonged cardiac arrest.

CONTRAINDICATIONS:
None
CYCLIC OVERDOSE: 1 mEq / kg IV or IO

VF/PULSELESS VT/ASYSTOLE: 1 mEq / kg IV or IO,
(may repeat q 10 minutes at 0.5 mEq / kg.)

HYPERKALEMIA: 50 mEq, IV/IO

CRUSH INJURY: Contact OLMC

PEDIATRIC: Same as adult, except for Hyperkalemia dose
Sodium Thiosulfate
INDICATIONS:
Cyanide poisoning.

CONTRAINDICATIONS:
None in cyanide poisoning.
CYANIDE POISONING: 50 ml slow IV over 10-20 minutes.
(Packaged in 12.5 grams / 50 ml vial)

PEDIATRIC: 1.65 ml/kg slow IV over 10-20 minutes.
Succinylcholine
INDICATIONS:
RSI, to achieve temporary paralysis where endotracheal intubation is indicated.

CONTRAINDICATIONS:
A. Hypersensitivity to the drug.
B. Major burns and crush injuries between 48 hours and 6 months old.
C. Stroke or spinal cord injuries with profound residual defecits between 48 hours and 6
months old.
D. Suspected hyperkalemia
RSI: 1.5 mg / kg IV/IO (for pts > 6 yrs old)

PEDIATRIC: 2 mg / kg, IV/IO (for pts < 6 yrs old)
Vasopressin
INDICATIONS:
VFib/Pulseless VT, Asystole, PEA
(the first line pressor agent in cardiac arrest).

CONTRAINDICATIONS:
Hypersensitivity to the medication.
CARDIAC ARREST: 40 Units IV/IO

PEDIATRIC: Not used!!
Vecuronium (Norcuron®)
INDICATIONS:
A. For sustained neuromuscular blockade in the intubated patient.
B. As the first line agent for Rapid Sequence Induction in the patient where Succinylcholine is contraindicated.

CONTRAINDICATIONS:
None
RSI / MAINTENANCE OF
POST-INTUBATION PARALYSIS: 0.1 mg / kg, IV/IO