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510 Cards in this Set

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CALCIUM CHLORIDE BRAND NAME
BRAND NAME: Calcium Chloride
DEXTROSE 50% BRAND NAME
BRAND NAME: Dextrose 50%, D50
BUMETANIDE BRAND NAME
BRAND NAME: Bumex
BRETYLIUM TOSYLATE BRAND NAME
BRAND NAME: Bretylol
ATROPINE SULFATE BRAND NAME
BRAND NAME: Atropine
ACETYLSALICYLIC ACID, ASA BRAND NAME
BRAND NAME: Bufferin, Anacin, APC
AMIODARONE BRAND NAME
Brand Name: Cordarone
ALBUTEROL SULFATE BRAND NAME
BRAND NAME: Proventil, Ventolin
ADENOSINE BRAND NAME
BRAND NAME: Adenocard
CHARCOAL, ACTIVATED (without sorbitol) BRAND NAME
BRAND NAME: Charcola, Actidose-aqua
VERAPAMIL HCl BRAND NAME
BRAND NAME: Isoptin, Calan, Verelan
THIAMINE HCl (vitamin B1) BRAND NAME
BRAND NAME: Betalin
SODIUM BICARBONATE 8.4% BRAND NAME
BRAND NAME: Sodium Bicarbonate 8.4%
PHENYLEPHRINE NASAL SPRAY 0.5% BRAND NAME
BRAND NAME: Neo-synephrine Nasal Spray 0.5%
OXYTOCIN BRAND NAME
BRAND NAME: Pitocin, Syntocin
NITROUS OXIDE 50% BRAND NAME
BRAND NAME: Nitronox
NITROGLYCERIN BRAND NAME
BRAND NAME: Nitrostat, Tridil
NALOXONE HCl BRAND NAME
BRAND NAME: Narcan
MORPHINE SULFATE BRAND NAME
BRAND NAME: Morphine Sulfate
DIPHENHYDRAMINE HCl BRAND NAME
BRAND NAME: Benadryl
MIDAZOLAM HYDROCHLORIDE BRAND NAME
BRAND NAME: Versed
METHYLPREDNISOLONE SODIUM SUCCINATE BRAND NAME
BRAND NAME: Solu-Medrol
MAGNESIUM SULFATE BRAND NAME
BRAND NAME: Magnesium Sulfate
LIDOCAINE HCl BRAND NAME
BRAND NAME: Xylocaine
GLUCAGON BRAND NAME
BRAND NAME: Glucagon
FUROSEMIDE BRAND NAME
BRAND NAME: Lasix
EPINEPHRINE HCl BRAND NAME
BRAND NAME: Adrenalin
DOPAMINE BRAND NAME
BRAND NAME: Intropin
DIAZEPAM BRAND NAME
BRAND NAME: Valium
DEXAMETHASONE SODIUM PHOSPHATE BRAND NAME
BRAND NAME: Decadron
CALCIUM CHLORIDE CLASS
CLASS: electrolyte
DEXTROSE 50% CLASS
CLASS: carbohydrate, hyperglycemic
BUMETANIDE CLASS
CLASS: Loop diuretic
BRETYLIUM TOSYLATE CLASS
CLASS: antiarrhythmic
ATROPINE SULFATE CLASS
CLASS: parasympatholytic, antimuscarinic, anticholinergic, parasympathetic antagonist, parasympathetic blocker
ACETYLSALICYLIC ACID, ASA CLASS
CLASS: analgesic; antipyretic; antiinflammatory
AMIODARONE CLASS
Class: Antiarrhythmic agent
ALBUTEROL SULFATE CLASS
CLASS: sympathomimetic, bronchodilator
ADENOSINE CLASS
CLASS: antiarrhythmic, endogenous nucleoside
CHARCOAL, ACTIVATED (without sorbitol) CLASS
CLASS: adsorbent
VERAPAMIL HCl CLASS
CLASS: calcium channel blocker
THIAMINE HCl (vitamin B1) CLASS
CLASS: vitamin
SODIUM BICARBONATE 8.4% CLASS
CLASS: buffer
PHENYLEPHRINE NASAL SPRAY 0.5% CLASS
CLASS: topical vasoconstrictor
OXYTOCIN CLASS
CLASS: pituitary hormone, polypeptide, uterine stimulant
NITROUS OXIDE 50% CLASS
CLASS: analgesic, inhalation
NITROGLYCERIN CLASS
CLASS: vasodilator, organic nitrate, antianginal
NALOXONE HCl CLASS
CLASS: narcotic (opioid) antagonist
MORPHINE SULFATE CLASS
CLASS: narcotic agonist
DIPHENHYDRAMINE HCl CLASS
CLASS: antihistamine; anticholinergic
MIDAZOLAM HYDROCHLORIDE CLASS
CLASS: Central nervous system depressant, benzodiazepine
METHYLPREDNISOLONE SODIUM SUCCINATE CLASS
CLASS: corticosteroid, glucocorticoid, steroid, anti-inflammatory
MAGNESIUM SULFATE CLASS
CLASS: electrolyte, tocolytic
LIDOCAINE HCl CLASS
CLASS: antiarrhythmic, local anesthetic
GLUCAGON CLASS
CLASS: pancreatic hormone, polypeptide, hyperglycemic agent
FUROSEMIDE CLASS
CLASS: loop diuretic
EPINEPHRINE HCl CLASS
CLASS: sympathomimetic
DOPAMINE CLASS
CLASS: sympathomimetic
DIAZEPAM CLASS
CLASS: benzodiazepine
DEXAMETHASONE SODIUM PHOSPHATE CLASS
CLASS: synthetic adrenocorticoid/ glucocorticoid with a predominance of glucocorticoid action, antiinflammatory
CALCIUM CHLORIDE Mechanism of Action
Mechanism of Action: Increases extracellular and intracellular calcium levels Stimulates release of catecholamines Increases cardiac contractile state (positive inotropic effect) May enhance ventricular automaticity Inhibits the effects of adenosine on mast cells
DEXTROSE 50% Mechanism of Action
Mechanism of Action: Provides short-term osmotic diuresis. Pharmacological: Aerobic metabolic substrate (ATP production). Clinical effects: Reverses CNS effects of hypoglycemia by rapidly increasing serum glucose levels.
BUMETANIDE Mechanism of Action
Mechanism of Action: Inhibits electrolyte reabsorption in the ascending loop of Henle leading to diuresis
BRETYLIUM TOSYLATE Mechanism of Action
Mechanism of Action: Elevates ventricular fibrillation threshold. Biphasic autonomic response: transient (15-20 minutes) adrenergic response (and possibly ventricular ectopy); followed by a decrease in arterial pressure from vasodilation (due to norepinephrine depletion and reuptake blockade). Decreases re-entry by decreasing refractory time imbalance between normal and infarcted tissue. Prolongs action potential and refractory period. Suppresses PVC's and ventricular arrhythmias 20 minutes to 2 hours after dosing.
ATROPINE SULFATE Mechanism of Action
Mechanism of Action: Pharmacological: Competitive antagonist of acetylcholine at muscarinic receptor sites (smooth muscle and glands, blocking parasympathetic response and allowing sympathetic response to take over). Clinical: CV: Increased heart rate (positive chronotropic effect); increased conduction velocity; increased force of contraction (slight). Resp: Decreased mucous production; increased bronchial smooth muscle relaxation (bronchodilation). GI: Decreased GI secretion and motility. GU: Decreased urinary bladder tone. Misc: Mydriasis (pupillary dilation); decreased sweat production.
ACETYLSALICYLIC ACID, ASA Mechanism of Action
Mechanism of Action: In small doses aspirin blocks thromboxane A2, a potent platelet aggregant and vasoconstrictor. This property has lead to its use in the acute phase of management of the myocardial infarction. Decreased platelet aggregation.
AMIODARONE Mechanism of Action
Mechanism of Action: Multiple effects on sodium, potassium and calcium channels. Prolongs action potential, refractory period, and ventricular automaticity (potassium blocker). Slows membrane depolarization and impulse conduction (sodium blocker). Coronary artery dilation and Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic activity (calcium channel and a-blocker
ALBUTEROL SULFATE Mechanism of Action
Mechanism of Action: ß agonist (primarily ß2); relaxes bronchial smooth muscle, resulting in bronchodilation; also relaxes vascular and uterine smooth muscle; decreases airway resistance
ADENOSINE Mechanism of Action
Mechanism of Action: Slows conduction time through AV node; can interrupt re-entrant pathways through the AV node. Slows sinus rate. Larger doses decrease BP by decreasing peripheral resistance.
CHARCOAL, ACTIVATED (without sorbitol) Mechanism of Action
Mechanism of Action: Pharmacological: Physical binding (adsorption) of toxins from GI tract. Clinical effects: Prevents/reduces systemic absorption of toxins.
VERAPAMIL HCl Mechanism of Action
Mechanism of Action: Blocks calcium ion influx into cardiac and smooth muscle cells causing a depressant effect on the contractile mechanism resulting in negative inotropy. Reduces contractile tone in vascular smooth muscle resulting in coronary and peripheral vasodilation. Slows conduction and prolongs refractory period in the AV node due to calcium channel blocking. Slows SA node discharge. In summary, decreases myocardial contractile force and slows AV conduction.
THIAMINE HCl (vitamin B1) Mechanism of Action
Mechanism of Action: Required for carbohydrate metabolism. Deficiency leads to anemia, polyneuritis, Wernicke's encephalopathy, cardiomyopathy. Administration may reverse symptoms of deficiency, but effects are dependent upon duration of illness and severity of disease.
SODIUM BICARBONATE 8.4% Mechanism of Action
Mechanism of Action: Buffers H+ and increases pH
PHENYLEPHRINE NASAL SPRAY 0.5% Mechanism of Action
Mechanism of Action: Stimulates a receptors in the blood vessels of the nasal mucosa which causes their constriction and thereby decreases the risk of nasal bleeding.
OXYTOCIN Mechanism of Action
Mechanism of Action: Binds to oxytocin receptor sites on surface of uterine smooth muscles: increases force and frequency of uterine contractions
NITROUS OXIDE 50% Mechanism of Action
Mechanism of Action: Centrally acting agent that produces CNS depression and elevation of the pain threshold
NITROGLYCERIN Mechanism of Action
Mechanism of Action: Smooth muscle relaxant acting on vascular, uterine, bronchial, and intestinal smooth muscle. Reduces workload on the heart by causing blood pooling (decreased preload). Arteriolar vasodilation (decreased afterload). Coronary artery vasodilation Increases blood flow to myocardium. Decreases myocardial O2 demand.
NALOXONE HCl Mechanism of Action
Mechanism of Action: Competitive inhibition at narcotic receptor sites. Reverses respiratory depression secondary to narcotics
MORPHINE SULFATE Mechanism of Action
Mechanism of Action: Alleviates pain by acting on the pain receptors in the brain; elevates pain threshold. Depresses central nervous system; depresses brainstem respiratory centers; decreases responsiveness to changes in PaC02. Increases venous capacitance (venous pooling), vasodilates arterioles, reducing preload and afterload. Histamine release.
DIPHENHYDRAMINE HCl Mechanism of Action
Mechanism of Action: Blocks cellular histamine receptors, but does not prevent histamine release; results in decreased capillary permeability and decreased vasodilation, as well as prevention of bronchospasm. Has some anticholinergic effects.
MIDAZOLAM HYDROCHLORIDE Mechanism of Action
Mechanism of Action: CNS effects are mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Acts at the limbic, thalamic, and hypothalamic levels of the CNS, producing anxiolytic, sedative, hypnotic, and anticonvulsant effects. Capable of producing all levels of CNS depression, from mild sedation to coma.
METHYLPREDNISOLONE SODIUM SUCCINATE Mechanism of Action
Mechanism of Action: Enters target cells and causes many complex reactions that are responsible for its antiinflammatory and immunosuppressive effects; thought to stabilize cellular and intracellular membranes.
MAGNESIUM SULFATE Mechanism of Action
Mechanism of Action: Pharmacology: Second most plentiful intracellular cation; essential to enhance intracellular potassium replenishment and activity of many enzymes; important role in neurochemical transmission and muscular excitability (may decrease acetylcholine released by nerve impulses); decreases myocardial irritability and neuromuscular irritability. Clinical: Cardiac-reduces ventricular irritability, especially when associated with hypomagnesemia; inhibition of muscular excitability.
LIDOCAINE HCl Mechanism of Action
Mechanism of Action: Decreases automaticity by slowing the rate of spontaneous phase 4 depolarization. Terminates re-entry by decreasing conduction in re-entrant pathways (by slowing conduction in ischemic tissue, equalizes conduction speed among fibers). Increases ventricular fibrillation threshold.
GLUCAGON Mechanism of Action
Mechanism of Action: Pharmacologic: Acts only on liver glycogen, converting it to glucose. Counteracts the effect of insulin. Relaxes GI smooth muscle causing dilation and decreased motility. Cardiac inotrope. Clinical effects: May reverse hypoglycemia (if patient has glycogen stored in liver) within 4-8 minutes (could be as long as 15 or more).
FUROSEMIDE Mechanism of Action
Mechanism of Action: Pharmacologic: Inhibits electrolyte reabsorption in the ascending Loop of Henle. Promotes excretion of sodium, potassium, chloride. Vasodilation increases venous capacitance and decreases afterload. Clinical: Diuresis
EPINEPHRINE HCl Mechanism of Action
Mechanism of Action: Pharmacological Effects: Direct acting a and ß agonist; a-bronchial, cutaneous, renal, and visceral arterial constriction (increased systemic vascular resistance); ß1-positive inotropic and chronotropic actions (increases myocardial workload and oxygen requirements), increases automaticity and irritability; ß2 bronchial smooth muscle relaxation and dilation of skeletal vasculature. Other: blocks histamine release. Clinical Effects: Cardiac Arrest- increases cerebral and myocardial perfusion pressure; increases systolic and diastolic blood pressures; increases electrical activity in the myocardium; can stimulate spontaneous contractions in asystole. Bradycardia- increases heart rate, increases BP; Bronchospasm/Anaphylaxis-reverse signs/symptoms
DOPAMINE Mechanism of Action
Mechanism of Action: Immediate metabolic precursor to norepinephrine. Effects are dose-dependent: 1-2 Mg/kg/min Acts on dopaminergic receptors to stimulate cerebral, renal and mesenteric vasculature to dilate; HR and B/P are usually unchanged; may increase urine output. 2-10 Mg/kg/min ß1 stimulant action is primary effect (increases cardiac output and partially antagonizes the a-adrenergic-mediated vasoconstriction. Overall effect is increased cardiac output and only modest increase in systemic vascular resistance (SVR). 10-20 Mg/kg/min a-adrenergic effects predominate resulting in renal, mesenteric and peripheral arterial and venous vasoconstriction with marked increase in SVR, pulmonary vascular resistance and further increased preload. 10-20 Mg/kg/min a-adrenergic effects predominate resulting in renal, mesenteric and peripheral arterial and venous vasoconstriction with marked increase in SVR, pulmonary vascular resistance and further increased preload
DIAZEPAM Mechanism of Action
Mechanism of Action: Acts on parts of the limbic system, the thalamus, and hypothalamus producing calming effects; decreases seizures by increasing the seizure threshold; transient analgesia; amnesic; sedative.
DEXAMETHASONE SODIUM PHOSPHATE Mechanism of Action
Mechanism of Action: Improves lung function and myocardial performance: stabilization of lysosomal and cell membranes, inhibition of compliment-induced granulocyte aggregation, rightward shift in oxygen-hemoglobin dissociation curve, inhibition of prostaglandin and leukotriene production, increase in surfactant production, decrease in pulmonary edema, relaxation of bronchospasm.
CALCIUM CHLORIDE Indications/field use
Indications and Field Use: Acute hypocalcemia Calcium channel blocker OD Acute hyperkalemia (known or suspected) Hypermagnesemia. Pre-treatment for IV verapamil administration
DEXTROSE 50% Indications/field use
Indications and Field Use: Known hypoglycemia. Altered level of consciousness of unknown etiology. Seizures of unknown etiology. Hyperkalemia
BUMETANIDE Indications/field use
Indications and Field Use: Pulmonary edema, Congestive heart failure
BRETYLIUM TOSYLATE Indications/field use
Indications and Field Use: Refractory VF/Pulseless VT, VT with pulses, wide complex tachycardia of unknown origin after other pharmacologic therapy. Lidocaine allergy.
ATROPINE SULFATE Indications/field use
Indications and Field Use: Symptomatic bradycardia (sinus, junctional, and AV blocks causing significant hypotension, ventricular ectopy, chest pain, altered level of consciousness, etc.), monitored patient only. Asystole (after epinephrine), monitored patient only. PEA with actual or relative bradycardia (after epinephrine), monitored patient only. Acetylcholinesterase inhibitor poisoning (organophosphate, cholinergic poisoning). Bronchospasm, refractory (second or third line), in conjunction with albuterol or isoetherine.
ACETYLSALICYLIC ACID, ASA Indications/field use
Indications and Field Use: Chest pain or other signs/symptoms, ECG changes suggestive of acute myocardial infarction, unstable angina. Pain, discomfort, fever in adult patient only
AMIODARONE Indications/field use
Indications for use: Treatment of: shock-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin. Control hemodynamically stable ventricular tachycardia when cardioversion unsuccessful. Adjunct to cardioversion of SVT and PSVT. Rate control in atrial fibrillation or flutter.
ALBUTEROL SULFATE Indications/field use
Indications and Field Use: Treatment of bronchospasm
ADENOSINE Indications/field use
Indications and Field Use: Conversion of supraventricular tachycardias with no known atrial fibrillation or atrial flutter. Wide complex tachycardia of uncertain origin unresponsive to lidocaine.
CHARCOAL, ACTIVATED (without sorbitol) Indications/field use
Indications and Field Use: Sole prehospital therapy of oral ingestion of toxic substances. Pre-lavage of oral ingestions of toxic substances.
VERAPAMIL HCl Indications/field use
Indications and Field Use: Supraventricular tachycardia Atrial fibrillation and atrial flutter with rapid ventricular response
THIAMINE HCl (vitamin B1) Indications/field use
Indications and Field Use: Alcoholism, delirium tremens. Coma of unknown origin, especially if alcohol or malnourishment may be involved. Suspect Wernicke or Korsakoff Syndrome. Other thiamine deficiency syndromes. Severe congestive heart failure
SODIUM BICARBONATE 8.4% Indications/field use
Indications and Field Use: Pre-existing metabolic acidosis. Overdose of aspirin, cyclic antidepressants (alkalinization of blood). Cardiac arrest after other interventions and ventilation is adequate
PHENYLEPHRINE NASAL SPRAY 0.5% Indications/field use
Indications and Field Use: Facilitation of nasotracheal intubation
OXYTOCIN Indications/field use
Indications and Field Use: Postpartum hemorrhage due to uterine atony
NITROUS OXIDE 50% Indications/field use
Indications for Field Use: Moderate to severe pain from musculoskeletal trauma, burns, AMI
NITROGLYCERIN Indications/field use
Indications and Field Use: Angina, Myocardial infarction, Congestive heart failure with pulmonary edema
NALOXONE HCl Indications/field use
Indications and Field Use: Antidote for: Opioid overdoses; May differentiate opioid-induced coma from other causes
MORPHINE SULFATE Indications/field use
Indications and Field Use: Analgesia, especially in patients with burns, myocardial infarction, or renal colic. Pulmonary edema (cardiogenic).
DIPHENHYDRAMINE HCl Indications/field use
Indications and Field Use: Anaphylaxis (2nd line). Phenothiazine reactions (extrapyramidal symptoms). Antiemetic
MIDAZOLAM HYDROCHLORIDE Indications/field use
Indications and Field Use: Anti-convulsant Sedation Management of acute agitation/treat cause first Induction for intubation
METHYLPREDNISOLONE SODIUM SUCCINATE Indications/field use
Indications and Field Use: Reactive airway disease: Acute exacerbation of emphysema, chronic bronchitis, asthma. Anaphylaxis. Burns potentially involving the airway. Acute spinal cord trauma (large loading and maintenance doses)
MAGNESIUM SULFATE Indications/field use
Indications and Field Use: Torsades de pointes, drug of choice; VF/Pulseless VT refractory to lidocaine and/or bretylium; Hypomagnesemia > Pre-term labor (PTL) > Pregnancy-induced hypertension (PIH, toxemia of pregnancy, pre-eclampsia and/or eclampsia).
LIDOCAINE HCl Indications/field use
Indications and Field Use: Suppression of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation, PVC's). Prophylaxis against recurrence after conversion from ventricular tachycardia or ventricular fibrillation. Frequent PVC's (>than 6 per minute; 2 or more in a row; multiform PVC's; or R-on-T phenomenon). Pre-intubation for head trauma or suspected Intra cranial hemorrhage (hypertension and focal neurologic S/S).
GLUCAGON Indications/field use
Indications and Field Use: Symptomatic hypoglycemia when IV access is delayed.
FUROSEMIDE Indications/field use
Indications and Field Use: Pulmonary edema; congestive heart failure
EPINEPHRINE HCl Indications/field use
Indications and Field Use: Cardiac arrest - VF/Pulseless VT; asystole; PEA (First line pharmacologic agent for any pulseless dysrhythmia in cardiopulmonary arrest). Severe bronchospasm, i.e., bronchiolitis, asthma. Anaphylaxis. Bradycardia, refractory with profound hypotension, monitored patient only. Hypotension unresponsive to other therapy, monitored patient only.
DOPAMINE Indications/field use
Indications and Field Use: Symptomatic bradycardias. Hemodynamically significant hypotension in the absence of hypovolemia (Cardiogenic or septic shock only after fluid administration; assess breath sounds first).
DIAZEPAM Indications/field use
Indications and Field Use: Grand mal seizures, especially status epilepticus. Transient analgesia/amnesia for medical procedures (e.g., fracture reduction, cardioversion, Transient analgesia/amnesia for medical procedures (e.g., fracture reduction, cardioversion, pacing). Delirium tremens. Treat the cause first.
DEXAMETHASONE SODIUM PHOSPHATE Indications/field use
Indications and Field Use: Reactive airway disease: Acute exacerbation of bronchial asthma. Anaphylaxis. Cerebral edema (non-traumatic). Acute spinal cord trauma
CALCIUM CHLORIDE Contraindications
Contraindications: Hypercalcemia Concurrent digoxin therapy (relative)
DEXTROSE 50% Contraindications
Contraindications: Known thiamine deficiency (relative, if suspected give thiamine close to same time). Delirium tremens; use with caution in patients with acute alcoholism, may be ineffective without thiamine. Head injury (unless documented hypoglycemia). Intra cranial hemorrhage (relative). Severe pain (paradoxical excitement may occur).
BUMETANIDE Contraindications
Contraindications: hypersensitivity, anuria, electrolyte deficiencies, hepatic coma. Cautious use: hepatic cirrhosis, ascites, history of gout, hypersensitivity to furosemide
BRETYLIUM TOSYLATE Contraindications
Contraindications: None, when used to treat life-threatening arrhythmias.
ATROPINE SULFATE Contraindications
Contraindications: Glaucoma, acute narrow angle (painful) (relative contraindication for patient with symptomatic bradycardia)
ACETYLSALICYLIC ACID, ASA Contraindications
Contraindications: Bleeding ulcer, hemorrhagic states, hemophilia, Known hypersensitivity to salicylates or other non-steroidal antiinflammatories that has lead to hypotension and/or Bronchospasm, Children and adolescents
AMIODARONE Contraindications
Contraindications: Bradycardia Second or third degree heart block cardiogenic shock Hypotension pulmonary congestion
ALBUTEROL SULFATE Contraindications
Contraindications: Synergistic with other sympathomimetics Use caution in patients with diabetes, hyperthyroidism, and cerebrovascular disease
ADENOSINE Contraindications
Contraindications: Sick sinus syndrome, 2nd or 3rd degree AV blocks; except in patients with a functioning ventricular pacemaker. Use cautiously in patients with known asthma (has precipitated acute bronchospasm). Patients on theophylline and related methylxanthines. Patients on dipyridamole (Persantine) or arbamazepine (Tegretol). Cardiac transplant patients are more sensitive to adenosine and require only a small dose (relative). Known atrial fibrillation or atrial flutter Pregnancy (no controlled studies)
CHARCOAL, ACTIVATED (without sorbitol) Contraindications
Contraindications: Ingestion of caustics, Ingestion of hydrocarbons (relative), Oral administration to comatose patient, Simultaneous administration of other oral drugs
VERAPAMIL HCl Contraindications
Contraindications: AV block, Sick sinus syndrome, any wide QRS complex tachycardia, Shock, severe CHF
THIAMINE HCl (vitamin B1) Contraindications
Contraindications: Do not give intra-arterial
SODIUM BICARBONATE 8.4% Contraindications
Contraindications: Alkalosis
PHENYLEPHRINE NASAL SPRAY 0.5% Contraindications
Contraindications: Known allergy to medication
OXYTOCIN Contraindications
Contraindications: Hypersensitivity
NITROUS OXIDE 50% Contraindications
Contraindications: Unconscious patient. Poor respiratory drive, compromise of respiratory status (i.e. pneumothorax) Abdominal pain unless intestinal obstruction has been completely ruled out. Severe head injury
NITROGLYCERIN Contraindications
Contraindications: Hypovolemia, Increased Intra cranial pressure
NALOXONE HCl Contraindications
Contraindications: Hypersensitivity
MORPHINE SULFATE Contraindications
Contraindications: Respiratory depression, Head injuries, Elevated Intra cranial pressure, Asthma, relative, Abdominal pain, relative
DIPHENHYDRAMINE HCl Contraindications
Contraindications: Known hypersensitivity to diphenhydramine or drugs of similar chemical structure. Newborn or premature infants; nursing mothers. Considerable caution in patients with glaucoma, acute narrow angle; stenosing or obstructive diseases of the GI tract; bronchial asthma; hyperthyroidism; cardiovascular disease or hypertension; age greater than 60 years (all relative benefit vs. risk).
MIDAZOLAM HYDROCHLORIDE Contraindications
Contraindications: Hypersensitivity to midazolam Relative contraindication in: Myasthenia gravis or other neuromuscular disorders; acute alcohol intoxication; severe, chronic obstructive pulmonary disease; and acute pulmonary insufficiency
METHYLPREDNISOLONE SODIUM SUCCINATE Contraindications
Contraindications: Preterm infants
MAGNESIUM SULFATE Contraindications
Contraindications: Hypermagnesemia, Use cautiously in patients with impaired renal function and pre-existing heart blocks (relative).
LIDOCAINE HCl Contraindications
Contraindications: Known hypersensitivity/allergy. Use extreme caution in patients with conduction disturbance (second or third degree block). > Do not treat ectopic beats if heart rate is < 60. They are probably compensating for the bradycardia; instead, treat the bradycardia!
GLUCAGON Contraindications
Contraindications: Known hypersensitivity, Pheochromocytoma, Insulinoma, Should not be routinely used to replace dextrose when IV access has been obtained
FUROSEMIDE Contraindications
Contraindications: Anuria (relative), Hypovolemia, Hypotension
EPINEPHRINE HCl Contraindications
Contraindications: None known for cardiac arrest. Hypothermia, relative contraindication
DOPAMINE Contraindications
Contraindications: Hypovolemic shock (relative). Pheochromocytoma. Pheochromocytoma
DIAZEPAM Contraindications
Contraindications: Hypersensitivity (allergy). Glaucoma, acute narrow angle (relative)
DEXAMETHASONE SODIUM PHOSPHATE Contraindications
Contraindications: Systemic fungal infections. Hypersensitivity to any component of dexamethasone, including sulfites. Preterm infants
CALCIUM CHLORIDE Adverse Reactions
Adverse Reactions: Brady-asystolic arrest. Severe tissue necrosis if solution extravasates Use cautiously in patients on digitalis; may cause serious arrhythmias
DEXTROSE 50% Adverse Reactions
Adverse Reactions: Cerebral edema in children when given IV undiluted. Worsening elevated ICP or cerebral edema from trauma or cerebral vascular accident. Extravasation leads to severe tissue necrosis. Sclerosing effect on peripheral veins.
BUMETANIDE Adverse Reactions
Adverse Reactions: Dizziness (most common), headache, muscle cramps, Hypotension,EKG changes associated with hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia,Nausea, vomiting, diarrhea, dry mouth, ringing in ears, High doses or frequent administration, particularly in the elderly, can cause profound diuresis, hypovolemia, and resulting circulating collapse with development of thrombi and emboli. May precipitate hypokalemic-induced digoxin toxicity.
BRETYLIUM TOSYLATE Adverse Reactions
Adverse Reactions: CV: Hypertension may occur initially due to catecholamine release; hypotension 15-20 minutes after administration (can usually be controlled); increased sensitivity to catecholamines; angina or bradydysrhythmias. GI: Nausea/vomiting after rapid IV administration.
ATROPINE SULFATE Adverse Reactions
Adverse Reactions: Major: Tachydysrhythmias; ventricular irritability; exacerbation/initiation of angina; acute narrow angle glaucoma; agitation to delirium. Minor: Dry mouth/mucous membranes; urinary retention; decreased sweating/increased body temperature.
ACETYLSALICYLIC ACID, ASA Adverse Reactions
Adverse Reactions: Use with caution in the patient with history of asthma. Anaphylactic reactions in sensitive patients have occurred; skin eruptions; other side effects rare with single dose
AMIODARONE Adverse Reactions
Adverse Reactions: Cardiovascular: bradycardia, hypotension, asystole/cardiac arrest, AV block, Torsades de Pointes, congestive heart failure; GI & Hepatic: nausea, vomiting, abnormal liver function tests Skin: slate-blue pigmentation. Other: fever, headache, dizziness, flushing, abnormal salivation, photophobia.
ALBUTEROL SULFATE Adverse Reactions
Adverse Reactions: CV: Dysrhythmias, tachycardia (with excessive use), peripheral vasodilation; Resp: Bronchospasm (rare paradoxical with excessive use); CNS: Tremors, nervousness; GI: Nausea, vomiting; Endocrine: Hyperglycemia
ADENOSINE Adverse Reactions
Adverse Reactions: CV: Transient dysrhythmias (systole, bradycardia, PVC's) occur in 55% of patients (none reported as irreversible). Palpitations, chest pressure, chest pain, hypotension, transient hypertension; facial flushing, sweating. Resp: Dyspnea, hyperventilation, tightness in throat, bronchospasm. CNS: lightheadedness, headache, dizziness, paresthesias, apprehension, blurred vision, neck-back pain. GI: Nausea, metallic taste.
CHARCOAL, ACTIVATED (without sorbitol) Adverse Reactions
Adverse Reactions: May provoke vomiting, May worsen overdosed induced Ileus
VERAPAMIL HCl Adverse Reactions
Adverse Reactions: Extreme bradycardia, Asystole, AV block, Hypotension, Congestive heart failure
THIAMINE HCl (vitamin B1) Adverse Reactions
Adverse Reactions: Hypotension (rare)
SODIUM BICARBONATE 8.4% Adverse Reactions
Adverse Reactions: CV: Congestive heart failure, edema secondary to sodium overload. Metabolic: Hyperosmolarity, metabolic alkalosis, hypernatremia, in cardiac arrest may cause extracellular alkalosis and intracellular acidosis.
PHENYLEPHRINE NASAL SPRAY 0.5% Adverse Reactions
Adverse Reactions: (rare with single dose, rarely absorbed systemically from nasal instillation). CV: Hypertension, palpitations. CNS: Tremors.
OXYTOCIN Adverse Reactions
Adverse Reactions: CV: Shock, tachycardia, dysrhythmias. Resp: Anaphylaxis. GI: Nausea and vomiting. GU: If used prior to delivery, can cause uterine rupture, uterine spasm, lacerations, and fetal damage. Other: Clotting disorders, electrolyte disturbances
NITROUS OXIDE 50% Adverse Reactions
Adverse Reactions: Resp: Worsening of pre-existing pneumothorax; may cause hypercarbia in oxygen sensitive patients (CO2 retainers). GI: Nausea and vomiting, may lead to rupture of intestine if administered to patient with intestinal obstruction.
NITROGLYCERIN Adverse Reactions
Adverse Reactions: CV: Hypotension, reflex tachycardia, bradycardia, decreased coronary perfusion at high doses (secondary to hypotension), headache secondary to dilation of meningeal vessels.
NALOXONE HCl Adverse Reactions
Adverse Reactions: Withdrawal symptoms, especially in neonates (nausea, vomiting, diaphoresis, increased heart rate falling blood pressure, tremors). > Be prepared for combative patient after administration.
MORPHINE SULFATE Adverse Reactions
Adverse Reactions: CV: Brady or tachydysrhythmias, orthostatic hypotension. Resp: Respiratory depression or arrest. CNS: Excess sedation, seizures to coma and arrest, pupillary constriction. GI: Nausea and vomiting, GI spasm. Derm: Histamine release may cause local urticaria.
DIPHENHYDRAMINE HCl Adverse Reactions
Adverse Reactions: CV: Hypotension; palpitations; arrhythmias; hemolytic anemia. Resp: Anaphylaxis; thickening of bronchial secretions, tightness in chest; wheezing; nasal stuffiness. CNS: Sedation; visual disturbances; seizures. GU/GI: Urinary frequency or retention; vomiting. Children: In children, may cause paradoxical CNS excitation, seizures, palpitations, thickening of bronchial secretions.
MIDAZOLAM HYDROCHLORIDE Adverse Reactions
Adverse Reactions: CV: Hypotension (especially in patients premedicated with narcotic); cardiac arrest; irregular or fast heartbeat. Respiratory: Apnea; respiratory depression, respiratory arrest; hyperventilation; wheezing or difficulty in breathing; hiccups; coughing. CNS: Emergence delirium; muscle tremor; uncontrolled or jerky movements of body; unusual excitement, irritability, or restlessness; dizziness, light-headedness, or feeling faint; prolonged drowsiness; headache. GI: nausea and/or vomiting. Midazolam administered intravenously has been associated with respiratory depression and respiratory arrest, especially when used concomitantly with opioid analgesics for conscious sedation or when rapidly administered. Midazolam may cause phlebitis. May need to adjust midazolam dose down for patients on erythromycin.
METHYLPREDNISOLONE SODIUM SUCCINATE Adverse Reactions
Adverse Reactions: None from single dose
MAGNESIUM SULFATE Adverse Reactions
Adverse Reactions: Cardiovascular: hypotension (may be transient), flushing circulatory collapse, depressed cardiac function, heart block, asystole, smooth muscle relaxant (antihypertensive effects). Respiratory: respiratory depression and/or paralysis may occur in both mother and/or infant during or up to 24 hours after the administration of MgSO4. CNS: sweating, drowsiness, hypothermia, depressed reflexes progressing to flaccidity and paralysis which may occur in both mother and/or infant during the administration of or up to 24 hours after the administration of MgSO4. GI: nausea GU: mild diuretic. Metabolic: hypocalcemia, hypermagnesemia
LIDOCAINE HCl Adverse Reactions
Adverse Reactions: CV: May also cause SA nodal depression or conduction problems and hypotension in large doses, or if given too rapidly. Excessive doses in pediatric patient may produce myocardial and circulatory depression. CNS: In large doses drowsiness, disorientation, paresthesias, decreased hearing acuity, muscle twitching, agitation, focal or generalized seizures.
GLUCAGON Adverse Reactions
Adverse Reactions: Rare side effects, Nausea and vomiting,Generalized allergic reactions including urticaria, respiratory distress and hypotension (made from beef/pork pancreas) Palpitations, hypertension, tachycardia
FUROSEMIDE Adverse Reactions
Adverse Reactions: May exacerbate hypovolemia; Hyperglycemia (due to hemoconcentration); Hypokalemia; May decrease the response to pressors
EPINEPHRINE HCl Adverse Reactions
Adverse Reactions: CV: Hypertension, ventricular dysrhythmias; tachycardia; angina.CNS: Anxiety, agitation. GI: Nausea/vomiting.
DOPAMINE Adverse Reactions
Adverse Reactions: CV: Cardiac arrhythmias may occur due to increased myocardial oxygen demand (usually tachydysrhythmias), hypertension, and hypotension at low doses. GI: Nausea and vomiting. GU: Renal shutdown (at higher doses). Other: Extravasation may cause tissue necrosis
DIAZEPAM Adverse Reactions
Adverse Reactions: CV: Bradycardia, hypotension, cardiovascular collapse; venous thrombosis; phlebitis; vascular spasm; Resp: Respiratory arrest; may be prolonged in neonate; CNS: Somnolence, confusion, coma, diminished reflexes; s/s may be prolonged in neonate; Other: Burning proximal to IV injection site; local irritation; swelling; extravasation will cause tissue necrosis
DEXAMETHASONE SODIUM PHOSPHATE Adverse Reactions
Adverse Reactions: Sodium retention, fluid retention, potassium loss, hypokalemic alkalosis, hypertension, convulsions, hyperglycemia, myocardial rupture following recent myocardial infarction
CALCIUM CHLORIDE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: All drugs -- flush line before and after administration
DEXTROSE 50% Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Sodium bicarbonate, Diazepam will precipitate if given concurrently without flushing
BUMETANIDE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: NSAIDs reduce diuretic effect, May increase blood levels of lithium increasing risk of lithium poisoning,Potentiates effects of various antihypertensive drugs
BRETYLIUM TOSYLATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Pressor effects of dopamine and epinephrine are variable.
ATROPINE SULFATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Sodium bicarbonate (relative)
ACETYLSALICYLIC ACID, ASA Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Not applicable with single dose therapy
AMIODARONE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Beta blockers, calcium channel blockers, and other antiarrhythmics are additive and can be proarrhythmic when given in combination with amiodarone due to similar mechanisms of action. Amiodarone precipitates at certain concentrations when mixed at a Y-site with sodium bicarbonate or furosemide.
ALBUTEROL SULFATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Tricyclic antidepressants (TCA's) and monoamine oxidase (MAO) inhibitors, other sympathomimetics (relative)
ADENOSINE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Adenosine is not blocked by Atropine. Theophylline and related methylxanthines (caffeine & theobromine-xanthine) in therapeutic concentrations decrease effectiveness. Dipyridamole (Persantine) & carbamazepine (Tegretol, Atretol) block uptake and potentiate effects.
CHARCOAL, ACTIVATED (without sorbitol) Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Ineffective for iron, lithium, heavy metals, and other ions. May reduce the effectiveness of other treatments (Mucomyst) in pure acetaminophen OD's. Since charcoal bonds with whatever it is mixed with, flavoring with drinks reduces effectiveness.
VERAPAMIL HCl Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: IV Beta-blockers
THIAMINE HCl (vitamin B1) Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: None
SODIUM BICARBONATE 8.4% Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Incompatible with other drug infusions
PHENYLEPHRINE NASAL SPRAY 0.5% Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: None
OXYTOCIN Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: None in prehospital arena
NITROUS OXIDE 50% Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Analgesic effect of nitrous oxide is potentiated by parenteral analgesics and sedatives (i.e. morphine, diazepam).
NITROGLYCERIN Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Other vasodilators, Viagra
NALOXONE HCl Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Should not be mixed with other drugs
MORPHINE SULFATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: CNS side effects (including respiratory depression) can be reversed by naloxone.
DIPHENHYDRAMINE HCl Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Additive effects with alcohol and other CNS depressants (hypnotics, sedatives, tranquilizers, etc.). MAO inhibitors prolong and intensify anticholinergic (drying) effects.
MIDAZOLAM HYDROCHLORIDE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Midazolam may potentiate the action of other CNS depressants, including opiate agonists or other analgesics, barbiturates or other sedatives, anesthetics, or alcohol. Erythromycin may double the half-life of midazolam.
METHYLPREDNISOLONE SODIUM SUCCINATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: None
MAGNESIUM SULFATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Concurrent digilization increases danger of dysrhythmias
LIDOCAINE HCl Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: None known
GLUCAGON Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Unknown
FUROSEMIDE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Increased effects with other antihypertensives
EPINEPHRINE HCl Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Potentiates other sympathomimetics. Reacts with alkaline solutions, such as sodium bicarbonate, should not be mixed with alkaline agents.
DOPAMINE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Incompatible in any alkaline solution. On-board MAO inhibitors will cause hypertensive crisis
DIAZEPAM Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Do not mix or dilute diazepam with other solutions or drugs in syringe, tubing or IV container.
DEXAMETHASONE SODIUM PHOSPHATE Incompatibilities/Drug Interactions
Incompatibilities/Drug Interactions: Dexamethasone is not compatible with Benadryl or Versed in IV tubing.
CALCIUM CHLORIDE Adult Dosage
Adult Dosage: Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia: 5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10 minutes. Pre-treatment for IV verapamil administration: 3 ml of 10% calcium chloride. May be repeated once.
DEXTROSE 50% Adult Dosage
Adult Dosage: Hypoglycemia, altered level of consciousness or seizures of unknown etiology: 25-100 ml of D50 (12.5-50 Gm, 2 to 2 amps) IV. Hyperkalemia: 50 Gm of Dextrose IV total may be given over 1 hour. This is a part of a combination drug therapy. See: profiles for calcium chloride and sodium bicarbonate. Insulin may be given upon arrival to ED.
BUMETANIDE Adult Dosage
Adult Dosage: 0.5 to 1.0 mg IV slowly over 1 to 2 minutes, or IM
BRETYLIUM TOSYLATE Adult Dosage
Adult Dosage: VF/Pulseless VT, refractory to defibrillation/lidocaine: 5 mg/kg rapid IVP initial bolus followed by a flush with 20 ml NS; if needed may repeat at 10 mg/kg rapid IVP; thereafter repeat at 5-30 minute intervals until total dose of 35 mg/kg/day. If VF/ Pulseless VT converts with bretylium, a constant infusion of 2 mg/min should be initiated. Refractory VT in conscious patient with pulses: Initial dose 5 mg/kg diluted in 50-100 ml of NS given over 8-10 minutes. If VT remains refractory, a second bolus may be given at 5-10 mg/kg or a continuous infusion may be established at 2 mg/min. If bretylium converts VT, complete the loading dose and begin a continuous infusion at 1-2 mg/min.
ATROPINE SULFATE Adult Dosage
Adult Dosage: Symptomatic Bradycardia: 0.5-1.0 mg rapid IV push or via ET every 3-5 minutes to a total dose of 3 mg if symptoms profound (0.03-0.04 mg/kg). Asystole or PEA with bradycardia: 1.0 mg rapid IV push or via ET every 3-5 minutes to a total dose of 3 mg. Cholinergic or organophosphate poisoning: 2.0-5.0 mg IV, may repeat in 5 minutes. Max dose is unlimited. Bronchospasm: 1.0 mg SVN prepared by using 2.5 ml of 0.4 mg/ml solution out of 8 mg/20 ml vial (may add 0.5 ml NS to make 3 ml inhalation treatment, 2.5 ml is adequate) administered with a mouth piece, O2 mask, or in-line with a ventilatory device; may repeat in 30 minutes or according to medical control preference.
ACETYLSALICYLIC ACID, ASA Adult Dosage
Adult Dosage: Cardiac: 160- 325 mg (2-4 pediatric chewable tabs), chew or swallow, Pain/discomfort/fever: 325 mg po (4 pediatric chewable tablets), chew or swallow
AMIODARONE Adult Dosage
Adult Dosage: For maintenance infusion post resuscitation: After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then up to 0.50 mg/min IV infusion for 18 hours. For maintenance infusion: Rates range from 0.50mg/min to 1mg/min. Maximum daily dose is 2.0 g
ALBUTEROL SULFATE Adult Dosage
Adult Dosage: Give 2.5 mg of premixed solution for inhalation (0.083%) via SVN with a mouth piece, or inline with a ventilatory device. Repeated according to medical control preference
ADENOSINE Adult Dosage
Adult Dosage: Initial: 6 mg rapid IV bolus over 1-3 seconds Special administration procedure: Follow immediately with 20 ml normal saline flush. IV site recommended is antecubital fossa (close to central circulation); use injection port nearest hub of IV catheter; arm elevated during procedure; constant ECG monitoring. Repeat: If no response in 1-2 minutes (of each dose, respectively) may repeat 12 mg, twice, utilizing the same procedure for repeat dose.
CHARCOAL, ACTIVATED (without sorbitol) Adult Dosage
Adult Dosage: 30-60 Gm (1-2 Gm/kg); if not in pre-mixed slurry, mix one part charcoal with four parts water.
VERAPAMIL HCl Adult Dosage
Adult Dosage: 2.5 - 5.0 mg IV PUSH over 2-3 minutes. May rebolus in 15-30 minutes with 5-10 mg IV PUSH until a maximum dose of 20 mg
THIAMINE HCl (vitamin B1) Adult Dosage
Adult Dosage: 100 mg
SODIUM BICARBONATE 8.4% Adult Dosage
Adult Dosage: Pre-existing Metabolic Acidosis or Alkalinization of Blood: 50-100 mEq IV per medical control authority. Infusion: 50 mEq of sodium bicarbonate/250 ml of NS or as determined by medical control. Cardiac arrest: First dose usually 1 mEq/kg (or as determined by blood gas analysis), with subsequent doses of 0.5 mEq/kg every 10 minutes in cardiac arrest after other standard treatment (defibrillation, CPR, intubation, ventilation and more than one trial of epinephrine) has been used.
PHENYLEPHRINE NASAL SPRAY 0.5% Adult Dosage
Adult Dosage: 2-4 sprays in each nostril before attempting tube insertion
OXYTOCIN Adult Dosage
Adult Dosage: Postpartum hemorrhage: 10-20 USP units added to 1000 cc NS or LR and run at a rate necessary to control uterine atony or 10 USP units may be given IM after delivery of placenta.
NITROUS OXIDE 50% Adult Dosage
Adult Dosage: Self-administer and self-regulated by the patient, who must hold the mask to face to create an airtight seal until the pain is significantly relieved or the patient drops the mask.
NITROGLYCERIN Adult Dosage
Adult Dosage: SL for Chest pain: 1/150 gr (0.4 mg) tablet or one full spray, may repeat x 3. SL for Pulmonary edema: 1-2 of the 1/150 gr (0.4 mg) tablets may be given SL every 5-10 minutes as long as the systolic BP is greater 90-100 systolic. ** IV infusion during interfacility transport must be given via infusion pump: Start at low range of 5 µg/min and increase in increments of 5 µg, monitoring pain and blood pressure until desired hemodynamic or clinical response is achieved (fall in SVR, relief of chest pain); most patients respond to 50-200 µg/min
NALOXONE HCl Adult Dosage
Adult Dosage: IV, IM, inject SL, SC, ET: 2.0 mg initial bolus IV or ET, may repeat every 2 minutes as necessary; titrate to effect. Intra-nasal: 1.0 mg each nostril using a Mucosal Atomizer Device for a total of 2 mg. May repeat every 2 minutes as necessary. Titrate to effect. ** Continuous IV Infusion: 2/3 of the initial bolus/hr (bolus that it took to reverse) administered as a continuous infusion; i.e., if 2 mg Narcan resulted in opioid reversal initially, then it can be maintained by continuous infusion of 1.4 mg/hr. Put 1.4 mg Narcan in 250 ml NS and run at 250 ml/hr. A repeat IV bolus of 2 the initial bolus administered 15 minutes after the initial bolus is recommended.
MORPHINE SULFATE Adult Dosage
Adult Dosage: IV Dose: Administer 1-3 mg increments slow IV PUSH (over 1-5 minutes) until desired effect.
DIPHENHYDRAMINE HCl Adult Dosage
Adult Dosage: Anaphylaxis: 25-50 mg slow IV push or deep IM. Extrapyramidal symptoms and antiemetic: 10-50 mg IV or deep IM, dose should be individualized according to the needs and patient response.
MIDAZOLAM HYDROCHLORIDE Adult Dosage
Adult Dosage: Patients 14 to 60 years of age: 2 to 5 mg IM /1 to 5 mg IV, titrate to effect, administer slowly in small increments of no more than 2.5 mg over at least 2 minutes. Patients over 60 years of age: 1 to 3 mg IM /1 to 3.5 mg IV, titrate to effect, administer slowly in small increments of no more than 1.5 mg over at least 2 minutes. Total dose: Should not exceed 20 mg. For emergency intubation: 0.1 mg/kg up to 0.3 mg/kg with dosage limit of 20 mg. Seizures: 0.2 mg/kg IM for status seizures if no IV access
METHYLPREDNISOLONE SODIUM SUCCINATE Adult Dosage
Adult Dosage: Reactive Airway Disease, Anaphylaxis, Burns Potentially Involving the Airway: Usual dose 125 mg slow IV bolus (much larger doses can be used). Acute Spinal Cord Trauma: Should be within 6 hours of insult and patient meeting criteria, initial bolus dose of 30 mg/kg IV administered over 15 minutes; bolus followed by a 45 minute rest period, then a 23-hour continuous infusion of 5.4 mg/kg/hr. See: Special Notes.
MAGNESIUM SULFATE Adult Dosage
Adult Dosage: VF/Pulseless VT: 1-2 Gms IV in 1-2 minutes or dilute 1-2 Gms in 100 ml NS administered over 1-2 minutes. Torsades de pointes: 1-2 Gms over 1-2 minutes or dilute 1-2 Gms in 100 ml NS administered over 1-2 minutes followed by the same amount infused over 1 hour. Hypomagnesemia: Dilute 1-2 Gms in 50-100 ml NS administered IV push over 5-60 minutes. Pre-term labor (PTL): Initial bolus (Field and Interfacility): 4-6 Gm over 15-20 minutes (Suggested method is the addition of 4 Gms to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml) Maintenance Infusion (Interfacility only): 1-4 Gms/hour infusion rate. Suggested method for treatment of premature labor is to follow initial bolus with infusion of 2 Gms/hr which may be continued until uterine contractions are reduced to < 1 every 10 minutes. Then, infusion is decreased to 1 Gm/hr and continued for 24-72 hrs. One method for mixing infusion is the addition of 40 Gms to 1000 ml LR. Resultant concentration equals 40 mg/ml. If this concentration is run at 50 ml/hr, MgSO4 delivered equals 2 Gms/hr). Pregnancy induced hypertension, preeclampsia/eclampsia, (PIH): Initial bolus (Field and Interfacility): 3-6 Gm over 10-15 minutes (Suggested method is the addition of 4 Gms to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml). Maintenance Infusion (Interfacility only): Follow bolus with 1-3 Gms/hour infusion rate. (Same mixture as for PTL). Rebolus: In an eclamptic emergency may rebolus with MgSO4, 2-4 Gms depending on patient size (mixed as in initial bolus) over 10-15 minutes if DTRs 2+ or higher, respirations >12/minute and urine output >30 ml/hr.
LIDOCAINE HCl Adult Dosage
Adult Dosage: Pulseless VF/VT: Initial bolus of 1.0-1.5 mg/kg IV PUSH every 3-5 minutes to a total of 3 mg/kg. An initial bolus of 1.5 mg/kg should be given for cardiac arrest situations. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min. Antidysrhythmic or rhythms with a pulse: Initial boluses can be given as 1.0-1.5 mg/kg IV PUSH and additional boluses can be given as 0.5-0.75 mg/kg every 5-10 minutes to a total dose of 3 mg/kg. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min; see below. Maintenance Infusion: Started after return of spontaneous rhythm for either indication above. Add 1 gm - 2 g to a 250 ml NS or 5 % dextrose solution or use premixed solution (2 gm in 500 ml) and initiate a drip at 2-4 mg/min according to concentration. Patients > 70 years or with hepatic, renal disease or poor perfusion state, reduce maintenance infusion by half. Pre-intubation for head trauma or suspected Intra cranial hemorrhage (hypertension and focal neurologic S/S). Consider administration of 1 mg/kg IV bolus 1-2 minutes prior to intubation.
GLUCAGON Adult Dosage
Adult Dosage: (children and adults greater than 20 kg or 44 lbs) Hypoglycemia: 1 mg IM, may repeat in 7-10 minutes
FUROSEMIDE Adult Dosage
Adult Dosage: On oral furosemide therapy: Consider initial dose of 2 times daily oral dose, if no effect in 20 minutes may double initial dose. Not on oral furosemide therapy: 0.5-1 mg/kg to a maximum of 2 mg/kg (usually 20-40 mg) IV slowly.
EPINEPHRINE HCl Adult Dosage
Adult Dosage: IV for Cardiac Arrest - VF/Pulseless VT, asystole, PEA: Use 1:10,000 solution and give 1.0 mg every 3-5 minutes flushing each with 20 ml of IV fluid, or, ET for Cardiac Arrest - VF/Pulseless VT, asystole, PEA: Give 2.0 - 2.5 mg via the ET tube. May use 1:10,000 or dilute 1:1000 to equal 10 ml via ET tube for adult. (i.e., 2 mg of 1:1000 epinephrine diluted with 8 ml NS in a 10 ml syringe) Continuous Infusion during Cardiac Arrest or profound Bradycardia: 1 mg every 3-5 minutes. Add 30 mg epinephrine to 250 ml NS to run at 100 ml/hr (same as 1 mg every 3 minutes) or titrated to desired hemodynamic end point. Central line preferred, patency of line must be assured. Continuous Infusion for Hypotension or Symptomatic Bradycardia: 1 mg added to 500 ml of NS administered at 1 mg/min titrated to desired hemodynamic response (range 2-10 Mg/min); not first-line therapy. Anaphylaxis and asthma: Give 0.1- 0.3 mg of 1:1000 solution SC, IM or inject SL; or in extreme cases only, may be asked to use 1:10,000 solution and give 0.1 mg, q 30-60 sec. IV, titrated to effect in patients without cardiovascular collapse, or give 0.3 - 0.5 mg ET or IV if cardiovascular collapse is present.
DOPAMINE Adult Dosage
Adult Dosage: (dosage range 2-20 Mcg/kg/min). Preparation: (If premixed not carried) Add 400 mg/ 250 ml NS or Dextrose = 1600 Mcg/ml. Bradycardia: Start at 5 Mcg/kg/min. Shock: cardiogenic or septic (non-hypovolemic): BP < 70 systolic: Start drip at 5 Mcg/kg/min. BP > 70 systolic: Start drip at 2.5 Mcg/kg/min
DIAZEPAM Adult Dosage
Adult Dosage: 2 mg increments slow IV push. Administer no faster than 2 mg/minute.
DEXAMETHASONE SODIUM PHOSPHATE Adult Dosage
Adult Dosage: Reactive Airway Disease, Anaphylaxis 8 - 24 mg. Cerebral edema: 1-5mg/kg
CALCIUM CHLORIDE Pediatric Dosage
Pediatric Dosage: Hypocalcemia, calcium channel blocker OD hyperkalemia and hypermagnesemia: 0.2 - 0.25 ml/kg of a 10% solution infused slowly. Should not be repeated without documented calcium deficiency.
DEXTROSE 50% Pediatric Dosage
Pediatric Dosage: (14 yrs and below includes infant) Administer 0.5 - 1 Gm/kg of a dextrose 10% solution; recommended to give slowly over a 20 minute period. Dilute D50 (dextrose 50% containing 25 Gm of dextrose) to a 1:4 solution. To prepare, obtain a 250 ml container of normal saline for IV use; waste 50 ml and add 50 ml of dextrose 50%. The resulting solution is dextrose 10% in normal saline or 10 grams/100ml.
BUMETANIDE Pediatric Dosage
Pediatric dosage: none
BRETYLIUM TOSYLATE Pediatric Dosage
Pediatric Dosage: Same as adult (rarely given)
ATROPINE SULFATE Pediatric Dosage
Pediatric Dosage: Symptomatic Bradycardia only: 0.02 mg/kg (minimum of 0.1 mg) IV push (after epinephrine). May repeat only one time. Maximum single doses: Child 0.5 mg; Adolescent 1 mg. Bronchospasm: 0.5 mg SVN prepared by using 1.25 ml of 0.4 mg/ml solution out of 8 mg/20 ml vial, may add 1.25-1.75 ml NS to make 2.5-3 ml inhalation treatment (2.5 ml is adequate). Administer with a mouth piece, O2 mask or in-line with a ventilatory device. May repeat in 30 minutes or according to medical control preference.
ACETYLSALICYLIC ACID, ASA Pediatric Dosage
Pediatric Dosage: Not recommended for children
AMIODARONE Pediatric Dosage
Pediatric Dosage: none
ALBUTEROL SULFATE Pediatric Dosage
Pediatric Dosage: For children < 40 lbs., administer half of 0.083% premixed solution; add 1-1.5 ml NS to make 2.5-3 cc inhalation treatment administered via SVN with a mouth piece, O2 mask or in-line with a ventilatory device. May be repeated according to medical control preference
ADENOSINE Pediatric Dosage
Pediatric Dosage: (Drug of choice for treating SVT in symptomatic infants and children) Initial: 0.1 mg/kg as a rapid IV bolus. Special administration procedure: Follow immediately with 2-3 ml normal saline flush. Use injection port nearest the hub of IV catheter for procedure; constant ECG monitoring. Repeat: If no response, dose may be doubled 1 time (0.2 mg/kg) using same administration procedure. Maximum singe dose: Should not exceed 12 mg. Infants with SVT associated with shock: Adenosine may precede cardioversion if vascular access is available, but cardioversion should not be delayed while IV access is achieved.
CHARCOAL, ACTIVATED (without sorbitol) Pediatric Dosage
Pediatric Dosage: 0.5 -1.0 Gm/kg; if not in pre-mixed slurry, mix one part charcoal with four parts water.
VERAPAMIL HCl Pediatric Dosage
Pediatric Dosage: IV form not used in children in the field
THIAMINE HCl (vitamin B1) Pediatric Dosage
Pediatric Dosage: Rarely used
SODIUM BICARBONATE 8.4% Pediatric Dosage
Pediatric Dosage: 1 mEq/kg IV or IO slowly, if ventilation is adequate according to medical control authority. Can contribute to acidosis and cause fluid overload. Neonatal Dosage: 1 mEq/kg IV or IO of 4.2% slowly. Waste 25 ml of 8.4% solution and add 25 ml of NS from IV bag, each ml will contain 0.5 mEq of sodium bicarbonate
PHENYLEPHRINE NASAL SPRAY 0.5% Pediatric Dosage
Pediatric Dosage: None
OXYTOCIN Pediatric Dosage
Pediatric dose: none
NITROUS OXIDE 50% Pediatric Dosage
Pediatric Dosage: Must be old enough to follow the instructions for use and large enough that the mask creates an airtight seal.
NITROGLYCERIN Pediatric Dosage
Pediatric dose: none
NALOXONE HCl Pediatric Dosage
Pediatric Dosage: < 5 years or < 20 kg: 0.1 mg/kg IV, ET, inject SL, SC, IO (includes neonate). > 5 years or > 20 kg: 2 mg IV, ET, inject SL, SC or IO
MORPHINE SULFATE Pediatric Dosage
Pediatric Dosage: 100-200 mcg/kg slow IV push
DIPHENHYDRAMINE HCl Pediatric Dosage
Pediatric Dosage: 1.0 -1.25 mg/kg slow IV push May also be given deep IM
MIDAZOLAM HYDROCHLORIDE Pediatric Dosage
Pediatric Dosage: 0.05 to 0.1 mg/kg slow IV push / 0.2 mg/kg IM for status seizures if no IV access
METHYLPREDNISOLONE SODIUM SUCCINATE Pediatric Dosage
Pediatric Dosage: Reactive Airway Disease, Anaphylaxis, Burns Potentially Involving the Airway: 2-4 mg/kg slow IV bolus
MAGNESIUM SULFATE Pediatric Dosage
Pediatric dosage: none
LIDOCAINE HCl Pediatric Dosage
Pediatric Dosage: Initial Bolus doses: 1 mg/kg, may repeat 1 time in 3-5 minutes for VF/Pulseless VT or in 15 minutes if used for refractory dysrhythmias with a pulse (VT with pulse, significant ventricular ectopy). Infusion with return of spontaneous rhythm, optional: 20-50 Mg/kg/min; prepared by adding 120 mg (3cc) of 1 Gm/25 ml (40 mg/ml) solution to 97 ml of NS, yielding 1200 Mg/ml. 1 ml/kg/hr delivers 20 Mg/kg/min. 2.5 ml/kg/hr delivers 50 Mg/kg/min. Reduce to < 20 Mg/kg/min for children with low cardiac output, severe CHF or compromised hepatic blood flow. Infusion should be avoided unless infusion pump available.
GLUCAGON Pediatric Dosage
Pediatric Dosage: (for children under 20 kg or 44 lbs) Hypoglycemia: 0.5 mg IM or a dose equivalent to 20-30 mg/kg, may repeat in 7-10 minutes
FUROSEMIDE Pediatric Dosage
Pediatric Dosage: 1 mg/kg IV slowly
EPINEPHRINE HCl Pediatric Dosage
Pediatric Dosage: (Cardiac arrest includes VF/Pulseless VT, Asystole, and PEA) IV/IO Initial Dose for Cardiac Arrest or Refractory Bradycardia: 0.01 mg/kg of 1:10,000. ET Initial Dose for Cardiac Arrest or Refractory Bradycardia: 0.1 mg/kg of 1:1000; diluted with NS to a volume of 3-5 ml prior to instillation or followed with flush of 3-5 ml of NS after instillation. IV/IO/ET Repeat Dose Cardiac Arrest: 0.1 mg/kg of 1:1000; dilute with 3-5 ml of NS. Repeat Dose Refractory Bradycardia: Same dose every 3-5 min. See: Special Notes section. Asthma/anaphylaxis: Use 1:1,000 solution; give 0.01 mg/kg SC (maximum of 0.35 mg/dose). IV Infusion: 0.1 Mg/kg/min; to prepare for small children 0. 6 x body wt. in kg = mg added to NS to make 100 ml. With this mixture, 1 ml/hr delivers 0.1 Mg/kg/min. Neonatal Dose for First 12 hours of life: IV/IO/ET Initial and Repeat Dose for Cardiac Arrest or Refractory Bradycardia: 0.01-0.03 mg/kg of 1:10,000 every 3-5 minutes Repeat Dose Consideration for ET Epinephrine: 0.1 mg/kg of 1:1000 solution if neonate has no vascular access, fails to respond to positive pressure ventilation with 100% O2, and standard epinephrine dose by the ET tube
DOPAMINE Pediatric Dosage
Pediatric Dosage: 2-20 Mg/kg/min for circulatory shock or shock unresponsive to fluid administration. To prepare infusion for small children: 6 x body wt. in kg = mg added to NS to make 100 ml. With this mixture 1 ml/hr delivers 1 mcg/kg/min; titrate to effect.
DIAZEPAM Pediatric Dosage
Pediatric Dosage: IV Dose: 0.2-0.3 mg/kg every 15-30 minutes (max. of 1.0 mg/kg); administer IV over at least 3 minutes or until seizure activity subsides. IV Dose after rectal dose: 0.1 mg/kg with same administration instructions. Rectal dose (<6 years): 0.3-0.5 mg/kg rectally at IV push rate; may repeat in 15-30 min at 0.25 mg/kg.
DEXAMETHASONE SODIUM PHOSPHATE Pediatric Dosage
Pediatric Dosage: Reactive Airway Disease, Anaphylaxis 0.25 - 0.5mg/kg. Cerebral Edema 0.5 -1.5mg/kg
CALCIUM CHLORIDE Routes of Administration
Routes of Administration: IV bolus
DEXTROSE 50% Routes of Administration
Routes of Administration: IV bolus (rapid)
BUMETANIDE Routes of Administration
Routes of administration: IV
BRETYLIUM TOSYLATE Routes of Administration
Routes of Administration: IV bolus, then IV infusion
ATROPINE SULFATE Routes of Administration
Routes of Administration: IV, ET, SVN
ACETYLSALICYLIC ACID, ASA Routes of Administration
Routes of Administration: Oral
AMIODARONE Routes of Administration
Route of Administration: IV infusion
ALBUTEROL SULFATE Routes of Administration
Routes of Administration: Nebulized, mouth piece or in-line via mask Inhaler, patients own, ET/NT in-line
ADENOSINE Routes of Administration
Routes of Administration: Rapid IV push
CHARCOAL, ACTIVATED (without sorbitol) Routes of Administration
Routes of Administration: Oral (po), nasogastric tube (ng), orogastric (og)
VERAPAMIL HCl Routes of Administration
Routes of Administration: IV slow push (See: Special Notes)
THIAMINE HCl (vitamin B1) Routes of Administration
Routes of Administration: IM, IV over several minutes
SODIUM BICARBONATE 8.4% Routes of Administration
Routes of Administration: IV bolus; IV infusion. For IV infusion to be monitored on interfacility transports, infusion pump is required
PHENYLEPHRINE NASAL SPRAY 0.5% Routes of Administration
Routes of Administration: Mucosal; spray in each nostril
OXYTOCIN Routes of Administration
Routes of Administration: IV infusion, IM (IV infusion on interfacility requires infusion pump)
NITROUS OXIDE 50% Routes of Administration
Routes of Administration: Self-administered via mask
NITROGLYCERIN Routes of Administration
Routes of Administration: IV or SL. ** IV infusion on interfacility transports; special training and infusion pump required
NALOXONE HCl Routes of Administration
Routes of Administration: IV, ET, SC, inject SL, IO or constant IV infusion
MORPHINE SULFATE Routes of Administration
Routes of Administration: Usually given IV in the field, can be given IM or SC.
DIPHENHYDRAMINE HCl Routes of Administration
Routes of Administration: IV, Deep IM
MIDAZOLAM HYDROCHLORIDE Routes of Administration
Routes of Administration: For IM administration, inject deep into large muscle mass. For IV bolus and infusion, administer slowly in small increments over at least 2 minutes and allow 2 more minutes between doses to evaluate effect.
METHYLPREDNISOLONE SODIUM SUCCINATE Routes of Administration
Routes of Administration: IV bolus
MAGNESIUM SULFATE Routes of Administration
Routes of Administration: IV PUSH, IV infusion bolus and IV infusion
LIDOCAINE HCl Routes of Administration
Routes of Administration: IV bolus, followed by IV infusion. May be given ET if IV access is delayed
GLUCAGON Routes of Administration
Routes of Administration: Hypoglycemia: IM or SC administration avoids possibility of inducing encephalopathy in a thiamine-deficient patient
FUROSEMIDE Routes of Administration
Routes of Administration: Slow IV push
EPINEPHRINE HCl Routes of Administration
Routes of Administration: Cardiac: IV push, IV infusion, ET, or IO (pediatric patients up to 6 years of age) Asthma/anaphylaxis/bronchiolitis: SC, SL injection, IM, IV, ET, IO Infusion pump required for IV infusions in interfacility transfers
DOPAMINE Routes of Administration
Routes of Administration: IV infusion. Infusion pump required on interfacility transfers
DIAZEPAM Routes of Administration
Routes of Administration: Slow IV push Rectally for children < 6 years
DEXAMETHASONE SODIUM PHOSPHATE Routes of Administration
Route of Administration: IV bolus, IM
CALCIUM CHLORIDE Onset of Action
Onset of Action: Seconds
DEXTROSE 50% Onset of Action
Onset of Action: Seconds
BUMETANIDE Onset of Action
Onset of Action: immediate
BRETYLIUM TOSYLATE Onset of Action
Onset of Action: 5 minutes
ATROPINE SULFATE Onset of Action
Onset of Action: 1 minute
ACETYLSALICYLIC ACID, ASA Onset of Action
Onset of Action: 20-30 minutes
AMIODARONE Onset of Action
Onset of Action: Variable
ALBUTEROL SULFATE Onset of Action
Onset of Action: 5-15 minutes
ADENOSINE Onset of Action
Onset of Action: Seconds
CHARCOAL, ACTIVATED (without sorbitol) Onset of Action
Onset of Action: Immediate
VERAPAMIL HCl Onset of Action
Onset of Action: 1-3 minutes
THIAMINE HCl (vitamin B1) Onset of Action
Onset of Action: Hours
SODIUM BICARBONATE 8.4% Onset of Action
Onset of Action: Seconds
PHENYLEPHRINE NASAL SPRAY 0.5% Onset of Action
Onset of Action: Seconds
OXYTOCIN Onset of Action
Onset of Action: Seconds
NITROUS OXIDE 50% Onset of Action
Onset of Action: Within a few breaths
NITROGLYCERIN Onset of Action
Onset of Action: Seconds
NALOXONE HCl Onset of Action
Onset of Action: IV -- within 2 minutes
MORPHINE SULFATE Onset of Action
Onset of Action: Seconds
DIPHENHYDRAMINE HCl Onset of Action
Onset of Action: IV 5 - 10 minutes
MIDAZOLAM HYDROCHLORIDE Onset of Action
Onset of Action: IM - 15 minutes, IV - immediate
METHYLPREDNISOLONE SODIUM SUCCINATE Onset of Action
Onset of Action: 1 - 6 hours; dogmatic 6 hour time to onset of benefit has decreased markedly during the last few years
MAGNESIUM SULFATE Onset of Action
Onset of Action: Seconds
LIDOCAINE HCl Onset of Action
Onset of Action: 1-5 minutes
GLUCAGON Onset of Action
Onset of Action: (dose and route dependent) 1 mg IM, 8-10 minutes. IV, 1 minute
FUROSEMIDE Onset of Action
Onset of Action: 5 minutes (vasodilation)
EPINEPHRINE HCl Onset of Action
Onset of Action: Seconds
DOPAMINE Onset of Action
Onset of Action: Almost immediate
DIAZEPAM Onset of Action
Onset of Action: Minutes
DEXAMETHASONE SODIUM PHOSPHATE Onset of Action
Onset of Action: 4-8 hours
CALCIUM CHLORIDE Peak Effects
Peak Effects: 3 - 5 minutes
DEXTROSE 50% Peak Effects
Peak Effects: Variable
BUMETANIDE Peak Effects
Peak Effect: IV – 15 to 30 minutes
BRETYLIUM TOSYLATE Peak Effects
Peak Effects: 45-60 minutes
ATROPINE SULFATE Peak Effects
Peak Effects: 2-5 minutes
ACETYLSALICYLIC ACID, ASA Peak Effects
Peak Effects: 2 hours
AMIODARONE Peak Effects
Peak effects: Variable
ALBUTEROL SULFATE Peak Effects
Peak Effects: 30 minutes - 2 hours
ADENOSINE Peak Effects
Peak Effects: Seconds
CHARCOAL, ACTIVATED (without sorbitol) Peak Effects
Peak Effects: Not applicable
VERAPAMIL HCl Peak Effects
Peak Effects: 3-5 minutes
THIAMINE HCl (vitamin B1) Peak Effects
Peak Effects: 3-5 days
SODIUM BICARBONATE 8.4% Peak Effects
Peak Effects: 1-2 minutes
PHENYLEPHRINE NASAL SPRAY 0.5% Peak Effects
Peak Effects: 30 minutes
OXYTOCIN Peak Effects
Peak Effects: Variable
NITROUS OXIDE 50% Peak Effects
Peak Effects: Not available
NITROGLYCERIN Peak Effects
Peak Effects: 5-10 minutes
NALOXONE HCl Peak Effects
Peak Effects: Variable
MORPHINE SULFATE Peak Effects
Peak Effects: 20 minutes
DIPHENHYDRAMINE HCl Peak Effects
Peak Effects: 1 hour
MIDAZOLAM HYDROCHLORIDE Peak Effects
Peak Effects: IM - 15 to 60 minutes, IV - 3 to 5 minutes
METHYLPREDNISOLONE SODIUM SUCCINATE Peak Effects
Peak Effects:8 hours
MAGNESIUM SULFATE Peak Effects
Peak Effects: Not known
LIDOCAINE HCl Peak Effects
Peak Effects: 5-10 minutes
GLUCAGON Peak Effects
Peak Effects: (does and route dependent)1 mg IM, 12-14 minutes, IV, 3-6 minutes
FUROSEMIDE Peak Effects
Peak Effects: 20-60 minutes (diuresis)
EPINEPHRINE HCl Peak Effects
Peak Effects: Minutes
DOPAMINE Peak Effects
Peak Effects: 5-10 minutes
DIAZEPAM Peak Effects
Peak Effects: Minutes
DEXAMETHASONE SODIUM PHOSPHATE Peak Effects
Peak Effects: 6 - 12 hours
CALCIUM CHLORIDE Duration of Action
Duration of Action: 15-30 minutes
DEXTROSE 50% Duration of Action
Duration of Action: Variable
BUMETANIDE Duration of Action
Duration of Action: 2 to 4 hours
BRETYLIUM TOSYLATE Duration of Action
Duration of Action: 5-10 hours
ATROPINE SULFATE Duration of Action
Duration of Action: 2 hours
ACETYLSALICYLIC ACID, ASA Duration of Action
Duration of Action: 4-6 hours
AMIODARONE Duration of Action
Duration of Action: Half-life may exceed 40 days.
ALBUTEROL SULFATE Duration of Action
Duration of Action: 3-4 hours
ADENOSINE Duration of Action
Duration of Action: 10-12 seconds (1/2 life 5 seconds)
CHARCOAL, ACTIVATED (without sorbitol) Duration of Action
Duration of Action: Dependent upon GI function; acts until excreted
VERAPAMIL HCl Duration of Action
Duration of Action: 2-5 hours
THIAMINE HCl (vitamin B1) Duration of Action
Duration of Action: Unavailable
SODIUM BICARBONATE 8.4% Duration of Action
Duration of Action: 10 minutes
PHENYLEPHRINE NASAL SPRAY 0.5% Duration of Action
Duration of Action: 30 minutes to 4 hours
OXYTOCIN Duration of Action
Duration of Action: 1 hour after discontinued
NITROUS OXIDE 50% Duration of Action
Duration of Action: 1-2 minutes
NITROGLYCERIN Duration of Action
Duration of Action: 1-10 minutes after IV discontinued
NALOXONE HCl Duration of Action
Duration of Action: Approximately 45 minutes
MORPHINE SULFATE Duration of Action
Duration of Action: 2-4 hours
DIPHENHYDRAMINE HCl Duration of Action
Duration of Action: 3-6 hours
MIDAZOLAM HYDROCHLORIDE Duration of Action
Duration of Action: 2 to 6 hours
METHYLPREDNISOLONE SODIUM SUCCINATE Duration of Action
Duration of Action: 18-36 hours
MAGNESIUM SULFATE Duration of Action
Duration of Action: 24 hours or greater
LIDOCAINE HCl Duration of Action
Duration of Action: Bolus only - 20 minutes
GLUCAGON Duration of Action
Duration of Action: (dose and route dependent) 1 mg IM, 12-27 minutes, IV, 20 minutes
FUROSEMIDE Duration of Action
Duration of Action:Variable
EPINEPHRINE HCl Duration of Action
Duration of Action: Several minutes
DOPAMINE Duration of Action
Duration of Action: Effects cease almost immediately when infusion is shut off
DIAZEPAM Duration of Action
Duration of Action: 20 minutes to 50 minutes
DEXAMETHASONE SODIUM PHOSPHATE Duration of Action
Duration of Action: 24 - 72 hours
CALCIUM CHLORIDE Dosage Forms/Packaging
Dosage Forms/Packaging: 1 Gm/10 ml prefilled syringes
DEXTROSE 50% Dosage Forms/Packaging
Dosage Forms/Packaging: 25 Gms/50 ml prefilled syringe
BUMETANIDE Dosage Forms/Packaging
Dosage Forms/Packaging: Depends on supply
BRETYLIUM TOSYLATE Dosage Forms/Packaging
Dosage Forms/Packaging: 500 mg/10 ml ampules
ATROPINE SULFATE Dosage Forms/Packaging
Dosage Forms/Packaging: 1 mg/10 ml Prefilled syringes and 8 mg/20 ml multi-dose vial
ACETYLSALICYLIC ACID, ASA Dosage Forms/Packaging
Dosage Forms/Packaging: 81 - 325 mg tablet individually packaged
AMIODARONE Dosage Forms/Packaging
Dosage Forms/Packaging: 2-3 glass ampules, 150mg/6.0 mL
ALBUTEROL SULFATE Dosage Forms/Packaging
Dosage Forms/Packaging: 2.5 mg albuterol premixed in 3 ml normal saline (independent dose) sulfite-free
ADENOSINE Dosage Forms/Packaging
Dosage Forms/Packaging: Flip top vials 6 mg/2 ml (3 mg/ml) Prefilled syringe 6 mg/2 ml (3 mg/ml)
CHARCOAL, ACTIVATED (without sorbitol) Dosage Forms/Packaging
Dosage Forms/Packaging: Powder, Pre-mixed slurries of 15, 25, and 50 g, Pre-mixed tubes of 25 g
VERAPAMIL HCl Dosage Forms/Packaging
Dosage Forms/Packaging: 5 mg/2 ml prefilled syringes, ampules and vials (2.5 mg/ml)
THIAMINE HCl (vitamin B1) Dosage Forms/Packaging
Dosage Forms/Packaging: 100 mg/ml; 1 ml ampule or tubes
SODIUM BICARBONATE 8.4% Dosage Forms/Packaging
Dosage Forms/Packaging: 50 mEq/50 ml prefilled syringes
PHENYLEPHRINE NASAL SPRAY 0.5% Dosage Forms/Packaging
Dosage Forms/Packaging: 0.5% solution, 15 ml bottle
OXYTOCIN Dosage Forms/Packaging
Dosage Forms/Packaging: 10 USP units/1 ml ampule or tubes
NITROUS OXIDE 50% Dosage Forms/Packaging
Dosage Forms/Packaging: Nitrous oxide machine that delivers a fixed ration of nitrous oxide and oxygen (50:50) utilizing a mixing valve with separate tanks of N2O and O2 with a fail safe device (O2 tank empty, no nitrous flows) and a self-administration mask
NITROGLYCERIN Dosage Forms/Packaging
Dosage Forms/Packaging: Bottles of 25 1/150 grain/tablets / Spray Bottle with 200 metered doses, each 0.4 mg. IV form not carried on drug box, must use infusion pump for interfacility transfers
NALOXONE HCl Dosage Forms/Packaging
Dosage Forms/Packaging: 0.4 mg/ml: 1 ml ampule; 1 ml, 10 ml vials, 1 mg/ml: 1 ml, 2 ml ampules; 1ml, 5ml, 10 ml vials
MORPHINE SULFATE Dosage Forms/Packaging
Dosage Forms/Packaging: 10 mg/ml ampules, only
DIPHENHYDRAMINE HCl Dosage Forms/Packaging
Dosage Forms/Packaging: 50 mg/1 ml syringes and vials
MIDAZOLAM HYDROCHLORIDE Dosage Forms/Packaging
Dosage Forms/Packaging: 1 mg midazolam/1 mL: 5 mL vials (5 mg)
METHYLPREDNISOLONE SODIUM SUCCINATE Dosage Forms/Packaging
Dosage Forms/Packaging: 125 mg/1 ml, 500 mg/4 ml, 1 g/8 ml mix-a-vial 2G vial w/ dilutent
MAGNESIUM SULFATE Dosage Forms/Packaging
Dosage Forms/Packaging: 1 Gm/2 cc vials (0.5 Gm/cc) 5 Gm/10 cc vials (0.5 Gm/cc)
LIDOCAINE HCl Dosage Forms/Packaging
Dosage Forms/Packaging: 100 mg/5 ml prefilled syringes (for bolus) 1 Gm in 25 ml vials and prefilled syringes (for infusion) 2 Gm in 500 ml D5W premixed bags (optional)
GLUCAGON Dosage Forms/Packaging
Dosage Forms/Packaging: 1 mg (1 unit) with 1 mL vial of diluting solution. 1 mg (1 unit) with prefilled syringe of diluting solution (Glucagon Emergency Kit)
FUROSEMIDE Dosage Forms/Packaging
Dosage Forms/Packaging: 20 mg/2 mL ampule, vial, syringe, 40 mg/4 mL ampule, vial, syringe, 100 mg/10 mL ampule, vial, syringe
EPINEPHRINE HCl Dosage Forms/Packaging
Dosage Forms/Packaging: 1:10,000 solution 1 mg/10 ml prefilled syringes. 1:1,000 solution 1 mg/1 ml ampule or prefilled syringes; 30 mg/30 ml vial.
DOPAMINE Dosage Forms/Packaging
Dosage Forms/Packaging: 400 mg/5 ml vials / 400 mg in 250 ml D5W premixed IV solution
DIAZEPAM Dosage Forms/Packaging
Dosage Forms/Packaging: 10 mg/2 ml prefilled syringes, ampules and vials. Diazepam Rectal Delivery Gel (optional) - 10 mg twin pack pediatric (total 20 mg)
DEXAMETHASONE SODIUM PHOSPHATE Dosage Forms/Packaging
Dosage Forms/Packaging: 20mg /5ml, 100mg/25ml, 120mg/5ml
CALCIUM CHLORIDE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 prefilled syringes
DEXTROSE 50% Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 2 - 4 prefilled syringes
BUMETANIDE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: If furosemide is not available: 4 – 8 vials of 1 mg/4 mL (0.25 mg/1mL)
BRETYLIUM TOSYLATE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 1 - 3 ampules
ATROPINE SULFATE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 3 - 4 (1 mg/10 ml) prefilled syringes, 1 - 2 (8 mg/20 ml, 0.4 mg/ml) multidose vial
ACETYLSALICYLIC ACID, ASA Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 36 - 100 Tablets
AMIODARONE Arizona Drug Box Supply Range
Arizona Drug Box Standard Supply: None.
ALBUTEROL SULFATE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 2 - 6 independent doses
ADENOSINE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 5 - 6 vials
CHARCOAL, ACTIVATED (without sorbitol) Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 2 - 4 (25 gm. tubes)
VERAPAMIL HCl Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 2 - 3 units
THIAMINE HCl (vitamin B1) Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 units
SODIUM BICARBONATE 8.4% Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 2 - 3 prefilled syringes
PHENYLEPHRINE NASAL SPRAY 0.5% Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 bottles
OXYTOCIN Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 units
NITROUS OXIDE 50% Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: Paramedic: Optional item / kept outside of box due to size
NITROGLYCERIN Arizona Drug Box Supply Range
Arizona Drug Box Supply: PARAMEDIC: 1 - 2 bottles of tablets or 1 - 2 spray bottles
NALOXONE HCl Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 10 mg total
MORPHINE SULFATE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 2 (20 mg)
DIPHENHYDRAMINE HCl Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 units
MIDAZOLAM HYDROCHLORIDE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: Paramedic: optional, 2-4 vials of 5 mg/5 mL
METHYLPREDNISOLONE SODIUM SUCCINATE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 125 mg/2 ml mix-a-vial. Optional: additional training requirement for Spinal Cord Trauma (2 g x 1, 1 g x 1, 500 mg x 1, 125 mg x 1)
MAGNESIUM SULFATE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 4 - 10 1 gm/2 ml vials
LIDOCAINE HCl Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 100 mg/5 ml prefilled syringes x 3 - 4 , 1 gm/25 ml vial x 1 - 2 2 gm/50 ml vial (premixed in 500 ml D5W optional) x 1 - 2
GLUCAGON Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2 units
FUROSEMIDE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 4 (20 mg/2 mL) or 4 (40mg/4mL) or 2 100mg/10mL)
EPINEPHRINE HCl Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 1:10,000 prefilled syringes x 6 - 8. 1:1000 ampules or prefilled syringes x 1 – 2; 1:1000 multidose vial x 1 – 2
DOPAMINE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 1 - 2
DIAZEPAM Arizona Drug Box Supply Range
Arizona Drug Box Supply Range:PARAMEDIC: 2 prefilled syringes (20 mg) 10 mg twin pack pediatric (20 mg)
DEXAMETHASONE SODIUM PHOSPHATE Arizona Drug Box Supply Range
Arizona Drug Box Supply Range: PARAMEDIC: 2 - 4 120mg/5ml and 2 - 4 20mg/5ml
CALCIUM CHLORIDE Special Notes
Special Notes: > For pediatrics, calcium chloride may be diluted with 1-2 ml of NS IV fluid per ml calcium chloride. > Concurrent administration of sodium bicarbonate and calcium chloride will produce a precipitate, calcium carbonate (chalk). > Studies have shown no benefit from calcium administration in asystole or PEA. There is increasing evidence that calcium increases damage to cells that have been injured and worsens the neurological outcome. > Calcium chloride is not recommended in patients with suspected digitalis toxicity. > Pediatric patients should not receive IV calcium channel blockers therefore there is no dose for pre-treatment. > Use of calcium chloride in treatment of hyperkalemia is a part of a combination drug therapy. Insulin may be given upon arrival to ED.
DEXTROSE 50% Special Notes
Special Notes: > Determine a blood glucose level before initiating administration of dextrose. Inducing an unnecessary hyperosmolar state during certain illness/injury states may worsen neurological outcome. Additionally dextrose is very necrosing to the vascular system. > Emergency treatment of hyperkalemia (clinical presentation, PMH and ECG changes) includes CaCl (or gluconate), sodium bicarbonate, and insulin and dextrose. Insulin may be given upon arrival to ED.
BUMETANIDE Special Notes
Special Notes: >Bumetanide does not have the vasodilatory effects of furosemide. >Patients allergic to sulfa drugs may show hypersensitivity. >May cause a reduction of blood supply to developing fetus. >Safety and effectiveness in pediatric patients is not established. >1.0 mg bumetanide = 40 mg furosemide
BRETYLIUM TOSYLATE Special Notes
Special Notes: > Bretylium is not considered first-line therapy for VF or VT because it is no more effective than lidocaine and is more likely to produce adverse hemodynamic effects during CPR. > In the non-cardiac arrest patient receiving bretylium transient hypertension may occur due to the initial stimulation of norepinephrine from adrenergic nerve terminals
ATROPINE SULFATE Special Notes
Special Notes: > Administering too small doses or administering too slowly may result in paradoxical bradycardia. > Signs and symptoms of cholinergic/organophosphate poisoning: excess salivation, lacrimation, urination, defecation, gastrointestinal cramping, excretion (SLUDGE), bradycardia; coma. > Signs and symptoms of poisoning/overdose of atropine-like drugs: dry mouth; thirst; hot, dry, flushed skin; fever; palpitations, restlessness; excitement; delirium.
ACETYLSALICYLIC ACID, ASA Special Notes
Special Notes: > Baby ASA is heat and light sensitive. The odor of acetic acid (vinegar-like smell) indicates degradation of product
AMIODARONE Special Notes
Special Notes: > May prolong QT interval. > Use with caution if hepatic failure is present or if administered in combination with other drugs. > Patient must be on a cardiac monitor. > Must be administered on an IV infusion pump. > Amiodarone is an optional drug.
ALBUTEROL SULFATE Special Notes
Special Notes: > Must be sulfite-free
ADENOSINE Special Notes
Special notes: > Dysrhythmias may recur (short half life). > Dysrhythmias appear in 55% of patients at conversion; lasting for a few seconds, do not usually require intervention. > Second dose must be prepared and available. > Check for crystallization in cold climates.
CHARCOAL, ACTIVATED (without sorbitol) Special Notes
Special Notes: > Give it! > Charcoal mixture should not contain sorbitol; carefully read label of exchange supply.
VERAPAMIL HCl Special Notes
Special Notes: > May be used in conjunction with cardioversion. > Vagal maneuvers may be tried first (Valsalva maneuver). > Monitor closely for hypotension and AV block during administration. > Slow IV push: Verapamil is generally given over a 1-2 minute period. In middle age or older patients the IV dose should be administered over a 3 minute period. Peak effects occur within 3-5 minutes of bolus injection. > Hypotension may be treated with fluids, supine position, and/or calcium chloride. > Cautious administration is recommended when IV verapamil is given to a patient receiving oral Beta blockers or oral calcium channel blockers (not a contraindication). > The ventricular response to atrial fibrillation in patients with Wolff-Parkinson-White (WPW) syndrome may be accelerated in response to verapamil and VF can occur. Verapamil should be used cautiously, if at all, in patients with WPW syndrome associated with atrial fibrillation and flutter. > Verapamil is not effective for the treatment of most types of VT. It may induce severe hypotension and predispose the patient to the development of VF. Avoid verapamil in patients with wide-QRS tachycardia unless it is known with certainty to be supraventricular in origin. > In patients with acute pump failure (not severe), therapy with verapamil is indicated (used cautiously) if resolution of the tachycardia will remove the cause of the hemodynamic compromise. IV calcium has been recommended as pretreatment therapy against hypotension in patients with marginal blood pressure or with left ventricular dysfunction. > Because of the shorter duration of action, adenosine is preferable in PSVT.
THIAMINE HCl (vitamin B1) Special Notes
Special Notes: > In the known alcoholic patient dextrose should not be administered without thiamine. > Thiamine has been shown to be useful in severe congestive heart failure.
SODIUM BICARBONATE 8.4% Special Notes
Special Notes: > Flush tubing before and after administration, especially with concurrent use of calcium chloride. > Sodium bicarbonate administration should be considered only for treatment of documented severe acidosis associated with prolonged cardiac arrest or an unstable hemodynamic state, hyperkalemia or certain overdoses (i.e. cyclic antidepressants, ASA, phenobarbital, etc.). > In premature infants hyperosmolarity from undiluted sodium bicarbonate has been correlated with an increased risk for periventricular-intraventricular hemorrhage. > Severe tissue necrosis will occur with extravasation.
PHENYLEPHRINE NASAL SPRAY 0.5% Special Notes
Special Notes: > Single patient use only. > Air or strong light causes potency loss; do not use solution if brown in color or precipitate is in bottle. > Nasal intubation tips: examine nares for most patent side; administer topical vasoconstrictor, use ETT 0.5-1.0 mm smaller than for oral intubation; lubricate nostril and tube; tube bevel face nasal septum to avoid abrading Kieselbach's Plexus; advance tube along nasal floor of more patent side.
OXYTOCIN Special Notes
Special Notes: > Post partum hemorrhage is defined as blood loss in excess of 500 ml at delivery and during the first 24 hours after delivery. It should be remembered that all blood seen at delivery is the mother's unless there is a spill of cord blood or trauma to the placenta. > Do not use if solution is discolored or contains a precipitate. > In addition to oxytocin, fundal massage is also indicated to remove clot formation and stimulate uterine contraction. > IV fluids are necessary to correct hypovolemia; if post partum hemorrhage is due to other causes such as vaginal or cervical lacerations or retained placental fragments, oxytocin and fundal massage will not be effective. > Oxytocin is an optional drug.
NITROUS OXIDE 50% Special Notes
Special Notes: > Does not work well for short periods of intense pain. > Does not mask serious conditions. > Must be self-administered by the patient
NITROGLYCERIN Special Notes
Special Notes:> NTG is heat and light sensitive; stock rotation assures fresh supply. > SL: Cautiously administer NTG to a patient who has never received it, consider establishing an IV prior to administration. > Patients with hypotension should be administered this drug with caution. > Closely monitor vital signs, cardiac rhythm. > Bradydysrhythmias and hypotension usually respond to Trendelenburg’s position; atropine and vasopressors may be administered if needed. > Monitoring IV nitroglycerin on patients during interfacility transport requires an infusion pump and is limited to prehospital providers that have completed a special training curriculum in accordance with their medical control authorities. ** Indicates special training requirement
NALOXONE HCl Special Notes
Special Notes: > Opioid drugs include heroin, Dilaudid, morphine, meperidine, codeine, methadone, Lomotil, Darvon, Darvocet, Talwin and others. Large amounts of the drug may be needed for Darvon, Darvocet, and Methadone. > If Naloxone HCl is not available, use Nalmefene HCl (2 mg/2mL). > For adult intra-nasal administration, 1 mg/1ml is the preferred solution. 0.4 mg/1 ml may be used as an alternative. ** Indicates special training requirement
MORPHINE SULFATE Special Notes
Special Notes: > Schedule II narcotic. > Watch for histamine effects (wheals, urticaria) proximal to IV site; contact medical control. > Correct hypotension before administration. > Maximum respiratory depression 7-10 minutes after administration; can be reversed with naloxone; use caution in patients with emphysema. > Infusions: IV infusions of morphine sulfate may be transported, however an infusion pump is required.
DIPHENHYDRAMINE HCl Special Notes
Special Notes: > Not used in newborn or premature infants; used in pregnancy only if clearly needed. > In anaphylaxis, used as a 2nd line treatment after epinephrine and steroids.
MIDAZOLAM HYDROCHLORIDE Special Notes
Special Notes: > Flumazenil is the accepted antagonist for midazolam. > Midazolam is an optional drug
METHYLPREDNISOLONE SODIUM SUCCINATE Special Notes
Special Notes: > Use for spinal cord trauma is limited to prehospital providers that have completed a special training curriculum in accordance with their medical control authorities. Proper administration of methylprednisolone for spinal cord trauma is imperative.> Infusions: An infusion pump is required for continuous infusions of corticosteroids during interfacility transports; a minimum of microdrip tubing is required for field use if administering loading dose therapy for spinal cord trauma.
MAGNESIUM SULFATE Special Notes
Special Notes: > O2 should be administered to patients receiving MgSO4. > For OB emergencies maintenance infusions of MgSO4 should be administered by infusion pump to prevent toxicity. Therefore, loading bolus therapy only, using a minimum of microdrip tubing is recommended for field to hospital intervention for OB indications. Interfacility transfers may include a loading dose followed by a maintenance infusion of MgSO4 which requires an infusion pump. > Transport gravid patients lying or tilted to left side to prevent restricting venous return to heart. > Use cautiously in patients with impaired renal function, pre-existing heart blocks and women in labor. > Keep calcium chloride (10%) 10 ml available to reverse magnesium toxicity. See: CaCl profile > Monitor vital signs every 15 minutes and DTR's hourly in patients receiving MgSO4 infusion. If DTR's are absent or respirations <12/min, discontinue MgSO4 infusion, notify medical control. > Hourly intake and output should be monitored on long transport; urine output should be >30 cc/hr. > When given to toxemic mothers within 24 hours before delivery observe newborn for S/S of MgSO4 toxicity (neuromuscular and/or respiratory depression). > Additional high risk prenatal consultation is available through: Tucson Area 1-800-852-6616 or Phoenix Area 1-800-552-5252. > Interfacility maternal transport teams are recommended and available for the transport of patients requiring continuous IV infusions of MgSO4. > In treatment of seizures associated with PIH it may be necessary to use an anticonvulsant such as diazepam.
LIDOCAINE HCl Special Notes
Special Notes: > Decrease maintenance infusion by 50% in cases of congestive heart failure, shock, liver disease. > Cross-allergenicity between local anesthetic "caine" drugs is controversial. > Consider increased dose for ET administration. > Infusions: Infusion pump is required for interfacility transports. A minimum of microdrip tubing is required for field use. Lidocaine drip rates established in field should be monitored carefully.
GLUCAGON Special Notes
Special Notes: > Blood sugar should be measured rapidly before deciding upon the administration of D50 or glucagon, especially in the non-diabetic patient. > Documented hypoglycemia is a true medical emergency, IM glucagon should be administered rapidly if IV access is delayed. > In known alcoholics, administer thiamine in addition to glucagon to prevent inducing an encephalopathy in a thiamine-deficient patient. > Patients with Type I diabetes do not have as great a response in blood glucose levels as Type II stable patients. For all patients having hypoglycemic episode, supplementary complex carbohydrates should be eaten within 2 hour, especially in a child or adolescent.
FUROSEMIDE Special Notes
Special Notes: > Ototoxicity and resulting deafness can occur. > Since furosemide is a sulfonamide derivative, it may induce allergic reactions in patients with sensitivity to sulfonamides (sulfa drugs).
EPINEPHRINE HCl Special Notes
Special Notes: > Total dose for an adult ET (drug plus diluting solution) should equal at least 10 ml to ensure that the drug reaches lung tissue rather than remaining in the tube. Pediatric patient should equal 3 - 5 ml. > Multi-dose Vial: 1 mg/ml (1:1000) in 30 ml bottle. May be used for administering the ACLS doses of epinephrine down the endotracheal tube (2-2.5 times the peripheral route dose, diluted with 8 ml NS to make a 1:10,000 solution) or for mixing an epinephrine infusions such as 30 mg/250 ml NS. > Pediatric: If first dose given ET, then IV established, begin at initial IV dose for next dose. > Data is inadequate to evaluate the safety of high dose epinephrine in newborns; may lead to prolonged hypertension and resultant complications such as Intra cranial hemorrhage in preterm infants. > Infusions: An infusion pump is required for interfacility transports. A minimum of microdrip tubing is required for field use.
DOPAMINE Special Notes
Special Notes: > Always monitor drip rate, never run "wide open". > An infusion pump is required for interfacility transports; a minimum of microdrip tubing is required for field use. > It is important to remember that even in low dose ranges dopamine elevates pulmonary artery occlusive pressure and may induce or exacerbate pulmonary congestion despite a rise in cardiac output. > Notify physician if infusion infiltrates for administration of antidote.
DIAZEPAM Special Notes
Special Notes:> Valium must be injected slowly and small veins such as those on the dorsum of the hand or wrist should be avoided. Risk of venous thrombosis, phlebitis, local irritation, swelling and vascular spasm is increased. > Extreme care must be taken to avoid intra-arterial injection or extravasation. > Diazepam may cause prolonged CNS depression in the neonate (30 days of age or less).
DEXAMETHASONE SODIUM PHOSPHATE Special Notes
Special Notes: > Use for spinal cord trauma is limited to prehospital providers that have completed a special training curriculum in accordance with their medical control authorities. Proper administration of dexamethasone for spinal cord trauma is imperative. >Infusions: An infusion pump is required for continuous infusions of corticosteroids during interfacility transports; a minimum of microdrip tubing is required for field use of administering loading dose therapy for spinal cord trauma.
SUCCINYLCHOLINE BRAND NAME
Brand Name: Anectine
VASOPRESSIN BRAND NAME
Brand Name: Pitressin
SUCCINYLCHOLINE CLASS
Class: Neuromuscular blocker (depolarizing)
VASOPRESSIN CLASS
Class: Naturally occurring antidiruetic hormone
SUCCINYLCHOLINE Mechanism of Action
Mechanism of Action: The quickest onset & briefest duration or all neuromuscular blocking drugs. Binds to the receptors for acetylcholine. Causes depolarization of muscle membrane & often leads to fascicualtions & some muscular contractions .
VASOPRESSIN Mechanism of Action
Mechanism of Action: Acts by direct stimulation of smooth muscle V1 receptors, when given in extremely high doses, it acts as a nonadrenergic peripheral vasoconstrictor.
SUCCINYLCHOLINE Indications/field use
Indications & Field Use: To facilitate intubation (RSI), terminating laryngospasm, muscle relaxation
VASOPRESSIN Indications/field use
Indications & Field Use: Alternative to epinephrine in adult shock-refractory VF, vasodilatory shock
SUCCINYLCHOLINE Contraindications
Contradictions: Acute injuries, hypersensitivity, skeletal muscle myopathies, Paramedic’s inability to control / support pt airway / ventilations, acute rhabdomyolysis.
VASOPRESSIN Contraindications
Contradictions: Responsive patents, w/ coronary artery disease
SUCCINYLCHOLINE Adverse Reactions
Adverse Reactions: CV: Hypotension, bradycardia, dysrhythmias, RESP: Resp depression. CNS: Initial muscle fascilation, excess salivation, malignant hyperthermia, allergic raction
VASOPRESSIN Adverse Reactions
Adverse Reactions: CV: Ischemic chest pain, RESP: Bronchial constriction, CNS: Tremors, sweating, GI: Nausea & vomiting, abdominal distress, uterine contraction
SUCCINYLCHOLINE Incompatibilities/Drug Interactions
Incompatabilites/Drug Interactions: Oxytocin, beta-blockers, contraceptives, organophosphates
VASOPRESSIN Incompatibilities/Drug Interactions
Incompatabilites/Drug Interactions: None have been reported.
SUCCINYLCHOLINE Adult Dosage
Adult Dosage: 0.3 to 1.1mg/kg (25 to 75mg) over 10 to 30secs IV, .04 - .07mg/kg to maintain relaxation.
VASOPRESSIN Adult Dosage
Adult Dosage: 40 U IVP, ONE TIME
SUCCINYLCHOLINE Pediatric Dosage
Pediatric Dosage: 1 - 2mg/kg
VASOPRESSIN Pediatric Dosage
Pediatric Dosage: Not recommended
SUCCINYLCHOLINE Routes of Administration
Routes of Administration: RIVP
VASOPRESSIN Routes of Administration
Routes of Administration: RIVP
SUCCINYLCHOLINE Onset of Action
Onset of Action: Seconds
VASOPRESSIN Onset of Action
Onset of Action: Immediate
SUCCINYLCHOLINE Peak Effects
Peak Effects: 2 – 3 mins
VASOPRESSIN Peak Effects
Peak Effects: 10 – 20mins
SUCCINYLCHOLINE Duration of Action
Duration of Action: 5 – 10min
VASOPRESSIN Duration of Action
Duration of Action: Variable
SUCCINYLCHOLINE Dosage Forms/Packaging
Dosage Forms/Packaging: 20, 50, 100mg/ml; 1G multi-dose vial
VASOPRESSIN Dosage Forms/Packaging
Dosage Forms/Packaging: 5 U / ml
SUCCINYLCHOLINE Arizona Drug Box Supply Range
AZ Drug Box : None
VASOPRESSIN Arizona Drug Box Supply Range
AZ Drug Box : None