Ems 30 Block 3

Front 1

Diazepam
-Drug Class
-Actions

Back 1

Class-
Anticonvulsant & Sedative & Muscle Relaxant (Benzodiazepine)
Actions- Anticonvulsant, Depresses C,P,A nervous systems, Decreases patient recall (amnesic effect)

Front 2

Diazepam
-Indications
-Contraindications

Back 2

Indications
-Active seizure activity
-sedation prior to cardioversion
-Prevent/suppress seizure caused by organophosphate poisoning
Contra- Shock/hypotension
-Alcohol intoxication(synergist)
-Acute narrow angle glaucoma
----rel. contra.Head Injury (decreased CNS Function)---

Front 3

Diazepam
-Adverse effects

Back 3

Cardio
-tachycardia, bradycardia, hypotension
Respiratory
-Apnea, hypoventilation
Neuro
-Blurred Vision, dizziness, confusion, restlessness, slurred speech
Other- worsens glaucoma, Phlebitis

Front 4

Diazepam
-Administration

Back 4

5-10mg IVP at 5mg per minute. Titrate to stop seizure activity or until sedation occurs for cardioversion. MR 5mg/min PRN to 20mg
ORGANOPHOSPHATE nerve agent severe poisoning
10 mg IM one time via auto-injector or syringe after mark I has been administered

Front 5

Diazepam
-peds Admin

Back 5

0.1-0.3 mg/kg IVP at 1 mg per minute or 0.5 mg/kg PR
-Titrate IV dose to stop seizure activity or until sedation occurs for cardioversion. MR IVP dose PRN up to 5mg(for up to 5yo) and 10mg (older than 5yo
ORGANOPHOSPHATE nerve agent, severe poisoning-0.2mg/kg IVP or IM. Max single dose 2mg. Max all dose 10mg

Front 6

Diazepam
-Precautions
-Rationale

Back 6

(P)Establish largest bore cannula in large vein and run IV wide open while administering medication (R)Drug may cause pain warmth or burning at IV site. Pt. may develop phlebitis, sclerosis or thrombosis of vein

Front 7

Diazepam
-Precautions
-Rationale cont

Back 7

(P) Support respirations (R) May cause respiratory depression
(P)Start NORMAL SALINE IV (R) Diazepam microprecipitates in D5W
(P) Inject med as close to IV as possible (R) diazepam is easily absorbed by plastic reducing concentration
(P)Flush line before and after med (R) incompatible w/ other meds
(P) Administer SLOWLY to elderly (R) Geri's have increased incidence of adverse effects

Front 8

Diazepam
-Note

Back 8

May be given for focal seizures if patient has ALOC. May alter Alter LOC. Use caution with pt.'s with head injury. Antidote for respiratory depression is Romazicon (flumazenil)...seizure... Schedule IV storage and records

Front 9

Morphine Sulfate
-class
-action

Back 9

Class- Narcotic Analgesic
Actions-
Alters pain perception and produces euphoria
Depresses central nervous system by interacting with opiate receptors in the brain
Decreases myocardial oxygen demand by: Decreasing preload by causing venous pooling due to peripheral vasodilation, Decreasing afterload by causing peripheral vasodilation resulting decreased systemic vascular resistance

Front 10

Morphine Sulfate
-indications

Back 10

Moderate to severe pain, **Especially burns or isolated extremity trauma
Chest pain of suspected myocardial origin
Pulmonary edema (not in LA)

Front 11

Morphine Sulfate
-contraindications

Back 11

Hypotension-Hypovolemia
Increased ICP- Head Injury
Patients at risk for respiratory depression (COPD)

Front 12

Morphine Sulfate
-Adverse affects

Back 12

Cardiovascular
-Tachycardia, Bradycardia
-HYPOTENSION
Respiratory
-bronchospasms
-apnea
-RESPIRATORY DEPRESSION
GI- n/v!!!
Neuro
-blurred vision, dizziness, hallucinations, confusion
Other
-ITCHING
-flushing (red line from IV...histamine response)

Front 13

Morphine Sulfate
-Administration

Back 13

2-10mg SLOW IVP at 2mg/min. Titrate to relief of pain. May repeat IV dose PRN to a maximum of 20mg
5-10mg IM as a single dose

Front 14

Morphine Sulfate
-Admin Peds

Back 14

0.1mg/kg slow IVP at 2mg/min. Titrate to relief of pain
0.1mg/kg IM as a single dose

Front 15

Morphine Sulfate
-Precautions/Rationale

Back 15

(P)Have Naloxone available (R) will reverse the respiratory depression caused by MS
(P) Monitor Vital Signs (R) May cause histamine mediated hypotension. Use shock position and/or fluids to treat hypotension. May cause hypotension in volume depleted or right ventricular infarction patients.
(P) Mix 10mg (1ml) Morphine w/ 9ml of NS to produce a concentration of 1mg/1ml

Front 16

Morphine Sulfate
-Note

Back 16

Morphine Sulfate is a schedule II med and will require additional storage and record keeping

Front 17

Morphine Sulfate
-Ref 806

Back 17

Moderate to severe pain due to ISOLATED extremity injury or burn
Titrate 2-4mg IV/IM if SBP >100 MRx1
PEDS- 0.1mg/kg IV/IM max single dose 4mg. MRx1

Front 18

Nalaxone
-class
-Actions
-Indications
-contraindications

Back 18

Narcan
class-Narcotic antagonist
Actions- reverses the respiratory and CNS sedation of narcotics by competing for opiate receptor sites in the brain
Indications- Suspected Narco OD with RR<12 or decreased TV
Contraindicaitons- not significant in indications listed above

Front 19

Naloxone
-Adverse Effects

Back 19

Cardio
-tachycardia
-dysrhythmias
-hypertension
GI- n/v!!!
Neuro
-tremors
-seizures

Front 20

Naloxone
-Admin

Back 20

0.8-2mg IVP,IM,IN. MR for all routes every 5min PRN. Titrate IV dose to adequate respiratory rate and tidal volume

Front 21

Naloxone
-Admin Peds

Back 21

0.1 mg/kg IVP, IM, IN MR dose for all routes every 5 min PRN

Front 22

Naloxone
-precautions
-rationale

Back 22

(P) Monitor patient status continuously, repeated doses may be needed (R) Actions may be as short as 30 min and patients may relapse into resp. depression.
(P) Administer med before consider ET intubation. (R) Patient will wake up and be pissed
(P)Recovery position, have suciton available (R) Protect Airway
(P) Monitor Vital Signs (does not reverse narcotic induced hypotension. Treat with shock position and fluids
(P) Prepare to protect pt. and EMS personnel (R)you just stole a junky's buzz

Front 23

Naloxone-
-Note...Reverses the Narcotics...

Back 23

MS, heroin, hydromorphone (vicodin), methadone, oxycodone (oxycontin) fentanyl citrate, paregoric, codeine, propoxyphene
AND
Reverses narcotic agonist-antagonist
-butorphanol tartrate, pentazocine (talwin), nalbuphine (nubain)

Front 24

Naloxone-
Supplied

Back 24

4mg/10ml vial: 2mg/2ml pre-fill syringe

Front 25

Naloxone-
Ref 806

Back 25

Resp Distress- Arrest/Hypovent (RR<_8min) Adult-0.8mg -2mg IV/IM MR PRN... Ped- 0.1 mg/kg IV/IM MR PRN
Altered LOC- Suspected narcotic OD w/ hypoventilation (prior to ET) Adult- 0.8-2 mg IV/IM....Ped- 0.1 mg/kg IV/IM

Front 26

Midazolam HCl
-Class
-Actions

Back 26

(Versed Hypnoval)
Class
-Anticonvulsant, Sedative, Hypnotic (Benzodiazepine)
Actions
-Depresses CNS
-Relaxes skeletal muscles
-Decreases patient recall (amnesic effect)

Front 27

Midazolam HCl
Indications

Back 27

-Suppression of Seizure activity
-Sedation prior to cardioversion/TCP
-Facilitates intubation
-Agitated Delirium (ETOH and/or drug Pt. ^BP, ^HR, ^Resp from surges of acetylcholamine

Front 28

Midazolam HCl
-Contraindications

Back 28

Contra
-Glaucoma
-Shock-Hypotension
-Patients taking calcium channel blocker or antifungal meds
Relative contra
-Head Injury
-Alcohol intoxication

Front 29

Midazolam HCl
-Adverse Effects

Back 29

Cardio
-tachycardia
-bradycardia
-HYPOTENSION
-PVC's
Respiratory
-apnea, HYPOVENTILATION, laryngospasm, bronchospasm, hiccups
Neuro
-Blurred vision, dizziness, drowsiness, confusion, restlessness, amnesia
Other
-Phlebitis

Front 30

Midazolam HCl
-Admin Adults

Back 30

Sedation for TCP or Cardioversion
1-2 mg SLOW IVP at 1mg/min. Titrate to produce sedation.
2.5 mg IM or IN. Max total dose is 10 mg
Seizure: 2-5mg SLOW IVPat 1mg/min. titrate to supress seizure activity. MR IVP every 3-5 min prn. 5mg IM or IN. MR IM/IN dose x1 in 5 min. Max dose 10mg
Agitated delirium- 2-5mg slow IVP at 1mg/min. 5mg IM/IN MR x 1.Maximum total dose 10 mg.

Front 31

Midazolam HCl
-Admin peds

Back 31

Seizure-
0.1mg/kg IVP at 1mg/min or 0.1mg/kg IM/IN. Titrate IV dose to suppress seizure activity. MR IVP/IM/IN dose x1 prn. Max total dose 5mg.

Front 32

Midazolam HCl
-Precautions
-Rationale

Back 32

(P) Monitor respiratory & cardiac status and prepare to support airway, ventilation & circulation. Have BVM and OP ready (R) Midazolam is 3-4x's more potent than diazepam...Significant risk of respiratory depression, especially w/ COPD pt.'s. (P) Continuous pulse ox (R) Monitor for hypoventilation
(P) Admin only 1/2 the recommended dose to debilitated pt.'s and pt.'s over 60yo (R) decreased hepatic metabolism prolongs the sedative effects.

Front 33

Midazolam HCl
-Notes

Back 33

-Ped pt.'s may require higher doses than adults, and children<6yo may require more than 6-12yo because of different metabolism.
-The action of Midazolam is potentiated when pt.'s are taking verapamil, ditiazem, ketoconazole, itraconazole, narcotics or have alcohol intoxication. the synergistic effet may result in life threatening resp depression or dysrhythmias

Front 34

Midazolam HCl
-Notes (cont)

Back 34

there is an increased risk of digoxin toxicity because of hypokalemia
- The antidote to reverse respiratory depression is Romazicon (flumazenil)
-Midazolam is a schedule IV med and will have additional storage and record keeping reqs.

Front 35

Midazolam HCl
-Ref 806

Back 35

Active Seizure- Adult
- titrate 2-5 mg IVP to seizure control. IF unable to start IVP, 5mg IM or IN MRx1
Pediatric
0.1mg/kg IVP to seizure control MR. If unstable to start IV, 0.1mg/kg IM or IN MR x1