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23 Cards in this Set

  • Front
  • Back
Activated charcoal
• Adsorbent
Rx—Poisoning/overdose: 1 gm/kg PO or by NG
tube. (Mix with water to make a slurry)
Contra—do not give before or together with ipecac.
Contact Poison Center for more advice.
SE—constipation.
Adenosine (ADENOCARD)
• Antiarrhythmic
Rx—PSVT: 6 mg (2 ml) IV rapidly over 1–3 secs.
[flush with 20cc NS bolus; elevate IV arm]
If no effect in 1–2 min, give 12 mg over 1–3 sec.
May repeat 12 mg bolus one more time.
Contra—2° or 3° AV block, VT, sick sinus syndrome.
SE—transient dysrhythmias, facial flushing, dyspnea,
chest pressure, hypotension, headache, nausea,
bronchospasm.
NOTE: adenosine is blocked by theophyllines; but
potentiated by dipyridamole, carbamazepine.
Peds: 0.1–0.2 mg/kg IV rapidly, IO up to 6 mg. May double dose
if no effect. Max: 12 mg/dose.
Albuterol 0.5% (VENTOLIN®)
•Bronchodilator
Rx—Bronchospasm 2° COPD, Asthma: 1.25–2.5 mg
(0.25–0.5 ml); mixed in 3 ml saline in nebulizer.
Contra—tachydysrhythmias.
SE—tachydysrhythmias, anxiety, nausea & vomiting.
Peds: 0.03 ml/kg nebulized; max: 1 ml.
Alteplase (ACTIVASE®, tPA)
• Fibrinolytic
Acute MI (< 12 hours old): 100 mg IV over 3 hrs.
Mix in 100 ml sterile water for 1 mg/ml.
Accelerated 1.5 hour infusion:
• Administer 15 mg IV bolus (15 ml) over 2 minutes,
• Then give 0.75 mg/kg (Max: 50 mg) over next
30 min,
• Followed by 0.5 mg/kg (Max: 35 mg) over next hr.
Or 3-hour infusion:
• Administer 10 mg IV bolus (10 ml) over 2 minutes,
• Then give 50 mg (50 ml) over first hour,
• Followed by 20 mg/hr (20 ml/hr) the next 2 hours.
Rx—Acute Ischemic Stroke (< 3 hours old):
0.9 mg/kg IV (Max: 90 mg) over 1 hour.
• Give 10% of the dose as an IV bolus over 1 minute,
• Then give the remaining 90% over the next hour.
Rx—Acute Pulmonary Embolism: 100mg IV over
2 hrs.
Contra—Any within 3 months: • stroke, • AV
malformation, • neoplasm, • recent trauma, • aneurysm, •
recent surgery. Active internal bleeding w/in 21 days;
major surgery or trauma w/in 14 days, aortic dissection,
severe HTN, known bleeding disorders, prolonged CPR
with thoracic trauma, LP w/in 7 days, arterial puncture at
a non-compressible site.
contraindications.
SE—reperfusion dysrhythmias, bleeding, shock.
Amiodarone (CORDARONE®)
• Antiarrhythmic
Rx—Cardiac Arrest VF / VT: 300 mg IVP. May repeat
150 mg IVP ¯q 3–5 minutes. Max: 2,200 mg/24 hours.
Rx—Stable Wide Complex Tachycardia:
Rapid infusion:
150 mg IV over 10 minutes. May repeat 150 mg IVP ¯q
10 minutes. Max 2,200 mg/24 hrs.
(mix 150 mg in 100 ml; run at 10 ml/min or 600 microdrop/min)
Slow infusion:
360 mg IV over 6 hours.
(mix 1000 mg in 500 ml; run at 30 ml/hr or 30 microdrop/min)
Maintenance infusion:
540 mg IV over 18 hours.
(mix 1000 mg in 500 ml; run at 15 ml/hr or 15 microdrop/min)
Contra—cardiogenic shock, bradycardia, 2°, 3° block;
do not use with drugs that prolong QT interval.
SE—vasodilation, ↓ BP, ↓ HR, AV block, hepatotoxicity,
↑ QTc, VF, VT. 40 day half-life.
Peds dose: 5 mg/kg IV/IO.
Amyl nitrite
• Cyanide Antidote
Rx—Cyanide poisoning: Administer vapors from
crushed inhalant for 30 sec, then administer oxygen
for 30 seconds, repeat continuously.
SE—hypotension, H/A, nausea, methemoglobinemia.
Anistreplase (EMINASE®, APSAC)
• Fibrinolytic
Rx—Acute MI (< 12 hrs old ): 30 IU IV over 2–
5 minutes (mix in 50 ml SW).
Contra—active internal bleeding within 21 days; Any
within 3 months: • stroke, • AV malformation, • neoplasm,
• aneurysm, • recent trauma, • recent surgery. Major
surgery or trauma within 14 days, aortic dissection,
severe uncontrolled HTN, known bleeding disorders,
prolonged CPR with thoracic trauma, lumbar puncture
within 7 days, arterial puncture at a non-compressible
site. See page 28 for additional contraindications.
SE—reperfusion dysrhythmias, bleeding, shock, H/A,
hypotension, allergic reaction, chest pain, N&V.
Aspirin (ASA)
• Antiplatelet
Rx—Acute Myocardial Infarction: 160–325 mg P.O.
(2–4 chewable children’s aspirin tablets).
Contra—allergy. Use caution with: asthma, ulcers, GI
bleeding, other bleeding disorders.
SE—GI bleeding.
Atenolol (TENORMIN®)
• Beta Blocker
Rx—VT, VF, Atrial fib, Atrial flutter, PSVT, HTN
Rx—Myocardial Salvage for:
• Acute Anterior MI ¯c HTN & Tachycardia
• Large MI < 6 hours old
• Refractory Cx Pain or Tachycardia 2° excess
sympathetic tone:
5 mg IV slowly over 5 minutes. Wait 10 minutes, then
give another 5 mg IV slowly over 5 minutes.
Contra—CHF, APE, bronchospasm, Hx asthma, ↓HR,
or 3° heart block, cardiogenic shock ↓BP.
SE—↓BP, CHF, bronchospasm, ↓HR, cx pain, H/A, N&
Calcium blockers may exacerbate side effects.
Atropine sulfate
• Vagolytic
Rx—Asystole, PEA: 1 mg IVP, (2–3 mg ET);
¯q 3–5 minutes; up to 0.04 mg/kg total dose.
Rx—Symptomatic Bradycardia: 0.5–1 mg IVP ¯q 3–5
minutes; up to 0.04 mg/kg total dose.
Rx—Organophosphate or Carbamate insecticide
poisoning: 2–5 mg IV ¯q 15–30 minutes
(0.05 mg/kg in children) until vital signs improve.
Rx—Asthma: 0.4–2 mg nebulized in 3 ml saline.
Rx—RSI (pediatric): 0.02mg/kg. Minimum 0.1mg
Contra—tachycardia, glaucoma.
SE—dilated pupils, ↑ HR, VT, VF, H/A, dry mouth.
Calcium chloride 10%
• Electrolyte
Rx—Calcium blocker toxicity; Hypocalcemia with
tetany; Hyperkalemia; Hypermagnesemia:
500–1000 mg IV over 5–10 minutes.
Contra—VF, digitalis toxicity, hypercalcemia.
SE—↓HR, asystole, ↓BP, VF, coronary & cerebral artery
spasm, N&V; extravasation causes necrosis.
Calcium gluconate 10%
• Electrolyte
Rx—Calcium blocker OD; Hypocalcemia;
Hyperkalemia; Hypermagnesemia: 500–1000 mg IV
slowly.
Contra—VF, digitalis toxicity, hypercalcemia.
SE—↓ HR, ↓ BP, VF, arterial spasm; infiltration causes
necrosis.
Peds: 60–100 mg/kg (0.6–1 mL/kg) IV, IO slowly.
NOTE: Precipitates with NaHCO3 in IV bag/tubing.
Dexamethasone (DECADRON®)
• Anti-inflammatory
Rx—Cerebral Edema, Anaphylaxis, COPD, Spinal
Trauma: 10–100 mg IV.
Contra—uncontrolled infections, TB, ulcers.
Peds: 0.25–1 mg/kg IV, IO, IM.
Dextrose 50%
• Nutrient
Rx—Coma, Hypoglycemia: 25 gm (50 ml) IV.
SE—tissue necrosis if extravasation occurs.
Contra—intracerebral bleeding, hemorrhagic CVA.
Diazepam (VALIUM®)
• Anticonvulsant/sedative
Rx—Status Epilepticus: 5–10 mg IV slowly.
Rx—Sedation: 5–15 mg IV slowly.
(Rectal diazepam: 0.5 mg/kg via 2" rectal catheter. Flush
with 2–3 ml of air after administration.)
Contra—head injury, ↓BP, acute narrow angle glaucoma.
SE—↓ respirations, ↓BP, drowsiness, venous irritation.
NOTE: overdose may be reversed with flumazenil.
Diphenhydramine (BENADRYL®)
• Antihistamine
Rx—Allergic Reaction, EPS: 25–50 mg IV, or deep IM.
Contra—asthma, pregnant or lactating females.
SE—sedation, blurred vision, anticholinergic effects.
Peds: 1–2 mg/kg IV, IO slowly, or IM.
Diltiazem (CARDIZEM®)
• Antiarrhythmic
Rx—PSVT; Rapid Atrial Fibrillation, Atrial Flutter:
0.25 mg / kg slowly IV over 2 minutes; if no
15 minutes: 0.35 mg/kg IV slowly over 2 minutes.
Drip: 10–15 mg / hr (5 mg/hr for some patients).
for drip: mix 125 mg (25 cc) in 100 ml IV solution (1
run at:]
Contra—2° or 3° block, ↓BP, sick sinus syndrome,
WPW or short PR syndrome with atrial fib or atrial
Do not give with oral beta blockers. Do not give with
furosemide in same IV line (flush line first).
SE—hypotension, bradycardia, H/A, N&V, CHF, dizziness,
weakness. Diltiazem ↑ serum digoxin levels.
Diltiazem (5mg/cc) Patient Weight in kg
Bolus Doses in ccs 50 60 70 80
1st dose: 0.25 mg/kg 2.5cc 3cc 3.5cc 4cc 4.5cc
2nd dose: 0.35 mg/kg 3.5cc 4.2cc 4.9cc 5.6cc 6.3cc
Diltiazem Drip mg/hour → 5 mg 10 mg
microdrops/min → 5 gtt 10 gtt
Droperidol (INAPSINE®)
• Tranquilizer
Rx—Chemical Restraint: 0.625–10 mg IV slowly or
Maintenance: 1.25–2.5 mg IV.
Contra—renal or hepatic disease, prolonged QTI.
SE—↓BP, tachycardia, apnea, EPS; VT (torsades).
Peds: 2–12 years: 0.1–0.15 mg/kg IV, IO, IM.
Dobutamine (DOBUTREX®)
• Inotrope
Rx—CHF: 2–20 mcg/kg/min.
Mix 250 mg in 250 ml D5W (1 mg/ml) and run at:
mcg/kg/
min.
Patient weight in kg
2.5 5 10 20 30 40 50 60 70 80 90 100
2 mcg * * 1 2 4 5 6 7 8 10 11 12
5 mcg * 1.5 3 6 9 12 15 18 21 24 27 30
10 mcg 1.5 3 6 12 18 24 30 36 42 48 54 60
15 mcg 2 5 9 18 27 36 45 54 63 72 81 90
20 mcg 3 6 12 24 36 48 60 72 84 96 108 120
Contra—tachydysrhythmias, IHSS, hypovolemia, poisoninduced
shock, shock with BP < 100.
SE—tachydysrhythmias, VT, VF, HTN, N&V, H/A, AMI.
Dopamine (INTROPIN®)
• Inotrope
Rx—Hypotension; Bradycardia: 2–20 mcg/kg/min.
Renal Dose: 2–5 mcg/kg/min.
Inotropic Dose: 5–10 mcg/kg/min.
Pressor Dose: >10 mcg/kg/min.
Mix 400 mg in 250 ml D5W (1600mcg/ml) & run at:
mcg/
kg/
Min.
Patient weight in kg
2.5 5 10 20 30 40 50 60 70 80 90 100
2 mcg * * * 1.5 2 3 4 5 5 6 7 8
5 mcg * 1 2 4 6 8 9 11 13 15 17 19
10 mcg 1 2 4 8 11 15 19 23 26 30 34 38
15 mcg 1.4 3 6 11 17 23 28 34 39 45 51 56
20 mcg 2 4 8 15 23 30 38 45 53 60 68 75
Contra—↑ HR, HTN. ↓dose to 1/10th for pts on MAOIs.
SE—tachydysrhythmias, VT, VF, HTN, N & V, H/A,
ischemia, AMI.
Enalaprilat (VASOTEC®)
• ACE Inhibitor / Antihypertensive
Rx—HTN, Acute MI, CHF: 0.625–1.25 mg IV slowly.
(Use lower dose if patient is on diuretics)
Repeat in 1 hr if no response, then 1.25 mg IV ¯q 6 hrs.
Contra—renal impairment, pregnancy, lactation.
SE—H/A, dizziness, fatigue, ↓ LOC, dyspnea, ↓ BP.
Epinephrine (ADRENALIN®)
• Sympathomimetic
Rx—Allergic Reaction: 0.3–0.5 mg (0.3–0.5 ml
1:1000) SQ.
Peds: 0.01 mg/kg (0.01 ml/kg) SQ—max 0.5 mg
Rx—Anaphylaxis: 0.3–0.5 mg (3–5 ml 1:10,000)
Rx—Asthma: 0.3–0.5 mg (0.3–0.5 ml 1:1000) SQ.
Rx—Bradycardia / Hypotension: 2–10 mcg/min
mix 1 mg in 250 ml D5W):
Rx—Cardiac arrest: 1 mg IV ¯q 3–5 minutes.
Alternative doses for cardiac arrest:
High Dose: 0.2 mg/kg IVP ¯q 3 – 5 minutes.
Endotracheal Dose: 2–2.5 mg ¯q 3 – 5 minutes.
Continuous Infusion: mix 30 mg in 250 ml NS,
D5W and run at 100 ml/hr (100 microdrops/minute).
Contra—tachydysrhythmias, coronary artery disease
SE—tachydysrhythmias, VT, VF, angina, HTN.
Epinephrine Drip
mcg / min→ 2 3 4 5 6 7 8 9
microdrops→ 30 45 60 75 90 105 120 135
Etomidate (AMIDATE®)
• Sedative/Hypnotic
Rx—Sedation for RSI: 0.3 mg/kg IV slowly.
Contra—pt < 10 y.o., pregnancy, do not use with
ketamine, immunosuppression, sepsis, transplant pt.
SE—apnea, bradycardia, ↓ BP, arrhythmias, N&V.