First Line Drugs

Front 1

LORAZEPAM (VALIUM)

Class: Benzodiazipine, anticonvulsant, sedative, antiaxiety

Indications: Active Major Motor Seizures; sedation prior to painful procedures; anxiety

Contraindications: Sensitivity to benzodiazipines; significant hypotension

Back 1

Administration: 1-2 mg SIVP over 2-5mins (0.1 mg/kg, max 4 mg/dose) or IM. Titrate to effect, may repeat every 5 mins to a max of 8mg.

Front 2

Midazolam (Versed)

Class: Benzodiazipine, sedative, hypnotic

Indications:Acute Anxiety;

AMNESTIC SEDATION PRIOR TO UNCOMFORTABLE PROCEDURES SUCH AS: cardioversion, intubation.

Contraindications: hypersensitivityor intolerances to benzodiazipines; narrow angle glaucoma, shock, acute alcohol intoxication

Back 2

Administration: 1.0-2.5 mg SIVP over 2-3 mins or 5 mg deep IM.

Front 3

Lidocaine (Xylocaine)

Class: Antidysrhythmic, local amid anesthetic

Therapuetic effects: Decreases ventricular irritability, increases fibrillatory threshold, decreases conduction through ischemic tissue, produces local anesthetic.

Indications: Ventricular ectopy (malignant PVCs), V-FIB, V-TACH, wide complex tachycardia of uncertain etiology, anesthesia prior to IO infusion.

Contraindications: Hypersensitivity to the drug, 2nd degree Type II & 3rd degree heart blocks, bradycardia rhythms, PVCs assoc. w/ bradycardia, Idioventricular rhtythms, WPW.

Side effects:

Cardiovascular: bradycardia, hypotension, cardiac arrest.

Neurological: dizziness, drowsiness, paraesthesia, seizures, restlessness, disorientation, slurred speech.

GI: nausea, vomiting.

Administration:

Ventricular ectopy & V-TACH WITH PULSES: SIVP 1-1.5 mg/kg slow IV push @ 50mg/min. May repeat 0.5-0.75 mg/kg in 5-10 mins to a max of 3 mg/kg.

V-FIB & PULSELESS VTACH-

SIVP- 1-1.5mg/kg slow IVP over 30-60 secs

Back 3

NOTES & PRECAUTIONS:

Dosage may be reduced by 1/2 for patients with liver and/or kidney disease.

Malignant PVCs are defined as frequent (6/min) or more of coupled, multi-focal, and R-ON-T phenomenon.

Currently, most authorities and protocols agree that Lidocaine is rarely given (if at all) for frequent unifocal PVCs despite the traditional definitions of malignant PVCs.

Packaged in many different concentrations; 1% & 2% for SIVP; 4% & 20% for IVPB infusion.

Standard ACLS concetration for IVPB administration is 2gm/ 500cc (800mcgtts/mins); however, many field protocols recommend a safer more diluted concentration, sometimes as low as 100mg/100cc.

Sensitivities are not common and allergies are rare.

The patient may not know about Lidocaine, but may report a reaction to "NOVOCAIN" at the dentist. Instead, it was probably 2% Lidocaine.

Used concurrently with BETA blockers may cause Lidocaine toxictiy.

May be potentiated when used concurrently with phenytoin, procainimide, or prop

Front 4

AMIODORONE (Cordorone, Pacerone)

Class: antidysrhtymic

Therapuetic effects: Amiodorone is a complex drug that effects sodium, potassium, and calcium channels.
*Acts on all cardiac tissue by prolonging the duration of the potential and refractory period.

* Has alpha & beta adrenergic blocking properties.

* Increases coronary perfusion and reduces PVR by relaxing smooth muscle

May provide some calcium channel blockade.

Indications: Persistent or reoccurring V-FIB and V-TACH.

Wide complex tachycardia of unknown etiology.

CONTRAINDICATIONS:

Sensitivity to the drug, pulmonary edema, cardiogenic shock, hypotension, concurrent use of procainamide or other drugs that prolong the QT interval.

Side effects:

CADRIOVASCULAR:

hypostension from vasodilation and decreased contractility, bradycardia, AV conduction abnormalities, prolonged QT interval.

OTHER:

Headache- dizziness


Administration:

CARDIAC ARREST:
300mg IVP diluted in 20-30 cc consider repeating 1/2 dose of 150mg in 3-5 min

Back 4

NOTES & PRECAUTIONS

Max total cumulative dose is 2.2 GM/ 24 hrs.

After the 6 hr infusion of 360mg at 1mg/min is finished; ACLS directs the in hospital staff to continue an Amiodorone drip at 0.5mg/min = 540mg over 18 hrs.

May be used for Atrial tachycardia and other Atrial or SVT dysrhtyhmias, after other standard therapies fail.

Many uses for Amiodorone are indicated only after digoxin and other therapies fail, and therefore may not be indicated in the field.

As a relatively new drug, very few field protocols exist for Amiodorone. Dosage regime may vary greatly from system to system, when campared to the doses above.

Half life maybe as long as 40 days.

Use caution in pregnancy and patients with hepatic or renal failure.

Front 5

DOPAMINE (INTROPIN)

Class: adrenergic sympathomimetic, catecholamine, Inotropic agent

Therapuetic Effects:

LOW DOSE: 1-5ug/kg/min:

Dilates renal and mesenteric artieries by stimulating dopmanergic receptors.
*May reduce BP due to vasodilation.

MODERATE DOSE: 5-10ug/kg/min
* Increases inotropy with little effect on chronotropy
* Selectively stimulates beta 1 which increases cardiac output and BP.

HIGH DOSE: 10-20ug/kg/min
* Stimulates alpha receptors causing vasoconstriction
*Stimulates both alpha and beta receptors which raise BP
*Increases both inotropy nd chronotropy

INDICATIONS:
Cardiogenic shock, vasodilatory shock

CONTRAINDICATIONS:
*Hypovolemic Shock prior to fluid resuscitation.

SIDE EFFECTS:

CARDIVASCULAR:
tachycardia, paplitations, hypotension, hypertension, chest pain, ventricular irritability, vasoconstriciton.

RESPIRATORY:
dyspnea

GI:
nausea vomiting

Administration:

IVPB: concentration of 400mg/250 D5W or NSS; Start at 2-5 ug/kg/min titrate to systolic BP of 90-100 and or sig

Back 5

NOTES & PRECUATIONS

Standard & Field Protocols frequently require a more diluted concentration on 800mg/250cc of D5W or NSS, starting at 5ug/kg/min.

In a fluid restricted adult, it may be appropriate to use a concentration of 800mg/250cc D5W or NSS.

may have slight beta 2 and or alpha adrenergic effects. These effects may or may not occur and are not additive to therapuetic effects. In fact, the absence of these effects makes dobutamine desirable and minimizes overall oxygen demand of the myocardium. Therefore, tachycardia should be considered a side effect.

IVP medications should not be administered through same line as a dopamine infusion.

Never administer Sodium Bicarb through the same line as it will inactivate the effects of dopamine.

Dopamine should not be discontinued abruptly, as it will cause a rapid drop in BP. The infusion should be tapered off gradually.

Front 6

DOBUTAMINE (DOBUTREX)

Class: Adrenergic beta-1 agonist, Inotropic Agent

Therapuetic Effetcs:
Increases inotropy (contractility) with little effect on chronotropy (heart rate) or vasculatures.
* Increases Av conduction

Indications: Hypovolemic shock

Side Effects:

CARDIOVASCULAR: palpatations, tachycardia, PVCs, hypertension, chest pain.

NEUROLOGICAL:
nervousness, headache

OTHER:
leg cramps

ADMINISTRATION:
250mg in 250cc D5W or NSS. Run @ 2-5ug/kg/min, titrated to effect, maximum 20yg/kg/min.

Back 6

NOTES & PRECAUTIONS:

Dopamine is the preferred drug for patients with cardiogenic shock in prehospital care.

Dobutamine may be used in hospital for cardiogenic shock w/ mild hypotension.

May have slight beta 2 and or alpha adrenergic effects. These effects may or may not occur and are not additive to the therapuetic effects. In fact the absence of these effects make dobutamine desirable and minimizes overall oxygen demand of the myocardium. Therefore tachycardia should be considered a side effect.

Adveres hypertension may be potentiated by tricyclic antidepressants

Front 7

MORPHINE SULFATE

CLASS: Narcotic analgesic

INDICATIONS: Chest pain associated with suspected MI

CONTRAINDICATIONS:

hypovolemia or severe hypostension, head injury, abdominal injury, severe respiratory depression, pain of unknown etiology.

Back 7

ADMINISTRATION:

SIVP: 2-5MG@ 2MG/ MIN. Titrate to effect, reassess vitals every 2-4 mg.

IM/SQ: 5-20mg

Front 8

NALOXONE (Narcan)

Class: Narcotic antagonist

Indications: Respiratory depression associated with suspected narcotic overose; ALOC w/ resp. depression

Contraindications: Not significant in the above conditions

Back 8

Administration:
REPIRATORY DEPRESSION: 0.4MG iv TITRATE TO adequate ventilation or max of 2mg.
OR 2mg IM or Intranasal.


RESPIRATORY or CARDIAC ARREST:
1-2mg IV/IO may repeat every 2-3 mins as needed. OR
2-4mg ET diluted w/ NSS to a min. of 10 cc

Front 9

Nitroglycerin/ Nitro Stat/ Nitro-Bid

Class: vasodilator

Indications: chest pain of suspected myocarial origin, ACS, CHF

CONTRAINDICATIONS: Head trauma, or cerebral hemorrhage, hypotension, hypovolemia, ED medication taken within last 24-48 hrs.

Back 9

ADMINISTRATION:
CHEST PAIN & ACS: 0.4 mg SL q5mins 3 times.

CHF:
0.4MG initially then repeat every 3-5 mins based on SBP:
3 nitro if SBP>180
2 if 140-180
1 if 100-140