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106 Cards in this Set
- Front
- Back
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What is the age of the youngest adult according to medical legal issues in Texas?
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18
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What is the age of the oldest pediatric according to medical legal issues in Texas?
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17
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When concerns are of a medical physical nature such as those dealing with intubation, what is the age cut-off for pediatric?
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?
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What three drugs can be given intranasally?
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Versed (midazolam) IN for Seizures only: 0.1 mg/kg to 0.3 mg/kg IN
Narcan (naloxone): 2.0 mg IN (I mg per nostril) fentanyl: 1-2 mcg/kg repeated in 15 minutes / max dose 100 mcg. |
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What is the Metrocrest protocol for asystole?
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CRITERIA:Pulseless/apneic
Asystole in two or more leads on ECG TREATMENT: CABC's,CPR, O2, ECG, IV, Intubation Consider treatable causes as soon as possible – The 6 H’s and 6 T’s Epinephrine 1:10,000 1.0 mg IV, or 1:1,000 2.0 mg ET Repeat every 3-5 minutes as 1.0 mg IV/2.0 mg ET Atropine 1.0 mg IV/2.0 mg ET Repeat every 3-5 minutes up to 3 mg NG intubation (Full Paramedic only) LIMITED PROTOCOL Sodium bicarbonate 1 mEq/kg IV if metabolic acidosis likely Consider Termination of Resuscitation (See Field Termination of Resuscitation protocol) MEDICAL CONTROL None |
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ET epinephrine, given in a 1:1,000 concentration, should be diluted with NS to a total volume of (blank to blank) cc prior to administration.
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8 - 10 cc
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Protocol for PEA
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PULSELESS ELECTRICAL ACTIVITY
CRITERIA: Pulseless/apneic Any ECG rhythm other than V-fib, V-tach, or asystole TREATMENT: CABC's, CPr, O2, ECG Intubate IF indicated (Full Paramedic only): Surgical airway IF DUE TO SURGICAL PROBLEM OR INJURY, TRANSPORT NOW Consider treatable causes as soon as possible – The 6 H’s and 6 T’s IF tension pneumothorax (Full Paramedic only): Needle chest decompression IV Epinephrine 1:10,000 1.0 mg IV, or 1:1,000 2.0 mg ET Repeat every 3-5 minutes as 1.0 mg IV/2.0 mg ET IF bradycardic rhythm: Atropine 1.0 mg IV/2.0 mg ET Repeat every 3-5 minutes up to 3 mg total TCP if bradycardia refractory to Atropine NG intubation (Full Paramedic only) LIMITED PROTOCOL Sodium bicarbonate 1 mEq/kg IV if metabolic acidosis likely MEDICAL CONTROL None |
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What are the 6 H's and T's?
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The 6 H’s: Causes
Hypovolemia Hypoxia Hydrogen Ion Hypo-/Hyperelectrolytes Hypo-/Hyperglycemia Hypo-/Hyperthermia The 6 T’s: Tablets Trauma Tamponade Tension Pneumothorax Thrombosis Thrombosis |
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Protocol for pulseless Vtach or VFib: What is the proper J. setting for the Philips Biphasic monitor?
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150j first shock
150j second shock 150j third shock |
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In Pulseless VTach/Vfib, what medication do you push after IV is established and 1 mg Epinephrine has been administered?
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IF IV access obtained:
Amiodarone 300 mg IV Repeat Amiodarone 150 mg IV after 3 - 5 minutes |
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In Pulseless VTach/Ffib, what medication do you push if IV/IO is not established and 2 mg Epinephrine has been administered via ET tube?
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IF no IV access obtained:
Lidocaine 3.0 mg/kg ET |
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What drug should you administer in pulseless VF refractory to IV Amiodarone (5 mins after second dose):
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Lidocaine 1.5 mg/kg IV/3.0 mg ET Repeat in 5 min as 1.5 mg/kg IV/3.0 mg ET
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In the "limited" protocol, what should be given for Torsades de Pointes or refractory Vfib?
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2G IV Mag sulfate
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In the "limited" protocol, what should be given for Vfib if metabolic acidosis is suspected?
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1 mEq per/kg sodium bicarb
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Ventilations during CPR should be delivered at a rate of (Blank) breaths/min without stopping compressions.
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8 to 10 breaths/minute
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Compressions during CPR should be hard and fast and allow complete recoil of the chest wall. The rate for compressions delivered should be (blank) per min.
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100 per minute
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ET epinephrine, given in a 1:1,000 concentration, should be diluted with (blank)....
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NS to a total volume of 8 - 10 cc prior to administration.
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ACLS guidelines list (blank 1) as the preferred antiarrhythmic for VF. If the patient remains in VF 3 - 5 minutes after the initial dose of (Blank 2), repeat a dose of (blank 3). Wait 5 minutes after the second dose of the drug to begin Lidocaine therapy.
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Blank 1 amiodarone
Blank 2 300 mg Blank 3 150 mg |
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ACLS guidelines list amiodarone as the preferred antiarrhythmic for VF. If the patient remains in VF 3 - 5 minutes after the initial dose of 300 mg of amiodarone, repeat a dose of 150 mg. Wait 5 minutes after the second dose of amiodarone to begin (blank).
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Lidocaine therapy:
DOSAGE: IV Push: • PVC's or V-Tach with a pulse: 1.0 mg/kg initial dose • Repeat every 5 min as 0.5 mg, up to 3 mg/kg • V-Fib: 1.5 mg/kg initial dose • Repeat once in 5 min as 1.5 mg/kg Infusion: • Adult: 2 to 4 mg/min of 4 mg/ml concentration • Pediatric: 20 - 50 mcg/kg/min or 4 mg/ml concentration |
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Limit the number of antiarrhythmic medications to no more than (blank). Finish administration of the first antiarrhythmic before beginning the second antiarrhythmic.
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two
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Under "LIMITED PROTOCOL"
in the "POST RESUSCITATION MANAGEMENT" protocol, (Blank) should be given if the pt. is still hypotensive 5 min after conversion from any rhythm, EXCEPT a hemorrhagic PEA (which becomes perfusing after a fluid bolus). |
Dopamine infusion 5-20 mcg/kg/min
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By Metrocrest protocol, one of two drugs should be considered before cardioverting a conscious patient. Name the two drugs and their dose.
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Lorazepam (Ativan) 2 - 4 mg IV is a benzodiazepine drug with short to medium duration of action. It has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant and muscle relaxant.[4] It is a powerful anxiolytic, and, since its introduction in 1977, lorazepam's principal use has been in treating the symptom of anxiety.
Midazolam 0.05 - 0.1 mg/kg IV (Versed) is an ultra short-acting benzodiazepine derivative. It has potent anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties |
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By Metrocrest protocols; what is the sequence of joules to convert by?
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Synchronized cardioversion at 100 J, 200 J, 300 J, 360 J monophasic, or at biphasic equivalent
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What two drugs are given in the Metrocrest "Limited" protocol to convert Unstable VTach w/pulse if 100j, 200j, 300j, 360j, Syncronized Cardioversion doesn't convert the pt.?
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Amiodarone 150 mg IV infused over 10 minutes
IF resolved by Amiodarone: Start an amiodarone drip 1 mg/min Lidocaine 1.0 mg/kg IV IF resolved by lidocaine: Start a lidocaine drip 2 - 4 mg/min |
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Below and after the Metrocrest "Limited" protocol, what drug might M.C. order for refractory VTach for alcoholics, malnutrition, anorexia, prolonged diarrhea, etc?
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Magnesium Sulfate 2.0 G Slow IV push may be ordered by Metrocrest for refractory V-Fib and V-Tach due to magnesium deficiency (alcoholics, malnutrition, anorexia, prolonged diarrhea, etc).
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Midazolam is given in 0.5 to 1.0 mg increments, at 1-2 min intervals until the desired response (i.e., adequate sedation) is achieved OR maximum dose is given. What is the maximum dose for Midazolam when used for sedation?
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Sedation: 0.05 - 0.1 mg/kg IV, titrated to effect up to 10 mg
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If the patient is converted from the tachycardia after cardioversion, but prior to antiarrhythmic administration, begin a(an) (blank).
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Amiodarone infusion.
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You've been called to a patient having seizures. When you get to the scene, you find a 47 y.o.m. in a run down apartment with empty vodka bottles scattered throughout. The patient is apparantly in the postictle state. After assessing CABC's, obtaining first set of V.S., administer O2, and check D-stick which reads 28 you prepare to give the patient 25 G of D-50. What drug must be given before you administer 25 G of D-50 to this patient?
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100 mg Thiamine IV or IM.
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What drug/dose is given with TCA overdose with significant CNS or cardiovascular symptoms?
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Sodium bicarbonate 1.0 mEq/kg IV
Followed by: Sodium Bicarbonate IV infusion 0.05 mEq/ml titrated to systolic BP > 90 mm/hg |
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What is the max dose for Narcan (naloxone)?
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8 mg
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What is the first dose of narcan given to a suspected OD of an opiate?
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0.5 mg to 2mg up to 8 mg max
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What is the method for administering O2 to suspected CO poinsoning victim?
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IF suspected CO poisoning:
CPAP at 5 cm H2O |
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Your patient presents with the following symptoms:
Fever Recent UTI symptoms Urinary catheter Rash What do you suspect and what is your treatment? |
Field Diagnosis: SEPSIS
TREATMENT: CABC's O2 V/S ECG IV: Fluid challenge 250 - 500 ml • May repeat every 5 minutes if still symptomatic Blood Glucose Determination: IF below 80 mg/dl, treat per hypoglycemia protocol LIMITED PROTOCOL IF hypotension refractory to 500 – 1000 ml IV fluid or continued fluid contraindicated: Administer Dopamine infusion 5 - 20 mcg/kg/min |
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What facilities in the Dallas area have capibility of offering emergency hyperbaric facilities?
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Hyperbaric Medicine:
Presbyterian – Dallas Methodist Medical Center |
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What is PAT?
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paroxysmal atrial tachycardia
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How do you treat PAT?
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vagel maneuvers and possibly diltiazam if the PAT is symptomatic.
DOSAGE: 0.25 mg/kg administered over 2 minutes, up to maximum dose of 20 mg Repeat once in 15 minutes if no conversion: • 0.35 mg/kg administered over 2 minutes, up to maximum dose of 25 mg |
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What is Diltiazem administered for and what is the dosage?
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Treated for narrow complex tachycardias such as SVT, PAT, PSVT, AFib and A Flutter with RVR.
First dose is 0.25 mg/kg Second dose is 0.35 mg/kg |
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In the unconscious anaphylactic patient in whom IV access cannot be rapidly established, 1:1,000 epinephrine 0.5 mg may be injected directly into the (Blank).
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sublingual tissue
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What does "PRN" mean?
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As needed
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An anaphylactic patient who is unconscious should first receive what drug and dosage?
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0.5 mg Epinephrine 1:10,000 IV
Or 0.5 mg Epi 1:1,000 SL |
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What is the dosage and medications for unconscious anaphylactic patient w/ IV access established?
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0.5 mg Epinephrine 1:10,000 IV over 5 minutes.
50 mg. Diphenhydramine 125 - 250 mg Methylprednisolone (solumedrol) |
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What is the dosage and medication for unconscious anaphylactic patient with no IV access established?
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Anaphylaxis
IF patient is unconscious: Epinephrine 1:10,000 0.5 mg IV over 5 mins, or 1:1,000 0.5 mg SL injection IF patient is conscious: • Epinephrine 1:1,000 0.5 mg SQ • Diphenhydramine 50 mg IV • Methylprednisolone 125-250 mg IV • Repeat previous dose of Epinephrine if anaphylaxis not resolved |
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At what weight is the "cut off" for the administration of Terbutaline?
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Terbutaline is contraindicated in patients < 35 kg
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What does URI stand for?
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Upper Respiratory Infection
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A stable pt. presenting with PSVT receives (blank) for the first dose and it may be followed up with a second and third dose of (blank) may be given in two minutes if the first dose doesn't work.
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6 mg Adenosine
12 mg adenosine |
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The primary indication for NG intubation is ......
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for the decompression of the stomach for pts receiving positive pressure ventilation.
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What is the dose for Methylprednisolone?
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125 to 250 mg. IV or IM
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What is the dose for Terbutaline?
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.25 mg SQ or nebulized inhalation - may be repeated once in 15 minutes.
.25 mg. repeat PRN for premature labor contractions. |
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Dose and route for Thiamine is (blank).
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100 mg IV or IM
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What is the dose for Solumedrol?
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125 - 250 mg.
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What is the dose and route for Versed (medozolam)?
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Sedation: 0.05 to 0.1 mg/kg up to 10 mg
Intubation: 0.1 to 0.3 mg/kg up to 20 mg Seizure: 0.1 mg/kg IV and 0.3 mg/kg IN up to 5 mg. Chemical Restraint: 0.1 mg up to 5 mg IV or up to 10 mg IM |
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Dose and route of Lorazepam:
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Seizure: 2 to 4 mg IV or Bucal Mucosa if IV unobtainable.
Sedation: 2mg IV may be repeated once in 10 minutes. |
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What is a contraindication for Dopamine?
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Hypovolemia
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A patient with new onset CHF precents with pulmonary edema. What is the correct dosage of Furosemide?
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0.5 mg/kg
If the pt was already taking furosemide, the dosage would be 1.0 mg/kg |
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IF still hypotensive 5 min after conversion from any rhythm, EXCEPT a hemorrhagic PEA (which becomes perfusing after a fluid bolus) give ......
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Dopamine infusion 5-20 mcg/kg/min
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Never give (blank) to a hypovolemic patient.
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Dopamine
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Nitroglycerin is contraindicated to pts with....
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Hypotension
Hypovolemia Increased ICP Patient’s use of medication for erectile dysfunction within the past 48 hours |
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what is the correct dosage for acetaminophen?
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15 mg/kg
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Albuterol may be given to help releive pneumonia? (true or false)
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False
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What is the drug and dosage for bradycardia?
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Atropine
0.5 mg every 5 minutes up to 3 mg |
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What two drugs, and their dosage are administered for PEA and Asystole?
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1 mg Epinephrine 1:10,000
1 mg Atropine |
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What is the drug and dosage for organophosphate poisoning?
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2 mg atropine q 5 minutes until symptoms resolve.
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Dopamine may be used to improve BP on a pt. with suspected internal bleeding? (true or false)
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False: Dopamine is contraindicated for hypovolemia.
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Terbutaline is not used in patients less than (Blank)?
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35 kg
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The treatment for a COPD pt who has inadequate tidal volume for inhalation therapy should be treated as follows:
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CPAP at 5 cmH2O with Albuterol 2.5 mg nebulized
inline Terbutaline 0.25 mg SQ Repeat once in 10 min if dyspnea not relieved |
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PL: Name 1 antipyretic we carry that would assist a pediatric patient with febrile seizures along with the amount you would give for a 22 Lb patient.
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Acetamenophen (15 mg/kg)
22Lbs = approx. 10kg. 150 mg |
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What is the dosage of acetamenophen?
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15 mg/kg
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Name three signs that distenguish a patient between stable and unstable tachycardia.
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Altered LOC
Pulmonary edema hypotension |
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Name three drugs and their dosage that we give IN.
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Versed (medazolam)
Fentanyl 1-2 mcg/kg up to 100mcg Naloxone (narcan) 2 mg/IN |
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What is the drug and dose for seizure if IV is established?
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2-4 mg lorazopam (ativan)
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What is the drug and dose for seizure if IV is NOT established?
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Midazolam (versed) 0.3 mg/kg IN (up to 5mg)
Lorazepam (ativan) 0.4 mg/kg buccal mucosa |
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ACETAMINOPHEN (TYLENOL) SUSPENSION
Dosage: |
ACETAMINOPHEN (TYLENOL) SUSPENSION
PHYSIOLOGICAL ACTIONS: Reduces fever (antipyretic) by acting directly on the heat regulating center of the hypothalamus THERAPEUTIC EFFECTS: Reduces fever INDICATIONS: Fever of any etiology in pediatric patients CONTRAINDICATIONS: None DOSAGE: 15 mg/kg, maximum dose 1 Gm ROUTE: PO PR SPECIAL NOTES: Doses may be repeated every 4 hours as needed, not to exceed 75 mg/kg total in a 24 hour period. Hepatic damage begins at overdoses of about 150 mg/kg SIDE EFFECTS: Rarely, gastric irritation |
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ADENOSINE (ADENOCARD)
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ADENOSINE (ADENOCARD)
PHYSIOLOGICAL ACTIONS: Directly blocks re-entrant mechanism in the atria and AV node Decreases AV conduction THERAPEUTIC EFFECTS: Converts SVT. INDICATIONS: SVT, including Wolf-Parkinson-White syndrome CONTRAINDICATIONS: Sick-sinus syndrome (unless ventricular pacemaker is in place and functioning) Second or third degree heart block Ventricular tachycardia DOSAGE: Adult: 6 mg • Repeat TWICE every 2 minutes as 12 mg if no conversion Pediatric: 0.1 mg/kg up to 6 mg • Repeat TWICE every 2 minutes as 0.2 mg/kg (max. of 12 mg) if no conversion ROUTE: RAPID IVP See Adenosine Administration procedure SPECIAL NOTES: MUST be given very rapidly and as directly into the vein as possible Repeat doses must be given in exactly two minutes Will not convert A-fib or A-flutter SIDE EFFECTS: Brief dyspnea Chest pressure N/V Hypotension Significant cardiac pauses |
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Albuterol
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ALBUTEROL (PROVENTIL, VENTOLIN)
PHYSIOLOGICAL ACTIONS: Beta 2 agonist Smooth muscle relaxant THERAPEUTIC EFFECTS: Bronchodilation INDICATIONS: Asthma Exacerbation of COPD CONTRAINDICATIONS: Poor respiratory tidal volume Tachydysrhythmias Ventricular ectopy DOSAGE: 2.5 mg in 2.5 (or 3) ml of NS ROUTE: Nebulized inhalation SPECIAL NOTES: See Nebulized Bronchodilation procedure Therapeutic effects may last 2-3 hours SIDE EFFECTS: Tachydysrhythmias Ventricular ectopy N/V Anxiety Palpitations |
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Amiodarone
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AMIODARONE (CORDARONE)
PHYSIOLOGICAL ACTIONS: Prolongs intranodal conduction and AV node refractory period Blocks beta receptors, sodium and potassium channels THERAPEUTIC EFFECTS: Antiarrhythmic INDICATIONS: Ventricular Fibrillation/Pulseless Ventricular Tachycardia Stable Ventricular Tachycardia Junctional Tachycardia, SVT, Atrial Flutter CONTRAINDICATIONS: Cardiogenic Shock Symptomatic Bradycardia Second or Third Degree AV Block DOSAGE: Pulseless Patient: • 300 mg IVP • Repeat dose of 150 mg after 3 - 5 minutes Post-resuscitation Infusion: • 1.0 mg/min • Mix 100 mg in 100 ml, infuse at 60 gtt/min (minidrip) Perfusing Patient: • Mix 150 mg in 100 ml, infuse over 10 minutes ROUTE: IV/IO SPECIAL NOTES: Do not agitate or foaming may occur SIDE EFFECTS: Hypotension Bradycardia |
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Aspirin
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ASPIRIN (ASA)
PHYSIOLOGICAL ACTIONS: Inhibits platelet aggregation Diminished peripheral activity of prostaglandins THERAPEUTIC EFFECTS: Anticoagulant Antipyretic Analgesic INDICATIONS: Suspected AMI CONTRAINDICATIONS: Bleeding disorders Active gastric/peptic ulcer Hypersensitivity DOSAGE: 160 - 162 mg ROUTE: PO SPECIAL NOTES: Instruct patient to chew pills and provide a small quantity of water if requested. This will increase absorption of the ASA and reduce its effects on the gastric mucosa. SIDE EFFECTS: Gastric irritation Exacerbation of gastric ulcers |
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Atropine
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ATROPINE
PHYSIOLOGICAL ACTIONS: Vagolytic THERAPEUTIC EFFECTS: Increases heart rate Increases AV conduction Reverses organophosphate intoxication INDICATIONS: Asystole PEA Bradycardias Organophosphate poisoning CONTRAINDICATIONS: 2 Type II-Fixed AV Block Complete (3o) AV Block DOSAGE: Adult: • Asystole / PEA: 1.0 mg repeat every 3-5 minutes up to 3 mg • Bradycardia: 0.5 mg every 5 minutes up to 3 mg • Organophosphate poisoning: 2 mg every 5 minutes until symptoms resolve Pediatric: • 0.02 mg/kg; min dose 0.1 mg, max single dose 0.5 mg • Repeat every 3-5 minutes until max dose of 2 mg (1 mg for infants) is reached ROUTE: IV/IO push May be ordered IM as well in organophosphate poisoning ET SPECIAL NOTES: Must be given rapidly Inadequate or slowly administered doses may result in a reflex bradycardia SIDE EFFECTS: Tachydysrhythmias Ventricular ectopy Dry mouth Dilated pupils |
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Dextrose 50
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DEXTROSE 50%
PHYSIOLOGICAL ACTIONS: Carbohydrate glucose source THERAPEUTIC EFFECTS: Raises blood glucose level INDICATIONS: Hypoglycemia, established or suspected Altered mentation of unknown cause CONTRAINDICATIONS: Intracranial hemorrhage Cerebral edema Increased ICP DOSAGE: Adult: • 25 - 50 G of 50% solution Pediatric: • 0.5 G/kg o > 10 kg: 1 cc/kg of D50% solution o < 10 kg: 2 cc/kg of D25% solution D25% is prepared by diluting equal parts D50% and NS ROUTE: IV/IO push PO SPECIAL NOTES: Will cause severe tissue damage if extravasation occurs MUST be preceded by thiamine in known or suspected alcoholics Dextrose 25% can be made by diluting equal parts of NS and D50%, yielding 0.25 Gm/ml SIDE EFFECTS: Neurological symptoms in unprotected alcoholic patients if not preceded by thiamine |
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Diltiazem
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DILTIAZEM (CARDIZEM)
PHYSIOLOGICAL ACTIONS: Calcium channel blocker THERAPEUTIC EFFECTS: Slows AV node conduction Prolongs AV node refractory period INDICATIONS: Atrial Fibrillation or Atrial Flutter with rapid ventricular response CONTRAINDICATIONS: Sick-sinus syndrome, unless ventricular pacemaker is in place and functioning Second or third degree heart block Ventricular tachycardia Wolff-Parkinson-White syndrome (accessory bypass tracts) DOSAGE: 0.25 mg/kg administered over 2 minutes, up to maximum dose of 20 mg Repeat once in 15 minutes if no conversion: • 0.35 mg/kg administered over 2 minutes, up to maximum dose of 25 mg ROUTE: IV SPECIAL NOTES: Use with caution in patients with severe CHF, acute MI, or cardiomyopathy Observe for bradycardias in patients taking other medications which affect AV conduction (i.e. digitalis, beta-blockers). SIDE EFFECTS: Hypotension PVC’s |
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DIPHENHYDRAMINE (BENADRYL)
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DIPHENHYDRAMINE (BENADRYL)
PHYSIOLOGICAL ACTIONS: Blocks histamine activity THERAPEUTIC ACTIONS: Reduces urticaria/itching and edema Reverses extra-pyramidal symptoms INDICATIONS: Allergic reaction Dystonic reactions CONTRAINDICATIONS: Asthma Pregnancy Intoxication from alcohol or depressants DOSAGE: Adult: • 25 - 50 mg Pediatric: • 1 - 2 mg/kg, up to 25 mg ROUTE: IV Deep IM SPECIAL NOTES: None SIDE EFFECTS: Sedation or drowsiness Anti-cholinergic effects including wheezing Blurred vision |
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DOPAMINE (INTROPIN)
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DOPAMINE (INTROPIN)
PHYSIOLOGICAL ACTIONS: Sympathomimetic; stimulates both Alpha and Beta receptors THERAPEUTIC EFFECTS: Increases heart rate Increases blood pressure Improves AV conduction INDICATIONS: Cardiogenic shock Sepsis if hypotension refractory to IV fluid administration CONTRAINDICATIONS: Hypovolemia DOSAGE: 5 - 20 mcg/kg/min, titrated to BP of 100 mmHg Shortcut for starting dopamine infusion drip rate: o Patient’s weight in lbs/10, subtract 2 = starting gtt/min (minidrip set) o i.e. Patient weighs 180 lbs, divide by 10 = 18, subtract 2 = 16 gtt/min ROUTE: IV infusion SPECIAL NOTES: Causes increased myocardial oxygen demand Pre-mix solution is 800 mg in 500 ml (1600 mcg/ml) Administer by starting drip using the formula above, using a minidrip set. Ensure the tubing is primed with dopamine as very small volumes are being administered. If no effect is seen after 5 minutes, increase the dose by doubling the drip rate every 5 minutes until systolic BP is 100 mm Hg or higher SIDE EFFECTS: Tachydysrhythmias Ventricular dysrhythmias Myocardial ischemia |
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EPINEPHRINE (ADRENALIN) 1:1,000
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EPINEPHRINE (ADRENALIN) 1:1,000
PHYSIOLOGICAL ACTIONS: Sympathomimetic; stimulates both Alpha and Beta receptors THERAPEUTIC EFFECTS: Bronchodilation Increased systemic vascular resistance Dilation of coronary arteries Increased automaticity of myocardium INDICATIONS: Allergic reaction Pediatric asthma Adult asthma and COPD refractory to other interventions Pediatric CPR, bradycardia, and refractory hypotension CONTRAINDICATIONS: Myocardial ischemia Hypertension Tachydysrhythmias Pulmonary edema DOSAGE: Adult: 0.3 - 0.5 mg injection Pediatric: • Asthma / Allergic Reaction: 0.01 cc/kg • CPR refractory to other efforts: 0.1 cc/kg • Neonate: Use Epinephrine 1:10,000. • Infusion: 0.1 - 1.0 mcg/kg/min. ROUTE: SQ IV/IO, IV infusion ET SL (anaphylaxis) SPECIAL NOTES: Causes increased myocardial oxygen demand and increased heart rate Infusion prepared by adding 1 mg of 1:1,000 to 100 ml NS (1 mcg/ml) SIDE EFFECTS: Ventricular ectopy Tachydysrhythmias Angina Hypertension Palpitations |
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EPINEPHRINE (ADRENALIN) 1:10,000
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EPINEPHRINE (ADRENALIN) 1:10,000
PHYSIOLOGICAL ACTIONS: Sympathomimetic; stimulates both Alpha and Beta receptors THERAPEUTIC EFFECTS: Increased systemic vascular resistance Dilation of coronary arteries Bronchodilation Increased automaticity of myocardium INDICATIONS: Cardiac Arrest Anaphylaxis CONTRAINDICATIONS: None in these settings DOSAGE: Adult: • Anaphylaxis: 0.5 mg, repeat every 5 minutes as needed • CPR: 1.0 mg, repeat every 5 minutes as 2.0 mg as needed Pediatric: • Anaphylaxis: 0.01 cc/kg repeat every 5 minutes as needed • Neonate CPR: 0.1 cc/kg repeat every 5 min as needed • CPR / Bradycardia: 0.1 cc/kg repeat every 5 minutes as needed ROUTE: IV/IO push ET SPECIAL NOTES: None SIDE EFFECTS: Ventricular ectopy Tachydysrhythmias Angina Hypertension Palpitations |
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FENTANYL (SUBLIMAZE)
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FENTANYL (SUBLIMAZE)
PHYSIOLOGICAL ACTIONS: Analgesia CNS Depression THERAPEUTIC EFFECTS: Analgesia INDICATIONS: Relief of severe pain related to trauma without hypotension CONTRAINDICATIONS: Head injury Bradycardia Hypotension Respiratory depression/failure DOSAGE: Adult: 1-2 mcg/kg • Max dose 100 mcg • May repeat dose in 15 minutes – 300 mcg maximum per patient Pediatric: 1-2 mcg/kg • Max dose 50 mcg • May repeat dose in 15 minutes – 150 mcg maximum per patient ROUTE: IV IN IM SPECIAL NOTES: Approximately 80 times more potent than Morphine Respiratory depression secondary to Fentanyl can be reversed with naloxone Cardiac chest pain and analgesia for burns should be treated with Morphine SIDE EFFECTS: CNS/respiratory depression Hypotension N/V Bradycardia Diaphoresis |
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FUROSEMIDE (LASIX)
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FUROSEMIDE (LASIX)
PHYSIOLOGICAL ACTIONS: Vasodilation Diuresis THERAPEUTIC EFFECTS: Reduce blood pressure Reduce pulmonary and peripheral edema INDICATIONS: CHF with pulmonary edema CONTRAINDICATIONS: Dehydration Hypotension DOSAGE: 0.5 - 1.0 mg/kg ROUTE: Slow IV push IM SPECIAL NOTES: Immediate effects occur through vasodilation Diuresis occurs about 15-20 minutes after administration Administer 0.5 mg/kg if patient is not currently taking furosemide, and 1.0 mg/kg if patient is on furosemide SIDE EFFECTS: Hypotension N/V Hypokalemia |
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GLUCAGON
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GLUCAGON
PHYSIOLOGICAL ACTIONS: Causes release of liver glycogen which can convert to glucose Positive inotropic agent through non- and non- receptors THERAPEUTIC EFFECTS: Raises blood glucose level. INDICATIONS: Hypoglycemia, established or suspected Unable to obtain IV access for dextrose administration -blocker overdose CONTRAINDICATIONS: Pheochromocytoma (adrenal gland tumor resulting in high levels of circulating epinephrine and norepinephrine) DOSAGE: Adult: • 1 unit (1 mg) Pediatric: • 0.5 unit (0.5 mg). ROUTE: IM IV for calcium channel blocker or -blocker overdose SPECIAL NOTES: Must be reconstituted prior to administration May take up to 15 minutes for patient to respond Glucagon is an inotropic agent that increases force of myocardial contraction through non-, non- receptors. It can be useful in mild to moderate shock induced by -blocker overdose. Glucagon should be administered with MC’s approval at 1-2 mg IV push. Vasopressors such as dopamine may also be required. SIDE EFFECTS: Occasional nausea/vomiting |
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LIDOCAINE (XYLOCAINE)
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LIDOCAINE (XYLOCAINE)
PHYSIOLOGICAL ACTIONS: Slows AV and intra-ventricular conduction Increases VF threshold THERAPEUTIC EFFECTS: Inhibits refractory or recurrent V-Tach and VF Suppresses PVC's INDICATIONS: PVC's (WITH CAUTION) V-Tach V-Fib Prior to oral intubation of CVA or Head Injury patients CONTRAINDICATIONS: Bradycardia Any heart block DOSAGE: IV Push: • PVC's or V-Tach with a pulse: 1.0 mg/kg initial dose • Repeat every 5 min as 0.5 mg, up to 3 mg/kg • V-Fib: 1.5 mg/kg initial dose • Repeat once in 5 min as 1.5 mg/kg Infusion: • Adult: 2 to 4 mg/min of 4 mg/ml concentration • Pediatric: 20 - 50 mcg/kg/min or 4 mg/ml concentration ROUTE: IV/IO push IV/IO infusion ET SPECIAL NOTES: Use ½ dose in patients older than 70 years A DRIP USUALLY (but not always) FOLLOWS PUSH ADMINISTRATION Use the infusion to maintain serum levels after ectopy is resolved with push dose SIDE EFFECTS: Seizures or altered mental status Suppresses myocardial activity |
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LORAZEPAM (ATIVAN)
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LORAZEPAM (ATIVAN)
PHYSIOLOGICAL ACTIONS: Raises seizure threshold at neuromuscular junction Limits propagation of seizure in brain CNS depressant Amnestic THERAPEUTIC EFFECTS: Anticonvulsant Sedative to facilitate therapies INDICATIONS: Status seizures Sedation for procedures CONTRAINDICATIONS: Pregnancy, except as anticonvulsant for eclamptic seizure refractory to magnesium sulfate DOSAGE: Adult: • Seizure: 2 - 4 mg IV or via buccal mucosa if IV unobtainable, may repeat once in 10 minutes • Sedation: 2 mg IV, may repeat once in 10 minutes Pediatric: • Seizure: 0.1mg/kg IV or via buccal mucosa if IV unobtainable, max single dose 2 mg, may repeat once in 10 minutes • Sedation: 0.1 mg/kg IV, max single dose 2 mg ROUTE: IV/IO Buccal Mucosa SPECIAL NOTES: Must be stored between 35 and 45F. For IV dose, dilute with equal quantity of NS, administer at rate of 2 mg/minute For administration via buccal mucosa, do not dilute Dose is individualized to each patient, use the minimal amount necessary to achieve the theraputic response desired Titrate to desired effect while closely observing for respiratory depression SIDE EFFECTS: Respiratory depression |
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MAGNESIUM SULFATE
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MAGNESIUM SULFATE
PHYSIOLOGICAL ACTIONS: Nervous system depressant THERAPEUTIC EFFECTS: Raises seizure threshold Decreases BP through vasodilation Anti-convulsant Corrects some ventricular dysrhythmias (Torsades de Pointes, etc.) Smooth muscle relaxant INDICATIONS: Toxemia of pregnancy (eclampsia and preeclampsia) Hypomagnesemic induced ventricular irritability Torsades de Pointes Refractory V-Fib Asthma refractory to other treatments CONTRAINDICATIONS: Heart block DOSAGE: Toxemia: • 2 G IV and 2 G IM Pulseless Dysrhythmias: • 2 G IV Perfusing Dysrhythmias/Asthma: • 2 G (4 ml) diluted in 6 ml IV fluid (total volume of 10 ml) over 1-2 min slow push ROUTE: IV/IO IM IV/IO infusion SPECIAL NOTES: Give slowly (over ~2 minutes) when used IV/IO on perfusing patients Used with caution in AMI SIDE EFFECTS: Hypotension CNS or respiratory depression |
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METHYLPREDNISOLONE (SOLUMEDROL)
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METHYLPREDNISOLONE (SOLUMEDROL)
PHYSIOLOGICAL ACTIONS: Suppresses immune reactions THERAPEUTIC EFFECTS: Reduces or inhibits allergic reactions Reduces or inhibits asthma attacks and exacerbation of COPD INDICATIONS: Allergic reactions Severe, refractory asthma Severe, refractory exacerbation of COPD CONTRAINDICATIONS: Systemic fungal infections DOSAGE: Adult: • 125 - 250 mg Pediatric: • 2 - 3 mg/kg, max dose of 125 mg ROUTE: IV IM SPECIAL NOTES: Onset of action is 30 minutes to 1 hour Effects may last up to 48 hours SIDE EFFECTS: None in the acute setting |
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MIDAZOLAM (VERSED)
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MIDAZOLAM (VERSED)
PHYSIOLOGICAL ACTIONS: CNS depressant Amnestic THERAPEUTIC EFFECTS: Sedative to facilitate therapies Chemical Restraint INDICATIONS: Sedative / amnestic for procedures which would cause discomfort to the patient Sedative to facilitate orotracheal intubation Status seizure refractory to lorazepam Status seizure patient without IV access Violent patients requiring chemical restraint CONTRAINDICATIONS: Pregnancy, except as anticonvulsant for eclamptic seizure refractory to magnesium sulfate and lorazepam. DOSAGE: Sedation: 0.05 - 0.1 mg/kg IV, titrated to effect up to 10 mg Intubation: 0.1 - 0.3 mg/kg IV, titrated to effect up to 20 mg Seizure: 0.1 mg/kg IV or 0.3 mg/kg IN up to 5 mg Chemical Restraint: 0.1 mg/kg IV up to 5 mg, or IM up to 10 mg ROUTE: IV/IO IM IN SPECIAL NOTES: Since midazolam can cause significant hypotension, its use in the hypotensive patient for rapid sequence induction/intubation should be used with extreme caution and titrated to effect. Dose is individualized to each patient Titrate to desired effect while closely observing for respiratory depression or hypotension SIDE EFFECTS: Respiratory depression Hypotension |
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MORPHINE SULFATE
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MORPHINE SULFATE
PHYSIOLOGICAL ACTIONS: Depresses CNS functions Induces vasodilation (both arterial and venous) Reduces both preload and systemic vascular resistance (afterload) THERAPEUTIC EFFECTS: Analgesia Vasodilation, with resulting increase in myocardial perfusion, decrease in myocardial work, reduction in pulmonary edema INDICATIONS: Relief of severe pain Myocardial ischemia Pulmonary edema CONTRAINDICATIONS: Head injury Altered mentation Hypotension Respiratory depression/failure DOSAGE: Adult: 2 - 20 mg in increments of 2 mg. Pediatric: 0.1 - 0.2 mg/kg in increments of 0.05 mg/kg • Max. single dose of 2 mg ROUTE: IV IM SQ SPECIAL NOTES: Respiratory depression secondary to MS can be reversed with naloxone Promethazine may be used to reduce nausea associated with MS Promethazine will increase effects of MS SIDE EFFECTS: CNS/respiratory depression Hypotension N/V Bradycardia Diaphoresis |
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NALOXONE (NARCAN)
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NALOXONE (NARCAN)
PHYSIOLOGICAL ACTIONS: Competitively blocks opiate receptors THERAPEUTIC EFFECTS: Reduces or reverses intoxication from narcotics, synthetic narcotics, alcohol, and other substances INDICATIONS: Known or suspected narcotic overdose Altered mentation of unknown etiology CONTRAINDICATIONS: None. DOSAGE: Adult: 0.5 – 2.0 mg IV, may administer up to 8 mg • OR 2.0 mg IN (1 mg per nostril) if IV route is delayed or not available • OR 2.0 mg IM if IV or IN routes are delayed or not available Pediatric: 0.1 mg/kg IV up to 2 mg single dose. ROUTE: IV ET IM IN SPECIAL NOTES: Substances other than narcotics and opiates will respond to naloxone, but require relatively high doses SIDE EFFECTS: Withdrawal symptoms in addicted patients Agitation or combativeness |
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NITROGLYCERINE (NITROSTAT/NTG
NITROLINGUAL) |
NITROGLYCERINE (NITROSTAT/NTG/NITROLINGUAL)
PHYSIOLOGICAL ACTIONS: Smooth muscle relaxant THERAPEUTIC EFFECTS: Vasodilation Reduction in BP Coronary artery dilation INDICATIONS: Myocardial ischemia Pulmonary edema CONTRAINDICATIONS: Hypotension Hypovolemia Increased ICP Patient’s use of medication for erectile dysfunction within the past 48 hours DOSAGE: 0.4 mg pre-metered spray Repeat every 5 minutes up to 3 doses ROUTE: SL SPECIAL NOTES: Recheck BP before administering each dose Occasionally causes sharp reduction in BP Be prepared to support BP with positioning and fluids SIDE EFFECTS: Hypotension Syncope Headache Dizziness Flushing Tachycardia |
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ONDANSETRON (ZOFRAN)
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ONDANSETRON (ZOFRAN)
PHYSIOLOGICAL ACTIONS: Selective serotonin receptor inhibitor Antiemetic THERAPEUTIC EFFECTS: Reduces nausea/vomiting INDICATIONS: Nausea CONTRAINDICATIONS: Prolonged QT Interval Severe hepatic disease DOSAGE: Adult: 4 mg • IV administration over 30 seconds Pediatric: 0.1 mg/kg up to 4 mg • IV administration over 30 seconds ROUTE: IV IM SPECIAL NOTES: Minimal sedative effect Does not potentiate the effects of Morphine Promethazine is preferred if the patient is actively vomiting SIDE EFFECTS: Headache Dizziness Blurred vision Fever |
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ORAL GLUCOSE (GLUTOSE, INSTA-GLUCOSE)
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ORAL GLUCOSE (GLUTOSE, INSTA-GLUCOSE)
PHYSIOLOGICAL ACTIONS: Carbohydrate glucose source THERAPEUTIC EFFECTS: Raises blood glucose level INDICATIONS: Hypoglycemia, established or suspected CONTRAINDICATIONS: Decreased mental status (unable to manage PO substances) DOSAGE: 25 - 80 G of paste ROUTE: PO SPECIAL NOTES: May be given to patients with altered mental status but intact gag reflex by carefully "smearing" the paste on the oral mucosa Is distasteful SIDE EFFECTS: None |
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OXYGEN
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OXYGEN
PHYSIOLOGICAL ACTIONS: Increases oxygen tension in blood THERAPEUTIC EFFECTS: Reduces or reverses hypoxemia or ischemia INDICATIONS: All hypoxic or ischemic patient, known or suspected CONTRAINDICATIONS: None DOSAGE: Varies with administration device and patient need ROUTE: Inhalation SPECIAL NOTES: When administering to COPD patients, watch closely for respiratory depression and be prepared to assist ventilations SIDE EFFECTS: Drying of mucous membranes if not humidified |
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PROMETHAZINE (PHENERGAN)
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PROMETHAZINE (PHENERGAN)
PHYSIOLOGICAL ACTIONS: Antihistamine H1 antagonist CNS sedative (selective functions) THERAPEUTIC EFFECTS: Reduces nausea/vomiting Potentiates narcotics INDICATIONS: Nausea/vomiting CONTRAINDICATIONS: Hypotension Altered mental status DOSAGE: Adult: 6.25 - 12.5 mg • May repeat once in 15 minutes if no relief Pediatric: 0.5 mg/kg up to 12.5 mg ROUTE: IV IM SPECIAL NOTES: Must be diluted in 9 ml’s of NS prior to slow IV administration If given with MS, will potentiate the effects of the MS Dose should be reduced to 6.5 mg in elderly patients SIDE EFFECTS: Hypotension Sedation |
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SODIUM BICARBONATE
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SODIUM BICARBONATE
PHYSIOLOGICAL ACTIONS: Increases systemic pH by binding hydrogen ions THERAPEUTIC EFFECTS: Reduces metabolic acidosis Interferes with the activity of certain drugs (specifically, tricyclic antidepressants) INDICATIONS: Metabolic acidosis Symptomatic tricyclic anti-depressant overdose (with cardiac dysrhythmias or significant mental status change) Cardiac arrest with suspected hyperkalemia CONTRAINDICATIONS: Hypokalemia Congestive heart failure DOSAGE: 1.0 mEq/kg, repeat doses are 0.5 mEq/kg at 10 min intervals Neonates: must receive bicarb at half the adult concentration (4.2 %) TCA Overdose: 1 mEq/kg initial bolus, followed by 0.05 mEq/ml infusion (50 mEq/1000 ml NS or 25 mEq/500 ml NS) titrated to systolic BP > 90 mmHg. Crush Injury: Add 50 mEq Sodium Bicarbonate to even numbered liters of IV fluids (i.e. 2nd, 4th, etc.) ROUTE: IV SPECIAL NOTES: RARELY indicated, except where metabolic acidosis is known or clearly the most probable culprit, such as DKA, ASA, or TCA overdose, ethylene glycol poisoning, etc. Cardiac arrest patients with a history of renal failure or other factors predisposing them for hyperkalemia should receive bicarb early in the resuscitation. SIDE EFFECTS: Volume overload Cellular acidosis Hypokalemia |
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SUCCINYLCHOLINE (ANECTINE)
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SUCCINYLCHOLINE (ANECTINE)
PHYSIOLOGICAL ACTIONS: Neuromuscular blocker THERAPEUTIC EFFECTS: Induces paralysis to achieve favorable intubation conditions INDICATIONS: Critical need for endotracheal intubation in patient not otherwise able to tolerate the procedure CONTRAINDICATIONS: Patients in whom a surgical airway would be difficult or impossible (i.e. massive neck swelling or injury) Patients who would be difficult to intubate or ventilate after paralysis (i.e. upper airway obstruction, acute epiglottitis) Hyperkalemia Neuromuscular disorders (ALS, MS, muscular dystrophy, etc.) History of malignant hyperthermia DOSAGE: 2 mg/kg ROUTE: IV/IO SPECIAL NOTES: Intubation conditions (complete paralysis) obtained in ~45 sec Duration of paralysis normally ~8 minutes May cause fasciculations (muscle twitching) prior to paralysis Must be stored between 35 and 45F, or replaced every 30 days if stored at room temperature SIDE EFFECTS: Apnea Elevated serum potassium |
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TERBUTALINE (BRETHINE)
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TERBUTALINE (BRETHINE)
PHYSIOLOGICAL EFFECTS: Beta 2 agonist Smooth muscle relaxant THERAPEUTIC EFFECTS: Bronchodilation Uterine relaxation (inhibition of contractions) INDICATIONS: Asthma Exacerbation of COPD Premature labor CONTRAINDICATIONS: None DOSAGE: 0.25 mg • May repeat once in 15 minutes if no relief • May repeat PRN for premature labor contractions ROUTE: SQ Nebulized inhalation SPECIAL NOTES: Generally not used in pediatrics < 35 kg If administered through nebulized inhalation, dilute in 2.5 ml NS. See Nebulized Bronchodilation procedure SIDE EFFECTS: In high doses, may have beta 1 properties (increased heart rate, etc.) Tremors Agitation and excitability, especially in pediatric patients |
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TETRACAINE
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TETRACAINE
PHYSIOLOGICAL ACTIONS: Local ocular anesthesia THERAPEUTIC EFFECTS: Provides relief from pain of eye injuries INDICATIONS: Corneal Abrasions Foreign bodies Chemical irritations of the eye CONTRAINDICATIONS: Open or disrupted globe DOSAGE: 1-2 gtts each eye, repeat every 10 minutes as needed ROUTE: Topical SPECIAL NOTES: None SIDE EFFECTS: May sting or burn initially |
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THIAMINE
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THIAMINE
PHYSIOLOGICAL ACTIONS: Allows glucose metabolism Protects nervous system from hypertonic insult THERAPEUTIC EFFECTS: Allows D50% administration in malnourished or de-myelinated patients Prevents or reverses Wernicke's encephalopathy INDICATIONS: Chronic alcoholism or suspected malnutrition Altered mentation of unknown etiology Prior to D50% administration to patients in whom alcohol abuse history cannot be ruled out CONTRAINDICATIONS: None DOSAGE: 100 mg ROUTE: IV IM SPECIAL NOTES: If used with dextrose, MUST PRECEDE D50% or oral glucose gel SIDE EFFECTS: None |
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VECURONIUM (NORCURON)
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VECURONIUM (NORCURON)
PHYSIOLOGICAL ACTIONS: Neuromuscular blocker, nondepolarizing THERAPEUTIC EFFECTS: Maintians paralysis in intubated patients INDICATIONS: Critical need for continued paralysis to maintain endotracheal tube in patients undergoing RSI CONTRAINDICATIONS: History of malignant hyperthermia Known hypersensitivity to the drug DOSAGE: 0.1 mg/kg ROUTE: IV/IO SPECIAL NOTES: Onset of action (complete paralysis) obtained in 2 ½ to 3 minutes Duration of paralysis normally 20 - 40 minutes SIDE EFFECTS: Apnea |
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Doses for Midazolam:
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DOSAGE:
Sedation: 0.05 - 0.1 mg/kg IV, titrated to effect up to 10 mg Intubation: 0.1 - 0.3 mg/kg IV, titrated to effect up to 20 mg Seizure: 0.1 mg/kg IV or 0.3 mg/kg IN up to 5 mg Chemical Restraint: 0.1 mg/kg IV up to 5 mg, or IM up to 10 mg |
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Doses for Lorazopam:
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DOSAGE:
Adult: • Seizure: 2 - 4 mg IV or via buccal mucosa if IV unobtainable, may repeat once in 10 minutes • Sedation: 2 mg IV, may repeat once in 10 minutes Pediatric: • Seizure: 0.1mg/kg IV or via buccal mucosa if IV unobtainable, max single dose 2 mg, may repeat once in 10 minutes • Sedation: 0.1 mg/kg IV, max single dose 2 mg Must be stored between 35 and 45F. For IV dose, dilute with equal quantity of NS, administer at rate of 2 mg/minute For administration via buccal mucosa, do not dilute Dose is individualized to each patient, use the minimal amount necessary to achieve the theraputic response desired Titrate to desired effect while closely observing for respiratory depression |
