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38 Cards in this Set
- Front
- Back
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Adenosine – Antiarrhythmic
Adenocard |
MOA
-Decreases SA node Automaticity and AV node conduction -effects are related to cAMP – decreased Calcium influx USED -Narrow complex tach -PSVT / PSVT associated with Wolf-Parkinson-White syndrome Contra -hypersensitivity -pre-existing 2nd/3rd degree AV block -Sinus node disease (sick sinus syndrome) -symptomatic bradycardia -atrial fib / atrial flutter -active bronchospasm / severe asthma -pt taking carbamazepine or dipyridamole Side effect -bradycardia -sob -hypotension -facial flushing -chest discomfort AHS protocol -may induce brief period of asystol -half 0.6-1.5 sec Dose -12 mg rapid IVP with rapid 20ml NS flush -do not repeat |
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Amiodarone – antiarrhythmic potassium channel blocker
Cordarone |
MOA
By blocking potassium channels it prolongs repolarization in fast pathways & increases ERP USED -Vfib / pulseless ventricular tach cardiac arrest with prolonged resus -ventricular tach Contra -none in emergency setting for Vfib/pVT -hypersensitivity to amiodarone or iodine -cardiogenic shock, sinus brad, or AV block 2nd or 3rd unless a pacemaker is present -cardiovascular collapse, severe atrial hypotension -pt predisposed to intracranial hypertension -acute hepatitis -thyroid dysfunction -thyroid dysfunction -interstitial pulmonary disease Side effect -pulmonary tox -teratogenic AHS protocol -us caution in renal failure present -use in-line filter tubing -do not exceed 30 mg/min -must be diluted -observe for signs of pulmonary toxicity -progressive apnea -cough -fever -pleuritic pain Dose Vfib/pulseless Vtach -300 mg IV/IO dilute in 20 ml D5W Repeat-150 mg IV/IO q 5 prn total max 450mg Ventricular tach -150 mg IV/IO dilute in 250 mL D5W bag inguse over 10 -do not repeat |
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Atropine – anticholinergic
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MOA
-competitive blockade of muscarinic receptors -nicotinic blockade can occur at high doses USED -asystole / PEA less than 60 bpm -symptomatic sinus brad or other brad -symptomatic 2nd degree type 1 heart block -organophosphate poisoning Contra -hypersensitivity -PEA greater then 60 bpm Side effect -dry mouth -blurred vision & photophobia -elevation of intraocular pressure -urinary retention -constipation -anhidrosis & hyperthermia -tachycardia -thickened bronchiole secretions AHS protocol -inappropriate to admin to pts with a heart transplant Dose Asystole / PEA -1mg IV/IO -q 3-5 prn to max of 3mg or 0.04mg/kg Bradycardia / Heart block -0.5 mg IV/IO -q 3-5 prn to max of 3mg or 0.04mg/kg Organophosphate poisoning -2mg IV/IO/IM -q 5 prn, titrate until reversal of toxicity (SLUDGEM) |
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Dexamethasone - steriod
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MOA
-long acting glucocorticoid -virtually no mineralocorticoid effects USED -anaphylaxis -bronchospam Contra -systemic fungal infection -hypersensitivity to dexamethasone or other steroids -hypersensitivity to benzyl alcohol or sodium sulfite Side effect -hyperglycemi -ulcers -myopathy -CNS effects -osteoporosis -glaucoma/cataracts -Cushing’s syndrome AHS protocol -clinical effects delayed 2-4 hr but -IM admin in lateral quad Dose -8mg IM/SIVP/IO -do not repeat |
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Glucagon - antihypoglycemic
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MOA
•Glycogenolysis •Gluconeogenesis •Decreased Glyconeogenesis •Increases intracellular cAMP •Relaxes smooth muscle in the GI tract USED OLMC-severe anaphylaxis with hypotension or bronchospasm refactory to fluid / bronchodilators / epinephrine -hTN BB/CCB od refractory to fluid boluses -symptomatic hypoglycemia Contra -hypersensitivity to glucagon, beef or pork Side effect -n/v AHS protocol -caution if cardiovascular or renal disease Dose Anaphylaxis – OLMC -1mg SIVP/IO -q 5 prn total max 5 mg BB/CCB OD -2mg IV/IO -q 5 prn total max 4mg Hypoglycemia -1mg IM -q 15 prn total max 2mg |
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Haloperidol - antipsychotic
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MOA
-butyrophenone family -D2 receptor antagonists -actions similar to chlorpromazine -↑ chances of EPS -↓ chances of other adverse effects USED OLMC – combative behaviour unresponsive to10 mg of midaz Contra -hypersensitivity -CNS depression / severe depressive states -Spastic disease -Parkinson’s -comatose states -seizures history Side effect -EPS -neuroendocrine -QT prolongation AHS protocol -Monitor 12-lead if possible -DO NOT USE EPI TO treat halodol hTN Dose OLMC – 5mg IM/IV -q 15 prn total max 10 mg -65 or older 2.5mg single dose |
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Ipratropium Bromide – anticholinergic, muscarinic antagonist, parasympatholytic
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MOA
-competitively blocks muscarinic receptors and promotes bronchodilation -little systemic absorption: *inhaled so local site specific *positively charge USED -anaphylaxis induced bronchospasm -bronchospasm Contra -hypersensitivity Side effect AHS protocol -Take care so it does not reach eyes Dose Anaphylaxis-admin continuously during rapid transport in pts who are in severe distress -500mcg (mixed with vent) neb prn Bronchospam -Nebulizer 500mcg (mixed with Vent) neb, Repeat prn -MDI with spacer 10 puffs -repeat q 20 prn total max 30 puffs |
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Ketamine – dissociative anesthetic
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MOA
-IV anesthetic with least amount of resp ↓ -negative effects are least likely seen in children USED -sedation prior to advanced airway in acute astha, airway burns, or when S BP↓ 100 -maintenance of sedation post Airway management when S BP↓ 100 -OLMC- pain management in hTN(BP↓ 80) or pain refractory to morphine or fent -Long lasting procedural sedation for paving and fracture realignment Contra -hypersensitivity -Relative – condition where significant HTN is hazardous Side effect -dissociative anesthesia: 1 catalepsy, 2 amnesia, 3 analgesia -depersonalization with hallucinations -broncholization -↑ in HR and BP -induce hypersalivation and tracheobronchial secretions AHS protocol -suction unit available -preferred agent when long lasting sedation is required e.g. pacing Dose Advanced airway -1.5mg/kg SIVP/IO -do not repeat Maintenance of sedation -0.5mg/kg SIVP/IO -q 10 prn Pain management OLMC-0.2 mg/kg SIVP/IO OLMC for repeat Procedural sedation -0.5 mg/kg SIVP -do not repeat |
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Lorazepam - Benzodiazepine
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MOA
-enhances action of gaba (inhibitory) -causes ↑ chloride influx into neurons -cannot mimic gaba USED -Alcohol withdrawal -Acute anxiety Contra -hypersensitivity to benzos -acute narrow angle glaucoma Side effect -CNS depression -anterograde amnesia -“sleep walking” -paradoxical effects: anxiety -respiratory depression -abuse: low -teratogenic AHS protocol Dose -1mg SL -q 5 prn total max 2mg |
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Magnesium Sulfate – antiarrhythmic, Electrolyte, Anticonvulsant
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MOA
-inhibits release of calcium from sarcoplasmic reticulum -important co-factor for ATPase pump it helps maintain membrane potential -prevents Ca attachment to actin and myosin, prevents smooth muscle contraction -inhibits transmission of ach at the NMJ -antagonizes NMDA receptors in the CNS USED -bronchospasm -Pre-eclampsia / eclampsia -polymorphic Vtach / torsades -Vfib / Pulseless Vtach Contra -any degree of heart block -renal failure Side effect AHS protocol Dose Bronchospasm -2g IV/IO in 50ml NS over 10min -do not repeat Pre-eclampsia / eclampsia -4g IV/IO in 50ml NS over 20min or 10g IM -maintenance dose 2g/hr diluted in 1000ml and infused over 1 hour -recurrent ongoing seizure with OLMC 4g IV/IO in 50 ml NS over 20 min polymorphic Vtach / torsades -2g IV/IO in 50ml NS over 5min -do not repeat Vfib / Pulseless Vtach -2g IV/IO -followed by 20-30ml flush -do not repeat |
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Oxytocin – oxytocic agent, peptide hormone
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MOA
-peptide hormone produced by posterior pituitary during labor and breast feeding -oxytocin receptors increase on uterus over course of gestation -stimulation stimulation by oxytocin leads to myometrial contraction by ↑ Ca release from sarcoplasmic reticulum USED -Post-delivery Contra -hypersensitivity -uterine inversion -placenta previa -abruptio placentae Side effect -water retention AHS protocol -multiple gestation births DO NOT ADMIN until all fetuses have been delivered Dose Post delivery -10u IM -do not repeat Post partum hemorrhage -10u IM -OLMC 20U SIVP/IO in 1000ml NS; admin 500ml bolus then titrate drip to control bleeding -do not repeat dose |
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Prednisone -corticosteroid
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MOA
-intermediate acting glucorticoid -minimal mineralocorticoid effects -convert to active form prednisolone via first past effect USED -anaphylaxis -bronchospasm Contra -pt already taking prednisone -pt altered LOC / unable to tolerate oral medications Side effect AHS protocol -very effective for decreasing airway edema associated with bronchospasm -clinical effects delayed 2-4 hours but used prehospital decreases treatment time and discharge time of pt Dose -50mg PO -do not repeat |
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Salbutamol – Bronchodilator, B2 agonist
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MOA
-sympathomimetic agonist with selective B2 adrenergic effects -stimulate beta 2 smooth muscle receptors of lung which ↑ production of cAMP -relieves bronchospasm -beta 2 agonists also supress histamine release in lung and increase ciliary action USED -anaphylaxis-induced bronchospasm -bronchospasm Contra -hypersensitivity -tachydysrhythmias Side effect Minimal with MDI/DPI Nebulizers and IV -anxiety, nervous -tremors -tachy -hypokalemia AHS protocol -administer continuously during rapid transport in pts in severe distress Dose Anaphylaxis -5mg mixed with ipratropium bromide nebulized -prn Bronchospasm -neb 5mg repeat prn -MDI with spacer 10puffs repeat q 5 prn |
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Tetracaine – local anesthetic
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MOA
-inhibits Na ion channels, stabilizing neuronal cell membranes and inhibiting nerve impulse initiation and conduction USED -local eye pain relief cause by foreign body substance, or corneal abrasion Contra -hypersensitivity to tetracaine or other ester type local anesthetics Side effect -may cause blurred vision AHS protocol Dose -1-3drops per eye -do not repeat |
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Tranexamic acid – antifibrinolytic agent
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MOA
-competitively inhibits multiple plasminogen binding sites, decreasing plasmin formation and fibrinolysis USED -OLMC- pt 16 y.o. or greater with in 3 hours of injury and presenting with HR ↑110 or S BP ↓ 90 Contra -active thromboemdolic diseases -unable to initiate bolus with in 3hrs of injury onset -unable to contact OLMC -no pt ↓ 16y.o. Side effect -n/v -diarrhea -giddiness -dizziness AHS protocol Dose OLMC- 1g IV/IO dilute in 250ml D5W or NS over 10 min -10gtt set to 4gtts/sec |
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Midazolam – benzodiazepines, intravenous anesthetics
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MOA
-enhances action of GABA, cannot mimic GABA USED -sedation prior to advanced airway management when systolic BP ↑ 100 -control combative behaviour -active motor seizure -Maintenance of sedation post advance airway S BP ↑ 100 -seizure due to eclampsia -Procedural sedation of cardioversion and fracture realignment -return of spontaneous circulation- shivering due to permissive hypothermia when S BP ↑ 100 -sympathomimetic OD with Chest pain, HTN crisis, symptomatic tachy, or agitation Contra -hypersensitivity to benzos -myasthenia gravis -systolic BP ↓ 100 Side effect -can induce post airway intervention hTN AHS protocol -caution with other sedatives / depressants -frequent reassessment of sedation Dose Advanced airway management -0.1mg/kg SIVP/IO single max 5mg -maintenance 2.5mg SIVP/IO q 10 prn Combative Behaviour -base dose on pt age/weight eg ↑65 y.o. or smaller body mass should receive the lower dose -2.5mg or 5mg SIVP -IV q 5 prn total max 10mg -5mg or 10mg IM –IM q 15 prn total max 10mg -OLMC an additional 5mg IM/SIVP may be admin q 15 prn to additional total max 10mg Generalized seizure protocol -10 mg IM(do not repeat IM dose) or 5 mg SIVP/IO -IV started after IM dose still seizing, 5mg SIVP/IO q 5 prn total max 10mg -Admin through IV first dose 5mg SIVP/IO q 5 prn to total max of 20 mg Pre-eclampsia / eclampsia -5mg SIVP/IO or 10mg IM(do not repeat IM dose) -SIVP/IO q 5 prn total max 20mg Procedural sedation -0.05mg/kg SIVP to single maximum dose 2.5mg (do not repeat) Sympathomimetic OD -5mg IV/IO or 10mg IM -2.5mg IV/IO q 5 prn total max 20mg or 5mg IM q 10 prn total max 20mg |
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D50W- caloric agent
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MOA
USED -Head injury symptomatic hypoglycemia -Symptomatic hypoglycemia -stroke with symptomatic hypoglycemia Contra -allergy to corn or corn products Side effect AHS protocol -ensure patency of IV site after half of dose is administered Dose Head injury -12.5g SIVP/IO -consider additional 12.5g only if BGL remains less than 4.0 mmol/L Hypoglycemia -25g SIVP/IO -q 5 prn titrate BGL to ≥ 4.0mmol/L or pt improvement to total max of 50g Stroke -12.5g SIVP/IO -consider additional 12.5g only if BGL remains less than 3.0 mmol/L |
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ONDANSETRON – antiemetic
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MOA
-Blocks Serotonin Receptors in CTZ and GI USED -Chemo Radiation Anesthesia -head injury refractory to other CONTRA -hypersensitivity SIDE -Head aches, Dizzy, Diarrhea AHS PROTOCOLS DOSE -8mg IV in 50 ml over 5 min -8mg IM |
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METOCLOPRAMIDE – antiemetic
Maxeran |
MOA
-block dop & serotonin in CTZ -↑ GI motility USED -headache suggested to be vascular in origin -N/V due to gastroenteritis, biliary colic, or suspected migraine CONTRA -bowel obstruction, perforation, bleeding -EPS -seizure disorders -monoamine oxidase inhibitor treatment within 14 days SIDE -EPS, Sedation, Diarrhea AHS PROTOCOLS -EPS occurs consider diphentlydramine -more effective in GI or CNS based problems DOSE -10mg IV in 50 ml over 5 min -10mg IM |
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DIMENHYDRINATE - antiemetics
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MOA
-block histamine/muscarinic mediated neuronal pathways inner ear → CTZ USED -vertigo, motion sickness, narcotic admin CONTRA -CNS ↓ -Narrow angle glaucoma SIDE - H1 sedation - M sedation - M drymouth - M urinary retention - M constipation AHS PROTOCOLS DOSE - 25 mg SIVP -50 mg IM |
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MORPNINE – narcotic analgesic
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MOA
-mimics actions of endogenous opioid peptides -effects on mu, minimal kappa USED -pain control -headache not suggestive for being vascular in origin or no relief with admin of metoclopramide -suspected ACS after 3 sprays of nitro have been admin CONTRA - Hypersensitivity - ACS, headaches: SBP ↓ 100mmHg - pain: SBP ↓ 90 mmHg SIDE - clinical triad ( resp , CNS ↓, Miosis) - biliary colic, N/V, ↑ICP (resp ↓) -euphoria/dysphoria, neurotoxicity -hypotension. urinary retention, constipation, antitussive AHS PROTOCOLS -vagotonic properties -caution with inferior or R vent infarct DOSE Headache -2.5mg SIVP -only with OLMC Pain management -0.1mg/kg SIVP/IM/IO max dose 5mg -q5 total max 20mg Suspected ACS -2.5 mg SIVP/IO -q 5 prn total max 15mg |
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FENTANYL - narcotic analgesic
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MOA
-mimics actions of endogenous opioid peptides -effects on mu, minimal kappa USED -break through pain relief-rapid onset short duration -sedation/induction and maintenance -headache with OLMC -procedural sedation for cardioversion and fracture realignment CONTRA - hypersensitivity -monoamine oxidase inhibitors treatment with in last 14 days -pain SBP ↓ 90 -sedation/airway s bp ↓100 -procedural sedation s BP ↓ 80 SIDE - clinical triad ( resp , CNS ↓, Miosis) - biliary colic, N/V, ↑ICP (resp ↓) -euphoria/dysphoria, neurotoxicity -hypotension. urinary retention, constipation, antitussive AHS PROTOCOLS - Caution with myasthenia gravis DOSE Airway management -2mcg/kg single max 200mcg -do not repeat Headache OLMC -1 mcg/kg SIVP -only with OLMC Maintenance of paralysis and sedation -50mcg SIVP/IO -q 10 prn Pain S BP↑ 90 -1mcg/kg SIVP/IO/IM max 100 mcg -q 3 prn total max 250 mcg S BP 80-90 -0.5mcg/kg SIVP/IO/IM -q 5 total total max 250mcg Procedural sedation S BP↑ 90 -1mcg/kg SIVP/IO/IM max 100 mcg S BP 80-90 -0.5mcg/kg SIVP/IO/IM -do not repeat |
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NARCAN – narcotic antagonist
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MOA
-competes with opioid receptors, antagonize actions of opioids USED -opioid OD reversal, for respiratory depression, -newborn mother received narcotics 4 hours before delivery CONTRA -newborn mother suspected addict SIDE AHS PROTOCOLS - IM preferred route DOSE Neonatal - 0.1 mg/kg IM, no repeat dose Opiate OD -1 mg IM q5 max 4 mg Or -0.5 mg IV/IO q2 max 2 mg |
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ROCURONIUM - NDNMBA
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MOA
-competes with Ach for NM receptors at NMJ -prevents depolarization skeletal muscle → paralysis USED -maintain paralysis post advanced airway management where the repeat dosing of sedation alone is ineffective in limiting pt movement or resp which compromises adequate ventilation or airway patency CONTRA -myasthenia gravis -hypersensitivity -lack of sedation SIDE -hypotension – NN block -respiratory arrest -may induce bronchospasm AHS PROTOCOLS - may cause slight ↑ in HR & BP DOSE - 1 mg/kg IV/IO - q 10 0.5 mg/kg IV/IO |
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SUCCINYLCHOLINE - DNMBA
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MOA
-persistent depolarization of NMJ USED -intubation CONTRA -hypersensitivity -known or suspected hyperkalemia -Family Hx malignant hyperthermia or ↓plasma pseudocholinesterase deficiency -myopathies associated with ↑CK -penetrating eye injuries SIDE AHS PROTOCOLS -withhold unless trismus present DOSE - 1.5 mg/kg IV/IO max 150 mg. DO NOT REPEAT |
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NITRO - antianginal
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MOA
-causes dilation preventing myosin from interacting with actin -primary in veins -dilation decreases blood flow to heart USED -chest pain, stable (prinzmetal/unstable angina} -STEMI/NSTEMI -Pulmonary edema CONTRA -BP↓ 100 -RVI -phosphodiesterase inhibitors SIDE AHS PROTOCOLS DOSE Pulmonary Edema Spray - 0.4 mg SL (1 spray) max 5 sprays or BP ↓100 Infusion -20 mcg/min, increase by 10 mcg/min q5 prn to max of 200 mcg/min ACS Spray - 0.4 mg SL (1 spray) q 5 prn to max of 200 mcg/min Infusion - 20 mcg/min, increase by 10 mcg/min q5 prn to max of 200 mcg/min |
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Acetylsalicylic Acid (ASA) - platelet inhibitor
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MOA
-irreversible inhibition of COX 1 & 2 -COX-1 MI/stroke decreases platelet aggregation -COX-2 pain inflammation & fever -COX prevents arachidonic acid into prostaglandins USED -suspected ACS CONTRA -hypersensitivity - active GI bleed -asthmatic with Pm Hx sensitivity ASA/NSAIDS SIDE COX – 1 - bleeding, anemia, GI ulceration, renal impairment COX – 2 - renal impairment AHS PROTOCOLS -diminishes platelet aggregation and thrombus formation / enlargement in ACS DOSE - 160 mg chew PO |
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KETOROLAC – non-steroidal anti-inflammatory
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MOA
-same MOA as ASA -potent analgesic effects -weak anti-inflammatory effects USED -pain control with OLMC -refractory to opioid -opioid use contra CONTRA -asthma -renal failure -suspected ICB -Hx GI bleeding SIDE -renal impairment ↑ AHS PROTOCOLS -OLMC needed DOSE -30 mg IV/IM with OLMC |
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Acetaminophen - antipyretic
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MOA
-COX inhibitor works CNS only -reduces pain and fever USED -Febrile ↑38.5oC oral/tympanic or 39.5oC axilla CONTRA -Hypersensitivity -acetaminophen-induced liver disease SIDE -Severe liver damage in OD AHS PROTOCOLS -do not admin if has been give n within 4 hours -document temp before and after DOSE -20 mg/kg PO -do not repeat |
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BENADRYL - antihistamine
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MOA
Block H1 receptors -vessels - ↓ dilation →↓ flushing -capillaries - ↓ permeability →↓ edema -sensory nerves - ↓ pruritis/pain -mucous membranes - ↓ mucous USED -allergic reaction -anaphylaxis -relief of extra pyramidal reaction or agitation due to metoclopramide CONTRA - hypersensitivity BEN/GRAV SIDE - CNS – sedation - GI –N/V, loss of appetite, diarrhea, constipation - anticholinergic – dry mouth, urinary retention, constipation, palpitations AHS PROTOCOLS - admin in lateral quad -avoid antihistamines in nursing mothers and neonates however should be used in life threatening anaphylaxis DOSE EPS after admin of metoclopramide - 25 mg SIVP or deep IM - do not repeat Anaphylaxis - 1 mg.kg IM/SIVP/IO to single max 50 mg - DO NOT REPEAT Allergic Reaction - (Elixir) 50 mg PO max dose 50 mg - 1 mg/kg IM/SIVP to single max 50 mg - DO NOT REPEAT |
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METOPROLOL – beta blocker
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MOA
decreases - automaticity of SA node - conduction through AV node - myocardial contractility Due to ↓ in Ca influx USED A Fib/ S Flutter with OLMC - stable ( BP ↑ 70 mmHg) -symptomatic ( altered LOC, significant chest pain, significant SOB) with A Fib/A Flut CONTRA - hypersensitivity - 2nd or 3rd AV blocks - bradycardia ↓50 bpm - S BP ↓ 100 mg - severe acute heart failure - bronchospastic COPD, reactive airway - recent (less 24 hours) cocaine use SIDE - bradycardia -rebound cardiac excitation - AV failure -CNS effects AHS PROTOCOLS DOSE OLMC - 5 mg SIVP - Q5 max 15 mg OR 110 bpm |
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SODIUM BICARBONATE – alkalinizing agent
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MOA
- important component plasma buffering system - ↑ pH will K+ intracellular USED -prolonged cardiac arrest -QRS width greater then 0.12 secondary to BB/CCB OD - sympathomimetic OD QRS ↑ 0.12 - CA with prolonged resuscitation, pre-existing hyperkalemia (renal failure), TCA, or ASA OD CONTRA - excessive chloride loss - metabolic or respiratory alkalosis - pts with hypocalcaemia whom alkalosis may induce tetany SIDE -NONE IN EMERGENCY SITUATIONS - alkalosis - hypernatremia - Tissue irritation/necrosis AHS PROTOCOLS - caution CHF, renal impairment, concurrent corticosteroid treatment DOSE Asystole/PEA/ V Fib/pulseless V Tach - 1 mEq/kg IV/IO - DNR - immediately flush 20-30 ml NS BB/CCB/TCA/SYMPATHOMIMETIC OD - 1 mEq/kg SIVP/IO - q5 prn total max 2 mEq/kg |
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CaCl - antiarrhythmic
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MOA
-contraction muscle via association of actin & myosin -depolarization SCC via influx stage 0 -regulation of neuronal transmission USED -VFIB/Pulseless VTach -cardiac arrest if hypo CA, hyper K/Mg suspected -hypotensive CCB OD refractory to fluid bolus & glucagon -asystole/PEA CONTRA - hypersensitivity - hypercalcemia - digitalis toxicity SIDE AHS PROTOCOLS DOSE Asystole/PEA/ V fib/ pulseless v tach - 1 g SIVP/IO - q10 prn to tal max 2g BB/CCB OD - 500 mg IV/IO, MIX 50 ml NS & infuse over 10 min -q 10 prn total max 1000mg |
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ENOXAPARIN - anticoagulant
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MOA
-polysaccharide chain is shorter so it attaches Xa & not thrombin -inhibits clotting through clotting factor Xa USED -STEMI PROTOCOL VHR CONTRA - hypersensitivity heparin, pork - active major bleed -acute or subacute bacterial endocarditis - heparin or LMW Hep induced thrombocytopenia - suspected or known ICB or spinal epidural hematoma -IV admin pts ↑ 75 year old SIDE AHS PROTOCOLS DOSE VHR doc/protocol |
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CLOPIDOGREL – antiplatelet agent
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MOA
- irreversibly block ADP receptors - prevents platelet activation for life time of platelet (7-10 days) USED - acute STEMI VHR CONTRA - Hypersensitivity - active bleed - significant liver impairment or cholestatic jaundice -liver impairment with Hx hepatitis, cirrhosis, long term alcohol abuse or presentation of jaundice -thrombotic thrombocytopenic purpura -suspected aortic dissection SIDE AHS PROTOCOLS DOSE |
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TENECTEPLASE - fibrinolytic
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MOA
- modified form of tPA – longer halflife 20-24min - converts plasminogen to plasmin -plasmin digests fibrin clots & degrades clotting factors USED - VHR CONTRA - hypersensitivity - active internal bleed - bleeding in the brain - structural anomaly of veins or arteries in brain - brain tumor - ischemic stroke within 3 months (except if in last 3 hours) -recent intra cranial/spinal surgery or trauma less than 2 months -suspected aortic dissection SIDE AHS PROTOCOLS DOSE VHR doc/protocol |
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EPINEPHRINE – sympathomimetic
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MOA
- B2 – cause Bronchodilation - may cause inhibition of histamine – release - A1/B1 effects improved pulmonary perfusion & aid decompensated shock states CONTRA - none in emergency setting - Pts with underlying cardiovascular disease EPINEPHRINE – sympathomimetic 1: 1,000 USED - anaphylaxis - severe bronchospasm refractory to initial treatment AHS PROTOCOLS Bronchospasm - only admin if treatments unresponsive to bronchodilators, are intubated or have sever respiratory failure (ApO2 ↓85% & altered LOC ) which intubation is anticipated DOSE Anaphylaxis - 0.3 mg IM - q 5 prn total max 0.9 mg Bronchospasm - 0.3 mg IM - q 20 prn total max 0.9 mg EPINEPHRINE – sympathomimetic 1: 10,000 USED - anaphylaxis -asystole/PEA -new born, neonate ; BP ↓60 unresponsive to Tx - VFib/pulseless V Tach AHS PROTOCOLS Anaphylaxis - reverses much of capillary permeability caused by histamine Asystole/Pulseless Electrical activity- primarily used for vasoconstriction DOSE Anaphylaxis - 0.1 mg SIVP/IO - q 2 prn total max 1 mg Asystole/PEA/V FIB/ Pulseless V Tach - 1 mg IV/IO - q 3-5 prn - immediate 20-30 ml flush Neonatal care/resuscitation - 0.1 mg/kg ETT single max 0.3 mg - 0.01 mg/kg IO with rapid flush up to 5 ml - Q 3-5 prn until HR ↑ 60 EPINEPHRINE – sympathomimetic INFUSION USED - OLMC – hTN BB/CCB OD refractory to fluid boluses, glucagon & CaCl AHS PROTOCOLS DOSE BB/CCB OD -IV/IO 2mcg/min, increase by 1 mcg/min prn, titrate to systolic BP ↑ 90 or max 10 mcg/min |
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DOPAMINE - sympathomimetic
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MOA
-dose dependent low- dopamine Moderate – B1 High – A1 -inotropic & chronotropic effects USED - Anaphylactic shock unresponsive to 2 fluid boluses & epinephrine - OLMC – hypotensive BB/ CCB OD refractory to fluid boluses, glucagon & CaCl - Symptomatic sinus brad & 2nd degree type 2 or 3rd degree heart block CONTRA - Hypovolemic shock where complete fluid resuscitation has not occurred - Pheochromocytoma - Uncorrected tachyarrhythmias - V Fib - Monoamine oxidase inhibitor therapy within 14 days - Hypersensitivity to sulphites SIDE - Tachycardia - Angina - Arrhythmia - Necrosis AHS PROTOCOLS DOSE Bradycardia/Heart Block - IV/IO start 5 mcg/kg/min, - Increase by 5 mcg/kg/min prn to max 10 mcg/kg/min Anaphylaxix, BB/CCB OD, General Shock Management, Pulmonary Edema - IV/IO 5 mcg/kg/min - Increase by 5 mcg/kg/min prn, - Max 20 mcg/kg/min - Titrate to systolic BP 90 or greater |
