Paramedic Drug Dose And Indications

Front 1

CHARCOAL, ACTIVATED

Back 1

CHARCOAL, ACTIVATED

Indications and Field Use:
Sole prehospital therapy of oral ingestion of poisons
Pre-lavage of oral ingestions of poison substances

Contraindications:
Ingestion of caustics (risk of gastrointestinal hemorrhage)
Ingestion of hydrocarbons (relative)
Oral administration to comatose patient
Simultaneous administration of other oral drugs
Absence of bowel sounds
Gastrointestinal perforation
Intestinal obstruction
Recent surgery

Adult Dosage:
50-100 Gm (1-2 Gm/kg) as a single initial dose; if not in pre-mixed slurry, mix one part charcoal with four parts water.

Pediatric Dosage: 0.5 -1 Gm/kg; if not in pre-mixed slurry, mix one part charcoal with four parts water.

Front 2

ADENOSINE

Back 2

ADENOSINE

Indications and Field Use:
Conversion of supraventricular tachycardias with no known atrial fibrillation or atrial flutter.
Wide complex tachycardia of uncertain origin unresponsive to lidocaine.

Contraindications:
Sick sinus syndrome, 2nd or 3rd degree AV blocks; except in patients with a functioning ventricular pacemaker.
Use cautiously in patients with known asthma (has precipitated acute bronchospasm).
Patients on theophylline and related methylxanthines.
Patients on dipyridamole (Persantine) or carbamazepine (Tegretol).
Cardiac transplant patients are more sensitive to adenosine and require only a small dose (relative).
Known atrial fibrillation or atrial flutter.
Pregnancy (no controlled studies)

Adult Dosage:
Initial: 6 mg rapid IV bolus over 1-3 seconds
Repeat: If no response in 1-2 minutes (of each

Pediatric Dosage: (Drug of choice for treating SVT in symptomatic infants and children)
Initial: 0.1 mg/kg as a rapid IV bolus.
Repeat: If no response, dose may be doubled 1 time (0.2 mg/kg) using same administration procedure.

Front 3

ALBUTEROL SULFATE

Back 3

ALBUTEROL SULFATE

Indications and Field Use:
Treatment of bronchospasm

Contraindications:
Synergistic with other sympathomimetics
Use caution in patients with diabetes, hyperthyroidism, and cerebrovascular disease

Pediatric Dosage: (children <40 lbs)
For children < 40 lbs., administer half of 0.083% premixed solution; add 1-1.5 ml NS to make 2.5-3 cc inhalation treatment administered via SVN with a mouth piece, O2 mask or in-line with a ventilatory device. May be repeated according to medical control preference

Front 4

AMIODARONE

Back 4

AMIODARONE

Indications for use:
Treatment of: defibrillation-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin.
Control hemodynamically stable ventricular tachycardia when cardioversion unsuccessful.
Adjunct to cardioversion of SVT and PSVT.
Rate control in atrial fibrillation or flutter.

Contraindications:
Bradycardia
Second or third degree heart block unless a functioning pacemaker is present
Cardiogenic shock
Hypotension
Pulmonary congestion

Adult Dosage:
VF/Pulseless VT
300 mg IV push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push
Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with cardioversion
150 mg IV over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes
Maintenance Infusion Post Resuscitation/Conversion
After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then up to 0.5 mg/min IV infusion for up to 18 hours, maximum daily dose is 2.2 grams
Mix 450 mg in 250 mL of D5W (special polyolefin bag), concentration 1.8 mg/mL, and run at 33.3 mL/hr for 1 mg/min or 16.7 mL/hr for 0.5 mg/min
For Other Maintenance infusion
Rates range from 0.5 mg/min to 1mg/min. Maximum daily dose is 2.2 grams

Pediatric Dosage:
VF/Pulseless VT
5 mg/kg IV push (max 300 mg single dose), may repeat every 5 minutes two times to a total maximum of 15 mg/kg/day
Probable VT with pulse
5 mg/kg IV administered over 20 minutes may repeat two more times to a total of 15 mg/kg/day

Front 5

ACETYLSALICYLIC ACID, ASPIRIN, ASA

Back 5

ACETYLSALICYLIC ACID, ASPIRIN, ASA

Indications and Field Use:
Chest pain or other signs/symptoms suggestive of acute myocardial infarction
ECG changes suggestive of acute myocardial infarction
Unstable angina
Pain, discomfort, fever in adult patient only

Contraindications:
Bleeding ulcer, hemorrhagic states, hemophilia
Known hypersensitivity to salicylates or other non-steroidal anti-inflammatories that has lead to hypotension and/or bronchospasm
Children and adolescents (prehospital personnel should not administer ASA to this age group)

Adult Dosage:
Cardiac: 160- 325 mg (2-4 pediatric chewable tabs), chew or swallow
Pain/discomfort/fever: 325 mg po (4 pediatric chewable tablets), chew or swallow

Adult Dosage:
Cardiac: 160- 325 mg (2-4 pediatric chewable tabs), chew or swallow
Pain/discomfort/fever: 325 mg po (4 pediatric chewable tablets), chew or swallow

Front 6

ATROPINE SULFATE

Back 6

ATROPINE SULFATE

Indications and Field Use:
 Symptomatic bradycardia (sinus, junctional, and AV blocks causing significant hypotension, ventricular ectopy, chest pain, altered level of consciousness, etc.), monitored patient only.
 Asystole (after epinephrine) monitored patient only.
 PEA with actual or relative bradycardia (after epinephrine) monitored patient only.
 Acetylcholinesterase inhibitor poisoning (organophosphate, carbamate cholinergic poisoning).

Contraindications:
 Hypersensitivity to atropine or any component of the formulation – Belladonna alkaloid allergy
 Glaucoma, acute narrow angle (relative contraindication for patient with symptomatic bradycardia), adhesions between the iris and lens
 Tachycardia
 Obstructive GI disease, paralytic ileus, intestinal atony of the elderly or debilitated patient, severe ulcerative colitis, or toxic megacolon complicating ulcerative colitis
 Hepatic disease
 Renal disease, obstructive uropathy
 Myasthenia gravis (unless used to treat side effects of acetylcholinesterase inhibitor
 Asthma
 Thyrotoxicosis
 Mobitz type II block
 3rd degree heart block

Adult Dosage:
Symptomatic Bradycardia:
IV – 0.5 mg every 5 minutes. Do NOT exceed a total dose of 3 mg or 0.04mg/kg if symptoms profound.

Organophosphate or carbamate poisoning:
IV – Initially: 1-5 mg. Doses should be doubled every 5 minutes until signs of muscarinic excess abate (clearing of bronchial secretions, bronchospasm, and adequate oxygenation)
IV infusion – 0.5-1 mg/hour or 10-20% of loading dose/hour
IM – (AtroPen) mild symptoms: Administer 2 mg as soon as exposure is known or suspected. If severe symptoms develop after first dose, 2 additional doses should be repeated in 10 minutes, not to exceed more than 3 doses. Severe symptoms: Immediately administer three 2 mg doses.

Pediatric Dosage:
Symptomatic Bradycardia:
IV – 0.02 mg/kg (minimum of 0.1 mg), may repeat at 5 minute intervals to a maximum total dose of 1 mg in children and 2 mg in adolescents
Maximum single doses: Child 0.5 mg; Adolescent 1 mg.

Organophosphate or carbamate cholinergic poisoning:
IV – 0.03-0.05 mg/kg every 10 to 20 minutes until cholinergic symptoms minimize, then every 1 to 4 hours for at least 24 hours
IM – Administer dose as listed below as soon as exposure is known or suspected. If sever symptoms develop after first dose, 2 additional doses should be repeated in 10 minutes. Do not administer more than 3 doses. For severe symptoms, immediately administer 3 doses as follows:
 < 6.8 kg (15 lbs): not recommended, administer atropine 0.05 mg/kg
 6.8-18 kg (15-40 lbs): 0.5 mg/dose
 18-41 kg (40-90 lbs): 1mg/dose
 > 41 kg (> 90 lbs): 2mg/dose

Front 7

CALCIUM CHLORIDE

Back 7

CALCIUM CHLORIDE

Indications and Field Use:
Acute hypocalcemia
Calcium channel blocker OD
Acute hyperkalemia (known or suspected)
Hypermagnesemia (Magnesium OD)
Pre-treatment for IV verapamil administration

Contraindications:
Hypercalcemia
Concurrent digoxin therapy (relative)

Adult Dosage:
Hypocalcemia, calcium channel blocker OD, hyperkalemia and hypermagnesemia: 5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10-20 minutes.
Pre-treatment for IV verapamil administration: 3 ml of 10% calcium chloride. May be repeated once.

Pediatric Dosage:
Hypocalcemia, calcium channel blocker OD hyperkalemia and hypermagnesemia: 0.2 - 0.25 ml/kg of a 10% solution infused slowly. Should not be repeated without documented calcium deficiency.

Front 8

DEXTROSE 50%

Back 8

DEXTROSE 50%

Indications and Field Use:
Known hypoglycemia
Altered level of consciousness of unknown etiology
Seizures of unknown etiology
Hyperkalemia

Contraindications:
Hypersensitivity
Known thiamine deficiency (relative, if suspected give thiamine close to same time).
Delirium tremens; use with caution in patients with acute alcoholism, may be ineffective without thiamine.
Head injury (unless documented hypoglycemia).
Intra cranial hemorrhage (relative).
Severe pain (paradoxical excitement may occur).
Diabetic coma with hyperglycemia
Glucose-galactose malabsorption symdrome
Anuria and hepatic coma

Adult Dosage:
Hypoglycemia, altered level of consciousness or seizures of unknown etiology: 25-100 ml of D50 (12.5-50 Gm, 1/2 to 2 amps) IV.
Hyperkalemia: 50 Gm of Dextrose IV total may be given over 1 hour. This is part of a combination drug therapy. See: profiles for calcium chloride and sodium bicarbonate. Insulin may be given upon arrival to ED.

Pediatric Dosage: (14 yrs and below includes infant)
Administer 0.5 - 1 Gm/kg of a dextrose 10% solution; recommended to give slowly over a 20 minute period.
Dilute D50 (dextrose 50% containing 25 Gm of dextrose) to a 1:4 solution. To prepare, obtain a 250 ml container of normal saline for IV use; waste 50 ml and add 50 ml of dextrose 50%. The resulting solution is dextrose 10% in normal saline or 10 grams/100ml.

Front 9

DIAZEPAM

Back 9

DIAZEPAM

Indications and Field Use:
Grand mal seizures, especially status epilepticus.
Transient analgesia/amnesia for medical procedures (e.g., fracture reduction, cardioversion, pacing).
Delirium tremens.
Treat the cause first.

Contraindications:
Hypersensitivity (allergy)
Glaucoma, acute narrow angle (relative)
Allergy to soy protein (Diazepam rectal gel only)

Adult Dosage:
2 mg increments slow IV push. Administer no faster than 5 mg/minute.
Status epilepticus: 5-10 mg IV push. May repeat at intervals of 10-15 min., to a total of 30 mg.

Pediatric Dosage:
IV Dose: 0.2-0.3 mg/kg every 15-30 minutes (max. of 1.0 mg/kg); administer IV over at least 3 minutes or until seizure activity subsides.
IV Dose after rectal dose: 0.1 mg/kg with same administration instructions.
Rectal dose (<6 years): 0.3-0.5 mg/kg rectally at IV push rate; may repeat in 15-30 min at 0.25 mg/kg.
Status epilepticus:
Neonates: 0.15-0.5 mg/kg IV
Infants (>30 days old) 0.2-0.5 mg IV every 2-5 minutes to a max of 5 mg
Children (>5 yrs old) 1 mg every 2-5 minutes, to a max of 10 mg

Front 10

DIPHENHYDRAMINE HCl

Back 10

DIPHENHYDRAMINE HCl

Indications and Field Use:
Anaphylaxis (2nd line)
Phenothiazine reactions (extrapyramidal symptoms)
Antiemetic

Contraindications:
Known hypersensitivity to diphenhydramine or drugs of similar chemical structure.
Newborn or premature infants; nursing mothers.
Considerable caution in patients with glaucoma, acute narrow angle; stenosing or obstructive diseases of the GI tract; bronchial asthma; hyperthyroidism; cardiovascular disease or hypertension; age greater than 60 years (all relative benefit vs risk).

Adult Dosage:
Allergic Reaction: 25-50 mg slow IV push or deep IM
Anaphylaxis: 25-50 mg slow IV push or deep IM.
Extrapyramidal symptoms and antiemetic: 10-50 mg IV or deep IM, dose should be individualized according to the needs and patient response.

Pediatric Dosage:
Allergic Reaction: 1.0-1.25 mg/kg slow IV push or deep IM
Anaphylaxis or Phenothiazine Overdose: 1-2 mg/kg slow IV push

Front 11

DILTIAZEM

Back 11

DILTIAZEM

Indications and Field Use:
Rapid ventricular rates associated with atrial fibrillation and atrial flutter, and for PSVT refractory to adenosine.

Contraindications:
Severe Hypotension
Hypotension (less than 90 mmHg systolic)
Acute Myocardial infarction
Cardiogenic shock
Ventricular tachycardia or wide-complex VT of unknown origin
Second or third-degree AV block
Wolff-Parkinson-White (WPW) syndrome
Sick Sinus syndrome
Concomitant IV Beta Blocker use within a few hours
Hypersensitivity

Adult Dosage:
Initial: 0.25 mg/kg IVP (usually 20 mg) administered over 2 minutes
If response is inadequate, repeat in 15 minutes: 0.35 mg/kg IVP administered over 2 minutes
Maintenance infusion: 5.0 to 15 mg/hr

Front 12

DOPAMINE

Back 12

DOPAMINE

Indications and Field Use:
Symptomatic bradycardias. Second line choice after Atropine
Hemodynamically significant hypotension in the absence of hypovolemia (Cardiogenic or septic shock only after fluid administration; assess breath sounds first).

Contraindications:
Hypersensitivity
Hypovolemic shock (relative)
Pheochromocytoma
MAO inhibitors, such as Marplan, Nardil, or Parnate
Tachyarrythmias / Ventricular Fibrillation

Adult Dosage: (dosage range 2-20 μg/kg/min)
Preparation: (If premixed not carried) Add 400 mg/ 250 ml NS or Dextrose = 1600 μg/ml.
Bradycardia: Start at 5 μg/kg/min
Shock: cardiogenic or septic (non-hypovolemic)
BP < 70 systolic: Start drip at 5 μg/kg/min
BP > 70 systolic: Start drip at 2.5 μg/kg/min

Pediatric Dosage:
2-20 μg/kg/min for circulatory shock or shock unresponsive to fluid administration. To prepare infusion for small children: 6 x body wt. in kg = mg added to NS to make 100 ml. With this mixture 1 ml/hr delivers 1 μ/kg/min; titrate to effect.

Front 13

EPINEPHRINE HCl

Back 13

EPINEPHRINE HCl

Indications and Field Use:
Cardiac arrest - VF/Pulseless VT; asystole; PEA (First line pharmacologic agent for any pulseless dysrhythmia in cardiopulmonary arrest).
Severe bronchospasm, i.e., bronchiolitis, asthma.
Anaphylaxis.
Bradycardia, refractory with profound hypotension, monitored patient only.
Hypotension unresponsive to other therapy, monitored patient only.
Croup

Contraindications:
None known for cardiac arrest
Hypothermia, relative contraindication

Pulseless Arrest –
IV/IO: 1 mg of 1:10,000 solution repeat every 3 - 5 minutes or,
ET: Give 2 - 2.5 mg via the ET tube.
May use 1:10,000 or dilute 1:1000 to equal 10 mL via ET tube for adult. (i.e., 2 mg of 1:1,000 epinephrine diluted with 8 mL NS in a 10 mL syringe)
Continuous Infusion for Hypotension or Symptomatic Bradycardia: 1 mg added to 500 mL of NS administered at 1 mcg/min titrated to desired hemodynamic response (range 2-10 mcg/min); not first-line therapy.
Anaphylaxis and asthma: Give 0.3 - 0.5 mg of 1:1,000 solution IM (preferred), SC, or inject SL, may repeat every 15 to 20 minutes; or in extreme cases only, may be asked to use 1:10,000 solution and give 0.1 mg every 5 minutes IV/IO or continuous IV/IO infusion of 1 - 4 mcg/min to prevent need for multiple injections.

Pediatric Dosage:
Pulseless Arrest or Refractory Bradycardia:
IV/IO: 0.01 mg/kg of 1:10,000 repeat every 3 - 5 minutes, maximum single dose 1 mg.
ET: 0.1 mg/kg of 1:1,000; diluted with NS to a volume of 3 - 5 mL prior to instillation or followed with flush of 3 - 5 mL of NS after instillation repeat every 3 - 5 minutes, maximum single dose 10 mg.
Asthma/anaphylaxis: Use 1:1,000 solution; give 0.01 mg/kg IM (preferred), SC (maximum single dose of 0.5 mg/dose).
IV Infusion: 0.1 – 1 mcg/kg/min; to prepare for small children 0. 6 x body wt. in kg = mg added to NS to make 100 mL. With this mixture, 1 mL/hr delivers 0.1 mcg/kg/min.
Croup: 3 mg 1:1,000 mixed in 3 mL NS via SVN.

Front 14

ETOMIDATE

Back 14

ETOMIDATE

Indications and Field Use:
Induction of anesthesia for rapid sequence intubation (RSI)

Contraindications:
Hypersensitivity

Adult Dosage:
0.3 mg/kg IV over 30-60 seconds

Front 15

FUROSEMIDE

Back 15

Indications and Field Use:
Pulmonary edema; congestive heart failure

Contraindications:
Anuria (relative)
Hypovolemia (relative)
Hypotension (relative)
Hypersensitivity

Adult Dosage:
0.5 to 1.0 mg/kg IVP to maximum dose of 40 mg
CHF/Pulmonary Edema: 20-40 mg IV over 1-2 minutes

Pediatric Dosage:
1 mg/kg IV over 1-2 minutes

Front 16

IPRATROPIUM BROMIDE

Back 16

IPRATROPIUM BROMIDE

Indications and Field use:
Treatment of bronchospasm associated with chronic obstructive pulmonary disease (emphysema and chronic bronchitis). To be used either alone or in combination with other bronchodilators especially beta adrenergics (i.e., albuterol).

Contraindications:
Ipratropium bromide is contraindicated in known or suspected cases of hypersensitivity to ipratropium bromide or to atropine and its derivatives. Precaution: should be used with caution in patients with narrow angle glaucoma.

Adult Dosage:
Give 500 mcg in 2.5 ml normal saline (1 unit dose vial) via SVN with a mouth piece or in-line with a ventilatory device. Repeat according to medical control preference. May mix one unit dose vial of ipratropium with one unit dose vial of albuterol.

Front 17

LIDOCAINE HCl

Back 17

LIDOCAINE HCl

Indications and Field Use:
Suppression of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation, PVC's).
Prophylaxis against recurrence after conversion from ventricular tachycardia or ventricular fibrillation.
Frequent PVC's (>than 6 per minute; 2 or more in a row; multiform PVC's; or R-on-T phenomenon).
Pre-intubation for head trauma or suspected Intra cranial hemorrhage (hypertension and focal neurologic S/S).

Contraindications:
Known hypersensitivity/allergy.
Use extreme caution in patients with conduction disturbance (second or third degree block).
> Do not treat ectopic beats if heart rate is < 60. They are probably compensating for the bradycardia; instead, treat the bradycardia!

Adult Dosage:
Pulseless VF/VT: Initial bolus of 1.0-1.5 mg/kg IV PUSH every 3-5 minutes to a total of 3 mg/kg. An initial bolus of 1.5 mg/kg should be given for cardiac arrest situations. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min. See: Maintenance Infusion below.
Antidysrhythmic or rhythms with a pulse: Initial boluses can be given as 1.0-1.5 mg/kg IV PUSH and additional boluses can be given as 0.5-0.75 mg/kg every 5-10 minutes to a total dose of 3 mg/kg. Following the return of a spontaneous rhythm, initiate a drip at 2-4 mg/min; see below.
Maintenance Infusion: Started after return of spontaneous rhythm for either indication above. Add 1 gm - 2 gms to a 250 ml NS or 5 % dextrose solution or use premixed solution (2 gm in 500 ml) and initiate a drip at 2-4 mg/min according to concentration. Patients > 70 years or with hepatic, renal disease or poor perfusion state, reduce maintenance infusion by half.
Pre-intubation for head trauma or suspected Intra cranial hemorrhage (hypertension and focal neurologic S/S). Consider administration of 1 mg/kg IV bolus 1-2 minutes prior to intubation.
Pediatric Dosage:
Initial Bolus doses: 1 mg/kg, may repeat 1 time in 3-5 minutes for VF/Pulseless VT or in 15 minutes if used for refractory dysrhythmias with a pulse (VT with pulse, significant ventricular ectopy).
Infusion with return of spontaneous rhythm, optional: 20-50 μg/kg/min; prepared by adding 120 mg (3cc) of 1 Gm/25 ml (40 mg/ml) solution to 97 ml of NS, yielding 1200 μg/ml.
1 ml/kg/hr delivers 20 μg/kg/min. 2.5 ml/kg/hr delivers 50 μg/kg/min. Reduce to < 20 μg/kg/min for children with low cardiac output, severe CHF or compromised hepatic blood flow. Infusion should be avoided unless infusion pump available.

Front 18

MAGNESIUM SULFATE

Back 18

MAGNESIUM SULFATE

Indications and Field Use:
• Torsade de pointes, drug of choice
• VF/Pulseless VT refractory to lidocaine and/or amiodarone
• Hypomagnesemia
• Pre-term labor (PTL)
• Pregnancy-induced hypertension (PIH, toxemia of pregnancy, pre-eclampsia and/or eclampsia).
• Hyperreactive Airway - Severe Asthma

Contraindications:
• Hypermagnesemia
• Use cautiously in patients with impaired renal function and pre-existing heart blocks (relative).
• Precautions: Caution when used with barbituates, narcotics, or other hypnotics (or system anesthetics) in conjunction with Magnesium Sulfate due to the additive central depressive effects of magnesium.

Adult Dosage:
Cardiac:
• VF/Pulseless VT: 1-2 Gm IV diluted in 50-100 ml NS or D5W, administered over 1-2 minutes.
• Torsade de pointes: 1-2 Gm IV diluted in 50-100 ml NS or D5W administered over 1-2 minutes, followed by the same amount infused over 1 hour.
• Hypomagnesemia: Dilute 1-2 Gm in 50-100 ml NS or D5W administered IV push over 5-60 minutes.
• Respiratory/Severe Asthma: Initial Infusion (field) 2 Gm Magnesium Sulfate mixed in 50 ml NS or D5W to be infused IV using microdrip tubing over 5 to 10 minutes. Stop infusion if hypotension, respiratory depression or bradycardia develop.
Pregnancy:
Pre-term labor (PTL): Initial bolus (Field and Interfacility): 4-6 Gm over 15-20 minutes (Suggested method is the addition of 4 Gm to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml.) Maintenance Infusion (Interfacility only): 1-4 Gm/hour infusion rate. (Suggested method for treatment of premature labor is to follow initial bolus with infusion of 2 Gm/hr which may be continued until uterine contractions are reduced to < 1 every 10 minutes. Then, infusion is decreased to 1 Gm/hr and continued for 24-72 hrs. One method for mixing infusion is the addition of 40 Gm to 1000 ml LR. Resultant concentration equals 40 mg/ml. If this concentration is run at 50 ml/hr, Magnesium Sulfate delivered equals 2 Gm/hr).
Pregnancy induced hypertension, pre-eclampsia/eclampsia, (PIH): Initial bolus (Field and Interfacility): 3-6 Gm over 10-15 minutes (Suggested method is the addition of 4 Gm to 100 ml D5W, LR or NS. Resultant concentration is 40 mg/ml). Maintenance Infusion (Interfacility only): Follow bolus with 1-3 Gm/hour infusion rate. (Same mixture as for PTL). Rebolus: In an eclamptic emergency may rebolus with Magnesium Sulfate, 2-4 Gm depending on patient size (mixed as an initial bolus) over 10-15 minutes if respirations >12/minute and urine output >30 ml/hr.

Front 19

METHYLPREDNISOLONE SODIUM SUCCINATE

Back 19

METHYLPREDNISOLONE SODIUM SUCCINATE

Indications and Field Use:
Reactive airway disease: Acute exacerbation of emphysema, chronic bronchitis, asthma
Anaphylaxis
Burns potentially involving the airway
** Acute spinal cord trauma (large loading and maintenance doses)

Contraindications:
Preterm infants

Adult Dosage:
Reactive Airway Disease, Anaphylaxis, Burns Potentially Involving the Airway
Usual dose 125 mg slow IV bolus (much larger doses can be used).
** Acute Spinal Cord Trauma: Should be within 6 hours of insult and patient meeting criteria, initial bolus dose of 30 mg/kg IV administered over 15 minutes; bolus followed by a 45 minute rest period, then a 23-hour continuous infusion of 5.4 mg/kg/hr. See: Special Notes.

Pediatric Dosage:
Reactive Airway Disease, Anaphylaxis, Burns Potentially Involving the Airway
2-4 mg/kg slow IV bolus

Front 20

MIDAZOLAM HYDROCHLORIDE

Back 20

MIDAZOLAM HYDROCHLORIDE - Versed

Indications and Field Use:
Anti-convulsant
Sedation
Management of acute agitation Treat cause first
Induction for intubation

Contraindications:
Hypersensitivity to midazolam
Relative contraindication in: Myasthenia gravis or other neuromuscular disorders; Acute alcohol intoxication; Severe, chronic obstructive pulmonary disease; and Acute pulmonary insufficiency

Adult Dosage:
Patients14 to 60 years of age: 2 to 5 mg IM
1 to 5 mg IV, titrate to effect, administer slowly in small increments of no more than 2.5 mg over at least 2 minutes.
Patients over 60 years of age: 1 to 3 mg IM
1 to 3.5 mg IV, titrate to effect, administer slowly in small increments of no more than 1.5 mg over at least 2 minutes.
Total dose: Should not exceed 20 mg
For emergency intubation: 0.1 mg/kg up to 0.3 mg/kg with dosage limit of 20 mg.
Seizures: 0.2 mg/kg IM for status seizures if no IV Access
0.3 IN (intranasal) Adults over 50 kg: 10 mg (2ml) Total volume (5mg/ml concentration) = (Total mg dose divided in each nostril).

Pediatric Dosage:
Pediatric patients: 0.05 to 0.1 mg/kg slow IV PUSH
0.2 mg/kg IM for status seizures if no IV Access
Calculate appropriate dose of IN (intranasal midazolam) using the following formula:
Children: Total kg wt X 0.2 mg = total mg maximum of 10mg

Front 21

MORPHINE SULFATE

Back 21

MORPHINE SULFATE

Indications and Field Use:
Analgesia, especially in patients with burns, myocardial infarction, or renal colic.
Pulmonary edema (cardiogenic).

Contraindications:
Respiratory depression
Head injuries
Elevated Intra cranial pressure
Asthma, relative
Abdominal pain, relative

Adult Dosage:
IV Dose: Administer 1-3 mg increments slow IV PUSH (over 1-5 minutes) until desired effect.

Pediatric Dosage:
100-200 μg/kg slow IV push

Front 22

NALOXONE HCl

Back 22

NALOXONE HCl

Indications and Field Use:
Antidote for: Opioid overdoses
May differentiate opioid-induced coma from other causes

Contraindications:
Hypersensitivity

Adult Dosage:
IV, IM, inject SL, SC, ET: 0.4 - 2 mg initial bolus IV or ET, may repeat every 2 minutes as necessary; titrate to effect.
Intra-nasal: 1 mg each nostril using a Mucosal Atomizer Device for a total of 2 mg. May repeat every 2 minutes as necessary. Titrate to effect.
** Continuous IV Infusion: 2/3 of the initial bolus/hr (bolus that it took to reverse) administered as a continuous infusion; i.e., if 2 mg Narcan resulted in opioid reversal initially, then it can be maintained by continuous infusion of 1.4 mg/hr. Put 1.4 mg Narcan in 250 ml NS and run at 250 ml/hr. A repeat IV bolus of twice the initial bolus administered 15 minutes after the initial bolus is recommended.

Pediatric Dosage:
< 5 years or < 20 kg: 0.1 mg/kg IV, ET, inject SL, SC, IO (includes neonate)
> 5 years or > 20 kg: 0.4 - 2 mg IV, ET, inject SL, SC or IO

Front 23

NITROGLYCERIN

Back 23

NITROGLYCERIN

Indications and Field Use:
Angina
Myocardial infarction
Congestive heart failure with pulmonary edema

Contraindications:
Hypovolemia
Increased Intra cranial pressure

Adult Dosage:
SL for Chest pain: 1/150 gr (0.4 mg) tablet or one full spray, may repeat x 3
SL for Pulmonary edema: 1-2 of the 1/150 gr (0.4 mg) tablets may be given SL every 5-10 minutes as long as the systolic BP is greater 90-100 systolic

IV infusion during interfacility transport must be given via infusion pump: Start at low range of 5 μg/min and increase in increments of 5 μg every 5 – 10 minutes, monitoring pain and blood pressure until desired hemodynamic or clinical response is achieved (fall in SVR, relief of chest pain); most patients respond to 50-200 μg/min

Front 24

Ondansetron

Back 24

Ondansetron

Indications for use:
Nausea and vomiting

Contraindications:
Hypersensitivity
Use with caution in patients with hepatic impairment

Adult Dosage:
4 – 8 mg IV slow push over 2 – 5 minutes
8 mg PO ODT or tablet

Pediatric Dosage: (1 month to 12 years old)
Greater than 40 kg- 4 mg IV slow push over 2 – 5 minutes
Less than 40 kg- 0.1 mg/kg IV slow push over 2 – 5 minutes

Front 25

OXYTOCIN

Back 25

OXYTOCIN

Indications and Field Use:
Postpartum hemorrhage due to uterine atony

Contraindications:
Hypersensitivity

Adult Dosage:
Postpartum hemorrhage: 10 USP units added to 1000 cc NS or LR and run at a rate necessary to control uterine atony which is 2 – 4 ml/min to start, or 10 USP units may be given IM after delivery of placenta.

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PHENYLEPHRINE NASAL SPRAY 0.5%

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PHENYLEPHRINE NASAL SPRAY 0.5%

Indications and Field Use:
Facilitation of nasotracheal intubation

Contraindications:
Known allergy to medication

Adult Dosage:
2-4 sprays in each nostril before attempting tube insertion

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SODIUM BICARBONATE 8.4%

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SODIUM BICARBONATE 8.4%

Indications and Field Use:
Pre-existing metabolic acidosis
Overdose of aspirin, cyclic antidepressants (alkalinization of blood)
Cardiac arrest after other interventions and ventilation is adequate

Contraindications:
Alkalosis

Adult Dosage:
Pre-existing Metabolic Acidosis or Alkalinization of Blood: 50-100 mEq IV per medical control authority.
Infusion: 50 mEq of sodium bicarbonate/250 ml of D5W NS or as determined by medical control.
Cardiac arrest: First dose usually 0.5 - 1 mEq/kg (or as determined by blood gas analysis), with subsequent doses of 0.5 mEq/kg every 10 minutes in cardiac arrest after other standard treatment (defibrillation, CPR, intubation, ventilation and more than one trial of epinephrine) has been used.

Pediatric Dosage:
0.5 - 1 mEq/kg IV or IO slowly, if ventilation is adequate according to medical control authority. Can contribute to acidosis and cause fluid overload.

Neonatal Dosage:
1 mEq/kg IV or IO of 4.2% slowly. Waste 25 ml of 8.4% solution and add 25 ml of D5W NS from IV bag, each ml will contain 0.5 mEq of sodium bicarbonate

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SUCCINYLCHOLINE

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SUCCINYLCHOLINE

Indications and Field Use:
Endotracheal intubation requiring paralysis (RSI) by a qualified EMT-P with authorization from the EMT-P’s administrative medical director

Contraindications:
Muscle disorders
Personal or family history of malignant hyperthermia
History of hyperkalemia
Burn injured patients*
Ocular injuries
Patients in whom successful endotracheal intubation is doubtful

Adult Dosage:
1.5 mg/kg IV push, may repeat in 2-3 minutes to achieve paralysis

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THIAMINE HCl (vitamin B1)

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THIAMINE HCl (vitamin B1)

Indications and Field Use:
Alcoholism, delirium tremens
Coma of unknown origin, especially if alcohol or malnourishment may be involved.
Suspect Wernicke or Korsakoff Syndrome
Other thiamine deficiency syndromes
Severe congestive heart failure

Contraindications:
Do not give intra-arterial

Adult Dosage:
100 mg

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VASOPRESSIN

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VASOPRESSIN

Indications and Field Use:
Adult shock-refractory ventricular fibrillation/pulseless ventricular tachycardia

Contraindications:
• Responsive patient with coronary artery disease
• Hypertension

Adult Dosage:
For ventricular fibrillation/pulseless ventricular tachycardia: 40 U, one time only prior to administration of epinephrine

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VERAPAMIL HCl

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VERAPAMIL HCl

Indications and Field Use:
Supraventricular tachycardia
Atrial fibrillation and atrial flutter with rapid ventricular response

Contraindications:
AV block, Sick sinus syndrome, any wide QRS complex tachycardia
Shock
Severe CHF

Adult Dosage:
2.5 - 5.0 mg IV PUSH over 2-3 minutes. May rebolus in 15-30 minutes with 5-10 mg IV PUSH until a maximum dose of 20 mg