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63 Cards in this Set

  • Front
  • Back
• Protocol: PEA
Vent. Fibrillation
• Indicated for severe hyperkalemia
• One amp (10 ml) or 1 gm IV
• Avoid use if pt is taking digoxin
• 20 mg/kg IV or IO slowly
Calcium Chloride
• Protocol: Overdose
• Binds, or absorbs, various chemical
agents and drugs from the GI tract
• Combined with Sorbitol to promote
GI motility
• 50 gms po or NG Tube
• 25 gms po or NG Tube
Charcoal
• Protocol: Hypertension
• Medication used to control
hypertension
• 0.1 mg po q 10-15 minutes
Clonidine
• Protocol: Fever
PEA
Heat Emergencies
Abdominal Pain
Altered Mental Status
Epistaxis
Hypotension
Vomiting and Diarrhea
Neonatal
Ped. Bradycardia
Ped. Hypotension
Ped. Multiple Trauma
Back Pain
Burns
Electrical Injuries
Multiple Trauma
• The IV fluid of choice for
access or volume infusion
• KVO for IV access
• Bolus in 250 ml for cardiac
• Bolus in 500 to 1000 ml amount for
volume
• Bolus in 1000 ml amount for burns
or electrical injuries
• KVO for IV or IO access
• Bolus in 20ml/kg for volume
(May be repeated x 3)
Crystalloid Solutions
(Normal Saline)
• Protocol: Suspected cyanide
poisoning
• Sodium Nitrite 300 mg IV (10 cc of
3% Sodium Nitrite) – OR – Amyl
Nitrite capsule po if unable to
obtain IV access
• Sodium Thiosulfate 12.5 gm IV (50
cc of 25% Sodium Thiosulfate)
• Sodium Nitrite 0.33cc/kg of 3%
sodium nitirite
• Sodium Thiosulfite 1.65 cc/kg of
25% sodium Thiosulfite
Cyanide Poisoning
Antidote Kit
• Protocol: Seizure
Ped. Seizure
• Seizure control
• Mild Sedation
• 4 mg IV initially then 2 mg IV every
3 - 5 minutes up to 10 mg max
unless med control dictates
• IM dosage = double the IV dosage
up to 20 mg total
• 0.1 - 0.3 mg/kg IV/IO
• (Max dose 4 mg IV, IO)
• O.5 mg/kg rectally (Dia-Stat)
• (Max dose 18 mg rectally)
• Repeat as directed by medical
control.
Diazepam
• Protocol: Per specific agency
• Agent used to improve cardiac
output in CHF and to assist with
rate control in atrial fibrillation
• IV bolus and infusion rate per
medical control
Digoxin
• Protocol: Allergic Reaction
• Antihistamine for control of allergic
reactions
• 50 mg IV/IM/PO
• 1 mg/kg IV/IO/IM
• Do not give in infants < 3 mo
• (Max dose 50 mg)
Diphenhydramine
(Benadryl)
• Protocol: Per specific agency
• Pressor agent used to maximize
cardiac output
• 2-20 micrograms/kg/min titrate to
BP systolic of 90 mmHg or as per
medical control
• 2 - 20 micrograms/kg/min IV or IO,
titrate to BP systolic appropriate for
age
Dobutamine
• Protocol: Bradycardia
PEA
Post Resuscitation
Hypotension
Ped. Hypotension
• A vasopressor used in shock or
hypotensive states
• 2 - 20 micrograms/kg/min titrate to
BP systolic of 90 mmHg
• 2 - 20 micrograms/kg/min IV or IO,
titrate to BP systolic appropriate for
age
Dopamine
• Protocol: Allergic Reaction
Resp. Distress
Ped. Resp. Distress
• Vasopressor used in allergic
reactions or anaphylaxis
• 0.3 mg SQ (if age < 50 yrs)
• 0.15 mg SQ (if age > 50 yrs)
• 0.01 mg/kg SQ
• (Max dose 0.3 mg)
Epinephrine 1:1,000
• Protocol: Asystole
PEA
Vent. Fibrillation
Allergic Reaction
Ped. Bradycardia
Ped. Pulseless Arrest
• Vasopressor used in cardiac
arrest.
• 1.0 mg IV
• Repeat every 3 - 5 minutes until
observe response
• (May be given by Endotracheal
tube in double the IV dose)
• 0.01 mg/kg IV or IO
• (Max dose 0.5 mg)
• Repeat every 3 - 5 minutes until
observe response
• (May be given by Endotracheal
tube --10 times the IV dose)
Epinephrine 1:10,000
• Protocol: RSI
• Hypnotic
• 0.3 mg/kg IV
• Usual adult dose = 20 mg
Etomidate
• Protocol: Overdose
• Medication that reverses
benzodiazepine sedation
• May precipitates seizures, esp in
mixed-drug overdose
• 0.2 mg IV
• May repeat q 1 min for 5 total
doses
• May repeat series of 5 doses 3
times per hour (Maximum dose = 3
mg/hour)
• 0.01 mg/kg (max 0.2 mg)
• May repeat q 1 minute for 5 total
doses
• Maximum dose is 1 mg/hour
Flumazenil
• Protocol: Pulmonary Edema
• Diuretic for pulmonary edema or
CHF
• 20 mg IV or dose to equal patient’s
normal single home PO dose
Furosemide
• Protocol: Altered Mental Status
CVA
Seizure
Syncope
Ped. Head Trauma
Ped. Hypotension
Ped. Pulseless Arrest
Ped. Seizure
• Drug acting to release glucose into
blood stream by glycogen
breakdown
• Use in patients with no IV access
• 1 - 2 mg IM
• Follow blood glucose in 15
minutes, if < 60 repeat.
• 0.5 mg IM
• Follow blood glucose in 15
minutes, if < 60 repeat.
• Age > 3 years
Glucagon
• Protocol: Neonatal
Ped. Bradycardia
Ped. Head Trauma
Ped. Hypotension
Ped. Pulseless Arrest
Ped. Seizure
• Use in unconscious or
hypoglycemic states
• 5 ml/kg IV or IO
• Repeat based on blood glucose
results
Glucose solutions -
Dextrose 10%
• Protocol: Altered Mental Status
CVA
Seizure
Syncope
• Use in unconscious or
hypoglycemic states
• One amp or 25 gm IV bolus
• Repeat based on blood glucose
results
Glucose Soluntions -
Dextrose 50%
• Protocol: Behavioral
• Medication to assist with sedation
of agitated patients
• 10 mg IV/IM
• May repeat as per Medical Control
Haldoperidol (Haldol)
• Protocol: Per specific agency
• Anticoagulant used in the setting of
suspected myocardial ischemia,
pulmonary embolism, etc.
• Bolus and infusion rate per medical
control
Heparin
• Protocol: Per specific agency
• Medication used to control stomach
acid and to assist in severe allergic
reactions
• 300 mg IV/IM/PO
Histamine 2 Blocker
(Cimetidine/Tagamet)
• Protocol: Per specific agency
• Medication used to control stomach
acid and to assist in severe allergic
reactions
• 50 mg IV
• 150 mg PO
Histamine 2 Blocker
(Ranitadine/Zantac)
• Protocol: Per specific agency
• Medication used to control
hyperglycemia and in the treatment
of hyperkalemia
• Hyperglycemia: per medical
control based on blood glucose
levels
• Hyperkalemia: 10 units IV. Give
with one amp dextrose IV
Insulin
• Protocol: Per specific agency
• Medication used in addition to
albuterol to assist in patients with
asthma and COPD
• 2 puffs per dose of MDI (18
mcg/spray)
--- OR ---
• 500 mcg per nebulizer treatment
Ipatroprium
• Protocol: Per specific agency
• Agent used to increase heart rate
• 0.02-0.06 mg IV
• 2-20 mcg/min infusion
Isoproterenol
• Protocol: Post Resuscitation
Vent. Ectopy
Vent. Fibrillation
Vent. Tachycardia
Ped. Pulseless Arrest
• Antiarrhythmic used for
control of ventricular dysrrythmias
• 1.5 mg/kg IV bolus (ETT dose = 2
x IV dose)
• Initial Dose 0.75 mg/kg in patients
> 60 years of age.
• Repeat 1/2 initial dose in 10
minutes.
• 1 mg/kg IV, IO bolus.
• Repeat 1/2 initial bolus in 10
minutes no drip.
Lidocaine
• Protocol: Seizure
• Benzodiazepine used to control
seizures
• Be alert for respiratory
depression
• 2-4 mg IV/IM
• May repeat q 5-10 minutes if
seizures not controlled
• 0.05-0.1 mg/kg IV/IM (max 2
mg/dose)
• May repeat q 5-10 minutes if
seizures not controlled
Lorazepam (Ativan)
• Protocol: OB / Gyn
Emergency
Vent. Fibrillation
Vent. Tachycardia
• Elemental electrolyte
• 2 g slow IV push
• dose may be repeated once
Magnesium Sulfate
• Protocol: Per specific agency
• Medication to control
intracranial pressure
• 1 gram/kg IV over 30 to 60
minutes.
• Typical Adult dose is 100 grams.
Mannitol
• Protocol: Per specific agency
• Medication used to treat
methemoglobinemia
• 1-2 mg/kg IV over 5 minutes
Methylene Blue
• Protocol: Allergic Reaction
Respiratory Distress
• Steroid used to reduce
inflammation
• 125 mg IV
• Per Medical Control only
• 2 mg/kg IV
Methylprednisolone
(Solu-medrol)
• Protocol: Behavioral
SVT
Vent. Tachycardia
Seizure
• Quick acting Benzodiazepine
• Preferred over Valium for IM use
• Use with caution if BP < 110
• 0.5-2 mg IV slowly over 2-3
minutes. May slowly titrate dose
up to 5 mg total if needed. Usual
total dose: 2.5-5 mg
• IM dosage: 5 mg
• Per Medical Control only
• 0.05-0.2 mg/kg IV
Midazolam (Versed)
• Protocol: Per specific agency
• Medication to increase cardiac
output in congestive heart failure
• 0.375-0.75 mcg/kg/min
Milrinone
• Protocol: Pain Control
Chest Pain
• Narcotic pain relief
• Antianxiety
• Possible beneficial effect in
pulmonary edema
• Avoid use if BP < 110
• 4 mg IV bolus then 2 mg IV/IM
every 3 - 5 minutes until
10 mg or improvement
• 0.1 mg/kg IV, IO
single bolus only
Narcotic Analgesic
(Morphine Sulfate)
• Protocol: Altered Mental Status
Overdose
Neonatal
Ped. Bradycardia
Ped. Head Trauma
Ped. Pulseless Arrest
• Narcotic antagonist
• 0.5 - 2 mg IV bolus titrated to
patient’s respiratory response
• May be given IM if unable to
establish IV in a known narcotic
overdose
• 0.01 mg/kg IV, IO
• May repeat in 5 minutes if no
effect.
Narcotic Antagonoist
(Naloxone/Narcan)
• Protocol: Airway
Epistaxis
• Vasoconstrictor used with nasal
intubation and epistaxis
• Relative Contraindication is
significant hypertension
• 2 sprays in affected nostril
• 1-2 sprays in affected nostril
Nasal Spray
(Afrin, Otrivin)
• Protocol: Chest Pain
Pulmonary Edema
Hypertension
• Vasodilator used in anginal
syndromes, CHF and
Hypertension.
Chest Pain
• 1 spray/tablet SL every 5 minutes
until painfree or 3 doses
• If SBP < 100, contact medical
control
• 1” paste after pain free or 3 doses
Pulmonary Edema
• 1 spray/tablet SL every 1-2 minutes
if BP >110 Systolic
Hypertension
• 1 spray/tablet SL every 1-2 minutes
until BP <110 Diastolic
Nitroglycerin
• Protocol: Per specific agency
• Medication used to treat severe
hypertension
• 0.3-10 mcg/kg/min IV. Titrate to
desired blood pressure
Nitroprusside Sodium
• Protocol: Per specific agency
• Medication used to assist with
control of pain
• Inhaled gas to effect per local
protocol with 50/50 mix
Nitrous Oxide
• Protocol: Per specific agency
• Various over-the-counter
medications which do not require a
perscription to use or obtain.
• Per local protocol or Medical
Direction
• Per local protocol or Medical
Direction
Non-Prescription
Drugs
• Protocol: Fever
Pain Control
• A nonsteroidal anti-inflammatory
drug (NSAID) used for pain and
fever control.
• Not to be used in patients with
history of GI Bleeding (ulcers) or
renal insufficiency.
• Not to be used in patients with
allergies to aspirin or other NSAID
drugs
• Avoid in patients currently taking
anticoagulants, such as coumadin.
• 400-800 mg po
• 10 mg/kg po
Nonsteroidal Antiinflammatory
– PO
(Ibuprofen/Motrin)
• Protocol: Pain Control
• A nonsteroidal anti-inflammatory
drug used for pain control.
• Not to be used in patients with
history of GI bleeding (ulcers),
renal insufficiency, or in patients
who may need immediate surgical
intervention (i.e. obvious fractures).
• Not to be used in patients with
allergies to aspirin or other NSAID
drugs such as motrin
• Avoid in patients currently taking
anticoagulants such as coumadin
• 30 mg IV or IM
Nonsteroidal Antiinflammatory
– IV/IM
(Ketorolac/Toradol)
• Protocol: As per specific agency
• Medication used to increase blood
pressure in the setting of nonhemmorhagic
shock
• 2-12 mcg/kg/min – titrate to desired
blood pressure
Norepinephrine
(Levophed)
• Protocol: Universal patient care
• Useful in Airway, Chest Pain, and
Respiratory Distress. Required for
pre-oxygenation whenever possible
prior to intubation.
• 1-4 liters/min via nasal cannula
• 6-15 liters/min via NRB mask
• 15 liters via BVM
• 1-4 liters/min via nasal cannula
• 6-15 liters/min via NRB mask
• 15 liters via BVM
Oxygen
• Protocol: Per specific agency
• Medication used to induce labor
and to control postpartum bleeding
• 0.001-0.02 units/min IV infusion
• 10 units IM X 1 for postpartum
hemmorrhage
Oxytocin
• Protocol: RSI
• Paralytic
• Avoid in patients with burns >24
hours old, chronic neuromuscular
disease (e.g., muscular dystrophy),
ESRD, or other situation in which
hyperkalemia is likely.
• 1.5 mg/kg IV. If inadequate
relaxation after 3 minutes, may
repeat dose. Consider atropine to
avoid bradycardia associated with
repeat dosing.
• 1.5 mg/kg IM (onset of action is
variable and may be substantially
delayed)
• 1-2 mg/kg IV, IO
• 1-2 mg/kg IM (onset of action is
variable and may be substantially
delayed)
• Consider atropine (appropriate per
color coded list) for any pediatric
patient due to likelihood of
bradycardia associated with
succinylcholine administration)
Paralytic Agents
(Succinylcholine)
• Protocol: RSI
• Paralytic
• Avoid in patients with chronic
neuromuscular disease (e.g.,
muscular dystrophy).
• 0.1 mg/kg IV. If inadequate
relaxation after 5 minutes, may
repeat dose.
• 0.1 mg/kg IV, IO
• Avoid in Broselow Pink
Paralytic Agents
(Vecuronium)
• Protocol: Per specific agency
• Medication to control seizures
• 10-20 mg/kg IV bolus to control
seizures
• Infusion rate per medical control
• 10-20 mg/kg IV bolus to control
seizures (maximum total dose
40mg/kg)
• Infusion rate per medical control
Phenobarbital
• Protocol: Seizures
• Medication to control
• Must be a administered very slowly
due to cardiac toxicity and local
pain at the infusion site
• 15-20 mg/kg IV over 30 minutes to
control seizures
• Patient must be on ECG monitor
during drug administration.
• 15-20 mg/kg IV to control seizures
• Patient must be on ECG monitor
during drug administration.
Phenytoin
• Protocol: Seizures
• Medication to control seizures by
the same mechanism as phenytoin
(Dilantin); this medication is safer
to administer
• 15-20 PE/kg IV/IM to control
seizures
• 15-20 PE/kg IV/IM to control
seizures
Phenytoin Derivatives
(Fosphenytoin)
• Protocol: Per specific agency
• Medication used to increase
intravascular volume in the setting
of shock, liver disease, etc.
• IV infusion rate per specific
agent/local medical control
Plasma Protein
Fragments
• Protocol: Per specific agency
• Medication used in acute coronary
syndromes
• IV dosing per specific agency
protocol
Platelet Iib/IIIa
Inhibitors (e.g.,
ReoPro, Aggrastat,
Integrelin)
• Protocol: Per specific agency
• Medication used to treat
hypokalemia
• IV Infusion rate per medical control
only
• Maximum rate is 10 meq per hour
IV controlled via an IV pump
Potassium Chloride
(KCl)
• Protocol: Overdose
• Antidote for Nerve Agents or
Organophosphate Overdose
• Administered with Atropine
• 600 mg IM or IV
• per Medical Control only
Pralidoxime (2-PAM)
• Protocol: Per specific agency
• Anti-dysrhythmic medication.
Monitor for QRS widening and
hypotension
• 100 mg IV load
• May repeat q 10 minutes per
medical control order
• 10-20 mg/min IV infusion
Procainamide
(Pronyestyl)
• Protocol: Per specific agency
• Medication for local anesthesia
• Inject SQ for local pain control.
Maximum dose = 10mg/kg if <
100kg or 1000mg if > 100 kg
• Dilute to 0.5% concentration
• Max dose = 15 mg/kg
Procaine (Novacain)
• Protocol: Per specific agency
• Medication for local anesthesia of
the eye. Useful for pain control
prior to, or during, irrigation
• Per local medical direction • Per local medical direction
Proparacaine
• Protocol: Asystole
Overdose
PEA
Vent. Fibrillation
Electrical Injuries
• A buffer used in acidosis to
increase the pH in Cardiac Arrest
or Tricyclic Overdose.
• 1 amp (50 mEq) IV initially, then
1/2 amp IV every 10 minutes as
needed
• In TCA (tricyclic), 1 amp (50 mEq)
bolus, then 2 amps in 1 liter of NS
for infusion at 200 ml/hr.
• 1 meq/kg IV, IO initally, then 1/2
meq/kg IV every 10 minutes as
needed.
• TCA (trycyclic) overdose per
medical control.
Sodium Bicarbonate
• Protocol: Altered Mental Status
CVA
Seizure
Syncope
• Essential vitamin needed for
glucose metabolism
• Given if patient receives D50
• 100 mg IV or IM
• Dilute IV dose in 10 ml Normal
Saline
Thiamine
• Protocol: Per specific agency
• A medication used to disolve blood
clot associated with stroke or heart
attack
• Per specific medical control order
Thrombolytic Agents
(e.g., tPA)
• Protocol: Per specific agency
• Used in a dedicated IV for
nutritional support. TPN lines
cannot be used for any other
medication/fluid administration
• Infusion rate per medical control
order
• Infusion rate per medical control
order
Total parenteral
nutrition (TPN)
• Protocol: Per specific agency
• Medication used in place of and/or
in addition to epinephrine in the
setting of ventricular
fibrillation/pulsesless ventricular
tachycardia
• 40 units IV X 1
Vasopressin
(Pitressin)
• Protocol: Per specific agency
• To be used in transfer and in the
treatment of victims of
hemmorhagic shock
• Continuation of transfusion
initiaited at the transferring facility
per medical control
• Initiation of non-type specific
transfusion on an emergent basis
by on-line or off-line medical
control
• Continuation of transfusion
initiaited at the transferring facility
per medical control
• Initiation of non-type specific
transfusion on an emergent basis
by on-line or off-line medical
control
Whole Blood and
Blood Components