Pierce County Protocol Drugs

Front 1

AMIODARONE

Back 1

Class: Antiarhythmic

Action: Rate control in a variety of A & V tachycarrhythmias

Onset: Immediate

Duration: Up to 40 days

Indication: (Shock refractory VF/ pulseless VT)
a. Polymorphic VT/wide complex tachycardia of uncertain origin
b. Control of hemodynamically stable VT when cardioversion is unsuccessful.
c. Adjunct to electrical cardioversion of SVT, PSVT.
d. Acceptable for termination of ectopic or multifocal atrial tachycardia with preserved LV function.
e. Used for rate control in treatment of atrial fibrillation or flutter when other therapies are ineffective.

Contraindication: Patients with a hypersensitivity to cordarone.
Patients with cardiogenic shock, marked sinus bradycardia, 2nd or 3rd degree AV block unless a pacemaker is available.

Caution: May produce vasodilation & hypotension.
May have negative inotropic effects & prolong QT interval.
Renal failure, terminal elimination is long.

Dose: (Cardiac arrest) 300mg - 150 in 3 to 5 minutes Max 2.2g IV/24 hours
(Wide complex tachycardia) Rapid Infusion 150mg over 10 min., may repeat every 10 min.

Adverse reation: Vasodilation, hypotension.

Front 2

ASPIRIN

Back 2

Class: Non-steroidal anti-inflammatory

Action: Inhibits platelet aggregation in patients with suspected acute MI.

Onset: 5-30 min

Duration: decreasing by 1/7th over 7 days

Indication: Suspected ischemic chest pain.

Contraindication: PT with known allergy to salicylates.
PT with peptic ulcer disease.
possible hemorrhagic stroke.

Caution: PT taking anti-coagulants.

Dose: (Adult) 160mg or 320mg (if have not taken any) assure asprin is non-erteric coated.
Contact Mary Bridge (Pediatric)

Adverse reation: None in the non-allergic patient with prescribed field dosage.

Front 3

ATROPINE

Back 3

Class: Parasympathetic blocker, anticholinergic.

Action: (Cardiac)
a. Increases firing rate of SA node which results in an increased pulse rate.
b. Increases conduction velocity through the AV node
(Non-cardiac)
a. Decrease of all body secretions.
b. Dilation of pupils & paralysis of the ciliary muscle.
c. Decrease in the bladder tone resulting in urinary retention.
d. Central nervous system stimulation.

Onset: Immediate

Duration: 4 hours

Indication: Cardiac rhythms<60/min, associated with hypotention, decreased mentation, PVC's, chest pain, symptomatic bradycardia.
2nd or 3rd degree heart block, asystole, however, often does not work.
PEA with rate<60 as second medication of choice after Epi. Correct hypoxia, hypovolemia & other potential causes of PEA first.
organophosphate anticholinesterase poisoning.
Nerve agent poisoning.
Preintubation in pediatrics for RSI.

Contraindication: A-fib A-flutter, HR>60, Brady 2nd to ICP.

Caution: Do not mix with sodium bicarb or PT that hypoxic.

Dose: Brady .5-1mg IV every 3-5 min as needed not to exceed .03-.04mg/kg.
Asystole or PEA: 1mg IV push every 3-5 min ET: 2-3mg diluted in 4-6ml NS.
(Pediatrics) .02mg/kg (minimum single dose .1mg) (Max single dose .5mg / max total 1mg)
(Max adolescent single dose 1mg / max total 2mg)
May double for second IV dose.
(Nerve agent poisoning)
Adult- 1mg IV every min until symptoms clear (max 10mg) If uusing the NAAK /MARK 1 KIT give 1 atropine auto inject (2mg) in to thigh followed by one 2-PAM chloride injection up to 3 sets (Ped's half the adult dose)

Adverse reaction: (cardiac) tachy, palpations, V-fib
(non-cardiac) dry mouth,

Front 4

ACETAMINOPHEN (TYLENOL)

Back 4

Class: anti-pyretic, analgesic

Action: Inhibits prostiglandin in CNS to reduce fever.
Blocks pain impulses.

Onset of action: 10-30 minutes

Durationof action: 3-4 hours

Indication: Fever

Contraindication: Hypersensitivity

Caution: Anemia, liver disease, renal disease

Dose: Pediatric-15mg/kg

Adverse reaction: Nausea, vomiting, rash

Front 5

ACTIVATED CHARCOAL

Back 5

Class: Gastric decontamination, absorbent

Action: Adheres to many medications and chemicals, inhibition absorption from the GI tract

Onset of action: Immediate

Duration: Unknown

Indication: Poison (almost all)

Contraindication: Decreased LOC

Caution: Renders Ipecac inactive (give Ipacac first)
Ingestion of corrosive agents.
Fluid & eletrolyte abnormalities
Fecal impaction
If gastric lavage is considered

Dose: A- 1gm/kg P-1gm/kg

Adverse reaction: Nausea & vomiting, black stool, excessive diarrhea, cramping, bloating, constipation.

Front 6

ADENOSINE (ADENOCARD)

Back 6

CLASSIFICATION
1. Antiarrhythmic.
ACTION
1. Acts on AV node to slow conduction. May inhibit reentry pathways.
ONSET OF ACTION
1. Immediate.
DURATION OF ACTION
1. Less than one minute.
INDICATION
1. Conversion of Paroxysmal SVT to sinus rhythm.
2. Wolff−Parkinson−White Syndrome with narrow QRS complex.
CONTRAINDICATION
1. Second and third degree heart blocks, sick sinus syndrome, unless patient has a pacemaker.
2. Hypersensitivity to adenosine.
USE WITH CAUTION
1. May produce TRANSIENT first, second, and third degree blocks OR ASYSTOLE for 10 − 15 seconds.
2. Asystolic pause may be longer in patients on Tegretol or Persantine.
3. Patients on theophyllines or caffeine may require higher doses.
4. Patients with asthma may experience bronchoconstriction.
5. May be used with wide QRS complex SVT at direction of Base Station. It’s use may cause acceleration of
the rate.
DOSAGE AND ADMINISTRATION
1. Adult: 6.0 mg by RAPID IV push. If no response within 1 − 2 minutes, give 12.0 mg, may repeat 12.0 mg
x 1. Push Adenosine as fast as possible followed by normal saline bolus of 20 ml; then elevate the
extremity.
2. Pediatric: 0.1 − 0.2 mg / kg. If no response within 1 − 2 minutes, double dose,
then double again (total 3 doses). Maximum single dose; 12.0 mg, rapid IV
bolus.
3. Place IV in antecubital for best absorption using at least an 18 gauge catheter.
ADVERSE REACTION
1. Common but transient: Asystole, Bradycardia (temporary), Hypotension, Chest pain, Flushing, Dyspnea,
Apprehension, Back/neck pain, Blurred vision, Burning sensation, Dizziness, Numbness, Tingling in
arms, Sweating, Palpitations, Nausea.

Front 7

AFRIN

Back 7

CLASSIFICATION
1. Adrenergic sympathomimetic.
ACTION
1. Unknown. Causes vasoconstriction of the smaller arterioles in the nasal passages which lasts up to 12
hours.
ONSET OF ACTION
1. Less than 5 minutes.
DURATION OF ACTION
1. Less than 12 hours.
INDICATION
1. Preparation for nasotracheal intubation.
2. Control of epistaxis.
CONTRAINDICATION
1. Known hypersensitivity to medication.
USE WITH CAUTION
1. Not recommended for children under 6 years old.
DOSAGE AND ADMINISTRATION
1. Adult & Pediatric over 6 years old: 2 to 3 sprays in each nostril.
2. Pediatric under 6 years old: none.
ADVERSE REACTION
1. Headache, Drowsiness, Insomnia, Palpitations, Hypertension, Rebound nasal congestion or irritation.
2. Burning, Stinging or Sneezing may occur if recommended dosage is exceeded.
3. Use of the dispenser by more than one patient may spread infection.

Front 8

ALBUTEROL

Back 8

CLASSIFICATION
1. Bronchodilator, beta-2 selective. sympathethic agonist.
ACTION
1. Relaxes bronchial and uterine smooth muscle by acting on beta adrenergic receptors.
2. Cause potassium influx into the cell.
ONSET OF ACTION
1. 5 − 15 minutes.
DURATION OF ACTION
1. 3 − 6 hours.
INDICATION
1. Wheezing, allergic reactions, asthma, COPD.
2. Suspected hyperkalemia.
CONTRAINDICATION
1. Known hypersensitivity.
USE WITH CAUTION
1. Patients with cardiovascular disease.
2. Patients taking tricyclics.
3. Elderly patients generally require a lower dose.
4. Watch heart rate.
5. Listen to lungs before and after treatment.
6. Beta blockers may blunt effect.
DOSAGE AND ADMINISTRATION
1. Adult: 2.5 mg in 3.0 ml NS SVN continuously.
2. Pediatric: Use blow-by if < 5 years old.
a. >6 months: 2.5 mg in 3.0 ml NS SVN continuously.
b. < 6 months: 1.25 mg 3.0 ml NS SVN continuously.
ADMINISTRATION
1. When assisting patient with a continuous neb inhaler, instruct patient to:
a. Clear nasal passages and throat.
b. Breathe and expel as much air as possible.
c. Place mouthpiece well into mouth, inhale deeply.
ADVERSE REACTION
1. Tremor, Nervousness, Dizziness, Headache, Tachycardia, Palpitations, Hypertension, Nausea and
vomiting, Ventricular arrhythmias.

Front 9

CALCIUM CHLORIDE

Back 9

CLASSIFICATION
1. Electrolyte.
ACTION
1. Involved in regulation of cell membrane permeability to sodium and potassium.
2. Plays a role in excitation contraction coupling (increases force of myocardial contraction and muscle
contraction).
ONSET OF ACTION
1. Immediate.
DURATION OF ACTION
1. 30 minutes − 2 hours.
INDICATION
1. Bradycardic renal dialysis patients secondary to hyperkalemia exhibiting tall, peaked T waves,
prolongation of QRS, low P waves.
2. Calcium channel blocker overdose.
3. Antidote for Magnesium Sulfate.
CONTRAINDICATION
1. Ventricular fibrillation.
2. Digitalis intoxication (may result in asystole).
3. Hypercalcemia.
USE WITH CAUTION
1. Extravasation causes tissue sloughing.
2. Do not mix with sodium bicarbonate (flush line first).
DOSAGE AND ADMINISTRATION
1. Adult: 500.0 − 1000.0 mg (5.0 −10.0 ml) IV.
2. Pediatric: 10.0 − 20.0 mg/kg IV or IO SLOWLY.
ADVERSE REACTION
1. Bradycardia, Asystole, Ventricular fibrillation

Front 10

DEXTROSE

Back 10

CLASSIFICATION
1. Simple carbohydrate.
ACTION
1. Provides glucose required for metabolic needs.
2. Spares body proteins.
ONSET OF ACTION
1. Immediate.
DURATION OF ACTION
1. Unknown.
INDICATION
1. Suspected hypoglycemia.
2. Coma of unknown origin.
CONTRAINDICATION
1. Increased ICP, Hyperglycemia.
USE WITH CAUTION
1. None.
DOSAGE AND ADMINISTRATION
1. Adult: 50ml of D50W (25gm) IV push, may repeat x1.
2. Pediatric: 2.0-4.0ml/kg of D25W IV or IO if blood glucose <60.
a. Check blood glucose after 5 minutes, if still <60, repeat as needed.
3. Infant: 2.0-4.0ml/kg of D25W IV or IO if blood glucose <40.
ADVERSE REACTION
1. Extravasation causes tissue sloughing.

Front 11

DIAZEPAM (VALIUM)

Back 11

CLASSIFICATION
1. Anticonvulsant, anti-anxiety, sedative.
ACTION
1. Depresses central nervous system.
2. Skeletal muscle relaxer.
ONSET OF ACTION
1. 1 − 5 minute, peak actions at 5 − 10 minutes.
DURATION OF ACTION
1. 15 − 60 minutes.
INDICATION
1. Seizures secondary to head trauma, status epilepticus.
2. Prior to pacing, cardioversion, and Rapid Sequence Intubation for relief of anxiety, tension, and diminish
recall of procedures.
3. Envenomations resulting in muscle spasm.
4. Skeletal muscle relaxer.
5. Severe anxiety.
CONTRAINDICATION
1. Known hypersensitivity.
2. Patients that have used other CNS depressants.
USE WITH CAUTION
1. Elderly.
2. Patients with inadequate pulmonary function.
3. Patients with liver and/or kidney disease.
4. Patients with a history of drug addiction.
DOSAGE AND ADMINISTRATION
1. Adult: 2.0 − 10.0 mg IV or IM if unable to start IV. For RSI: 0.2mg/kg IV; 0.1mg/kg IV if hypotensive.
2. Pediatric: 0.2 mg/kg IV or IO in increments no greater than 2.0 mg to a maximum
dose of 10.0mg. Wait 1−2 minutes between doses to observe effect. Rectally, 0.5
mg/kg in increments no greater than 2.0 mg to a maximum dose of 10.0 mg. Wait
at least 5 minutes between doses. Contact Mary Bridge for repeat dose.
ADVERSE REACTION
1. Central nervous system depression, Ataxia, Drowsiness, Fatigue, Dizziness, Urticaria, Skin rash,
Transient hypotension, Respiratory depression.
2. Venous thrombosis and phlebitis at the injection site.

Front 12

DILIAZEM (CARDIZEM)

Back 12

CLASSIFICATION
1. Calcium − channel blocker.
ACTION
1. Slows conduction through AV node.
2. Can cause hypotension.
ONSET OF ACTION
1. 3 minutes.
DURATION OF ACTION
1. 1 − 3 hours.
INDICATION
1. Symptomatic A-fib/A-Flutter.
2. PSVT (narrow complex).
CONTRAINDICATION
1. Sick Sinus Syndrome.
2. 2nd or 3rd degree heart block.
3. A-fib associated with WPW or short PR syndrome.
4. Hypotension − systolic < 100.
5. Cardiogenic shock.
6. Hypersensitivity.
7. Wide complex tachycardia.
USE WITH CAUTION
1. Impaired renal or hepatic function.
DOSAGE AND ADMINISTRATION
1. Adult: 0.25 mg/kg IV over 2 minutes − used up quickly.
0.35 mg/kg IV over 2 minutes − second dose after 15 minutes.
2. Pediatric: Contact Mary Bridge.
ADVERSE REACTION
1. Bradycardia, Chest pain, Syncope, Ventricular arrhythmia, Ventricular fibrillation, Sweating, Dizziness,
Dry mouth.

Front 13

DIPHENHYDRAMINE
(BENADRYL)

Back 13

CLASSIFICATION
1. Antihistamine, sedative.
ACTION
1. Potent antihistamine agent which possesses anticholinergic (antispasmodic), antiemetic, and sedative
effects.
ONSET OF ACTION
1. Immediate with IV administration.
2. Unknown for IM administration.
DURATION OF ACTION
1. 6 − 8 hours for IV and IM administration.
INDICATION
1. Antihistamine.
a. Anaphylaxis, use as a adjunct to epinephrine.
b. Uncomplicated allergic conditions.
c. Dystonic or extrapyramidal reactions to phenothiazines.
CONTRAINDICATION
1. Hypersensitivity.
2. Asthmatic attack.
USE WITH CAUTION
1. Has Atropine-like action.
2. Use with caution in patients with a history of asthma, hypotensive patients, in pregnancy, glaucoma.
DOSAGE AND ADMINISTRATION
1. Adult: 25.0 – 50.0mg IV or deep IM: maximum dose 100.0mg.
2. Pediatric: 1.0 – 2.0mg/kg IM, slowly IV or IO, maximum dose 50.0mg.
ADVERSE REACTION
1. Sedation, Sleepiness, Dizziness, Disturbed coordination, Epigastric distress, Dry mouth, Thickening of
bronchial secretions, Hypotension, Palpitations, Tachycardia, Bradycardia, Blurred vision.

Front 14

DOPAMINE

Back 14

CLASSIFICATION
1. Alpha/beta adrenergic stimulator. Sympathomimetic. Dopaminergic.
ACTION
1. Increases blood pressure.
2. At low dose of 1 − 2 μg/kg/min, dopaminergic effects occur resulting in vasodilation of renal, mesenteric, and
cerebral arteries increasing renal blood flow and urine output, but may not increase pulse or BP.
3. At dose of 2 − 10 μg/kg/min, beta-adrenergic effects occur resulting in increased cardiac output with minimal
changes in systemic vascular resistance or preload.
4. At dose of 10 − 20 μg/kg/min, alpha-adrenergic effects occur resulting in vasoconstriction in the renal, mesenteric
and peripheral arteries and veins.
ONSET OF ACTION
1. 5 minutes.
DURATION OF ACTION
1. 10 minutes after infusion ends.
INDICATION
1. Hypotension secondary to non-hypovolemic states.
2. Low cardiac output states such as cardiogenic, anaphylactic, septic or neurogenic shock.
3. Symptomatic Bradycardia after Atropine/Pacing.
CONTRAINDICATION
1. Uncorrected tachyarrhythmia, Ventricular fibrillation.
2. Hypovolemic Shock.
USE WITH CAUTION
1. Avoid extravasation of dopamine into surrounding tissue. If intravenous infusion infiltrates, it must be immediately
removed. Notify the physician.
2. DO NOT mix sodium bicarbonate or similar alkaline solutions, or inactivation of dopamine will result.
DOSAGE AND ADMINISTRATION
1. Dopamine must be diluted prior to administration; mix 400.0 mg in 250ml NS.
a. Begin at 2.5 − 5.0 μg/kg/min up to 20 μg/kg/min, titrate to maintain BP >90/S (100/S for rales).
2. May use: DUGGAN FORMULA.
a. Estimate the patient’s weight in pounds.
b. Mix 400.0 mg Dopamine in 250.0 ml NS with a minidrip.
c. Cross off the 3rd digit of the weight in pounds to get gtts/min, i.e. 183 pounds = 18.
d. 18 gtts/min, you will be administering 5.0 − 6.0 μg/kg/min.
3. May use: Patient weight in kg.
Patient weight in kg.
μg/
kg/min 2.5 5 10 20 30 40 50 60 70 80 90 100
2 μg * * * 1.5 2 3 4 5 5 6 7 8
5 μg * 1 2 4 6 8 9 11 13 15 17 19
10 μg 1 2 4 8 11 15 19 23 26 30 34 38
15 μg 1.4 3 6 11 17 23 28 34 39 45 51 56
20 μg 2 4 8 15 23 30 38 45 53 60 68 75
Microdrops per minute (or ml/hr).
ADVERSE REACTION
1. Hypertension, Supraventricular tachycardia, Ventricular arrhythmias (premature ventricular contractions, ventricular
tachycardia/fibrillation).

Front 15

EPINEPHRINE
(ADRENALIN)

Back 15

CLASSIFICATION
1. Beta adrenergic stimulator.
ACTION
1. Alpha and beta adrenergic effects.
a. Increases force of myocardial contraction.
b. Increases pulse rate and systolic blood pressure.
c. Increases conduction velocity through the A-V node.
d. Increases irritability of ventricles.
e. Dilates bronchi & coronary arteries.
f. Increases cerebral blood flow (alpha effects).
ONSET OF ACTION
1. IV, ET⎯Immediate.
2. IM⎯Variable.
3. SQ⎯6 − 15 minutes.
4. Inhalation⎯3 − 5 minutes.
DURATION OF ACTION
1. IV, ET⎯1 − 4 hours.
2. IM⎯unknown.
3. SQ⎯unknown.
4. Inhalation⎯1 − 3 hours.
INDICATION
1. As a cardiac stimulant during a cardiac arrest.
2. Anaphylactic shock.
3. Severe allergic reactions.
4. Status asthmaticus (subcutaneously).
5. Bradycardia unresponsive to atropine, TCP, dopamine.
6. Croup.
7. Upper airway obstruction edema.
CONTRAINDICATION
1. Chest pain accompanied by ectopic beats or tachycardia.
USE WITH CAUTION
1. Bronchial asthma and significant emphysema, when patients may also have congestive heart disease.
DOSAGE AND ADMINISTRATION
1. Adult:
a. Cardiac Arrest: 1.0 mg IV (10.0 ml of 1:10,000). If no IV, mix 2.0 − 2.5 mg of 1:1,000 with 4.0 − 6.0
ml NS, give down ET tube.
b. Bradycardia: unresponsive to atropine or pacing. 1.0 mg/250 ml NS @ 2.0 − 10.0 μg /min.
c. Acute allergic reaction: 0.3 − 0.5 mg 1:1,000 SQ.
d. Anaphylaxis: 0.3 − 0.5 mg IV (3.0 − 5.0 ml of 1:10,000). If no IV, mix 2.0 − 2.5 mg of 1:1,000 with
4.0 − 6.0 ml NS, give down ET tube.
e. Asthma: 0.3 mg of a 1:1,000 subcutaneously. May repeat in 20 minutes if necessary.
f. Upper airway edema due to obstruction: 1:1,000 0.3 mg SQ or 1:10,000 0.3 mg IV.
2. Pediatric:
a. If croup suspected: 0.5 mg of epinephrine 1:1,000 diluted in 3.0 ml NS
nebulizer and given blow by.
b. Cardiac arrest/Bradycardia/Anaphylaxis: 0.01 mg/kg of 1:10,000 solution
(0.1 ml = 0.01mg of 1:10,000 solution) IV,IO; ET: use 0.1 mg/kg (1:1,000 0.1
ml/kg).
c. Allergic Reaction/Asthma: 0.01 mg/kg to maximum of 0.3 mg SQ (0.01 mg =
0.01 ml of 1:1,000).
d. Upper airway edema due to obstruction: 0.01 mg/kg IV.
L-18
3. Epi-Pen Auto-Injector.
a. Adult (>65 lbs): one adult auto-injector (0.3 mg) Epi-Pen.
b. Pediatric: one pediatric auto-injector (0.15 mg) Epi-Pen Jr.
c. Injection site: lateral portion of thigh mid way between waist and knee given IM.
ADVERSE REACTION
1. Hypertension, Supraventricular tachycardia, Ventricular arrhythmias (Premature ventricular contraction,
Ventricular tachycardia, Ventricular fibrillation).

Front 16

ETOMIDATE (AMIDATE)

Back 16

CLASSIFICATION
1. Non-narcotic, non-barbiturate, sedative hypnotic.
ACTION
1. Depresses the activity of the brain stem reticular system. It may lower intraocular and intracranial
pressure, and lower the rate of cerebral oxygen utilization, all with minimal cardiovascular and respiratory
depressant effects.
ONSET OF ACTION
1. Within 10 – 60 seconds.
DURATION OF ACTION
1. Dose dependent but can be 3 – 5 minutes with full recovery in 15 minutes.
INDICATION
1. Induction agent for RSI in adults and pediatric patients > 10 years old.
CONTRAINDICATION
1. Known hypersensitivity to the agent.
2. Not recommended for pregnant or nursing mothers.
USE WITH CAUTION
1. While adrenal suppression has not been reported after a single dose, solumedrol 125mg should be
considered for administration in patients on prednisone.
DOSAGE AND ADMINISTRATION
1. Adult: 0.3mg/kg IV push over 30-60 seconds.
2. Pediatric: Contact Mary Bridge. 0.3mg/kg IV/IO push over 30-60 seconds.
Doses of Etomidate at a concentration of 2.0 mg/ml given at 0.3 mg/kg for various weights
Weight lb. 60 70 80 90 100 110 120 130 140 150 170 190 210 230 250
Weight kg. 27 32 36 41 45 50 55 59 64 68 77 86 95 105 114
Dose mg 8 10 11 12 14 15 16 18 19 20 23 26 29 31 34
Dose ml 4.1 4.8 5.5 6.1 6.8 7.5 8.2 8.9 9.5 10.2 11.6 13 14.3 15.7 17
ADVERSE REACTION
1. Painful myoclonus (diffuse muscle contraction) which may be painful after patient awakens. This can be
reduced be giving muscle relaxant immediately after Etomidate is given.
2. Pain at the injection site, moderated by using a large vessel and giving with IV fluid.
3. Apnea, Hypotension, Tachycardia, Nausea and vomiting.

Front 17

FUROSEMIDE (LASIX)

Back 17

CLASSIFICATION
1. Diuretic.
ACTION
1. Promotes fluid & electrolyte (Sodium, Potassium, Chloride, Magnesium) loss.
2. Vasodilator, promotes the pooling of blood in veins.
ONSET OF ACTION
1. 5 − 15 minutes for diuretic effects.
DURATION OF ACTION
1. 2 hours.
INDICATION
1. Congestive heart failure with pulmonary edema.
CONTRAINDICATION
1. Known hypersensitivity to furosemide.
2. Dehydration.
3. Electrolyte depletion (potential with patients already on diuretics).
4. Hypotension (systolic BP < 100).
USE WITH CAUTION
1. Concomitant medication therapy such as steroids, Digitalis preparations, other diuretics, hypotensive
agents.
2. Cirrhosis of the liver.
3. Renal disease.
DOSAGE AND ADMINISTRATION
1. Adult: 40.0 − 80.0 mg IV push, consider larger doses if the patient is already on Lasix.
2. Pediatric: 1.0 mg/kg IV, IO slowly.
ADVERSE REACTION
1. Hypotension.
2. Transient deafness or ringing in the ears (tinnitus) which results from rapid infusion, primarily in patients
with renal insufficiency.
3. Failure to urinate within 30 minutes, after which bladder distention due to obstruction must be considered.
4. Symptoms of electrolyte depletion: leg cramps, dizziness, lethargy, mental confusion, cardiac
arrhythmias

Front 18

GLUCAGON

Back 18

CLASSIFICATION
1. Anti-hypoglycemic agent/hormone.
ACTION
1. Increases blood glucose concentration by converting liver glycogen to glucose.
2. Relaxes smooth muscle of stomach, duodenum, small bowel and colon.
ONSET OF ACTION
1. 1 minute IV.
2. 10 minutes IM.
DURATION OF ACTION
1. 25 minutes IV.
2. 30 minutes IM.
INDICATION
1. Blood glucose < 80, especially if IV insertion is difficult or impossible.
2. Beta blocker overdose.
3. Foreign body in esophagus.
CONTRAINDICATION
1. Known hypersensitivity.
USE WITH CAUTION
1. Liver, renal or cardiovascular disease.
2. Starvation.
DOSAGE AND ADMINISTRATION
1. Draw blood glucose sample.
2. Adult:
a. 1.0 mg IM.
b. 1.0 − 5.0 mg IV over 2 − 5 minutes for beta blocker OD.
3. Pediatric: 0 .1 mg/kg IM, not to exceed 1.0 mg.
ADVERSE REACTION
1. Nausea and vomiting, Allergic reactions, Headache, Hypertension, Dizziness.

Front 19

GLUCOSE, ORAL

Back 19

CLASSIFICATION
1. Monosaccharide.
ACTION
1. When given orally, it is readily absorbed in the intestine.
2. After absorption from the gastrointestinal tract, glucose is readily distributed in the tissues and provides a
prompt increase in circulating blood glucose.
ONSET OF ACTION
1. 30 − 60 minutes.
DURATION OF ACTION
1. Hours.
INDICATION
1. Patients with altered mental status.
2. Hypoglycemia.
CONTRAINDICATION
1. Unconsciousness.
2. Known diabetic who has not taken his insulin for days.
3. Unable to swallow.
USE WITH CAUTION
1. Because changes in levels of consciousness can change rapidly in patients with hypoglycemia, it is
important to ascertain the patient’s ability to swallow an oral preparation of glucose without airway
compromise.
DOSAGE AND ADMINISTRATION
1. Adult: 25 grams. Squeeze glucose from tube onto tongue depressor and insert tongue depressor into
patient’s mouth between cheek and gum. Alternatively, let patient squeeze the oral glucose into his/her
own mouth to swallow.
2. Pediatric: Titrate to effect.
ADVERSE REACTION
1. May be aspirated by patient without a gag reflex.
2. Nausea, bad taste

Front 20

IPRATROPIUM BROMIDE
(ATROVENT)

Back 20

CLASSIFICATION
1. Anticholinergic bronchodilator.
ACTION
1. Inhibits vagally mediated reflexes by antagonizing the action of acetylcholine.
ONSET OF ACTION
1. 5-15 minutes.
DURATION OF ACTION
1. 4-5 hours.
INDICATION
1. Bronchospasms secondary to COPD, asthma and reactive airway disease.
CONTRAINDICATION
1. Allergy to soy products or peanuts.
USE WITH CAUTION
1. Glaucoma.
DOSAGE AND ADMINISTRATION
1. Adult: 0.5 mg to be added to second Albuterol/NS SVN, may repeat once.
2. Pediatric: 0.25 mg to be added to second Albuterol/NS SVN, may repeat once.
ADVERSE REACTION
1. Dry mouth, Headache, Cough, Dizziness, Nervousness, Palpitations.

Front 21

LIDOCAINE

Back 21

CLASSIFICATION
1. Antiarrhythmic.
ACTION
1. Suppresses ventricular arrhythmias.
2. Local anesthetic.
ONSET OF ACTION
1. Immediate.
DURATION OF ACTION
1. 10-20 minutes.
INDICATION
1. Cardiac arrest from VF/VT.
2. Stable VT, wide-complex tachycardias of uncertain type, wide complex PSVT (Indeterminate).
3. Block development of increasing ICP secondary to intubation.
CONTRAINDICATION
1. Known hypersensitivity.
2. Heart blocks.
USE WITH CAUTION
1. Liver disease.
2. Congestive heart failure.
3. Severe respiratory depression.
4. Hypovolemia.
5. Shock.
6. Any form of heart block.
DOSAGE AND ADMINISTRATION
1. Cardiac Arrest from VF/VT, use as follows:
a. IV bolus 1.0−1.5 mg/kg.
b. May give additional 0.5−0.75mg/kg IV for refractory VF; repeat in 5-10 minutes; maximum total dose is
3mg/kg.
c. A single dose of 1.5 mg/kg in cardiac arrest is acceptable.
d. ETdose: 2−4mg/kg.
2. Perfusing arrhythmia of stable VT, wide complex tachycardia of uncertain type, significant ectopy, use as follows:
a. IV bolus 0.5-0.75mg/kg up to 1.0-1.5 mg/kg.
b. Repeat 0.5−0.75 mg/kg IV every 5 − 10 minutes, maximum total dose is 3.0 mg/kg.
3. Maintenance infusion: Mix 1 gm in 250 ml = 4.0 mg/ml or use premixed solution at 2.0 − 4.0 mg/min.
MICRODROPS/MINUTE mg/min
60.0 4.0
45.0 3.0
30.0 2.0
15.0 1.0
NOTE: In patients with liver disease or severe congestive heart failure, administer half of the above recommended doses for
maintenance dose (not initial).
4. Rapid Sequence Intubation for reactive airway or increased ICP prophylaxis: 1.5mg/kg IV.
5. Pediatric: 1.0 mg/kg.
ADVERSE REACTION
1. CNS: Dizziness, Somnolence, Confusion, Paresthesias, Muscle twitching, Seizures, Slurred speech.
2. CV: Hypotension, Bradycardia.
3. EENT: Tinnitus, Blurred vision

Front 22

ISOPROTERENOL (ISUPREL)

Back 22

CLASSIFICATION
1. Class IIb Beta Adrenergic stimulator.
ACTION
1. Increases force of myocardial contraction.
2. Increases pulse rate and blood pressure.
3. Increases conduction velocity through the A-V node.
4. Increases irritability of ventricles.
5. Increases myocardial oxygen demand.
6. Dilates bronchi.
ONSET OF ACTION
1. 1 − 5 minutes.
DURATION OF ACTION
1. 15 − 30 minutes.
INDICATION
1. Heart blocks unresponsive to atropine, transcutaneous pacing, dopamine, or epinephrine drip.
CONTRAINDICATION
1. Tachyarrythmias.
2. Previous history of hypersensitivity.
3. Hypovolemic shock.
4. Angina.
USE WITH CAUTION
1. Heart disease.
2. Hypotension.
3. Diabetes mellitus.
4. Myocardial infarction—it may extend the infarct by increasing myocardial oxygen demand.
DOSAGE AND ADMINISTRATION
1. Isuprel must be diluted prior to administration; mix 1.0mg in 250ml NS.
a. Adult: Begin at 2.0 – 20.0 μg/minute, titrating to pulse which should be monitored frequently with a
goal of maintaining a ventricular rate of 60 – 100 beats per minute.
b. Pediatric: Contact Mary Bridge.
ADVERSE REACTION
1. Hypotension/hypertension, Tachycardia greater than 110, Supraventricular tachycardia, Ventricular
arrhythmias (Premature ventricular contractions, Ventricular tachycardia, Ventricular fibrillation).

Front 23

MAGNESIUM SULFATE

Back 23

CLASSIFICATION
1. Antiarrhythmic, anticonvulsant, CNS depressant, electrolyte.
ACTION
1. Replaces and maintains magnesium levels.
2. Reduces muscle contractions by interfering with release of acetylcholine at the myoneural junction.
3. Stabilizes membranes in hyperkalemia.
ONSET OF ACTION
1. 1 − 2 minutes.
DURATION OF ACTION
1. 30 minutes.
INDICATION
1. Seizures due to pre-eclampsia, eclampsia.
2. Life threatening ventricular arrhythmias due to digitalis toxicity, tricyclic overdose.
3. Torsades de Pointes with a pulse.
4. Refractory VF after Lidocaine.
5. Respiratory distress (Asthma).
CONTRAINDICATION
1. Impaired renal function.
2. Myocardial damage or heart block.
3. Dialysis patients.
4. Hypocalcemia.
USE WITH CAUTION
1. Patients receiving digitalis preparation.
2. Excessive dose may cause respiratory depression, cardiac arrest.
DOSAGE AND ADMINISTRATION
1. Seizures due to eclampsia: (4.0 − 8.0 ml of 50.0% solution) 2.0 − 4.0 gm slow IV push over 5 minutes.
Must be given slowly to avoid cardiac or respiratory distress.
2. Ventricular arrhythmias: 1.0 − 2.0 gm (2.0 − 4.0 ml of 50.0%) IV push for VF, or 2.0 gm IV for Torsades.
3. Asthma: 1.0 − 2.0 gm IV slowly.
ADVERSE REACTION
1. CNS: Weak or absent reflexes, Flaccid paralysis, Hypothermia, Drowsiness.
2. CV: Slow-weak pulse, Hypotension, Flushing, Monitor EKG continuously while administering.
3. Resp: Respiratory depression.
4. ANTIDOTE is Calcium Chloride.

Front 24

NAAK/MARK1 KIT

Back 24

CLASSIFICATION
1. Antidote for organophosphate poisoning (nerve agent/insecticide).
ACTION
1. Reactivates organophosphate-inhibited cholinesterase.
INDICATION
1. Organophosphate/nerve agent poisoning.
CONTRAINDICATIONS
1. Hypersensitivity to atropine or 2-Pam.
DOSAGE AND ADMINISTRATION
1. Administer atropine auto injector.
2. Administer pralidoxime (2-Pam) auto injector.
3. Repeat up to three times if symptoms persist.

Front 25

METHYLPREDNISOLONE
(SOLUMEDROL)

Back 25

CLASSIFICATION
1. Anti-inflammatory/corticosteroid.
ACTION
1. An adrenocortical steroid with potent anti-inflammatory effects.
ONSET OF ACTION
1. 1 − 4 hours.
DURATION OF ACTION
1. 7 days.
INDICATION
1. Moderate to severe asthma / COPD exacerbations.
2. Moderate to severe allergic reactions.
3. Moderate to severe angioedema.
4. Anaphylaxis.
CONTRAINDICATION
1. Known hypersensitivity.
DOSAGE AND ADMINISTRATION
1. Adult: 125 mg IV, single dose only.
2. Pediatric: 1.0 – 2.0 mg/kg IV.
3. Incompatible with Diphenhydramine (Benadryl), flush between medications.
ADVERSE REACTION
1. None acutely.
2. Some adverse metabolic effects if taken long term, greater than a few weeks

Front 26

MIDAZOLAM (VERSED)

Back 26

CLASSIFICATION
1. Tranquilizer (Benzodiazepine).
ACTION
1. Hypnotic, amnesiac, sedative, anticonvulsant.
2. Potent but short-acting, 3 − 4 times more potent than diazepam.
3. Has NO effect on pain.
ONSET OF ACTION
1. 1.5 − 5 minutes IV.
2. 2 – 6 minutes intranasal (IN).
3. 15 minutes IM.
DURATION OF ACTION
1. 2 − 6 hours for IV, IN or IM.
INDICATION
1. Premedication prior to cardioversion (IV/IM).
2. Acute anxiety states (IV/IM).
3. Premedication prior to use of paralytics (IV/IM).
4. Seizures (IV/IN/IM).
CONTRAINDICATION
1. History of hypersensitivity.
2. Narrow angle glaucoma.
3. Shock, alcoholic coma.
USE WITH CAUTION
1. Resuscitative equipment should be available.
2. Must constantly monitor vitals, great potential to cause respiratory depression and arrest.
3. May be accentuated by narcotics, alcohol.
DOSAGE AND ADMINISTRATION
1. Adult: Give in 2.0 mg increments to a maximum dose of 0.1 mg/kg or 10 mg (whichever is less) IV, or IM if unable to
start an IV.
2. Give half doses if > 60 years old.
3. Pediatric: 0.2 mg/kg IM or 0.1 mg/kg IV. Give slowly IV (over 2 minutes) with maximum
per dose 2.0mg. Maximum total 5.0 mg IV.
4. Adult and Pediatric IN route for seizures: 0.2 mg/kg of a 5 mg/ml concentration.
NOTE: IV first–line route for adults, IN first-line route for pediatrics.
INTRANASAL Midazolam volume in
Patient age ml of 5mg/ml concentration
(years)
Weight
(kg) IN volume (ml)
5 mg / ml
Dose (mg)
Neonate 3 kg 0.3 ml 0.6 mg
<1 yr 6 kg 0.4 ml 1.2 mg
1 yr 10 kg 0.5 ml 2.0 mg
2 yr 14 kg 0.7 ml 2.8 mg
3 yr 16 kg 0.8 ml 3.2 mg
4 yr 18 kg 0.9 ml 3.6 mg
5 yr 20 kg 1.0 ml 4.0 mg
6 yr 22 kg 1.0 ml 4.4 mg
7 yr 24 kg 1.1 ml 4.8 mg
8 yr 26 kg 1.2 ml 5.2 mg
9 yr 28 kg 1.3 ml 5.6 mg
10 yr 30 kg 1.4 ml 6.0 mg
11 yr 32 kg 1.4 ml 6.4 mg
12 yr 34 kg 1.5 ml 6.8 mg
Small teenager 40 kg 1.8 ml 8.0 mg
Adult or full-grown teenager ≤ 50 kg 2.0 ml 10.0 mg
L-30
ADVERSE REACTION
1. Drowsiness, Hypotension, Amnesia, Respiratory depression, Apnea, Laryngospasm, Bronchospasm, Dyspnea,
Bradycardias, Tachycardias, PVCs, Retching.
2. May decrease ICP in head injured patients.
3. Causes nasal burning for 30-45 seconds post IN administration.

Front 27

MORPHINE SULFATE

Back 27

CLASSIFICATION
1. Narcotic analgesic.
ACTION
1. Potent analgesic, sedative and euphoric.
2. Decreases rate of A-V conduction (vagotonic).
3. Peripheral vasodilation and venous pooling of blood.
ONSET OF ACTION
1. 5 minutes IV.
2. 10 − 30 minutes IM.
DURATION OF ACTION
1. IV or IM 4 − 5 hours.
INDICATION
1. Severe pain, i.e.; myocardial infarction, burns, isolated extremity injuries, abdominal pain.
2. Adjunct in treating pulmonary edema.
CONTRAINDICATION
1. Known hypersensitivity.
2. Head trauma.
3. Altered states of consciousness.
4. Systolic BP < 100.
USE WITH CAUTION
1. Respiratory depression, i.e.; associated with asthma, COPD.
2. Elderly patients.
3. Hypotension.
4. Pregnancy.
DOSAGE AND ADMINISTRATION
1. Adult: Give in 2.0 mg increments, repeat 2x2x2 up to 10.0 mg slow IV push. Can give IM or IV for
severe abdominal pain.
2. Pediatric: 0.1 mg/kg IV up to 10.0 mg. Contact Mary Bridge.
ADVERSE REACTION
1. Respiratory depression, Respiratory arrest, Hypotension, Nausea and vomiting, Bradycardia, Heart block,
Drowsiness.

Front 28

NALOXONE (NARCAN)

Back 28

CLASSIFICATION
1. Narcotic antagonist.
ACTION
1. Binds up opiate receptor sites, displaces narcotic molecules from opiate receptors.
2. May precipitate withdrawal symptoms in patients physically dependent on narcotics.
3. Reverses respiratory depression secondary to narcotic overdose.
ONSET OF ACTION
1. 1 − 2 minutes IV, ET.
2. 3 – 4 minutes IN.
3. 2 − 5 minutes IM.
DURATION OF ACTION
1. Variable with route and agent.
INDICATION
1. Respiratory depression secondary to narcotics and synthetic narcotic agents and related drugs.
2. Effective against MS, Demerol, Heroin, Codeine, Methadone, Percodan, Dilaudid, Fentanyl, Nubain,
Talwin, Stadol, Darvon.
3. Suspected acute opiate overdosage with respiratory depression.
4. Treatment of coma of unknown origin with apnea/hypoventilation or in neonatal resuscitation.
CONTRAINDICATION
1. Known hypersensitivity.
USE WITH CAUTION
1. In patients known to be physically dependent on narcotics, may precipitate withdrawal symptoms.
2. Be prepared to restrain potentially violent patients if necessary after naloxone has been administered.
DOSAGE AND ADMINISTRATION
1. 0.4 − 2.0 mg IN, IV, ET, or IM; dose may be repeated every 2 − 3 minutes, up to 10.0 mg just until
patient begins to breathe.
2. It is not necessary to wake the patient; just give enough to make them breathe on their own.
3. If no response is observed after 10.0 mg, consider different etiology of respiratory depression or
unconsciousness.
4. Higher doses may be ordered if no initial response.
5. Pediatric: 0.1 mg/kg IV, IM, ET, IO. Dose may be repeated every 2-3 minutes,
up to 10.0mg just until patient begins to breathe.
ADVERSE REACTION
1. Withdrawal symptoms: Sweating, Gooseflesh, Tremor, Nausea and vomiting, Dilation of pupils, Tearing
of eyes, Agitation, Belligerence, Convulsions, Hyper or Hypoventilation.

Front 29

NITROGLYCERINE

Back 29

CLASSIFICATION
1. Vasodilator.
ACTION
1. Dilates veins and arteries in peripheral circulation resulting in:
a. Reduced resistance to blood flow.
b. Decreased blood pressure.
c. Decreased workload on heart.
2. Dilates coronary arteries.
3. Dilates blood vessels in smooth muscle; i.e., gastrointestinal tract, gallbladder, bile ducts, uterus.
4. Improves cardiac output in patient with congestive heart failure.
ONSET OF ACTION
1. 1 − 3 minutes.
DURATION OF ACTION
1. 30 − 60 minutes.
INDICATION
1. Chest pain.
2. Congestive heart failure with pulmonary edema and adequate BP.
CONTRAINDICATION
1. Known hypersensitivity.
2. Systolic BP < 100.
USE WITH CAUTION
1. With evidence of AMI, limit systolic BP drop to 10% if patient is normotensive. If hypertensive, limit
systolic BP drop to 30%.
DOSAGE AND ADMINISTRATION
1. 0.4 mg (1/150gr) tablet SL (sublingually-under the tongue).
2. Nitro spray: Metered dose SL delivers 0.4 mg.
3. May be given every 5 minutes x 3 (maximum during acute attack) as long as systolic BP > 100, additional
doses may be requested by supervising physician.
4. Patient should sit or lie down while administered.
ADVERSE REACTION
1. Hypotension, Throbbing headache, Skin flushing

Front 30

NITROUS OXIDE (NITRONOX)

Back 30

CLASSIFICATION
1. Anesthetic, potent analgesic.
ACTION
1. Nitronox is a blended mixture of 50% nitrous oxide and 50% oxygen.
2. Effect quickly dissipates, (within 2 – 5 minutes) after cessation of administration.
ONSET OF ACTION
1. 2 − 5 minutes.
DURATION OF ACTION
1. 2 − 5 minutes.
INDICATION
1. Acute myocardial infarction, angina.
2. Musculoskeletal pain due to fractures.
3. Burns.
4. Severe pain with physician approval.
CONTRAINDICATION
1. Severe head injury with evidence of increased intracranial pressure, decreased LOC.
2. COPD, pneumothorax.
3. Bowel obstruction, abdominal pain.
USE WITH CAUTION
1. O2 saturation <90%.
2. Self-administered only.
DOSAGE AND ADMINISTRATION
1. Adult: self-administered by inhalation (50% oxygen/50% nitrous oxide mix).
2. Pediatric: Contact Mary Bridge.
CAUTION: Must be used in well-ventilated area. If used in ambulance keep exhaust fan running, window
open.
ADVERSE REACTION
1. Nausea and vomiting, Bizarre behavior.

Front 31

ONDANSETRON (ZOFRAN)

Back 31

CLASSIFICATION
1. Antiemetic, antinauseant.
ACTION
1. Blocks the actions of chemicals in the body that cause nausea and vomiting.
ONSET OF ACTION
1. 15 to 30 minutes.
DURATION OF ACTION
1. 4 to 6 hours.
INDICATION
1. Nausea and or vomiting.
CONTRAINDICATION
1. Hypersensitivity to medication/class/compound.
USE WITH CAUTION
1. Use with caution with patients with impaired liver function.
DOSAGE
1. Adult: 8.0 mg PO.
2. Pediatric: >11 years old 8.0 mg PO. Contact Mary Bridge.
3. Pediatric: 4-11 years old 4.0 mg PO. Contact Mary Bridge.
ADMINISTRATION
1. Place on tongue immediately after opening blister pack. Handle with dry hands only. Do not cut or chew.
Administration with water is not necessary. Tablet is fragile and will dissolve in seconds on tongue.
ADVERSE REACTION
1. Headache, Hypoxia, Pyrexia, Dizziness, Agitation, Pruritus, Anaphylaxis, Bronchospasm, Extrapyramidal
reactions, Oculogyric crisis

Front 32

OXYGEN

Back 32

CLASSIFICATION
1. Naturally occurring atmospheric gas.
ACTION
1. Odorless, tasteless, colorless gas present in room air at approximately 21%.
2. It is used to reverse hypoxemia.
ONSET OF ACTION
1. Immediate.
DURATION OF ACTION
1. As long as is on.
INDICATION
1. Confirmed or suspected hypoxia.
2. Ischemic chest pain.
3. Respiratory insufficiency.
CONTRAINDICATION
1. None.
USE WITH CAUTION
1. Patients with COPD and chronic carbon dioxide retention.
DOSAGE AND ADMINISTRATION
1. Via nasal cannula, non-rebreather mask, ET tube, BVM, or by whatever means to maintain highest O2
saturation possible.
ADVERSE REACTION
1. High-concentration oxygen may cause decreased LOC and respiratory depression over time in patients
with chronic carbon dioxide retention

Front 33

PRALIDOXIME CHLORIDE
(2-PAM)

Back 33

CLASSIFICATION
1. Cholinesterase reactivator.
ACTION
1. Reactivates cholinesterase so destruction of accumulated acetylcholine can occur.
ONSET OF ACTION
1. 15 minutes.
DURATION OF ACTION
1. 3 hours.
INDICATION
1. Organophosphate poisoning.
2. Nerve Agent (GB or VX) poisoning.
CONTRAINDICATION
1. Hypersensitivity to medication.
2. Do not use morphine, theophylline, aminophylline, or succinylcholine with this medication.
3. Avoid reserpine or phenothiazine-type tranquilizer use with this medication.
4. This medication is not indicated as an antidote for intoxication by pesticides of the carbamate class.
5. This medication is not effective in the treatment of poisoning due to phosphorus, inorganic phosphates, or
organophosphates not having anticholinesterase activity.
USE WITH CAUTION
1. Use great caution in treating organophosphate/nerve agent poisoning in cases of myasthenia gravis.
2. Monitor the dosage in the presence of renal insufficiency.
DOSAGE AND ADMINISTRATION
1. Adult: 1 auto-injector (600 mg) IM into thigh. May be repeated depending on symptoms.
ADVERSE REACTION
1. 40 − 60 minutes after the IM injection, mild to moderate pain may be experienced at the site of the
injection.
2. Blurred vision, Diplopia, Impaired accommodation, Dizziness, Headache, Drowsiness, Nausea,
Tachycardia, Increased BP, Hyperventilation, Muscular weakness.

Front 34

PHENEGAN (PROMETHAZINE)

Back 34

CLASSIFICATION
1. Antihistamine.
ACTION
1. Mild Anticholinergic activity (H1 antagonist).
2. Antiemetic.
3. Potentiates actions of analgesics.
ONSET OF ACTION
1. 3 − 5 minutes IV or IM.
DURATION OF ACTION
1. 2 − 6 hours.
INDICATION
1. Nausea and vomiting.
2. Severe vertigo and motion sickness.
CONTRAINDICATION
1. Known allergy to Phenergan or Reye’s Syndrome.
2. Comatose states.
3. Patients under effects of large amounts of depressants (including alcohol).
4. In patients taking MAO (mono-amine oxidase) inhibitor-class of antidepressants.
USE WITH CAUTION
1. Use with caution in asthma patients.
DOSAGE AND ADMINISTRATION
1. Adult: 12.5 − 25.0 mg IM or IV push. Dilute the IV dose in 10 ml of normal saline. Administer the dose
over at least 1-2 minutes, not faster than 25.0 mg/minute.
2. Pediatric: 0.5 mg/kg IM or IV push. Dilute the IV dose in 10 ml of normal saline.
Administer the dose over at least 1-2 minutes, not faster than 25.0 mg/minute. MUST
contact Mary Bridge.
ADVERSE REACTION
1. Drowsiness, Restlessness, Hyperactivity, Anxiety, Extrapyramidal symptoms, Dizziness.
2. Use in children may cause paradoxical hyperexcitability.
3. Geriatric: Dizziness, Hypotension, Sedation.

Front 35

SODIUM BICARBONATE

Back 35

CLASSIFICATION
1. Class IIb alkalizing agent.
ACTION
1. Alkalizing agent, binds up hydrogen ions.
2. Increases potassium influx into cells.
3. Increases pH of urine.
ONSET OF ACTION
1. Immediate.
DURATION OF ACTION
1. Unknown.
INDICATION
1. Late in cardiac arrest with documented metabolic acidosis, if given at all.
2. Tricyclic antidepressant overdose.
3. Correction of metabolic acidosis/known hyperkalemia.
CONTRAINDICATION
1. Metabolic alkalosis.
USE WITH CAUTION
1. DO NOT MIX WITH:
a. Calcium chloride. May form a precipitate.
b. Deactivates if mixed with Epinephrine (adrenalin), Dopamine (Intropin), Isoproterenol (Isuprel).
DOSAGE AND ADMINISTRATION
1. Adult: 1.0 mEq/kg (50.0 mEq or 1 prefilled syringe of 8.4% solution) IV, then ½ the initial dose every 10
minutes until circulation is restored.
2. Neonates: 1.0 mEq/kg of 4.2% solution.
ADVERSE REACTION
1. Congestive heart failure with shortness of breath and/or rales

Front 36

SODIUM CHLORIDE .9%
(NORMAL SALINE)

Back 36

CLASSIFICATION
1. Isotonic crystalloid solution.
ACTION
1. Replace extracellular fluid by remaining in vascular space.
INDICATION
1. Use for mixing/dilution of medications.
2. To keep vein open.
3. Hypovolemia.
4. Heat exhaustion.
5. Shock.
CONTRAINDICATION
1. None.
USE WITH CAUTION
1. Hypertensive patients.
2. Fluid overloaded patients.
3. Use volume control device with pediatric patients.
DOSAGE AND ADMINISTRATION
1. Adult: Route and indication dependent.
2. Pediatric: 20 ml/kg, repeat PRN. May give up to 3 rapid infusions if inadequate
perfusion.
ADVERSE REACTION
1. Fluid overload

Front 37

SUCCINYLCHOLINE (ANECTINE)

Back 37

CLASSIFICATION
1. Ultra short acting skeletal muscle relaxant, depolarizing neuromuscular blocker.
ACTION
1. Prolongs depolarization of the muscle end plate.
2. Induces skeletal muscle relaxation causing onset of flaccid paralysis in less than 1 minute.
3. Has no effect on consciousness, pain threshold or cerebration.
ONSET OF ACTION
1. 30 − 60 seconds.
DURATION OF ACTION
1. 4 − 10 minutes.
INDICATION
1. To facilitate endotracheal intubation in patients with an intact gag reflex.
CONTRAINDICATION
1. Known hypersensitivity.
2. Acute glaucoma, penetrating eye injuries.
3. Suspected hyperkalemia.
4. 24 hours or more post burn.
5. 7 days or more post crush injury.
USE WITH CAUTION
1. Should be used ONLY by persons skilled in airway management.
2. Changes in cardiac rhythm may result from vagal stimulation.
3. In patients with possible increased ICP.
DOSAGE AND ADMINISTRATION
1. Adult: 1.5 mg/kg IV.
2. Pediatric: 1.0 mg/kg IV.
ADVERSE REACTION
1. Prolonged muscle relaxation, Prolonged respiratory depression or apnea, Bradycardia, Tachycardia,
Hypertension, Hypotension, Arrhythmias, Excessive salivation.
2. Potential increase in ICP with second and third doses

Front 38

SYRUP OF IPECAC

Back 38

CLASSIFICATION
1. Emetic.
ACTION
1. Induces vomiting by acting on the chemoreceptor zones of the gastric mucosa ⎯ local irritant and effects
emetic center of brain.
ONSET OF ACTION
1. 15 − 30 min when administered P.O.
DURATION OF ACTION
1. Until vomiting ceases. This may vary in patients with varying chemoreceptor excitability.
INDICATION
1. To induce vomiting after ingestion of many poisonous substances or overdose in an alert patient.
CONTRAINDICATION
1. Unconscious or potentially unconscious or poorly responsive patients.
2. Patients under 6 months old.
3. DO NOT induce vomiting with the following ingested poisons:
a. Strychnine.
b. Strong acids.
c. Strong alkalis.
d. Petroleum distillates such as kerosene, gasoline, coal, oil, fuel oil, paint thinner, or cleaning fluid.
e. Antiemetic overdose.
USE WITH CAUTION
1. May stimulate contractions in pregnant patients in their last trimester.
2. Patients with unstable seizure disorders or cardiac disease.
3. Tricyclic overdoses.
4. Lactating females.
DOSAGE AND ADMINISTRATION
1. The dose of Ipecac administered MUST be recovered since cardiac toxicity (tachycardia, hypotension)
may occur if a significant amount of Ipecac is absorbed.
2. Adult: 30.0 ml by mouth, follow with 500-1,000 ml of warm water. May repeat in 15 − 20 minutes if no
response.
3. Pediatric: 6 months − 3 years old. 15.0 ml by mouth, follow with 250 − 500 ml
of warm water.
4. < 6 months old, give none.
ADVERSE REACTION
1. Failure to induce vomiting within 10 − 15 minutes

Front 39

VASOPRESSIN

Back 39

CLASSIFICATION
1. Hormone, ADH.
ACTION
1. Potent peripheral vasoconstrictor.
ONSET OF ACTION
1. Immediate.
DURATION OF ACTION
1. 10−20 minutes.
INDICATION
1. Alternative pressor to epinephrine in the treatment of adult shock-refractory VF (Class IIb) unresponsive
to initial 3 defibrillations.
2. May be useful for hemodynamic support in vasodilatory shock (eg. septic shock).
CONTRAINDICATION
1. Responsive patients with coronary artery disease.
USE WITH CAUTION
1. Increased vascular resistance may provoke cardiac ischemia.
DOSAGE AND ADMINISTRATION
1. 40 U IV, IO push x 1.
ADVERSE REACTION
1. Cardiac Ischemia.

Front 40

VECURONIUM (NORCURON)

Back 40

CLASSIFICATION
1. Skeletal muscle relaxant.
2. Non-depolarizing neuromuscular blocker.
ACTION
1. Provides skeletal muscle relaxation to facilitate endotracheal intubation.
ONSET OF ACTION
1. 1 minute.
DURATION OF ACTION
1. 25 − 30 minutes.
INDICATION
1. Maintenance of paralysis AFTER intubation to assist ventilation during prolonged transport.
CONTRAINDICATION
1. Hypersensitivity.
2. Inability to intubate.
USE WITH CAUTION
1. Elderly.
2. Patients with cardiovascular disease, hepatic disease, obesity, neuromuscular disease.
3. Do not mix with alkaline solutions.
4. Prior administration of succinylcholine may enhance the neuromuscular blocking effect.
5. Monitor heart rate continuously.
6. Should be used ONLY by persons skilled at intubation.
DOSAGE AND ADMINISTRATION
1. 0.1mg/kg IV.
ADVERSE REACTION
1. Prolonged dose related to respiratory insufficiency or apnea, Wheezing, Aspiration, Bradycardia, Sinus
arrest, Hyper or Hypotension, Increased intraocular pressure.

Front 41

XYLOCAINE JELLY 2%

Back 41

CLASSIFICATION
1. Topical anesthetic.
ACTION
1. Aqueous producing local anesthetic effect when applied topically.
ONSET OF ACTION
1. 3 – 5 minutes after contact with topical region or mucosa.
DURATION OF ACTION
1. 1.5 – 2.0 hrs; can vary with dosage and site of application.
INDICATION
1. Nasal/oral endotracheal intubation.
2. Nasogastric tube placement.
CONTRAINDICATION
1. Known hypersensitivity to local anesthetics.
USE WITH CAUTION
1. Reduce dose with elderly/young.
2. Wear protective gloves when handling to prevent numbing sensation.
3. Do not apply to stylet or inner lumens of endotracheal/nasogastric tubes.
DOSAGE AND ADMINISTRATION
1. Apply moderate amount to external surfaces of endotracheal/nasogastric tubes prior to placement.
ADVERSE REACTION
1. Impaired swallowing may lead to aspiration.
2. Numbness of tongue or bucchal mucosa may enhance possibility of unintentional biting trauma.
3. Allergic reaction, Bradycardia, Hypotension, Drowsiness, Blurred/double vision, Light headedness