Protocols For Division 2

Front 1

Tx for Mild Allergic Reaction

Back 1

Benadryl 50 mg IM

Front 2

Tx for Moderate to Severe Allergic Reaction

Back 2

Bronchospasm: Albuterol 5mg in 6ml NS
Epi 1:1,000 .01mg/kg SQ (.5mg max)
IV NS TKO
Benadryl 1mg/kg IV or IM max 50mg

Front 3

Tx for Anaphylaxis

Back 3

Epi 1:1,000 .01 mg/kg SQ or SL. (.5mg max)
Benadryl 1 mg/kg IM 50mg max.
IV NS fluid challenge, 10ml/kg. Recheck v/s every 250ml

Front 4

Tx for unresponsive and no palpable BP (allergic reaction)

Back 4

Epi (1:10,000) 0.01mg/kg, 0.5mg max IV.
IV NS fluid challenge, 10ml/kg. Recheck v/s every 250 ml.
If BP improves, Benadryl 1mg/kg IM. Max 50mg

Front 5

If hypotension persists after two fluid challenges

Back 5

Dopamine, IV. 10mcg/kg/min. Use 400mg/250ml NS. Monitor BP q 3-5m.

Front 6

Tx for Pulmonary Edema

Back 6

Nitro 0.4mg SL, may repeat q 5m if BP>100s.
Lasix 40mg IV(10mg/min). 80mg if pt on Lasix.
CPAP
Consider Morphine 2-5mg IVP

Front 7

Tx for ALOC

Back 7

AEIOUTIPS
BS<80mg/dl, Dextrose 50% 25g IV. Glucagon 1mg IM,SQ if no IV
OD: Narcan IV,SQ,IM,SL. Titrate, max 2.0mg.

Front 8

Routine ALS Care

Back 8

BSI
BLS
ECG
02, >96%
IV access
Glucose determination
Transport

Front 9

Albuterol
A/M

Back 9

Selective direct acting B2 agaonist

Front 10

Albuterol
Indications

Back 10

Bronchial Asthma, emphysema, chronic bronchitis, allergic bronchospasm, reversible bronchospasm

Front 11

Albuterol
Contra

Back 11

Known hypersensitivity
Caution: Cardiovascular disease, HTN, elderly

Front 12

Albuterol
Side effects

Back 12

CNS: tremor, anxiety, dizziness, seizure
CV:headache,HTN, tachycardia, CP
R:Bronchospasm
GI:Nausea, vomiting drymouth

Front 13

ASA
A/M

Back 13

Reduces rate of nonfatal reinfarction/nonfatal stroke.
Platelet aggregator, arterial constrictor

Front 14

ASA
Indications

Back 14

Inhibit clot formation @ onset of new chest pain suggestive of MI/CVA

Front 15

ASA
Contra

Back 15

Hypersensitivity to salicylates
Relative: Active ulcer disease, asthma.
Caution: Bleeding disorders NSAID allergies.

Front 16

ASA
SE

Back 16

CV:Prolonged bleeding
R:Wheezing, bronchospasm
GI:Nausea, vomiting, heartburn, GI BLeed

Front 17

ASA
Dose

Back 17

324mg PO. 4 * 81mg chewable after onset of chest pain.

Front 18

Atropine
A/M

Back 18

-vagal tone, + chronotrophy & AV conduction. Competitive antagonist for ACH @ muscarinic receptors. Bronchodialates via parasympatholytic mech.

Front 19

Atropine
Indication

Back 19

Hemodynamically significant bradycardia & aystole.
Cholinergic poisoning by mushrooms, insecticides/nerve gas.

Front 20

Atropine
Contra

Back 20

0 significant.
May worsen bradycardia,heart block.
Caution: Pt w/myocardial ischemia

Front 21

Atropine
SE

Back 21

CNS:pupil dilation, confusion, seizure
CV:tachy,paradoxical brady
R:mucous plugs
Gi:Dry mouth

Front 22

Atropine
Dose

Back 22

Brady: 0.5-1.0mg IVP MRA 3-5m to max 0.04mg/kg
Asystole & PEA:initial 1.0mg IV MRA 3-5m max 3mg.
Poison: Initial 2.0mg, max 5mg
Ped: 0.05mg/kg IV,IM,IO every 10-15m

Front 23

Atrovent
A/M

Back 23

Inhibits ACH @ muscarinic receptors. Bronchodilation, reduces dries respiratory tract secretions.

Front 24

Atrovent
Indication

Back 24

Relieve bronchospasm associated w/ chronic bronchitis, asthma, emphysema

Front 25

Atrovent
Contra

Back 25

Hypersensitivity to Atropine/derivatives. Not used as 1* trtmnt. Caution: CV disease, HTN, elderly, PG or nursing moms

Front 26

Atrovent
SE

Back 26

CNS: anxiety, dizziness, nervousness
CV: palp, headache, HTN
GI: dry m/m n+ v

Front 27

Atrovent
Dose

Back 27

500 mcg 3ml NS via HHN.
Peds: 125-250 mcg 2.5 - 3 ml NS

Front 28

Diazepam (Valium)
A/M

Back 28

Uncertain. Interacts @ GABA receptors. Produces sedation, amnesia, decreases anxiety. Increases seizure threshold.

Front 29

Diazepam (Valium)
Indications

Back 29

Prolonged seizure activity.
Premed b4 cardioversion.
Acute anxiety states.
Skeltal muscle spasm

Front 30

Diazepam (Valium)
Contra

Back 30

Hypersensitivity. Avoid in non-life threat emergencies when other CNS depressants.

Front 31

Diazepam (Valium)
SE

Back 31

CNS: Drowsy, ataxia, confusion, blurred vision
CV: headache, hypotension
R: depression, apnea
GI: N+V

Front 32

Diazepam (Valium)
Dose

Back 32

5-10 mg slow IVP. Titrate to relieve seizure. Repeat prn, max 20mg.
Ped: .5-2.0 mg IV/R/IM (.2-.5mg/kg IV)

Front 33

Benadryl
A/M

Back 33

Blocks Histamine by H-1 receptors antagonism. Reverses extrapyramidal reactions via anticholinergic effect

Front 34

Benadryl
Indications

Back 34

Mild to moderate allergic reaction. As an adjunct to Epi in anaphylaxis.
Phenothiazine induced dystonic reactions

Front 35

Benadryl
Contra

Back 35

Hypersensitivity
Avoid/Caution: acute asthma attack

Front 36

Benadryl
SE

Back 36

CNS: Drowsiness, confusion, coma, seizure
R: Dry mouth, dry bronchial secretions
GI: Urinary retention

Front 37

Benadryl
Dose

Back 37

50-100 mg slow IVP @ 25mg/min or deep IM
Ped: 1mg/kg IVP @ 25mg/min

Front 38

Dopamine
A/M

Back 38

Acts directly on dopaminergic, alpha, beta receptors. Action dose related.

Front 39

Dopamine
Indication

Back 39

Hypotension not resulting from hypovolemia
Cardiogenic shock

Front 40

Dopamine
Contra

Back 40

Sole agent in hypovolemia, significant tachycardia, dysrhythmia, pheochromocytoma.

Front 41

Dopamine
SE

Back 41

CNS: Nervousness
CV: headache, dysrhythmia, palp, cp
R: dyspnea
GI: n + v

Front 42

Dopamine
Dose

Back 42

Initial: 2-5 mcg/kg/min. Increase to raise BP. Max dose typically 20mcg/kg/min, never past 50mcg/kg/min

Front 43

Epi
A/M

Back 43

Directly agonizes beta and alpha recepters. Inhibits release of histamine from mast cells. inhibits uterine smooth muscle contraction

Front 44

Epi
Indication

Back 44

Cardiac arrest(asystole, VT, VF, PEA)
Severe active airway disease
Moderate to severe allergic reactions

Front 45

EPI
Contra

Back 45

None in cardiac arrest
Relative: Hemorrhagic, hypovolemic, traumatic, cardiogenic shock.
Caution: CAD, +35, diabetes.
Do not use in 2nd stage labor.

Front 46

EPI
SE

Back 46

CNS:restlessness, anxiety, tremor, dizziness, CVA, syncope
CV: angina, palp, HTN, MI, SVT, VF, VT, pallor
GI: N + V

Front 47

EPI
Dose

Back 47

Cardiac Arrest; 1mg IV q 3-5m(1:10,000)
Bronchospasm, Allergic Rxn, Anaphylaxis:.01mg/kg (1:1000) SQ. Max .5mg
Anaphylaxis 0 AVPU, 0 BP, .01mg/kg (1:10,000) IV, max .5mg

Front 48

Nitro
A/M

Back 48

Relaxes vascular smooth muscle, decreases preload & some afterload, O2 demand. Decreases BP.

Front 49

Nitro
Indications

Back 49

Relieve cp in myocardial origin. Reduce preload in CHF/cardiogenic pulmonary edema.

Front 50

Nitro
Contra

Back 50

Head trauma, neuro deficit, Increase ICP, shock, hypersensitivity, pts on viagra type drugs w/in 24hrs.

Front 51

Nitro
SE

Back 51

CNS: dizziness, syncope
CV: hypotension, palp, tachy, headache, flushed skin, +angina, circulatory collapse.
GI:n+V, dry mouth, sublingual burning

Front 52

Nitro
Dose

Back 52

0.4mg SL. MRA 3-5m up to 3 doses.