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144 Cards in this Set
- Front
- Back
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Adenosine
Name, Class, Action |
Adenosine (Adenocard)
Class -Endogenous Nucleoside (Occurs naturally in all cells of the body) Action -Slows electrical conduction through AV node, and inhibits re-entry pathway, converting SVT to NSR. |
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Adenosine
Onset/Duration |
Onset=within 30 seconds, Duration=1-2 minutes
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Adenosine
Indication & Dosage/Route # 1 |
SVT:
Supraventricular Tachycardia (S-127, S-163) ---------- -Adult: 6mg rapid IVP, follow with 20ml NS 12mg rapid IVP, follow with 20ml NS If no sinus pause MR x 1 in 1-2" If patient has history of bronchospasm or COPD: Dosing as above per BHO -PEDS: Same as adult PDC BHPO |
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Adenosine
Contraindications |
-2nd and 3rd degree AV heart blocks.
-Sick Sinus Syndrome(without pacemaker) |
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Adenosine
Side Effects |
-SOB/Dyspnea; may cause bronchospasm in asthma patients (BHO).
-Chest Pressure/palpitations; may be acute in some patients for brief period. -Mild hypotension (decreased peripheral vascular resistance). -Dizzy / Lightheadedness / Headache -Nausea -Transient Arrhythmias, (Bradycardia, AV blocks, ventricular ectopy). These are generally not treated and are quickly self-limiting. |
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Adenosine
Special Info |
Concentration = 6mg/2ml
Use large bore IV in proximal large vein to assist administration of rapid IV push. Obtain ECG documentation before, during, and after giving adenosine. Discontinue medication if 2nd or 3rd degree block develops. Caffeine and Theophylline acts as an antagonist; maximum doses may be required. |
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Albuterol
Name, Class, Action |
Albuterol (Proventil, Ventolin)
Class: -Sympathomimetic Action: -Activates the beta-2 adrenergic receptors to relax bronchial smooth muscles. -Bronchodilation, relieves bronchospasms, and reduces airway resistance. |
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Albuterol
Onset/Peak/Duration |
Onset = 5 min
Peak = 1 hour Duration = 3-4 hours |
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Albuterol
Indication & Dosage/Route # 1 |
Respiratory distress with bronchospasms:
-Respiratory origin -Allergic reaction/anaphylaxis -Burns ---------- -Adult: 6ml (0.083%) via nebulizer MR -PEDS: PDC via nebulizer MR |
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Albuterol
Contraindications |
None
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Albuterol
Side Effects |
-Tachycardia / palpitations
-Dizziness, headache -Tremors, nervousness |
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Albuterol
Special Information |
Concentration = 2.5mg/3ml *1 dose*
Drug becomes unstable in temperatures > 77 degrees, if the drug is discolored or precipitated, discard drug. Causes minimal cardiac stimulation; monitor ECG & heart rate. Report to base hospital any patient use of anti-asthmatic drugs prior to paramedic arrival. Use with caution in pregnancy. |
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Aspirin
Name, Class, Action |
Aspirin, ASA (Acetylsalicylic Acid)
Class: -Salicylate Action: -Inhibits the normal tendency for platelets to accumulate inside injured or occluded cardiac arteries thereby promoting better blood flow through the vessels to better perfuse the heart. |
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Aspirin
Onset/Duration |
Onset = 15-30min
Duration = days (Antiplatelet Effects) |
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Aspirin
Indication/Dosage Route # 1 |
Indication:
-Discomfort/pain of suspected cardiac origin Dosage/Route: -Adult Only 162 mg PO (two 81mg chewable tablets) |
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Aspirin
Contraindications |
None
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Aspirin
Side Effects |
-GI Upset (indigestion, nausea/vomiting, epigastric pain, heartburn)
-Occult Bleeding |
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Aspirin
Special Information |
-Concentration = 81mg chewable tablets
-ASA decomposes at high temperatures or with high humidity/moisture. Pills may crumble or have a "vinegar" smell that may be detected when ASA has deteriorated. If either of these are observed, replace immediately. -Give even if patient has taken ASA that day. -Give if patient had pain or discomfort of suspected cardiac origin that they self medicated (NTG) and are pain free now. -Can give if patient on anticoagulants. |
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Atropine
Name, Class, Action |
Atropine Sulfate
Class: -Anticholinergic Action: -Competes with acetylcholine for receptor sites blocking the PNS response at SA and AV nodes. -Increases heart rate by increasing electrical conduction through the heart. -Inhibits secretions by decreasing PNS effect on bronchial, salivary, sweat, and GI glands. |
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Atropine
Onset/Duration |
Onset = IV 2-4 min
Duration = 2-6 hours |
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Atropine
Indication/Dosage Route # 1 |
Indication:
-PEA with Bradycardia < 60 Dosage/Route: -Adult Only 1mg IVP; MR x2 q 3-5" to max 3mg --OR-- 2mg ET; MR x 2 q 3-5" to max 6mg administered dose |
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Atropine
Indication/Dosage Route # 2 |
Indication:
-Unstable Bradycardia: Narrow complex OR wide complex if pacing unavailable. Dosage/Route: -Adult 0.5mg IVP for pulse < 60 bpm; MR q 3-5" to max 3mg --OR-- 1mg ET for pulse < 60 bpm; MR q 3-5" to max 6 mg administered dose |
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Atropine
Indication/Dosage Route # 3 |
Indication:
-Unstable bradycardiac Pediatrics Dosage/Route: -PEDS: If age > 30 days: <9yo HR <60; 9-14yo HR <40 PDC IV/IO/ET; MR x 1 in 5" |
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Atropine
Indication/Dosage Route # 4 |
Indication:
-Organophosphate Poisoning Dosage/Route: -Adult 2mg IVP/IM; MR q 3-5" x 2; <R q 3-5" prn BHO --OR-- 4mg ET; MR q 3-5" x 2; MR q 3-5" prn BHO -PEDS PDC IV/IO/IM/ET MR q 3-5" x 2; MR q 3-5" prn BHO |
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Atropine
Contraindications |
None
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Atropine
Side Effects |
-Tachycardia / Palpitations
-Dry Mouth / Nausea / Vomiting -Pupil Dilation / Blurred Vision -Flushed / hot / dry skin |
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Atropine
Special Information |
-Concentration = 1mg/10ml or 0.4mg/1ml)
-Use with caution for patients with MI (may extend infarct area). -Smaller doses given slowly may produce a paradoxical slowing of the heart rate. |
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Atrovent
Name, Class, Action |
Atrovent (Ipratropium Bromide)
Class: -Anticholinergic Action: -Antagonizes the action of acetylcholine, preventing the interaction of acetylcholine with muscarinic receptors in bronchial smooth muscle causing bronchodilation. -Bronchodilation, site specific (in lung - not systemic) |
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Atrovent
Onset/Peak/Duration |
Onset = of action within 15-30 min
Peak = at 1-2 hours Duration = 4-5 hours |
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Atrovent
Indication/Dosage Route # 1 |
Indication:
Respiratory distress with bronchospasm: -Respiratory Origin -Allergic Reaction/Anaphylaxis -Burns Dosage/Route: -Adult 2.5ml (0.02%) via nebulizer added to first dose Albuterol -PEDS: PDC via nebulizer added to first dose of Albuterol |
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Atrovent
Contraindications |
None
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Atrovent
Side Effects |
-Nausea
-GI Distress -Nervous/Dizziness -Headache -Palpitations -Blurred vision/eye irritation (With direct contact of mist) |
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Atrovent
Special Information |
-Concentration = .5mg/2.5ml - 0.02% unit dose vial.
-Use of nebulizer with mouthpiece rather than facemask may be preferable to avoid contact with eyes. -If a patient has self-medicated with bronchodilator prior to paramedic intervention, Atrovent should still be given with first prehospital Albuterol treatment. -When mixed with albuterol, atrovent is stable for up to 1 hour. -Check lung sounds, O2 saturation, capnography wave forms and respiratory rate before and after administration of Atrovent to determine effectiveness. |
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Benadryl
Name, Class, Action |
Bendaryl (Diphenhydramine Hydrochloride)
Class: -Antihistamine Action: -Binds to histamine receptor sites, suppressing histamine induced allergic symptoms. -Does not prevent histamine release. |
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Benadryl
Onset/Duration |
Onset = 15-30 min
Duration = 6-12 hours |
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Benadryl
Indication/Dosage Route # 1 |
Indications:
-Allergic Reaction/Anaphylaxis -Extrapyramidal Reactions Dosage/Route: -Adult: 50mg slow IVP/IM -PEDS: PDC IM/IVP |
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Benadryl
Contraindications |
None
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Benadryl
Side Effects |
-Drowsiness / sedation (excitement in children)
-Dry mouth / thickened bronchial secretions -Hypotension -Palpitations / tachycardia -Seizures |
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Benadryl
Special Information |
-Concentration = 50mg/1ml
-Use with caution in asthma and children <20 lbs. due to thickened bronchial secretions. -Extrapyramidal Drugs = Haldol, Compazine, Thorazine, Stelazine, Prolixin (Phenothiazine, Anti-Psychotic) |
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Calcium
Name, Class, Action |
Calcium Chloride (10% CACL2)
Class: -Electrolyte Action: -Increases myocardial conctractility -Enhances ventricular automaticity -Reverses cardio-electric changes produced by hyperkalemia -Shifts potassium back into cell to prevent intravascular hyperkalemia |
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Calcium
Onset/Duration |
Onset = 5-15 min
Duration = dose dependant, may persist 4 hours after IVP |
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Calcium
Indication/Dosage Route # 1 |
Indication:
-Suspected hyperkalemia in a hemodialysis pt. in the presence of widened QRS complex and peaked T-Wave. Dosage/Route: -Adult Only 500mg IVP BHO MR BHO |
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Calcium
Indication/Dosage Route # 2 |
Indication:
-Crush injury with extended compression > or = 2 hours of extremity or torso Dosage/Route: -Adult Only 500mg IVP over 30 seconds BHO |
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Calcium
Contraindications |
None
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Calcium
Side Effects |
-Decreased heart rate (may cause asystole)
-Hypotension -Metallic Taste |
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Calcium
Special Information |
-Concentration = 1Gm/10ml
-Use with caution in pts. taking digitalis preparations as it may worsen arrhythmias. -Precipitates if mixed with Sodium Bicarbonate, flush tubing between administration of drugs. -Extravasation of Calcium will cause severe necrosis. Check for IV patency before administration and watch for signs of infiltration. If infiltration occurs, discontinue administration and advise hospital. |
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Charcoal
Name, Class, Action |
Charcoal (Activated Charcoal)
Class: -Absorbent Action: -Binds and absorbs ingested toxins present in the GI tract. -Inhibits intestinal absorption preventing systemic toxicity. |
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Charcoal
Onset/Duration |
Onset = immediate
Duration = 4-12 hours |
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Charcoal
Indication/Dosage Route # 1 |
Indiction:
-Oral ingestion of poison or overdose |
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Charcoal
Contraindications |
-Isolated alcohol ingestion
-Heavy metal ingestion -Caustic agents ingestions -Hydrocarbon ingestions -Iron Ingestions |
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Charcoal
Side Effects |
-Constipation/Diarrhea
-Abdominal Cramping -Nausea/Vomiting |
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Charcoal
Special Information |
-Concentration = 50GM/240ml
-Poison control contact is recommended prior to administration. -Do not use sorbitol/charcoal mixture. -Administer to alert, cooperative patient with a gag reflex. -Most effective if administered within 30 minutes of ingestion, relatively insoluble to water. -Anticipate vomiting complication during administration. Repeat dose may be required. |
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Dextrose
Name, Class, Action |
Dextrose 50% (D50W, 50% Glucose)
Class: -Carbohydrate Action: -Increases blood glucose by providing free sugar quickly released into the blood stream. |
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Dextrose
Onset/Duration |
Onset = 1 min
Duration = depends on level of hypoglycemia |
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Dextrose
Indication/Dosage Route # 1 |
Indication:
-Adult Symptomatic patient with altered LOC or unresponsive to oral glucose agents: -If BS <75mg/dl -If patient remains symptomatic and BS remains: <75mg/dL MR -Pediatric Symptomatic patient unresponsive to oral glucose agents: -If BS: <75 mg/dL (infant <60, neonate <45) -If patient remains symptomatic and BS remains: <75 mg/dL (infant <60, neonate <45) MR Dosage/Route: -Adult 25 Gm IVP -PEDS PDC 25% solution IVP |
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Dextrose
Contraindications |
None
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Dextrose
Side Effects |
-Local venous irritation / infection
-Hyperglycemia |
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Dextrose
Special Information |
-Concentration = 25Gm/50ml
-Tissue necrosis occurs with infiltration; make sure injection is intravenous; aspirate before and halfway through injection of D50W. -Do not use for increased IVP or CVA without hypoglycemia; hypertonic solution can increase cerebral edema. |
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Dopamine
Name, Class, Action |
Dopamine Hydrochloride (Intropin)
Class: -Sympathomimetic (Both alpha and Beta properties) Action: -At low and medium doses, selectively dilates blood vessels supplying the brain, kidneys, heart, and GI tract. -At medium to high doses, increases cardiac output by increasing contractility and stroke volume, thereby increasing blood pressure. -At high doses, causes vasoconstriction and increased heart rate. |
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Dopamine
Onset/Duration |
Onset = <5 min
Duration = approximately 10 min after drip is stopped |
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Dopamine
Indication/Dosage Route # 1 |
Indications:
-Discomfort/Pain of ?cardiac origin with associated shock -Shock: Normovolemic (anaphylactic, neurogenic, septic) -Bradycardia (after max atropine or after initiation of TCP) Dosage/Route: -Adult Only 10-40mcg/kg/min in 250ml NS or D5W IV Drip: titrate to BP of > or = 90 systolic BHO |
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Dopamine
Contraindications |
None
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Dopamine
Side Effects |
-At high infusion rates, hypertension and extreme vasoconstriction may occur
-At low infusion rates, hypotension may occur -Tachyarrhythmias / palpitations -Increased myocardial O2 demand |
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Dopamine
Special Information |
-Concentration = 400mg in 250ml NS = 1,600mcg/ml)
-Tissue necrosis may occur with infiltration. If this occurs, discontinue the IV, circle infiltrated area and inform receiving hospital. -Titrate to BP > or = 90 but not to exceed 120 systolic. -Always run as piggyback drip, never run as primary IV. |
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Epi
Name, Class, Action |
Epinephrine (Adrenalin, Epi)
Class: -Sympathomimetic (both alpha and beta effects) Action: -On The bronchi: bronchodilation (beta-2) -On the peripheral vasculature: vasoconstriction (alpha) -On the heart: Increased heart rate (beta-1)/chronotropic Increased contractility/inotropic Increased AV conduction/dromotropic Increased automaticity/dromotropic |
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Epi
Onset/Duration |
Onset = IV/ET 1-2 min, SC/IM 5-10 min
Duration = 5-10 min |
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Epi
Indication/Dosage Route # 1 |
Indication:
-Allergic reaction with respiratory distress / bronchospasm Dosage/Route: ADULT: If NO KNOWN cardiac history and < 65yo: 0.3mg IM 1:1,000; MR q 10” x 2 If KNOWN cardiac history and/or > 65yo: 0.3mg IM 1:1,000 BHO MR q 10” x 2 BHO PEDS: PDC IM 1:1,000; MR q 10” X2 |
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Epi
Indication/Dosage Route # 2 |
Indication:
-Anaphylaxis Dosage/Route: ADULT: 0.3mg IM 1:1,000 MR q 10” X2 0.1mg IVP 1:10,000 BHO; MR q 3-5” X 2 BHO 2mg ET 1:1000 BHO; MR q 3-5” BHO PEDS: PDC - IM 1:1,000; MR q10" X2 PDC - IVP/IO 1:10,000 BHO; MR q 3-5” X2 BHO PDC - ET 1:1,000 BHO; MR q 3-5” X 2 BHO |
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Epi
Indication/Dosage Route # 3 |
Indication:
-Respiratory Distress with bronchospasm Dosage/Route: ADULT: If NO KNOWN cardiac history and < 65yo: 0.3mg SC 1:1,000; MR q 10” x 2 If KNOWN cardiac history and/or > 65yo: 0.3mg SC 1:1,000 BHPO MR q 10” x 2 BHPO PEDS: PDC - SC 1:1,000; MR q 10" X2 |
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Epi
Indication/Dosage Route # 4 |
Indication:
-Respiratory distress with stridor in pediatric patients Dosage/Route: 1:1,000 PDC via nebulizer MR x 1 |
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Epi
Indication/Dosage Route # 5 |
Indication:
-Cardiac arrest (pulseless patient) Dosage/Route: ADULT: 1mg IVP 1:10,000; MR q 3-5" 2mg ET 1:1,000 ; MR q 3-5" 10mg ETAD 1:1,000 ; MR q 5" PEDS: PDC - IVP/IO 1:10,000; MR q 3-5” X2; MR q 3-5” BHO OR: PDC - ET 1:1000; MR q 3-5" X2 ; MR q 3-5" BHO OR: PDC - ETAD 1:1000; MR q 5" X2 ; MR q5” BHO |
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Epi
Indication/Dosage Route # 6 |
Indication:
-Newborn deliveries if HR remains < 60 after 30 seconds of CPR Dosage/Route: PEDS: PDC - IVP/IO 1:10,000; MR q 3-5” X2; MR q 3-5” BHO OR: PDC - ET 1:1000; MR q 3-5" X2 ; MR q 3-5" BHO |
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Epi
Contraindications |
None
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Epi
Side Effects |
• Anxiety / restlessness
• Palpitations / tachyarrhythmias • Ventricular irritability • Hypertension • Angina • Headache • Nausea |
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Epi
Special Information |
-Concentration = 1:10,000 = 1mg/10ml, 1:1,000 = 1mg/1ml.
-Use with caution with patients over 65 or with cardiac history -Epinephrine is the only drug to be given down #1 ETAD port (when distal tip is placed in the esophagus). #2 ETAD port (when distal tip placed in the trachea) can receive standard ET medication doses of Epinephrine, Atropine and Lidocaine. -Alkalosis or acidosis may decrease the effectiveness of Epi, flush tubing between Sodium Bicarbonate and Epi. |
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Glucagon
Name, Class, Action |
GLUCAGON
CLASS: • Pancreatic Hormone ACTION: • Increases blood glucose by converting glycogen stored in the liver to glucose. |
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Glucagon
Onset/Duration |
Onset = 20 min
Duration = 60-90 min |
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Glucagon
Indication/Dosage Route # 1 |
Indication:
-Adult Symptomatic patient with altered LOC or unresponsive to oral glucose agents: If NO IV: if BS < 75mg/dL -Pediatric Symptomatic patient unresponsive to oral glucose agents: IF NO IV : if BS < 75mg/dL (infant < 60, neonate < 45) Dosage/Route: -Adult 1ml (1 unit) IM -PEDS PDC IM |
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Glucagon
Contraindications |
None
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Glucagon
Side Effects |
-Nausea / Vomiting
-Tachycardia |
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Glucagon
Special Information |
-Concentration = 1mg (1unit)/1ml
-Glucagon will not work if a patient's glycogen stores in the liver are depleted (severe hypoglycemia, malnutrition, adrenal insufficiency). -To check if mixed well, be sure that solution is transparent and does not have any undissolved medication in it. |
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Lidocaine
Name, Class, Action |
LIDOCAINE (2% XYLOCAINE)
CLASS: • Amide Derivative ACTION: • Decreases ventricular excitability by suppressing automaticity in the His-Purkinje system |
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Lidocaine
Onset/Duration |
Onset = 1-2 min
Duration = 10-20 min |
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Lidocaine
Indication/Dosage Route # 1 |
Indication:
-VTach Dosage/Route: ADULT ONLY: 1.5 mg/kg slow IVP; MR 0.5mg/kg IVP q8-10" to max 3mg/kg administered dose (including initial bolus) If no IV: 3mg/kg ET; MR 1mg/kg 8-10” to max 6mg/kg administered dose (including initial bolus) |
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Lidocaine
Indication/Dosage Route # 2 |
Indication:
-VFib/Pulseless VTach Dosage/Route: ADULT: 1.5mg/kg IVP; MRx1 in 3-5" If no IV: 3mg/kg ET; MR x1 in 3 - 5" to max 6mg/kg administered dose (including initial bolus) PEDS: PDC IVP/IO; MR x2 q3-5" If no IV: PDC ET; MR x2 q3-5" |
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Lidocaine
Indication/Dosage Route # 3 |
Indication:
-Post Conversion VFib/VTach with pulse > or = 60 Dosage/Route: ADULT: 1.5mg/kg IVP; MR 0.5mg/kg IVP q8-10" to max 3mg/kg administered dose (including initial bolus) If no IV: 3mg/kg ET; MR 1mg/kg q 8-10" to max 6mg/kg administered dose (including initial bolus) PEDS: PDC IVP/IO; MR x 2 q 8-10" If no IV: PDC ET; MR x 2 q 8-10" |
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Lidocaine
Contraindications |
• 2nd & 3rd degree heart blocks
• Idioventricular rhythms |
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Lidocaine
Side Effects |
(TOXICITY)
Early Anxiety Euphoria Combative Nausea Twitching Numbness Late Seizure Decreased BP Coma Widening QRS Prolonged PRI V-FIB |
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Lidocaine
Special Information |
-Concentration = 100mg/5ml
-Post conversion includes AICD, precordial thump, spontaneous or SAD -Do not push faster than 50 mg/min in an awake patient. -Recommended all adult doses be rounded off to the nearest 20mg -Toxicity and delayed effect is more likely in elderly, CHF and liver disease due to reduced ability to metabolize drug. Repeat doses in this patient population should be given at 10 minute intervals. -Use with caution in AV blocks (suppressing automaticity may cause further block). |
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Lido Jelly
Name, Class, Action |
LIDOCAINE JELLY (XYLOCAINE JELLY)
CLASS: • Topical Anesthetic ACTION: • Prohibits the initiation and conduction of impulses thereby effecting local anesthetic action. • Decreases sensation where tube is inserted thereby decreasing intracranial pressure |
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Lido Jelly
Indication/Dosage Route # 1 |
Indication:
-ET / Intubation Nasopharyngeal Airway Insertion Dosage/Route: -Adult & PEDS: topically prn to ET tube or nasal airway |
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Lido Jelly
Contraindications |
-Known Hypersensitivity
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Lido Jelly
Side Effects |
-None
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Lido Jelly
Special Information |
-Concentration = 20mg/1ml
-Will further impair patient’s ability to control secretions so monitor airway closely. -Will numb back of throat, if patient wakes up may bite tongue and be unaware. -Use with caution on patients with oral or nasal burns. -Optional item. |
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MS
Name, Class, Action |
MORPHINE SULFATE (MS, MS04)
CLASS: • Opioid ACTION: • CNS depressant acting on opiate receptors in the brain • Potent pain reliever and sedative • Relaxes respiratory effort. • Decreases myocardial workload through peripheral vasodilatation lowering preload and afterload. |
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MS
Onset/Duration |
Onset = 1-2 min
Duration = 2-7 hours |
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MS
Indication/Dosage Route # 1 |
Indication:
-Pain or discomfort of ?cardiac origin if NTG ineffective or contraindicated Dosage/Route: ADULT ONLY: If BP > 100 systolic 2-4 mg IVP; MR to max 10mg MR to max 20mg BHO If BP < 100 systolic above doses per BHO |
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MS
Indication/Dosage Route # 2 |
Indication:
-Respiratory distress with rales ?cardiac origin Dosage/Route: ADULT ONLY: If BP > 100 systolic 2-4 mg IVP; MR to max 10mg If BP < 100 systolic 2-4 mg IVP BHO |
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MS
Indication/Dosage Route # 3 |
Indication:
-Pain Management: Pain >5 on pain scale and BP >100 systolic: • Burns • Trauma • Envenomation Dosage/Route: ADULT: 2-10 mg in 2-4mg increments IVP to max of 10 mg; MR to max 20 mg BHO or 5 mg IM; MR to max 10 mg BHO or 10 mg PO; MR to max 30 mg BHO PEDS: PDC IVP/IM/PO; MR BHO |
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MS
Indication/Dosage Route # 4 |
Indication:
-Pain associated with external cardiac pacing after capture occurs Dosage/Route: ADULT ONLY: if BP >100 systolic 2-10 mg in 2-4mg increments IVP to max of 10 mg BHPO |
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MS
Contraindications |
None
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MS
BHPO: Use With Caution |
• Chronic pain states
• Isolated head injuries • Acute onset severe headache • Drug/ETOH intoxication • Multiple trauma with GCS of < 15 • Suspected active labor • Abdominal pain |
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MS
Side Effects |
• Respiratory depression / arrest
• Decreased LOC • Transient hypotension • Palpitations / Arrhythmias • Nausea / Vomiting • Pinpoint pupils |
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MS
Special Information |
-Concentration = IV/IM 10mg/1ml, PO 10mg/5ml.
-NTG is the priority for chest pain patients. -If respiratory arrest occurs, assist ventilations and obtain an order for Narcan. -If hypotension occurs, elevate the patient's legs; obtain order for Narcan and fluid bolus. -If patient has chest pain which continues after the 20mg of MS, continue with NTG every 3 – 5 minutes. -"Pinching off” proximal IV tubing during administration is not recommended for small volumes of concentrated meds as med will accumulate in distal IV tubing and rapidly infuse after restoring flow. Administering medication bolus while IV runs at TKO is the recommended technique. |
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Narcan
Name, Class, Action |
NALOXONE HYDROCHLORIDE (NARCAN)
CLASS: • Opioid Antagonist ACTION: • Reverses respiratory depression, sedation and hypotensive effects of opioid overdose by occupying opiate receptor sites |
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Narcan
Onset/Duration |
Onset = IV 1-2 min, IM 2-5 min
Duration = IV 30-60 min, IM longer |
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Narcan
Indication/Dosage Route # 1 |
Indication:
-Symptomatic suspected opioid OD excluding opioid dependent pain management patients Dosage/Route: ADULT: with RR < 12 2mg IVP/direct IVP/IM; MR If patient refuses transport: give additional 2 mg IM PEDS: PDC IVP/direct IVP/IM; MR |
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Narcan
Indication/Dosage Route # 2 |
Indication:
-Suspected symptomatic opioid OD in opioid dependent pain management patients Dosage/Route: ADULT: with RR <12 0.1mg increments up to 2mg IVP/direct IVP OR 1-2 mg IM MR BHO PEDS: PDC IVP/direct IVP MR BHO |
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Narcan
Contraindications |
None
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Narcan
Side Effects |
• Acute withdraw symptoms
• Nausea / vomiting • Tachycardia / hypertension |
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Narcan
Special Information |
-Concentration = 1mg/1ml
-For titrated dosing; ADULT: dilute IV dose (2mg) to 10 ml with NS (new concentration = 0.1 mg/ 0.5ml) PEDIATRIC: dilute 1 mg to 10 ml with NS (new concentration = 0.1 mg/ 1 ml) -Effective against: Codeine Darvon Demerol Dilaudid Fentanyl Heroin Lomotil Methadone Morphine Nubain Oxycontin Paragoric Percodan Stadol Talwin Vicodin |
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Nitro
Name, Class, Action |
NITROGLYCERIN (NTG, NITRO)
CLASS: • Nitrate ACTION: • Relaxes systemic venous & arterial vessels causing vasodilatation thereby: Decreases preload & afterload Decreases myocardial workload. Decreases myocardial O2 consumption. • Dilates coronary arteries |
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Nitro
Onset/Duration |
Onset = SL 2 min; Topical 30-60 min
Duration = SL 30-60 min; Topical 24 hours |
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Nitro
Indication/Dosage Route # 1 |
Indication:
-Pain or discomfort of suspected cardiac origin Dosage/Route: If BP > or = 100 0.4mg SL; MR q 3-5” Topical ointment / paste 1" If BP <100 0.4mg SL BHO; MR BHPO |
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Nitro
Indication/Dosage Route # 2 |
Indication:
-Respiratory distress with rales of suspected cardiac origin Dosage/Route: If BP > or = 100 Topical ointment / paste 1" If BP > or = 100 but <150: 0.4mg SL; MR q 3-5” If BP > or = 150 0.8 ml SL; MR q 3-5” X 3; MR BHO If BP <100: 0.4mg SL BHO; MR BHPO |
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Nitro
Contraindications |
• Suspected intracranial bleed
• Patient who has taken a sexual enhancement medication such as Viagra® / Cialis® / Levitra® within 48 hours |
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Nitro
Side Effects |
• Orthostatic hypotension (can be profound)
• Temporary pulsating headache • Dizziness / syncope • Facial flushing • Reflex tachycardia |
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Nitro
Special Information |
-Concentration = 0.4mg spray, 1" paste = 15mg.
-Nitroglycerine is used for ADULTS ONLY. -Check patient's BP before and after administration of each dose of NTG. -Remove existing NTG patch prior to any use of your NTG. -Do not shake NTG spray -Avoid application of dermal NTG to areas that may be used for cardioversion. Avoid irritated / broken skin. -Tape patch to patient to prevent movement of paste. -One inch of the dermal medication contains approximately 15 mg. -If patient’s chest pain is resolved / gone on medic arrival (self medicated with own NTG), continue treatment with NTG ointment and ASA. -Patients taking Silenadil/Levitra/Cialis or other medications for sexual enhancement may have a fatal drop in blood pressure of 50 - 60 mm Hg. Suspect patient may be on these medications if they have unexplained LOC. Half life of these medications is 4+ hours |
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Saline
Name, Class, Action |
NORMAL SALINE (0.9% SOLUTION SODIUM CHLORIDE, NS)
CLASS: • Electrolyte / Isotonic Crystalloid ACTION: • Electrolyte solution which is equivalent osmotically to blood. • Increases the circulating volume the vascular system. (2/3 of infused volume leaves vascular space within 1 hour.) |
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Saline
Indication/Dosage Route # 1 |
Indication:
• Definitive therapy, or anticipated Dosage/Route: ADULT & PEDS: IV SO; adjust prn |
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Saline
Indication/Dosage Route # 2 |
Indication:
• Shock Hypovolemia (S-S-138, S-139) • Suspected intra-abdominal catastrophe or? Aortic aneurysm (S-120 adult) • Shock (normovolemic: anaphylactic, neurogenic) (S-138, S-168) • Anaphylaxis (S-122, S-162) Dosage/Route: ADULT: IV 500 ml bolus. MR to maintain BP 90 systolic PEDS “non cardiogenic”: IV/IO PDC; MR to maintain BP > [70 + (2Xage)] |
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Saline
Indication/Dosage Route # 3 |
Indication:
• Shock ?cardiac origin/septic shock (S-126, S-138, S-168)) • Dysrhythmias (S-127) Dosage/Route: ADULT: IV Bolus to max 250ml with clear lungs MR to maintain BP 90 systolic PEDS “cardiogenic”: IV/IO PDC with clear lungs MR to maintain X1 to maintain BP > [70 + (2Xage)] |
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Saline
Indication/Dosage Route # 4 |
Indication:
• Crush injury with extended entrapment > 2 hours of extremity or torso Dosage/Route: ADULT: 500 ml fluid bolus just prior to extremity release PEDS: IV PDC just prior to extremity release BHO |
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Saline
Indication/Dosage Route # 5 |
Indication:
• Burn patients with > 20% 2nd degree or >5% 3rd degree Dosage/Route: ADULT: > 15 yo = 500ml bolus then TKO PEDS: 5-14 yo = 250ml bolus then TKO < 5 yo = 150ml bolus then TKO |
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Saline
Indication/Dosage Route # 6 |
Indication:
• Respiratory distress with croup-like cough Dosage/Route: ADULT & PEDS: 5ml via nebulizer |
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Saline
Contraindications |
-Rales for fluid boluses
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Saline
Side Effects |
None
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Saline
Special Information |
-Concentration = 1000ml or 250ml
-Content of the 0.9% solution: 154 MEQ NA/LITER 154 MEQ CL/LITER -Be conservative in use of fluids with a suspected head injury patient to minimize the risk of developing cerebral edema. Judicious fluid use may be needed for hypotension associated with head injury to maintain cerebral perfusion. [ CPP= MAP-ICP ] -Check BP and lung sounds to determine if fluid overload may be developing. -Flow Rates: 18 Ga catheter delivers 80ml/min wide open (maxi tubing) 14 Ga catheter delivers 160ml/min wide open (maxi tubing) -TKO is approximately: 5 gtts/min with maxi drip (10 gtt tubing) 30 gtts/min with mini drip tubing (60 gtt tubing) |
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Bicarb
Name, Class, Action |
SODIUM BICARBONATE (BICARB, NaHC03)
CLASS: • Electrolyte ACTION: • Reduces acidosis or causes alkalosis by direct release of bicarbonate ion in blood stream |
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Bicarb
Onset/Duration |
Onset = 2-10 min
Duration = 30-60 min |
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Bicarb
Indication/Dosage Route # 1 |
Indication:
-PEA Dosage/Route: ADULT ONLY: 1mEq/kg IVP MR 0.5mEq/kg IVP q10" BHO |
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Bicarb
Indication/Dosage Route # 2 |
Indication:
-Hyperkalemia in a hemodialysis patient -Tricyclic OD with cardiac effects -Crush injury with extended entrapment > 2 hours of extremity or torso when extremity released Dosage/Route: ADULT: 1mEq/kg IVP BHO PEDS: PDC IVP x 1 BHO |
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Bicarb
Contraindications |
None
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Bicarb
Side Effects |
-Electrolyte / pH imbalances
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Bicarb
Special Information |
-Concentration = 50meq/50ml
-Cardiac effects = hypotension, heart block or widened QRS -Flush tubing between administration of meds: Effectiveness of Epinephrine will be decreased if it is mixed with Bicarb. Calcium Chloride will precipitate with Bicarb. Be sure to flush tubing between drugs. |
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Versed
Name, Class, Action |
MIDAZOLAM ( VERSED )
CLASS: • Benzodiazepine ACTION: • CNS depressant • Produces retrograde amnesia, then sedation • Stops and prevents seizures |
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Versed
Onset/Duration |
Onset = IV 2-5 min, IM 15 min
Duration = 1-4 hours |
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Versed
Indication/Dosage Route # 1 |
Indication:
Seizures: (S-123, S-161) • Generalized seizures lasting > 5 minutes • Focal seizures with respiratory compromise • Recurrent seizures without lucid interval • Eclamptic seizures of any duration Dosage/Route: ADULT 0.1mg/kg IVP (1mg/min) to max 5mg MR x1 in 10” If no IV 0.2mg/kg IM to max 10mg MR x1 in 10” PEDS PDC IV/IM |
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Versed
Indication/Dosage Route # 2 |
Indication:
Precardioversion (S-127) • Conscious VT- Adult Only Dosage/Route: 1-5 mg slow IVP (1mg/min) If age > 60 consider lower dose with attention to age and hydration status |
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Versed
Indication/Dosage Route # 3 |
Indication:
Precardioversion (S-127, S-163) • SVT- Adult & Peds Dosage/Route: ADULT: 1-5 mg slow IVP (1mg/min) BHO If age > 60 consider lower dose with attention to age and hydration status PEDS: PDC slow IVP (1mg/min) BHPO. |
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Versed
Indication/Dosage Route # 4 |
Indication:
Precardioversion (S-127) If rhythm refractory to treatment or symptoms are severe: • A/Fib, A/Flutter- Adult only Pacemaker insertion with capture after Morphine (S-127) Dosage/Route: ADULT: 1-5 mg slow IVP (1mg/min) BHPO If age > 60 consider lower dose with attention to age and hydration status |
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Versed
Contraindications |
None
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Versed
Side Effects |
• Respiratory depression / apnea
• Drowsiness / confusion • Hypotension |
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Versed
Special Information |
-Concentration = 5mg/1ml or 10mg/2ml
-Versed should be administered slowly at a rate of 1mg/min when given IVP -For seizure treatment, discontinue administration if seizure stops. -Some patients may respond to as little as 1.0 mg -Carefully monitor adequacy of respiratory status and O2 saturation during administration. -Side effects of Versed, i.e. respiratory depression, may be potentiated when combined with the use of ETOH, other sedative hypnotics and other CNS depressants. |
