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144 Cards in this Set

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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.
Adenosine
Onset/Duration
Onset=within 30 seconds, Duration=1-2 minutes
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
SVT
Adenosine
Contraindications
-2nd and 3rd degree AV heart blocks.
-Sick Sinus Syndrome(without pacemaker)
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.
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.
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.
Albuterol
Onset/Peak/Duration
Onset = 5 min
Peak = 1 hour
Duration = 3-4 hours
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
Respiratory Distress
Albuterol
Contraindications
None
Albuterol
Side Effects
-Tachycardia / palpitations
-Dizziness, headache
-Tremors, nervousness
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.
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.
Aspirin
Onset/Duration
Onset = 15-30min
Duration = days (Antiplatelet Effects)
Aspirin
Indication/Dosage Route # 1
Indication:
-Discomfort/pain of suspected cardiac origin

Dosage/Route:
-Adult Only
162 mg PO
(two 81mg chewable tablets)
Discomfort
Aspirin
Contraindications
None
Aspirin
Side Effects
-GI Upset (indigestion, nausea/vomiting, epigastric pain, heartburn)
-Occult Bleeding
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.
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.
Atropine
Onset/Duration
Onset = IV 2-4 min
Duration = 2-6 hours
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
PEA
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
Unstable Brady: Narrow
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"
Unstable PEDS
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
OPP
Atropine
Contraindications
None
Atropine
Side Effects
-Tachycardia / Palpitations
-Dry Mouth / Nausea / Vomiting
-Pupil Dilation / Blurred Vision
-Flushed / hot / dry skin
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.
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)
Atrovent
Onset/Peak/Duration
Onset = of action within 15-30 min
Peak = at 1-2 hours
Duration = 4-5 hours
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
Respiratory Distress
Atrovent
Contraindications
None
Atrovent
Side Effects
-Nausea
-GI Distress
-Nervous/Dizziness
-Headache
-Palpitations
-Blurred vision/eye irritation (With direct contact of mist)
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.
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.
Benadryl
Onset/Duration
Onset = 15-30 min
Duration = 6-12 hours
Benadryl
Indication/Dosage Route # 1
Indications:
-Allergic Reaction/Anaphylaxis
-Extrapyramidal Reactions

Dosage/Route:
-Adult:
50mg slow IVP/IM
-PEDS:
PDC IM/IVP
-Allergic
-Extrapyramidal
Benadryl
Contraindications
None
Benadryl
Side Effects
-Drowsiness / sedation (excitement in children)
-Dry mouth / thickened bronchial secretions
-Hypotension
-Palpitations / tachycardia
-Seizures
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)
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
Calcium
Onset/Duration
Onset = 5-15 min
Duration = dose dependant, may persist 4 hours after IVP
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
Hyperkalemia
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
Crush
Calcium
Contraindications
None
Calcium
Side Effects
-Decreased heart rate (may cause asystole)
-Hypotension
-Metallic Taste
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.
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.
Charcoal
Onset/Duration
Onset = immediate
Duration = 4-12 hours
Charcoal
Indication/Dosage Route # 1
Indiction:
-Oral ingestion of poison or overdose
Oral Ingestion
Charcoal
Contraindications
-Isolated alcohol ingestion
-Heavy metal ingestion
-Caustic agents ingestions
-Hydrocarbon ingestions
-Iron Ingestions
Charcoal
Side Effects
-Constipation/Diarrhea
-Abdominal Cramping
-Nausea/Vomiting
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.
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.
Dextrose
Onset/Duration
Onset = 1 min
Duration = depends on level of hypoglycemia
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
Dextrose
Contraindications
None
Dextrose
Side Effects
-Local venous irritation / infection
-Hyperglycemia
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.
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.
Dopamine
Onset/Duration
Onset = <5 min
Duration = approximately 10 min after drip is stopped
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
Dopamine
Contraindications
None
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
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.
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
Epi
Onset/Duration
Onset = IV/ET 1-2 min, SC/IM 5-10 min
Duration = 5-10 min
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
Allergic Reaction
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
Anaphylaxis
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
Respiratory Distress
Epi
Indication/Dosage Route # 4
Indication:
-Respiratory distress with stridor in pediatric patients

Dosage/Route:
1:1,000 PDC via nebulizer MR x 1
Respiratory Distress PEDS
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
Cardiac Arrest
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
Newborn HR < 60
Epi
Contraindications
None
Epi
Side Effects
• Anxiety / restlessness
• Palpitations / tachyarrhythmias
• Ventricular irritability
• Hypertension
• Angina
• Headache
• Nausea
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.
Glucagon
Name, Class, Action
GLUCAGON

CLASS:
• Pancreatic Hormone

ACTION:
• Increases blood glucose by converting glycogen stored in the liver to glucose.
Glucagon
Onset/Duration
Onset = 20 min
Duration = 60-90 min
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
Glucagon
Contraindications
None
Glucagon
Side Effects
-Nausea / Vomiting
-Tachycardia
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.
Lidocaine
Name, Class, Action
LIDOCAINE (2% XYLOCAINE)

CLASS:
• Amide Derivative

ACTION:
• Decreases ventricular excitability by suppressing automaticity in the His-Purkinje system
Lidocaine
Onset/Duration
Onset = 1-2 min
Duration = 10-20 min
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)
VTach
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"
VFib
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"
Post Conversion
Lidocaine
Contraindications
• 2nd & 3rd degree heart blocks
• Idioventricular rhythms
Lidocaine
Side Effects
(TOXICITY)

Early
 Anxiety
 Euphoria
 Combative
 Nausea
 Twitching
 Numbness

Late
 Seizure
 Decreased BP
 Coma
 Widening QRS
 Prolonged PRI
 V-FIB
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).
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
Lido Jelly
Indication/Dosage Route # 1
Indication:
-ET / Intubation
Nasopharyngeal Airway Insertion

Dosage/Route:
-Adult & PEDS:
topically prn to ET tube or nasal airway
ET/NPA
Lido Jelly
Contraindications
-Known Hypersensitivity
Lido Jelly
Side Effects
-None
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.
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.
MS
Onset/Duration
Onset = 1-2 min
Duration = 2-7 hours
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
Pain/Discomfort
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
Resp. Distress
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
Pain Management
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
Pacing
MS
Contraindications
None
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
MS
Side Effects
• Respiratory depression / arrest
• Decreased LOC
• Transient hypotension
• Palpitations / Arrhythmias
• Nausea / Vomiting
• Pinpoint pupils
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.
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
Narcan
Onset/Duration
Onset = IV 1-2 min, IM 2-5 min
Duration = IV 30-60 min, IM longer
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
OD not on pain meds
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
OD on pain meds
Narcan
Contraindications
None
Narcan
Side Effects
• Acute withdraw symptoms
• Nausea / vomiting
• Tachycardia / hypertension
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
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
Nitro
Onset/Duration
Onset = SL 2 min; Topical 30-60 min
Duration = SL 30-60 min; Topical 24 hours
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
Pain Cardiac
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
Resp. Distress Rales
Nitro
Contraindications
• Suspected intracranial bleed
• Patient who has taken a sexual enhancement medication such as Viagra® / Cialis® / Levitra® within 48 hours
Nitro
Side Effects
• Orthostatic hypotension (can be profound)
• Temporary pulsating headache
• Dizziness / syncope
• Facial flushing
• Reflex tachycardia
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
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.)
Saline
Indication/Dosage Route # 1
Indication:
• Definitive therapy, or anticipated

Dosage/Route:
ADULT & PEDS:
IV SO; adjust prn
Definitive
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)]
Shock non-cardiac
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)]
Shock Cardiac
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
Crush
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
Burns
Saline
Indication/Dosage Route # 6
Indication:
• Respiratory distress with croup-like cough

Dosage/Route:
ADULT & PEDS:
5ml via nebulizer
Resp. Distress Croup
Saline
Contraindications
-Rales for fluid boluses
Saline
Side Effects
None
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)
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
Bicarb
Onset/Duration
Onset = 2-10 min
Duration = 30-60 min
Bicarb
Indication/Dosage Route # 1
Indication:
-PEA

Dosage/Route:
ADULT ONLY:
1mEq/kg IVP
MR 0.5mEq/kg IVP q10" BHO
PEA
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
HyperK, Tricyclic, Crush
Bicarb
Contraindications
None
Bicarb
Side Effects
-Electrolyte / pH imbalances
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.
Versed
Name, Class, Action
MIDAZOLAM ( VERSED )

CLASS:
• Benzodiazepine

ACTION:
• CNS depressant
• Produces retrograde amnesia, then sedation
• Stops and prevents seizures
Versed
Onset/Duration
Onset = IV 2-5 min, IM 15 min
Duration = 1-4 hours
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
Seizures
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
VT Cardioversion
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.
SVT Cardioversion
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
AFib Cardioversion, Pacer
Versed
Contraindications
None
Versed
Side Effects
• Respiratory depression / apnea
• Drowsiness / confusion
• Hypotension
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.