Paramedic MA State Protocol drugs
Terms
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- ADENOCARD: (Adenosine)
-
ACTIONS:
An endogenous nucleotide from human body cells, it slows conduction time through the AV-node restoring patients to a normal sinus rhythm.
INDICATIONS:
• Paroxysmal supraventricular tachycardia
• Narrow complex tachycardia
CONTRAINDICATIONS:
• 2nd or 3rd degree AV block
• Known sick sinus syndrome unless an artificial pacemaker is in place
• Known hypersensitivity to adenosine
PRECAUTIONS:
• Wide Complex Tachycardia
• Atrial Fibrillation and Atrial Flutter with a rapid ventricular response
• Patients with ASTHMA, or COPD
• Patients known or suspected of taking Theodur, Persantine or any product containing Dipyradamole
ADVERSE REACTIONS:
• Transient high grade AV block, chest pain, palpitations, and shortness of breath.
DOSAGE:
• 6mg given rapidly (1-2 seconds) IV push, followed by a 20cc flush. If the first dose fails to convert the rhythm within 2 minutes, a second dose of 12mg rapid IV push, followed by a 20 cc flush, may be administered. The half-life of adenocard is 10 seconds. After drug administration flush the IV for 30 seconds.
ROUTE:
• IV. Should not be administered through veins distal to antecubital vein
HOW SUPPLIED:
• 6 mg in a 2 ml pre-filled syringe. 12 mg in a 4 ml pre-filled syringe.
• 6 mg in a 2 ml vial - ASPIRIN
-
ACTIONS:
Aspirin blocks pain impulses in the CNS, dialates peripheral vessels, and inhibits platelet aggregation.
INDICATIONS:
• Prevention of platelet aggreagation in ischemia and thromboembolism
• Unstable angina
• Prevention of myocardial infarction or reinfarction
CONTRAINDICATIONS:
• Hypersensitivity to salicylates
• GI bleeding
• Active ulcer disease
• Hemorrhagic stroke
• Bleeding disorders
PRECAUTIONS:
• None
ADVERSE REACTIONS:
• Stomach irritation
• Indigestion
• Nausea or vomiting
• Allergic reaction
DOSAGE:
• 162 mg
ROUTE:
• Chewed and swallowed
HOW SUPPLIED:
• 81 mg chewable tablets - ATROPINE: (Atropine Sulfate)
-
ACTIONS:
Parasympathetic blocker, reducing vagal tone. Atropine is a Parasympatholytic (Anticholinergic) that acts to block acetylcholine receptors, thus inhibiting parasympathetic stimulation.
INDICATIONS:
• Hemodynamically symptomatic bradycardias
• Heart blocks
• Asystole
• Organic phosphate poisoning
CONTRAINDICATIONS:
• Tachycardias
• Second Degree Type II and Third Degree heart blocks
PRECAUTIONS:
• If given in too small a dose, or if given too slowly, bradycardia may worsen.
ADVERSE REACTIONS:
• Dryness of the mouth and nose, blurred vision, dilated pupils, tachycardia, headache and restlessness
DOSAGE :
ADULT:
• Brady-Dysrhythmias: 0.5mg every 5 minutes to 0.03 - 0.04mgs/kg
• Asystole: 1mg IV push to be repeated every three minutes to a maximum of 0.03 - 0.04 mgs / kg
• Organic Phosphate Poisoning: 0.5-1 mg boluses, titrating until signs / symptoms
resolve
PEDIATRIC:
• Brady and Asystole: 0.01 - 0.03 mg / kg.
ROUTE:
• IV, IM, or ET
HOW SUPPLIED:
• 1 mg in a 10 ml pre-filled syringe
• 0.5 mg in a 5 ml pre-filled syringe - Diphenhydramine: BENADRYL
-
ACTION:
Benadryl is an antihistamine with anticholinergic (drying) and sedative side effects. Antihistamines compete with histamine for cell receptor sites during allergic reactions.
INDICATIONS:
• Anaphylaxis (administered after epinephrine)
• Allergic Reactions
PRECAUTIONS:
• Use with caution in patients with a history of asthma, cardiovascular disease, and hypertension
• Sedative effects are more pronounced when patient has ingested alcohol or other CNS depressants (barbiturates, phenothiazine, antidepressants, or narcotics)
ADVERSE REACTION:
• Tachycardia
• Hypotension
• Central Nervous System depression
• Nausea and vomiting
DOSAGE:
ADULT:
• 25 mg to 50 mg
PEDIATRIC:
• 10 to 25mg, usually 1 mg / kg
ROUTE:
• IV, IM
HOW SUPPLIED:
• 50 mg in a 1ml vial
• 50 mg in a 1 ml pre-filled syringe - Diltiazem: CARDIZEM
-
ACTION:
Cardizem is a benzothiazepine calcium channel blocker,. Cardizem inhibits the influx of extracellular calcium across both the myocardial and vascular smooth muscle cell membranes. The end result decreases the contractility of the myocardial smooth muscle, dilation of the coronary and systemic arteries.
INDICATIONS: • Atrial Fibrillation • Atrial Flutter • Angina • Hypertension • Paroxysmal supraventricular tachycardia (PSVT) refractory to adenosine
CONTRAINDICATIONS: • Patients with cardiogenic shock, or patients with a systolic B/P - Amiodarone: CORDARONE
-
ACTIONS:
Antiarrhythmic drug with sodium channel blocking, and anti-sympathetic nervous system properties, resulting in negative dromotropic effect on the heart. Prolonged administration results in a lengthening of the cardiac action potential. Amiodarone possesses negative chronotropic effects slowing conduction and prolonging the refractory period. Amiodarone administration prolongs intranodal conduction and refractoriness of the atrioventricular node, but has no effect on the sinus node. Used in a wide variety of atrial and ventricular tachyarrhythmias and for rate control of rapid atrial arrhythmias in patients with impaired LV function.
INDICATIONS: Ventricular Fibrillation and Pulseless Ventricular Tachycardia.
• Treatment of Polymorphic Ventricular Tachycardia and Wide Complex Tachycardia of uncertain etiology
• Control of hemodynamically stable Ventricular Tachycardia when cardioversion is unsuccessful
• Used as adjunct to cardioversion of SVT and PSVT
• May be used for rate control in atrial fib and flutter when other therapies are ineffective or contraindicated
• Acceptable for termination of ectopic or multifocal atrial tachycardia with Left Ventricular dysfunction
CONTRAINDICATIONS:
• Torsade de Pointes
• Cardiogenic Shock
• Hypotension
PRECAUTIONS:
• May produce vasodilatation and hypotension, and negative inotropic effects
• May prolong QT interval, DO NOT USE WITH OTHER DRUGS THAT PROLONG THE QT INTERVAL
• Use with caution in renal failure, half-life can last up to 40 days
ADVERSE REACTIONS:
• Hypotension
• Headache
• Bradycardia
• AV conduction abnormalities
• Flushing
DOSAGE:
• Cardiac Arrest: 300 mg IV push, repeated in 3-5 minutes at 150 mgs if required.
• Wide Complex Tachycardia (stable): 150mg in 100 ml D5W over 10 minutes
• Pediatric dose in VF/pulseless VT is 5 mg / kg
• Pediatric dose in perfusing supraventricular and ventricular arrhythmias is 5mg / kg over 20-60 minutes ( max of 15 mg /kg / day ).
ROUTE:
• IV
HOW SUPPLIED: 150 mg in a 3 ml vial
D5W: (5% dextrose in water)
ACTION:
D5W is a hypotonic glucose solution, used to keep a vein open and to supply calories necessary for cell metabolism. While it will have an initial effect of increasing the circulatory volume, glucose molecules rapidly diffuse across the vascular membrane with a resultant free water increase. It has a Ph of 4.3 and contains 5g of dextrose per 100ml.
INDICATIONS:
• Infusion of Cordarone or Magnesium Sulfate
CONTRAINDICATIONS:
• None for its intended use
PRECAUTIONS:
• N/A
ADVERSE REACTIONS:
• N/A
DOSAGE:
• 100 ml
ROUTE:
• IV infusion
HOW SUPPLIED:
• 100 ml bags - DOPAMINE: (Intropin)
-
ACTION:
Vasopressor – dose dependent alpha, beta, and dopaminergic agonist.
• Low dose (0.5-2mcg/kg/min.) causes vasodilatation in renal, mesenteric, cerebral, and coronary arteries, via activation of the dopamine receptor sites.
• Intermediate doses (2-10 mcg/kg/min.) produce a step-wise increase in contractility, automaticity, and conductivity via beta-receptor effects.
• High doses (10-20mcg/kg/min.) the alpha receptor effects predominate producing peripheral vasoconstriction.
• Extremely dose (>20mcg/kg) renal and mesenteric vessels constrict resulting in decreased blood flow.
INDICATIONS:
• Hypoperfusion due to myocardial infarction, sepsis, severe congestive heart failure, and pulmonary edema
• Cardiogenic shock
CONTRAINDICATIONS:
• Tachydysrhythmias
• VF
PRECAUTIONS:
• Correct any volume deficit before instituting dopamine therapy, unless otherwise directed.
• Do not mix with Sodium Bicarbonate; this deactivates Dopamine
ADVERSE REACTIONS:
• Ectopy, local tissue narcosis if line infiltrates, tachycardia, palpitations, dysrhythmias, hypotension, nausea and vomiting
DOSAGE:
• 400mg/250cc premixed bag yields 1600mcg/ml
• Initiate therapy at rate of 5mcg/kg/min and titrate to a blood pressure of 100 systolic in adults and 80-90 in pediatric patients
ROUTE:
• IV
HOW SUPPLIED:
• 400 mg in a 10 ml pre-filled syringe
• 400 mg in a 250 ml premix bag - GLUCAGON
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ACTION:
Pancreatic hormone, Insulin antagagonist. Increases the breakdown of glycogen to glucose and stimulates glucose synthesis, resulting in blood glucose elevation.
INDICATIONS:
• Persistent symptomatic hypoglycemia
• Unable to gain IV access
CONTRAINDICATIONS:
• Hypersensitivity
• Only effective if liver glycogen is available
• May be ineffective in chronic states of hypoglycemia, starvation, and adrenal insufficiency
• Do not mix with saline
PRECAUTIONS:
• None
ADVERSE REACTIONS:
• Tachycardia
• Hypotension
• Nausea and vomiting
• Urticaria
DOSAGE:
ADULT:
• 0.5 – 1 mg IM
PEDIATRIC:
• 0.025 – 1 mg IM
ROUTE:
• IM
HOW SUPPLIED:
• Glucagon must be reconstituted (with provided diluent) before administration
• Dilute 1 unit (1 mg) white powder in 1 ml of diluting solution (1 mg / ml) - EPINEPHRINE
-
ACTION:
Alpha and beta adrenergic agonist that stimulates all the effects of the sympathetic nervous system except those affecting the arteries of the face and sweat glands; major sympathetic effects include: Positive chronotropic effect, positive inotropic effect, increased systemic vascular resistance, bronchodilation, assist in the conversion of ventricular fibrillation, and Increased cerebral blood flow in cardiac arrest
INDICATIONS:
• Asystole
• Pulseless electrical activity
• Heart blocks, bronchospasms, and anaphylaxis.
• Hemodynamically unstable bradycardias
• Ventricular fibrillation (in the absence of Vasopressin)
• Pulseless ventricular tachycardia
CONTRAINDICATIONS:
• Hypovolemic Shock
PRECAUTIONS:
• Give cautiously in patients with hypertension, tachycardia, or who are pregnant.
• Do not mix with Sodium Bicarbonate. This results in a deactivation of the Epinephrine.
ADVERSE REACTIONS:
• Tachycardia, palpitations, anxiety and headache
• Increased myocardial oxygen demand
DOSAGE:
• Ventricular Fibrillation, Pulseless Ventricular Tachycardia, Pulseless Electrical Activity and Asystole – 1 mg of 1:10,000 repeated every three to five minutes.
• Endotracheal Dose is 2 times the IV dose (give one time only)
• Asthma and Anaphylactoid reactions 0.3ml of 1:1,000 is given sq.
• Anaphylactic shock (life threatening) 2 mg of 1:1,000 in 250 NS started at 1 mcg / min and titrate to effect.
• Epinephrine Drip – Bradycardias and blocks 2 mg/250cc run at 2-4 mcg / min
• See Broslow Tape for correct pediatric dose
ROUTE:
• IV,IM,ET,SQ.
HOW SUPPLIED:
• 1:1000 - 1 mg in a 1 ml Tubex syringe, 30mg in 30cc multi-dose vial
• 1:10,000 – 1 mg in a 10ml pre-filled syringe. - Furosemide: LASIX
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ACTION:
Potent vasodilator and diuretic. Blocks the reabsorbtion of the sodium in the Loop of Henle as well as the distal and proximal tubules.
INDICATIONS: • Congestive heart failure • Pulmonary Edema • Hypertension • Cerebral Edema
CONTRAINDICATIONS: • Dehydrated patients • Blood Pressure - LIDOCAINE: Xylocaine
-
ACTIONS:
Antiarrhythmic – decreases phase 4 depolarization inhibits impulse transmission in the myocardial nervous system.
INDICATIONS:
• Ventricular Fibrillation (in the absence of Amiodarone) (Class IIb)
• Pulseless Ventricular Tachycardia (in the absence of Amiodarone) (Class IIb)
• Significant ventricular ectopy in the seting of myocardial ischemia / infarction
• Stable Ventricular Tachycardia
• Wide Complex Tachycardia of unclear etiology
CONTRAINDICATIONS:
• Bradycardia with PVC’s
PRECAUTIONS:
• Prophylactic use in MI’s is not indicated
• Reduce dose (maintenance, not loading) with liver impairment or LV dysfunction
• Discontinue infusion at first sign of toxicity
ADVERSE REACTIONS:
• Lidocaine Toxicity (Light headiness, dizziness, blurred vision, nausea, vomiting, seizures, hypotension, bradycardia and central nervous system depression)
DOSAGE:
ADULT:
• Cardiac arrest from VF/VT, 1.5mg/kg
• Refractory VF, give an additional 1.5 mg/kg dose in 5-10 minutes, achieving the maximum of 3 mg/kg
• Tracheal administration is 3 mg/kg ( used for initial dose )
• Stable VT, WCT, significant ectopy, 1-1.5mg/kg IV push, repeat .5 to .75mg/kg every 5-10 minutes to a max of 3mg/kg
• Maintenance infusion 1-4mg/min
PEDIATRIC (up to 38kgs):
• Loading dose: 1 mg/kg
• Infusion: Utilize Broselow tape for appropriate concentration and infusion rates
HOW SUPPLIED:
• 100 mg in a 5 ml pre-filled
• 1 Gram in a 250 ml premix bag - MAGNESIUM SULFATE
-
ACTIONS:
Magnesium is an intracellular electrolyte that is vital to many body functions. It acts as a physiological calcium channel blocker and blocks neuromuscular transmission. Hypomagnesemia will greatly affect the neuromuscular, gastrointestinal and cardiovascular systems. Hypomagnesemia is associated with cardiac arrhythmias, symptoms of cardiac insufficiency, and sudden death. Hypomagnesemia can cause refractory ventricular fibrillation. Administration of magnesium sulfate in the emergency setting appears to reduce the incidence of ventricular arrhythmias that follow an acute myocardial infarction.
Magnesium sulfate is a central nervous system depressant effective in the management of seizures associated with eclampsia. It is used for the initial therapy of convulsions associated with pregnancy. If Magnesium fails to control seizures, procede with other anticonvulsant agents.
INDICATIONS:
• Cardiac arrest if torsade or suspected hypomagnesemia suspected
• Ventricular Fibrillation refractory to Amiodarone
• Torsade de Pointe with a pulse
• Life threatening arrhythmias with digitalis toxicity
• Eclampsia
CONTRAINDICATIONS:
• Heart Block or AMI
PRECAUTIONS:
• Magnesium should be administered slowly to minimize side effects
• Maintain continuous cardiac monitoring
• Use with caution in renal failure
ADVERSE REACTIONS:
• Flushing of the skin, sweating
• Central Nervous System depression
• Respiratory depression
• Hypotension
• Bradycardias and cardiac arrhythmias
DOSAGE:
• VF/VT or torsade de pointe: 1 gram IV
• Eclampsia: 4 grams IV over 5 minutes
HOW SUPPLIED:
• 1 Gram in 2 ml vial - MORPHINE
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ACTION:
Morphine is central nervous system depressant and potent analgesic.
As such morphine provides both analgesia and sedative properties. It increases peripheral venous capacity and decreases venous return while providing mild arterial dilatation; central nervous system depression; decreases myocardial oxygen demand; decreases preload and after load. Increases venous capacity equaling to decrease in venous return, which in turn causes decrease in the systemic vascular resistance.
INDICATIONS:
• Pain relief due to myocardial ischemia
• Pain relief per the “Pain Management Protocol”
• Acute pulmonary edema
• Chronic heart failure
CONTRAINDICATIONS:
• Hypotension
• Shock due to volume depletion
• Cerebral insult (traumatic or medical)
• Abdominal pain
PRECAUTIONS:
• Hypotension
ADVERSE REACTIONS:
• Hypotension
• Central Nervous System depression
• Respiratory depression
DOSAGE:
ADULT:
• Pain Management - 2mg increments, up to a maximum of 6mg.
• Congestive Heart Failure/Pulmonary Edema – 2mg increments, up to a maximum of 6mg
If more than 6mg of Morphine Sulfate is required call Emergency Department Physician for orders.
PEDIATRIC:
• 0.1 mg /kg slowly
ROUTE:
• IV , IM
HOW SUPPLIED:
• 10mg in 1ml vial - Naloxone: NARCAN
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ACTION:
Narcotic antagonist reverses the central nervous system and respiratory depression effects of narcotics; reverses the cardiovascular effects to a lesser extent. Naloxone competes for narcotic receptor sites in the brain, and displaces narcotic molecules from the opiate receptors.
INDICATIONS:
• Known or suspected narcotic overdoses involving the following:
• morphine Demerol heroin
• paregoric Dilaudid codeine
• Percodan Fentanyl methadone
• Known or suspected overdoses of the following synthetic narcotics:
• Nubian Talwin Stadol Darvon
• Coma of unknown origin
• Unwitnessed cardiac arrests
CONTRAINDICATIONS:
• Hypersensitivity reaction
PRECAUTIONS:
• Narcan should be administered cautiously to patients who are known or suspected to be physically dependent on narcotics. Abrupt and complete reversal of narcotic effects by Naloxone can cause withdrawal-type effects.
ADVERSE REACTIONS:
• Aspiration
• Hypotension/hypertension
• Ventricular arrhythmias
• Nausea/Vomiting
• Acute narcotic withdrawal syndrome (nausea, vomiting, sweating, tachycardia, hypertension, tremor, agitation, diarrhea, abdominal cramps, seizures, and cardiac arrest)
DOSAGE:
ADULT:
• 2 mg (higher doses 2-5mg may be required in Darvon OD)
PEDIATRIC:
• 0.1mg/kg
ROUTE:
• IV, IM, SQ, ET
HOW SUPPLIED:
• 2 mg in a 2 ml pre-filled syringe - NITROGLYCERIN DRIP: Tridal
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ACTION:
Antianginal Agent: Nitroglycerin is a rapid smooth-muscle relaxant that reduces cardiac work and, to a lesser degree, dilates the coronary arteries. This results in increased coronary blood flow and improved perfusion of the ischemic myocardium. Relief of ischemia causes reduction and alleviation of chest pain. Pain relief following nitroglycerine administration usually occurs within 1-2 minutes, and the therapeutic effects can be observed up to 30 minutes later.
As a rapid-acting smooth-muscle relaxant, nitroglycerine causes vasodilation, which reduces preload. Decreased preload leads to decreased cardiac work and relaxation of the vascular smooth muscle and consequent dilation of the peripheral arteries and veins. Arteriolar relaxation reduces systemic vascular resistance and systolic arterial pressure, thereby reducing afterload, further reducing the workload of the myocardium.
INDICATIONS:
• Angina pectoris
• Myocardial infarction
• Congestive heart failure
• Hypertension
CONTRAINDICATIONS:
• Hypotension
• Increased intracranial pressure
• VIAGRA taken within 24 hours
PRECAUTIONS:
• Volume-depleted patients may experience exaggerated hypotensive response
• Postural hypotension
• Right Inferior Infarct
ADVERSE REACTIONS:
• Headache
• Nausea/Vomiting
• Tachycardia
• Dizziness
• Palpitations
• Apprehension
DOSAGE:
• 25 mg in 250cc of D5W (100ug/cc). Starting at 5ug/min and titrate to effect.
ROUTE:
• IV infusion
HOW SUPPLIED:
• 25 mg in 250 ml of D5W - NITROGLYCERIN SPRAY
-
ACTION:
Antianginal Agent: Nitroglycerin is a rapid smooth-muscle relaxant that reduces cardiac work and, to a lesser degree, dilates the coronary arteries. This results in increased coronary blood flow and improved perfusion of the ischemic myocardium. Relief of ischemia causes reduction and alleviation of chest pain. Pain relief following nitroglycerine administration usually occurs within 1-2 minutes, and the therapeutic effects can be observed up to 30 minutes later.
As a rapid-acting smooth-muscle relaxant, nitroglycerine causes vasodilation, which reduces preload. Decreased preload leads to decreased cardiac work and relaxation of the vascular smooth muscle and consequent dilation of the peripheral arteries and veins. Arteriolar relaxation reduces systemic vascular resistance and systolic arterial pressure, thereby reducing afterload, further reducing the workload of the myocardium.
INDICATIONS:
• Angina pectoris
• Myocardial infarction
• Congestive heart failure
• Hypertension
CONTRAINDICATIONS:
• Hypotension
• Increased intracranial pressure
• VIAGRA taken within 24 hours
PRECAUTIONS:
• Volume-depleted patients may experience exaggerated hypotensive response
• Postural hypotension
• Right Inferior Infarct
ADVERSE REACTIONS:
• Headache
• Nausea/Vomiting
• Tachycardia
• Dizziness
• Palpitations
• Apprehension
DOSAGE:
• 0.4 mg that may be repeated one or two more times depending on the patient’s blood pressure
ROUTE:
• Sublingual
HOW SUPPLIED:
• Each aerosol contains 200-metered doses of 0.4mg - NORMAL SALINE: (0.9% Sodium Chloride)
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ACTION:
Normal saline is an isotonic crystalloid solution, used for fluid and electrolyte replacement. 0.9% normal saline contains 154 Milliequivalents of sodium ions (Na+) and 154 Milliequivalents of chloride (Cl-) ions per liter of thus making it isotonic with the extracellular fluid. It has a Ph of 5.0 and contains 900mg of sodium per 100ml.
INDICATIONS:
• Diabetic ketoacidosis
• Heat related emergencies
• Freshwater drowning
• Keep vein open
CONTRAINDICATIONS:
• Congestive Heart Failure
• Pulmonary Edema
PRECAUTIONS:
• Circulatory overload
• Renal disease
• Large volume infusion may dilute other electrolytes; Lactated Ringers may be a more prudent choice for large volume infusion
ADVERSE REACTIONS:
• Febrile response
• Infection at the injection site
• Venous thrombosis
DOSAGE:
• Titrate to effect; larger volumes may be required in patients suffering DKA
ROUTE:
• IV
HOW SUPPLIED:
• 100ml bags, 250 ml bags, 1000 ml bags - OXYGEN
-
ACTION:
Increased concentrations of oxygen increase the saturation level in the hemoglobin in the red blood cell. This results in an increased oxygenation level at the tissue. Oxygen is required for the efficient breakdown of glucose into a usable energy form.
INDICATIONS:
• Hypoxia
• Oxygen should be used in any type of patient that has or may have a condition in which an increased oxygen level will decrease tissue hypoxia
• Chest pain
• Abdominal pain
• Trauma patients
• Respiratory distress
CONTRAINDICATIONS:
• None
PRECAUTIONS:
• Possible oxygen toxicity in COPD patients
• Never deprive the hypoxic patient of oxygen for fear of respiratory depression
ADVERSE REACTIONS:
• None
DOSAGE:
• Patients in mild distress should receive 4 to 6 liters via a nasal cannula
• Patients in moderate to severe distress from should receive 100% oxygen via a 100% non-rebreather
• Severe multiple trauma patients, cardiac arrest patients, severe pulmonary edema, etc., should be orally or nasally intubated
ROUTE:
• Self-Explanatory
HOW SUPPLIED:
• Self-Explanatory - Albuterol Sulfate: PROVENTIL
-
ACTIONS:
A selective beta-2 adrenergic receptor agonist, thereby decreasing bronchospasms.
INDICATIONS:
• Asthma
• Chronic bronchitis
• Emphysema
• Anaphylaxes
• Chronic Obstructive Pulmonary Disease (COPD)
• Pulmonary edema
CONTRAINDICATIONS:
• Cardiac dysrhythmias associated with tachycardias
PRECAUTIONS:
• Concern should be given in patients with a history of cardiovascular disease due to the beta-2 effect Albuterol has on the heart.
• Hypertension
• Sensitivity to the drug
ADVERSE REACTIONS:
• Tachycardia
• Palpitations
• Paradoxical bronchospasms
• Exacerbation of angina
• Anxiety
• Hypertension
• Palpitations
DOSAGE:
ADULT:
• One dose vial (2.5mg in 3 ml NS) nebulized
PEDIATRIC:
• Remove 1.5 ml of solution, replace with 1.5 ml of NS to half concentration
ROUTE:
• Nebulizer at 6 liters per minute
HOW SUPPLIED:
• 2.5 mg in a 3 ml vial - SODIUM BICARBONATE
-
ACTION:
Alkalinizing agent used in the treatment of metabolic acidosis.
INDICATIONS:
• Any life – threatening acidosis
• Cardiac Arrest (after defibrillation, airway management, and other pharmaceutical interventions) Rarely administered in the first 10 minutes of resuscitation
• Tricyclic antidepressant overdose
• Known hyperkalemia
• Phenobarbital overdose
CONTRAINDICATIONS:
• Respiratory acidosis
PRECAUTIONS:
• Possible fluid overload in patients with a history of heart failure
• Precipitates calcium chloride
• Inactivates catecholamines
ADVERSE REACTIONS:
• Metabolic alkalosis
• Tissue necrosis if the IV infiltrates.
DOSAGE:
ADULT/PEDIATRIC:
• 1Meq/kg of 8.4% repeated in 10-15 minutes if necessary at 0.5Meq/kg
INFANT:
• 2Meq/kg of 4.2% repeated in 10-15 minutes if necessary at 1Meq/kg
ROUTE:
• Intravenously and Intraosseous.
HOW SUPPLIED:
• 8.4% - ADULT: 50 Meq in 50 ml, in a pre-filled syringe.
• 4.2% - INFANT: 5 Meq in 10 ml, in a pre-filled syringe. - THIAMINE: (Vitamin B1)
-
ACTION:
Thiamin is a necessary component for carbohydrate metabolism. Certain states such as alcoholism and malnourishment may affect the intake, absorption, and utilization of glucose.
INDICATIONS:
• Coma of unknown origin, especially if alcohol may be involved, with Thiamine given prior to glucose administration
• Delirium tremors, with Thiamine given prior to glucose administration
CONTRAINDICATIONS:
• Hypersensitive reaction to Thiamine
PRECAUTIONS:
• Thiamine should be administered prior to the administration of glucose
ADVERSE REACTIONS:
• Allergic reaction
DOSAGE:
• 100 mg
ROUTE:
• IV, IM
HOW SUPPLIED:
• 100 mg in a 1 ml vial
• 200 mg in a 2 ml vial
VALIUM: (Diazepam
ACTION: (Benzodiazepine)
Valium is a central nervous system depressant, anticonvulsant, sedative and hypnotic medication. Valium is the principal anticonvulsant used in the prehospital setting. It suppresses the spread of seizure activity through the motor cortex of the brain. It does not appear to abolish the abnormal discharge focus.
Peek effects of Valium are seen 5 to 10 minutes after administration.
INDICATIONS:
• Major motor seizures
• Status epilepticus
• Conscious sedation prior to cardioversion
• Muscle spasms
• Delirium tremors associated with acute alcohol withdrawal
• Acute anxiety states
CONTRAINDICATIONS:
• History of hypersensitivity to Valium
PRECAUTIONS:
• Respiratory depressant effects are more pronounced when patient has ingested alcohol or other CNS depressant agents
• Because Valium is a relativity short acting drug, seizure activity may recur
• Administer slowly until desired effects are obtained (1ml per minute)
ADVERSE REACTIONS:
• Respiratory depression
• Hypotension
• Bradycardia
DOSAGE:
ADULT:
• Sedation, seizures and muscle spasms - 5 to 10mg, at a rate of 5mg/minute, if more is required contact ED Physician
PEDIATRIC:
• 0.2mg/kg at a rate of 1mg/min
ROUTE:
• IV, IM, rectal
HOW SUPPLIED:
• 10 mg in a 2 ml vial - VASOPRESSIN: Pitressin
-
ACTION: (Hormone)
The mechanism of action of Vasopressin during cardiac arrest is poorly understood. Hemodynamic measurements suggest it causes profound shunting of blood to the myocardium and brain and away from the muscles and skin. This may be mediated by the release of nitric oxide. In the brain Vasopressin provides significantly more perfusion during cardiopulmonary resuscitation than epinephrine, perhaps secondary to nitric acid release.
Unlike epinephrine, Vasopressin continues to cause intense vasoconstriction in the presence of the severe acidosis that accompanies cardiopulmonary arrest. Vasopressin possesses a longer duration of action than epinephrine. Unlike epinephrine, which significantly increases myocardial oxygen consumption via ß1-adrenergic receptor activation, Vasopressin enhances myocardial oxygen delivery and may increase cardiac contractility, without the marked increased in oxygen consumption observed with catecholamines.\"
INDICATION:
• Refractory Ventricular Fibrillation
• Pulseless Ventricular Tachycardia
• May be useful for hemodynamic support in vasodilatory shock (septic or anaphylactic shock)
CONTRAINDICATIONS:
• Known hypersensitivity to the drug
• Responsive patients with known coronary artery disease
PRECAUTIONS:
• Potent peripheral vasoconstrictor.
• Increased peripheral vascular resistance may provoke cardiac ischemia and angina
ADVERSE REACTIONS:
• Local or systemic allergic reactions
DOSAGE:
• Ventricular Fibrillation: 40 units, administered one time only
• Pulseless Ventricular Tachycardia: 40 units, administered one time only
• The half-life of Vasopressin is 10-20 minutes.
ROUTE:
• IV
HOW SUPPLIED:
• 20 units in a 2ml vial - Midazolam: VERSED
-
ACTION:
Versed is a potent, but short-acting benzodiazepine with strong hypnotic and amnestic properties. It is widely used as a sedative prior to cardioversion and intubation. Versed is 3-4 times more potent than Valium, with a 1.5 minute onset of action when administered intravenously and 15 minutes when administered intramuscularly. Versed has impressive amnestic properties making it the drug of choice for conscious sedation. Like all benzodiazepine class drugs, Versed is a central nervous system depressant.
INDICATIONS:
• General anesthesia
• Conscious sedation of patients prior to short-term invasive procedures (intubation, cardioversion, etc.)
• Versed may be used as a 2nd line drug in seizures, where Valium does not work (in adults only)
CONTRAINDICATIONS:
• Not to be used in pediatrics for seizure control
• Hypersensitivity to the drug
• Narrow-angle glaucoma
• Obstetrical patients in the last few weeks of pregnancy
PRECAUTIONS:
• A slight to moderate decrease in mean arterial pressure, cardiac output, systemic vascular resistance and heart rate may be seen
• Lower dosages should be considered in patients that are debilitated or chronically ill
ADVERSE REACTIONS:
• Respiratory depression
• Laryngospasm
• Bronchospasm
• Respiratory depressant effects are more pronounced when patient has ingested alcohol or other CNS depressant agents
DOSAGE:
• Conscious Sedation: 2 mg slow IV push, repeat as necessary in boluses of 0.5–2mgs, titrated to the desired level of sedation, do not exceed a total dosage of 10mgs IV.
• Seizures 2-5 mgs IV (in adults only).
• Additional dosages may be titrated to achieve the desired level of sedation.
NOTE: You may dilute 5mg of Versed in 9cc of saline to result in a 0.5mg/cc concentrated.
ROUTE:
• IV, IM
HOW SUPPLIED: 5 mgs in a 1ml vial - DEXTROSE: (D50/D25)
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ACTION:
Dextrose in water supplies supplemental glucose in cases of hypoglycemia. D-50% is a hypertonic solution primarily used to elevate the blood sugar. It may be used to initially decrease intracranial pressure.
INDICATIONS:
• Hypoglycemia
• Coma of unknown origin
• Cardiac arrest
• And in rare instances cerebral edema
CONTRAINDICATIONS:
• Patients with increased ICP or intracranial hemorrhage
PRECAUTIONS:
• Perform a glucometer check and draw a blood tubes prior to administration, if possible
• Localized venous irritation and tissue necrosis may result from infiltrated line
ADVERSE REACTIONS:
• Hyperglycemia
• Thrombophlebitis
DOSAGE:
ADULT:
• 25 grams of D50
PEDIATRIC:
• 0.25 - 0.5 gm / kg of D25
ROUTE:
• IV
HOW SUPPLIED:
• D-50 - 25 grams glucose in a 50 ml pre-filled syringe.
• D-25 - 2.5 grams of glucose in a 10 ml pre-filled syringe. - Calcium Chloride: Calcium Gluconate
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T/C:electrolyte
MOA:Increases extracellular and intracellular calcium levels, Increases cardiac contractile state (positive inotropic effect) May enhance ventricular automaticity
I:Acute hypocalcemia, Calcium channel blocker OD, Acute hyperkalemia, Hypermagnesemia
C/I:Hypercalcemia, Concurrent digoxin therapy
Dose:5-10 ml (0.5-1 Gm) of 10% calcium chloride
Carried:1 Gm/10 ml prefilled syringes (1-2 vials)