AEMT meds Flashcards
Cetacaine
Topical anesthetic (benzocaine, aminobenzoate and tetracaine)
Dont use if pt is allergic and dont use with other meds
Use caution with pts <2yo and elderly pts
Etomidate name and class
Name: Amidate
Class: Nonbarbiturate hypnotic, anesthesia induction agent, CNS depressant
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Etomidate indication contraindication
Indication: Sedation/Premedication for medication-facilitated intubation or procedural sedation
Contraindication: Hypersensitivity, labor/delivery, septic shock (particularly in children), Renal impairment (impairs RAAS)
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Etomidate action and side effects
Action: short-acting (effects last less than 10 minutes) hypnotic that acts at the level of the reticular activating system
Side effects: apnea, resp depression, hypoventilation, hyperventilation, dysrhythmias, hypotension, hypertension, nausea, vomiting, involuntary muscle movement, pain at injection site
Etomidate dosage and special considerations
Adult: 0.2 to 0.6 mg/kg IV over 30-60 seconds (typical adult dose is 20mg)
Pedi: 0.2 to 0.4 mg/kg IV/IO over 30-60 seconds for RSI (older than 10 years old), one time only. Max dose: 20mg
Special considerations: Use cation with pregnancy and weigh risks to the baby.
Consider lowering dosage in older pts and pts with cardiac conditions
Ketamine name and class
Name: Ketalar
Class: Sedative, general anesthetic, analgesic dissociative anesthetic
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Ketamine indications and contraindications
Indications: excited delirium, pain management, procedural sedation
Contraindications: hypersensitivity, conditions where hypertension would be hazardous to the pt’s care
Ketamine action and side effects
Action: blocks pain receptors and minimizes spinal cord activity, affecting the association pathways of the brain between the thalamus and limbic system
Side effects: hypertension, dysrhythmia, bronchodilator, resp depression
Ketamine dosage and special considerations
Adult: 1 to 2 mg/kg IV push over 1-2 minutes
Pedi: 1 to 2 mg/kg IV push over 1-2 minutes
- Starts taking effect after about 30 seconds
- Lasts about 5-10 mins
Special considerations: pts may have excessive drooling. Some pts may experience an emergence reaction after the full duration of the meds effect.
Midazolam name and class
Name: Midazolam hydrochloride, Versed
Class: Benzodiazepine, short/intermediate-acting; schedule IV drug
Midazolam indications and contraindications
Indications: Seizures, sedation for medical procedures, chemical restraint
Contraindications: Acute narrow-angle glaucoma, shock, coma, alcohol intoxication, overdose, depressed vitals. Concomitant use with barbiturates, alcohol, narcotics, or other CNS depressants
Midazolam action and side effects
Action: Reversibly interacts with GABA receptors in the CNS causing sedative, anxiolytic, amnesic, and hypnotic effects
Side effects: Headache, somnolence, resp depression, resp arrest, apnea, hypotension, cardiac arrest, nausea, vomiting, pain at the injection site
Midazolam dosage and special considerations
adult: - Seizures: 0.2 mg/kg IM or IN, max dose 10mg; 0.1 mg/kg IV, max dose 4mg.
- Procedural sedation: 0.5 to 2.5 mg IV. May be repeated to total max: 0.1mg/kg
- Chemical restraint: 5mg IV or IN; 5mg IM
Pedi: - Seizure: 0.1 to 0.3 mg/kg IV/IM (max single dose 10mg) 0.2 mg/kg IN
- Procedural sedation 0.05 to 0.5 mg/kg IV; 0.1 to 0.15 mg/kg IM; 0.3 mg/kg IN
Special considerations: Risk to Fetus needs to be considered before administering. Should not breastfeed after administration.
Administer immediately prior to intubation.
Decrease dose by 50% in older pts and in pts with hepatic and renal dysfunction.
IM and IN control seizures faster that IV if IV needs to be placed
Rocuronium name and class
Name: Rocuronium Bromide, Zemuron
Class: Nondepolarizing neuromuscular blocker
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Rocuronium indications and contraindications
Indications: RSI/DSI
Contraindications: Known sensitivity to bromides; use with caution in heart and liver disease
Rocuronium action and side effects
Action: Antagonizes acetylcholine at the motor end plate producing skeletal muscle paralysis
Side effects: Bronchospasm, wheezing, rhonchi, resp depression, apnea, dysrhythmias, tachycardia, transient hypotension and hypertension, nausea, vomiting
Rocuronium dosage and special considerations
Adult: 0.6 to 1.2 mg/kg IV/IO
Pedi (older than 3 months): 0.6 to 1.2 mg/kg IV/IO
Special considerations: always make sure to sedate pt before administration.
Decrease doses for pts with renal disease
Succinylcholine name and class
Name: Succinylcholine Chloride, Anectine
Class: Neuromuscular blocker, depolarizing; skeletal muscle relaxant
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Succinylcholine indications and contraindications
Indications: RSI/DSI
Contraindications: Acute narrow-angle glaucoma, penetrating eye injuries, malignant hyperthermia; acute injury after multisystem trauma, major burns, or extensive muscle injury that may result in hyperkalemia
Succinylcholine action and side effects
Action: Ultra-short-acting depolarizing skeletal muscle relaxant that mimics acetylcholine as it binds with the cholinergic receptors on the motor end plate, producing a phase 1 block as manifested by fasciculations
Side effects: Apnea, resp depression, dysrhythmia, cardiac arrest, salivation, prolonged muscle rigidity, rhabdomyolysis, malignant hyperthermia, increased intraocular pressure, hyperkalemia
Succinylcholine dosage and special considerations
Adult: 1 to 2 mg/kg rapid IV. Repeat once if needed
Pedi: 1 to 2 mg/kg rapid IV. Repeat once if needed
Special considerations: sedate pt before administration.
Time management is needed since such short-acting.
Vecuronium name and class
Name: Vecuronium Bromide, Norcuron
Class: neuromuscular blocker, nondepolarizing
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Vecuronium indications and contraindications
Indications: RSI/DSI
Contraindications: Acute narrow-angle glaucoma, penetrating eye injuries, inability to control airway or support ventilations with oxygen and positive pressure, newborns, myasthenia gravis, hepatic or renal failure
Vecuronium action and side effects
Action: Neuromuscular agent with intermediate duration of action that competes with acetylcholine for receptors at the motor endplate resulting in neuromuscular blockade
Side effects: weakness, prolonged neuromuscular block, bronchospasm, apnea, dysrhythmias, bradycardia, tachycardia, PVCs, transient hypotension, cardiac arrest, excessive salivation
Vecuronium dosage and special considerations
Adult: 0.1 to 0.2 mg/kg IV push. Maintenance dose within 45 to 60 minutes: 0.8 to 1.2 mg/kg IV push
Pedi: 0.1 to 0.3 mg/kg IV/IO. Maintenance dose within 20-40 minutes: 0.01 to 0.15 mg/kg IV push
Special considerations: Decrease doses for pts with renal disease
Acetaminophen name and class
Name: Tylenol
Class: centrally-acting analgesic, antipyretic
Acetaminophen indications and contraindications
Indications: reducing pain, reducing fever
Contraindications(/cautions): Hypersensitivity, hepatic impairment (liver failure), liver disease, renal impairment, hypovolemia, malnutrition, chronic alcohol use
Acetaminophen side effects
Side effects: anaphylaxis, skin reaction, hepatotoxicity (liver poisoning), renal tubular necrosis, nephropathy, anemia, thrombocytopenia, nausea, rash, headache
Acetaminophen dosage and special considerations
Adult (12 and older): 1-2 tabs/caps PO q4-6h prn; Max: 10 tabs/caps in 24h. Do not exceed 1g/4h and 4g/day
Normally is 325mg per tab/caps
Pedi (6-11): 1 tab/cap PO q4-6h prn; Max: 5 tabs/caps in 24h. Do not exceed 75mg/kg/day, up to 1g/4h and 4g/day
Special considerations: Can damage liver.
Butorphanol name and class
Name: Butorphanol Tartrate, Stadol
Class: Opioid agonist/antagonist
Butorphanol indications and contraindications
Indications: pain reliever
Contraindications: hypersensitivity, resp depression, asthma, GI obstruction, paralytic ileus, coma/impaired consciousness, labor and delivery
Butorphanol side effects
Side effects: Sedation, dissiness, nausea, vomiting, diaphoresis, headache, resp depression, resp arrest, apnea, central sleep apnea, hypotension, bradycardia, biliary spasm, adrenal insufficiency, seizures, anaphylaxis, Hypertension, dependency, abuse, withdrawal symptoms if stopped abruptly
Butorphanol dosage and special considerations
Adult: - Pain: 0.5-2mg IV q3-4h prn. Use lowest effective dose, shortest effective duration
- Anesthesia adjunct: 2mg IV x1 then 0.5-1mg IV prn before induction
Pedi: Not recommended
Special considerations: is an opioid so can be very addictive. Use caution when using on elderly pts.
Fentanyl name and class
Name: Fentanyl Citrate, Sublimaze
Class: Opioid analgesic, schedule 2 drug
Fentanyl indications and contraindications
Indications: Pain management, anesthesia adjunct
Contraindications: Known hypersensitivity. Use with caution in traumatic brain injury
Fentanyl action and side effects
Action: Binds to opiate receptors, producing analgesia and euphoria
Side effects: Confusion, paradoxical excitation, delirium, drowsiness, CNS depression, sedation, resp depression, apnea, dyspnea, dysrhythmias, bradycardia, tachycardia, hypotension, syncope, nausea, vomiting, abd pain, dehydration, fatigue
Fentanyl dosage and special considerations
Adule: 50-100 mcg (1 mcg/kg) IM and IV slow push (over 1 to 2 minutes) to maximum 150 mcg. IN is rapid push
Pedi: 1-2 mcg/kg IM, IV or IN slow push (over 1-2 mins).
Special considerations: The safety and efficacy in children younger than age 2 years has not been established. Chest wall rigidity possible with a high dose rapid infusion.
Ibuprofen name and class
Name: Advil, Motrin
Class: Non-steroidal anti-inflammatory drug (NSAID)
Ibuprofen indications and contraindications
Indications: For the acute management of pain or antipyretic
Contraindications: Aspirin allergy; preterm infants with untreated proven or suspected infection; bleeding with active intracranial hemorrhage or GI bleed; thrombocytopenia, coagulation defects, significant renal impairment, congenital heart disease
Ibuprofen action and side effects
Action: Pain reliever
Side effects: GI bleeding, GI perforation, GI ulcer, MI, Stroke, Hypertension, CHF, bronchospasm
Ibuprofen dosage and special considerations
Adult: 300-800 mg PO tid-qid (3-4 times a day)
Pedi: 6mo - 11yo: 5-10 mg/kg/dose PO q6-8h prn; Max 40mg/kg/day
12+yo: 200-400 mg PO q4-6h prn; Max: 1200 mg/day
Morphine name and class
Name: Morphine Sulfate, Roxanol, MS Contin
Class: Opioid analgesic; schedule 2 drug
Morphine indications and contraindications
Indications: Severe heart failure, acute cardiogenic pulmonary edema, chest pain associated with AMI, analgesia for moderate to severe acute and chronic pain
Contraindications: Head injury, exacerbated COPD, depressed respiratory drive, hypotension, undiagnosed abd pain, decreased level of consciousness, suspected hypovolemia, pts who have taken MAOIs within 14 days
Morphine action and side effects
Action: Alleviates pain through CNS action. Suppresses fear and anxiety centers in the brain. Depresses brainstem resp centers. Increases peripheral venous capacitance and decreases venous return. Decreases preload and afterload, which decreases myocardial oxygen demand.
Side effects: confusion, sedation, headache, CNS depressants, resp depression, apnea, bronchospasm, dyspnea, hypotension, orthostatic hypotension, syncope, bradycardia, tachycardia, nausea, vomiting, dry mouth
Morphine dosage and special considerations
Adult: STEMI: Initial dose: 2-4mg slow IV (over 1-5 mins) repeat dose: 2-8 mg at 5 - 15 mins intervals
NSTEMI/unstable angina: 1-5 mg IV push if symptoms not relieved by nitrates, use with caution
Pedi: 0.1-0.2 mg/kg per dose IV, IO, IM, subcutaneous. Max dose 5mg
Special consideration: use caution weighing risks and benefits during pregnancy.
Tranexamic Acid name and class
Name: Cyklokapron, Lysteda
Class: Hemostatic agent, antifibrinolytic, plasminogen inactivator
Tranexamic Acid indications and contraindications
Indications: Blunt or penetrating trauma less than 3 hours from onset with hemodynamic compromising, bleeding
Contraindications: Hypersensitivity, MOI greater than 3 hours; subarachnoid hemorrhage; history of PE, DVT, or other thromboembolic disorder
Tranexamic Acid action and side effects
Action: reduces plasminogen activation, mitigating conversion to plasmin
Side effects: fatigue, headache, abd pain, anemia, DVT, PE, other thromboembolic disorder. Rapid infusion may cause hypotension
Tranexamic Acid dosage and specific considerations
Adult: 1g IV over 10 minutes
Pedi: not recommended
Special considerations: Must be mixed into an infusion bag, typically 100ml of NaC1
