Drug Indications/Dosages Flashcards
Indications and Dosages
Acetaminophen
Indications:
Pain Management ADULT
-mild, mod, severe
Dose: 1,000mg slow IV drip over 15 min.
Pain Management PEDS
-mild, mod
Dose:
PDC in 100mL of NS slow IV drip over 15 min.
NOTE:
ADULT/PEDS
-Abdo
-Burns
-Envenomation
-Trauma
ADULT
-Cardiac Pain
-Cardiac Pacing
Adenosine (Adenocard)
Indications:
Arrythmias SVT Adult s-127
-stable symptomatic
Dose: 6mg rapid IV/IO followed by 20ml NS rapid IV/IO
12mg rapid IV/IO followed by 20ml NS rapid IV/IO MR x1
Arrhythmias SVT PEDS s-163
-stable symptomatic
Dose: PDC rapid IV/IO, followed with 20ml NS rapid IV/IO MR x2
Albuterol (Proventil, Ventolin)
Indications:
Resp. distress*
-suspected non-cardiac Adult
-With bronchospasm Peds
Allergic Reaction/Anaphylaxis*
-Anaphylaxis with resp. involvement
Burns
-resp. distress with bronchospasm
Dose:
Adult- 6ml via neb MR
Peds-PDC via neb MR
*Ipra added to first dose
PEA
-suspected hyperkalemia
PEA/Asystole
-Suspected hyperkalemia
Hemodialysis pt
-suspected hyperkalemia (Widened QRS complex or peaked T waves)
Trauma
-Crush injury requiring extrication with compression of extremity or torse greater/equal to 2 hours
-immediately prior to extremity release
Dose:
Adult-6ml via neb continuous
PEDS-PDC via neb continuous
Amiodarone Hydrochloride (Cardarone, Pacerone, Nexterone)
Indications:
CPR/arrhythmias VT adult/peds
-stable vt
Dose:
Adult- 150mg in 100ml of NS over 10 min IV/IO MR x1 in 10min
PEDS- PDC IV/IO BHPO
CPR/Arrhythmias Adjunct cardiac devices adult s-127
-reported witnessed AICD firing greater/equal to 2 and pulse above/equal to 60
Dose:
150mg in 100ml of NS over 10min IV/IO MRx1 in 10min
CPR/Arrhythmias Adjunct cardiac devices PEDS s-163
-reported witnessed AICD firing greater/equal to 2
Dose: PDC IV/IO MR BHPO
CPR/Arrhythmias VF/Pulseless VT
-persistent VF/Pulseless VT after 3 defib attempts
Dose:
Adult
-300mg IV/IO MR 150mg q3-5min
PEDS:
-PDC IV/IO MR PDC x2
Aspirin, ASA (Acetylsalicylic Acid)
Indication:
Discomfort pain of suspected cardiac origin (S-126)
Dose:
324mg PO
Atropine Sulfate
Arrhythmias: Unstable Bradycardia s-127 Adult
Dose: 1mg IV/IO MR q3-5min to max 3mg
Arrhythmias: Unstable Bradycardia s-163 PEDS
Infant/child <9 years with HR <60
Child 9-14 years HR <40
-after BVM for 30sec, AND
-CPR initiated if unconscious AND
-after 3rd dose of Epi
Dose: PDC IV/IO MR x1 in 5min.
Poisoning OD
-symptomatic organophosphate poisoning for continued s/s of SLUDGE/BBB
Dose:
Adult-2mg IV/IO MR at double previous dose IV/IO q3-5min
PEDs-PDC IV/IO MR at double previous dose IV/IO q3-5min
Calcium Chloride
Indications:
CPR/Arrhythmias: PEA Adult
CPR/Arrhythmias: PEA/Asystole Peds
-suspected hyperkalemia
Dose:
Adult-500mg IV/IO (Given before Bicarb) MR x1 in 5min for continued EKG findings of hyperk
PEDS-PDC IV/IO (Given before Bicarb) MR x1 in 5min for continued EKG findings of hyperk
Hemodialysis Pt
-suspected hyperk
-if widened QRS peaked T waves
Dose: 500mg IV/IO
Poisoning OD
-suspected calcium channel blocker OD with SBP<90
Dose: 20mg/kg IV/IO MRx1 in 10min
Trauma
-Crush injury requiring extrication with compression of extremity or torso greater/equal to 2 hours
Dose:
Adult-immediately prior to anticipated release 500mg IV/IO over 30 sec MR x1 in 5min for continued EKG findings consistent with hyperk
(PDC for PEDS)
Charcoal (Activated Charcoal)
Indications:
Poisoning / OD s-134
-ingestion with ANY of the following and within 60 min.s “SOAPBACCS” OR poison control
Dose: 50gm PO
Poisoning / OD s-165
-if ingestion within 60 min.s and recommended by poison control
Dextrose / Glucose (50%, D50 / 10%, D10, D10W)
Indications:
Altered Neurologic s-123 / s-161
-symptomatic hypoglycemia: with altered LOC or unresponsive to oral glucose agents
Doses:
Adult- D50 25gm IV, if pt remains symptomatic and BS remains <60mg/dl, MR
PEDS (<60, <45 for neonates)- D10 PDC IV, if pt remains symptomatic and BS remains <60mg/dl (<45 neonates), MR
Diphenhydramine (Benadryl)
Indications:
Allergic Reaction / Anaphylaxis s-122, s-162
-Allergic reactions (skin signs only)
-Anaphylaxis Treatment (after 1st Epi IM)
Poisoning / OD
-Extrapyramidal reactions
Dose:
ADULT- 50mg Slow IV/IM
PEDS- PDC slow IV/IM
Epinephrine Push-Dose
Indications: “D/PCRAnaSS”
Discomfort / pain of suspected cardiac origin with associated shock
-if BP is refractory to second bolus
CPR/Arrythmias Bradycardia
-if SBP <90 after atropine or initiation of pacing
ROSC s-127, s-163
-adult: SBP <90
-PEDS: unresponsive to fluid bolus and hypotensive for age
Shock s-138, s-168
-Adult: if BP <90 after second bolus
-Peds: hypotension for age after second fluid bolus
Sepsis s-143, s-177
-Adult: if BP<90 after fluid boluses
-Peds: if hypotensive for age after fluid bolus
DOSE:
adult- titrate to maintain BP >90, 1ml slow IV/IO MR q3 min
Peds- titrate to maintain adequate perfusion, PDC slow IV/IO MR q3 min
Anaphylaxis Adult/Peds
-severe anaphylaxis or inadequate response to treatment
Adult-titrate to maintain SBP >90 or improvement in status, 1ml slow IV/IO MR q3 min
PEDs- titrate to adequate perfusion or improvement in staus, PDC slow IV/IO MR q3 min
Epinephrine (Adrenalin, Epi)
Indications:
Anaphylaxis
-anaphylaxis treatment
Respiratory Distress
-severe resp. distress / failure OR inadequate response to neb treatments (ADULT: hx of asthma or suspected allergic reaction)
DOSE:
Adult- 0.5mg IM (1:1,000) MR x2 q5 min
Peds (Lat Thigh)- PDC IM (1:1,000) MR x2 q5 min
Resp Distress PEDS
-with stridor at rest
Burns PEDS
-resp. distress with stridor
DOSE:
PDC(1:1,000) via nebulizer (combined with 3ml NS) MR x1
if no improvement after Epi via neb x2 OR impending resp/airway compromise:
PDC(1:1,000) IM, MR x2 q3-5 min
CPR/arrhythmias
-cardiac arrest
DOSE:
adult-1mg IV/IO (1:10,000), MR q3-5min
Peds-PDC IV/IO (1:10,000), MR q3-5min
CPR/Arrhythmias PEDS s-163
-unstable bradycardia: if no increase in HR after 30 sec of BVM ventilations
DOSE: PDC IV/IO (1:10,000), MR x2 q3-5 min, MR q3-5 BHO
Newborn with HR <60
-with chest compression and BVM ventilations
DOSE: PDC IV/IO 1:10,000, MR q3-5 min
Fentanyl Citrate
Pain Management: Adults
-for mod or severe -for mild (1-3) if pt refuses or has contraindications to acetaminophen
-abdominal
-burns
-envenomation
-trauma
-discomfort/pain of suspected cardiac origin if BP greater/equal to 100
-external cardiac pacing with capture and BP greater/equal to 100
DOSE:
ADULT IV:
up to 100mcg IV
MR up to 50mcg IV q5 x2
Max total IV 200mcg
Pain Management: PEDS
-with signs of adequate perfusion
-for pain: mod or severe
-abdominal
-burns
-envenomation
-trauma
DOSE:
PEDS: <10kg
PDC IV/IN
MR BHO
PEDS: >10kg
PDC IV/IN
MR SO
Glucagon
Indications:
Altered Neurologic
-Unable to start IV in symptomatic hypoglycemia with altered LOC or unresponsive to oral glucose agents.
DOSE:
Adult BS<60- 1ml(1 unit) IM
PEDS BS <60 <45 neonates- PDC IM
Poisoning / OD
-suspected beta blocker OD with cardiac effects (e.g. bradycardia, with hypotension)
DOSE:
Adult- 1-5mg IV MR 5-10min for a total of 10mg
Ipratropium Bromide (Atrovent)
Indications:
Resp Distress
-suspected non cardiac adult
-with bronchospasm Peds
Allergic Reaction / Anaphylaxis
-anaphylaxis with resp. involvement
DOSE:
Adult- 2.5ml (0.02%) via nebulizer added to first dose of albuterol
Peds- PDC via nebulizer added to first dose of albuterol
Ketamine (Ketalar)
Indications:
Pain Management: Adults
-for mod or severe -for mild (1-3) if pt refuses or has contraindications to acetaminophen
-abdominal
-burns
-envenomation
-trauma
-discomfort/pain of suspected cardiac origin if BP greater/equal to 100
-external cardiac pacing with capture and BP greater/equal to 100
*Requirements for Ketamine
-over/equal to 15 YO
-AND GCS 15
-AND not pregnant
-AND no known or suspected alcohol or drug intoxication
DOSE:
IV Dosing: 0.3 mg/kg in 100ml of NS slow IV drip over at least 10 minutes (Max single IV dose 30mg)
MR x1 in 15 min if pain remains mod to severe
-total IV dose not to exceed 60mg
IN Dosing: 0.5mg/kg IN (50mg/kg concentration)
max dose for IN 50mg
MR x1 in 15 min if pain remains mod to severe
-Total IN dose not to exceed 100mg
Lidocaine (2% Xylocaine)
Indications:
>CPR/arryhthmias: VT (AdultPeds) - Stable VT
>Dose:
Adult - 1.5mg/kg slow IV/IO MR 0.5mg/kg IV/IO q8-10min to max 3mg/kg
Peds - PDC IV/IO BHPO
>CPR/arryhthmias: VF/Pulseless VT (AdultPeds) - Persistant after 3 defib attempts
>DOSE:
Adult - 1.5mg/kg slow IV/IO MR 0.5mg/kg IV/IO q5min to max 3mg/kg
Peds - PDC IV/IO MR PDC x1 q5min
>CPR/arryhthmias Adjunct Cardiac Devices Adult - Reported/witnessed AICD firing >2 with pulse >60
Adult - 1.5mg/kg slow IV/IO MR 0.5mg/kg IV/IO q8-10min to max 3mg/kg
>CPR/arryhthmias Adjunct cardiac devices Peds - reported/witnessed AICD firing >2
Peds - PDC IV/IO, MR BHPO
>ALS skills - Conscious patient prior to IO infusion
Adult Only - 40mg slow IO prior to fluid admin
Midazolam (Versed)
Indications:
>Altered Neurologic - Status epilepticus (generalized ongoing & recurrent seizures w/ no lucid interval)
Adults - Pt’s >40kg = 10mg IM Pt’s <40kg = 0.2mg/kg IM
if vascular access present = 0.2mg/kg IV/IO to max of 5mg MR x1 in 10min, max 10mg total, d/c if stops
Peds - PDC IM
if vascular access present = PDC IV/IO, MR x1 in 10min
>Altered Neurologic Seizures - Partial seizure lasting >5min
>Obstetrical Seizures - Eclampsia seizures
Adults - 0.2mg/kg IN/IM/IV/IO to max 5mg. MR x1 in 10min, max 10mg total. d/c if seizure stops
Peds - PDC IN/IM/IV/IO MR x1 in 10min
>Unstable Bradycardia - pre pacing
>Unstable SVT - pre sync cardioversion
>Unstable Afib/Aflutter - rate of >180, pre sync cardioversion
Adults - 1-5mg IV/IO
Peds - PDC IV/IO BHO for pacing, PDC IV/IO SO for cardioversion
>Pre-existing medical interventions - intubated pt’s with agitation and potential for airway compromise
Adults - 2-5mg IM/IN/IV, MR x1 in 5-10min
Morphine Sulfate
Indications:
>Pain Management Adult if Fent unavailable
>~For pain mod or severe
>~mild if pt has contraindications or refuses acetaminophen
>~Abdo, Burns, envenomation, trauma, cardiac pain if BP>100, Pacing pain w/ capture and BP >100
Adult IV - up to 0.1mg/kg IV, MR in 5 min at half initial IV dose(0.05mg/kg) MR in additional 5 min at half initial BHO
Adult IM - up to 0.1mg/kg IV, MR in 15 min at half initial IV dose(0.05mg/kg) MR in additional 15 min at half initial BHO
>Pain Management Adult if Fent unavailable
>~with signs of adequate perfusion
>~For pain mod or severe
>~Abdo, Burns, envenomation, trauma
Peds <10kg - PDC IV/IM, MR BHO
Peds >10kg - PDC IV/IM, MR
Naloxone (Narcan)
Indications:
>Poisoning OD and Altered Neurologic ADULT
>~Symptomatic suspected opiod OD with respiratory depression: (RR <12, SpO2 <96%, OR ETCO2 >40)
>Poisoning OD and Altered Neurologic Peds
>~Symptomatic suspected opioid OD with respiratory depression: (RR low for age, SpO2 <96%, OR ETCO2 >40)
DOSE:
Adult - 2mg IN/IM/IV, MR titrate IV dose to effect, to drive the resp. effort, titrate slowly in opioid dependant pain pt’s
OR 4mg IN nasal spray preloaded single dose device, MR, admin full dose in one nostril.
ADULT: If pt refuses transport
2mg IM additional dose OR 4mg IN nasal spray preloaded single dose device, admin full dose in one nostril.
*For pt’s and/or other individuals suspected of opioid use disorder, provide Leave behind naloxone kit with education per S-145, treat per S-145 participating agencies
Peds - PDC IN/IM/IV, MR, for opioid dependant pt’s, dilute and titrate slowly PDC
Nitroglycerin (NTG, Nitro)
Indications:
>Discomfort/pain of suspected cardiac origin S-126
Adult Only - If SBP >100 = 0.4mg SL MR q3-5min
>Resp distress: Suspected cardiac/CHF
>Hemodialysis: Fluid overload with Rales S-131
Adult Only - if SBP ≥100 but <150 = 0.4mg SL, MR q3-5min
if SBP ≥150 = 0.8mg SL, MR q3-5min
Ondansetron (Zofran)
Indications:
>ADULT Abdominal discomfort non-traumatic - for nausea and vomiting
Adult Only - 4mg IV/IM/ODT, MR x1 in 10min
>PEDS Abdominal discomfort GI/GU - for nausea and vomiting
Peds - ≥6 months IV/IM/ODT PDC
Sodium Bicarbonate (Bicarb, NaHCO3)
Indications:
>Adult CPR/Arrythmias: PEA - suspected hyperkalemia
>Peds CPR/Arryhthmias: PEA/Asystole -suspected hyperkalemia
Adult - 1mEq/kg IV/IO (After Calcium Chloride given)
Peds - PDC IV/IO (After Calcium Chloride given)
>Hemodialysis Pt - suspected hyperkalemia (Widened QRS or peaked T waves)
Adult - 1mEq/kg IV/IO (After Calcium Chloride given)
>Poisoning OD (Adults/Peds) - Suspected tricyclic antidepressant OD with cardiac effects (hypotension, heart block, or widened QRS)
Adult - 1mEq/kg IV/IO
Peds - PDC IV
>Trauma (Adults/Peds) - Crush injury requiring extrication with compression of extremity or torso ≥2 hours, immediately prior to anticipated release
Adult - 1mEq/kg IV/IO
Peds - PDC IV/IO
Tranexaic Acid (TXA, Cyklokapron, Lysteda)
Indications:
>Adult Trauma associated hemmorhage - Trauma associated hemorrhage <3 hours prior and at least one of the following: 1. SBP <90 2. Shock index ≥1 (HR ≥ SBP) 3. Uncontrolled external bleeding
Adult - 1gm/10ml IV/O, in 50-100mL NS, over 10min
>Post partum hemorrhage - if estimated blood loss ≥500mL, AND within 3 hours of delivery
Adult - 1gm/10ml IV/O, in 50-100mL NS, over 10min
