Drug Protocol Flashcards
ASYSTOLE - 2.2
Administer EPINEPHRINE as indicated below:
Adult patients: administer EPINEPHRINE 1:10,000 1.0 mg IV push; Repeat every 3-5 minutes ifasystole persists.
If unable to establish an IV, administer EPINEPHRINE 1:1,000 2.0-2.5 mg diluted in 10 mL
NORMAL SALINE by endotracheal tube. Repeat every 3-5 minutes if asystole persists.
Pediatric patients <16 years of age: administer EPINEPHRINE as indicated on Pediatric Dosing
Device (0.01 mg/kg), and repeat every 3-5 minutes as necessary.
BRADYCARDIA - Adult - 2.3
Atropine Sulfate I.V. Push or Diluted in 10mg of Normal Saline administer via E.T. Tube Rx: Dopamine Infusion Rx: Glucaon by I.M. Rx: Calcium Chloride by I.V.
BRADYCARDIA - Pediatric - 2.4
Epinephrine (Adrenalin) 1:10,000 by I.V. Epinephrine (Adrenalin): 1:1,000 via E.T. Tube Atropine Sulfate I.V. Push Rx: Glucagon by I.M. Rx: Calcium Chloride by I.V.
CHEST PAIN - 2.5
Acetyl-salicylic Acid (Aspirin) by P.O. Nitroglycerin by sub-lingual Aluminum Hydroxide (Mylanta) by P.O. Morphine Sulfate by I.V., I.M., or SQ. Rx: Dopamine Infusion Paramedic Rx Only: Epinephrine (Adrenalin) by I.V. Bolus with Dopamine
CHF - CONGESTIVE HEART FAILURE - 2.6 - Pulmonary Edema
Acetyl-salicylic Acid (Aspirin) by P.O. Albuterol by Nebulizer Nitroglycerin by sub-lingual Nitroglycerin Paste applied topically Ipratropium (Atrovent) by Nebulizer Rx: Dopamine Infusion Rx: Morphine Sulfate by I.V., I.M., or SQ.
Pulseless Electrical Activity -P.E.A. - 2.7
Epinephrine (Adrenalin) 1:10,000 by I.V. Push Rx: Sodium Bicarb by I.V. push Rx: Glucagon by I.M. Rx: Calcium Chloride by I.V.
S.T. Elevation Myocardial Infarction - S.T.E.M.I. - 2.8
Oxygen via Non-Rebreather Acetyl-salicylic Acid (Aspirin) by P.O. Nitroglycerine (NTG) by Sub-lingual or I.V. Rx: Dopamine &/or Rx: Epinephrine (Adrenalin) 1:10,000 by I.V.
Supra-ventricular - Tachycardia - S.V.T. - Stable Adult - 2.9
Oxygen via Non- Rebreather Adenosine (adenocard) by I.V. push followed by rapid flush. Rx: Diltiazem (Cardizem) by I.V. over 2 minutes. Only in Patients without C.H.F.! If systolic blood pressure falls below 100 mm-Hg. administer Calcium Chloride 500 mg. I.V. over 1-2 minutes.
Supra-ventricular - Tachycardia -SVT - Unstable Adult - 2.10
Highest concentration of Oxygen via airway adjunct & assist with ventilation as needed. Synchronized Cardioversion at 50 joules. If unsuccessful repeat at 100 joules, 200 joules, 300 joules, and 360 joules or maximum energy or manufacturers biphasic setting. I.V. of Normal Saline or Lactated Ringers at K.V.O. Adenosine (Adenocard) I.V. Push followed by rapid flush (less than 3 seconds). Rx: Diltiazem (Cardizem) by I.V. over 2 minutes. Only in Patients without C.H.F.! If systolic blood pressure falls below 100 mm-Hg. administer Calcium Chloride 500 mg. I.V. over 1-2 minutes. Paramedic Rx ONLY!: Verapamil, Amiodarone, or Amiodarone Infusion
Supra-ventricular - Tachycardia - S.V.T. - Stable Pediatric - 2.11
Oxygen via Non- Rebreather Synchronized Cardioversion at 0.5 to joules/kg. If unsuccessful repeat at 2 joules/kg, or manufacturers biphasic setting. I.V. of Normal Saline or Lactated Ringers at K.V.O. Rx: Adenosine (Adenocard) 0.2 mg/kg (max 1st dose 12 mg.) rapid I.V. Push (less than 3 seconds) followed by rapid flush 2 ml. of Normal Saline or Lactated Ringers.
Supra-ventricular - Tachycardia - S.V.T. - Unstable Pediatric - 2.12
Highest concentration of Oxygen via airway adjunct & assist with ventilation as needed. Rx: Adenosine
Ventricular Fibrillation (VF) & Pulseless Ventricular Tachycardia (VT) - VF/Pulseless VT - 2.13
If witnessed by ALS personnel DIFIBRILLATE within 30 seconds @ 360 joules for Adults monophasic or manufacturers biphasic setting. PEDIATRIC @ 2 joules/kg monophasic or manufacturers biphasic setting. All subsequent defibrillations @ 4 joules/kg monophasic or manufacturers biphasic setting. I.V. of Normal Saline or Lactated Ringers at K.V.O. Highest concentration of Oxygen via airway adjunct & assist with ventilation as needed. ADULT: Epinephrine (Adrenalin) 1:10,000 1.0 mg I.V. Push REPEAT: Every 3-5 minutes or until conversion PEDIATRIC: Epinephrine (Adrenalin) 1:10,000 0.01 mg/kg I.V. Push REPEAT: Every 3-5 minutes or until conversion. C.P.R. 30-60 seconds REPEAT/Start Defibrillations as noted above. If no conversion administer Lidocaine or Amiodarone I.V. Bolus Lidocaine Infusion Rx: Sodium Bicarbonate 1 mEq/kg I.V. Push followed by 0.5 mEq/kg I.V. Push every 10 minutes. Paramedic ONLY!: Magnesium Sulfate 1 mg I.V. Rx: Glucagon if Beta-blocker overdose is suspected. Rx: Calcium Chloride 1 mg I.V. if hyperkalemia or calcium blocker overdose suspected.
VT - Stable
Rx: Amiodarone
VT - Unstable
Rx: Amiodarone Rx: Lidocaine Bolus & Infusion Rx: Amiodarone Infusion Rx: Adenosine Rx: Glucagon Rx: Ca Cl
POISONING/OVERDOSE - 3.6
CONTACT POISON CONTROL & MEDICAL CONTROL - Activated Charcoal by P.O.
ANAPHYLAXIS/BEE STING - 4.3
Epinephrine (Adrenalin) 1:1,000 by I.M. Epinephrine (Adrenalin) 1:10,000 by I.V. over 5-10 Minutes Diphenhydramine (Benadryl) by P.O., I.M. or I.V. Hydro-cortisone Sodium Succinate (Solu-Cortef) by I.V. Rx: Dopamine infusion
DYSPNEA - S.O.B. - 4.5 - without airway obstruction
Epinephrine (Adrenalin) 1;1,000 by Nebulizer 5-15 minutes
IMPAIRED CONSCIOUSNESS - 4.7
Oral Glucose by P.O. Glucagon by I.M. Dextrose by I.V. Naloxone (Narcan) by I.M. or I.N. Thiamine (B1) by I.V. Push or I.M.
NEWBORN RESUSCITATION - 4.9
Epinephrine (Adrenalin) 1:10,000 by I.V.
SEIZURES/POSTICTAL STATE - Adult - 4.10
Oral Glucose by P.O. Glucagon by I.M. Thiamine (B1) by I.M. or I.V. Push Dextrose D50W by I.V. Naloxone (Narcan) by I.M. or I.N. Rx: Midazolam (Versed) by I.M. or I.N. Rx: Lorazepam (Ativan) by I.V. over 1 minute or I.M. Rx: Diazepam (Valium) by I.V. over 1 minute or P.R.
SEIZURES - Pediatric - 4.11
Oxygen highest concentration. Acetaminophen (Tylenol) by P.R. for temperature over 102 degrees. Oral Glucose by P.O. or Glucagon by I.M. if B.G. level is below 60 mg.dl. D25W by I.V. Rx: Midazolam (Versed) by I.M. or I.N. Rx: Lorazepam (Ativan) by I.V. over 1 minute or I.M. Rx: Diazepam (Valium) by I.V. over 1 minute or P.R.
SHOCK - 4.12.3
Rx: Dopamine Infusion If patient is wearing Medical ID that says ADRENAL INSUFFICIENCY administer Hydro-cortisone Sodium Succinate (Solu-Cortef) by I.V.
BURNS - 5.2
BURNS - 5.2 Epinephrine (Adrenalin) 1:1,000 by Nebulizer -For exposure to hydrofluoric acid apply Calcium Gluconate 2.5% topical gel to exposed area. - May also follow RI-OEMS 8.4 Patient Comfort - Pain Management
MAJOR INCIDENT - Nerve Agent - 6.6
Albuterol by Nebulizer & repeat every 5 minutes. Atropine by I.M. 2 PAM by I.M. Midazolam (Versed) by I.M. or I.V.
INTRAOSSEOUS INFUSION - I.O. - Advanced I.V. Access - 7.2
Lidocaine by I.O.
PATIENT COMFORT - 8.4 - Pain Management
Acetaminophen (Tylenol) by P.O. Morphine Sulfate by I.V. Naloxone (Narcan) by I.V. push, I.M., or I.N.
PATIENT COMFORT - 8.4.4- Nausea & Vomiting
Ondenasetron (Zofran) by I.M. or I.V. over 2-5 minutes
Acetaminophen / Tylenol
Use: Mild pain, fever management Dose: Adlt 650mg, Pedi 15mg per kg Route: PO,PR Onset: 30 min. Duration: 6-8 hrs. Contra: Active liver disease Permission: A
Activated charcoal / Acta-Char
Use: Absorption of ingested toxins Dose: Container full Route: PO Onset: 1 min. Duration: 4-12 hrs. Contra: None Permission: A
Albuterol / Ventolin
Use: Bronchodilator, Asthma Dose: 2.5 mg/ml Route: Inh neb Onset: 5 min. Duration: 3-6 hrs. Contra: None Permission: R
Aspirin / Bayer
Use: Mild pain, fever management, MI Dose: 160-325 mg/ml Route: PO Onset: 30 min. Duration: 3-6 hrs. Contra: Bleeding disorders Permission: A
Atropine / ATRO-pen
Use: Never agent antidote Dose: 2mg/ml Route: IM Onset: Immediate Duration: 2-6 hrs. Contra: None Permission: A (Mass Incident)
Calcium Gluconate
Use: Hydrofluoric acid burns Dose: 2.5% gel Route: Transdermal Onset: Immediate Duration: ? Contra: ? Permission: A
Epinephrine / EPI-pen
Use: Anaphylaxis Dose: Adlt 1:1000 0.3mg/ml, Children (25-50lbs.) 1:1000 0.2mg/ml, Pedi 1:1000 .01 mg/ml - 1.0mg/ml Route: IM Onset: Immediate Duration: 1-4 hrs. Contra: Tachycardia Permission: A (anaphylaxis), R (asthma)
Glucagon / Glucagen
Use: Hypoglycemia Dose: Adlt 1unit/1mg, Pedi 0.1 - 1mg Route: IM Onset: 4-20 min. Duration: 12-30 min. Contra: Pheochromocytoma Permission: R
Glucose Oral / gluctose
Use: Hypoglycemia Dose: 15 mg/ml Route: Buccal Onset: 30 mins. Duration: 1 hrs. Contra: Unconscious or unable to maintain airway. Permission: A
Naloxone HCI / Narcan
Use: Overdose Dose: Suspected overdose - 2.0mg/ml till 10.mg/ml Altered mental status - 0.mg/ml @ 1min till 2.0mg/ml Route: IM, IN Onset: 1-2min. Duration: 30-45min. Contra: known formula allergy Permission: R
Nitroglycerine (Pts own)
Use: Chest pain management Dose: 0.4 mg/ml (1 tablet or oral spray) Route: SL Onset: 1-3 mins. Duration: 30 - 60 mins. Contra: BP >90 Permission: R
Organophosphate (Auto injector) / 2 Pam (AJ)
Use: Never agent antidote Dose: Pen Route: IM Onset: Immediate Duration: ? Contra: ? Permission: A (Mass incident)