Drugs

Question 1

Asystole/PEA

Answer 1

• Epi 1/10,000 1mg iv/io bolus

- Sodium Bicarb(Md) 50mEq iv/io bolus

Question 2

Vfib/Vtach

Answer 2

-Epi 1/10,000 1mg iv/io bolus
-Amiodarone 300mg(1st round iv/io slow push
150mg(2nd round)
-Consider Sodium Bicarb 50mEq
-Consider Mag Sulfate 2grams
-Lidocaine(Md) 1.5mg/kg bolus or infusion

Question 3

Return Of Spontaneous Circulation

Answer 3

-Amiodarone (if patient was in VF/Vtach)
150mg in 100ml Norm. Saline over 10mins via 10gtts set.

-Chilled Normal Saline 30ml/kg up to 2 liters

• Fentanyl (shivering) 50mcg x 5mins (SBP>100)
• Versed(sedation) 2.5mg x 5mins(SBP>100)
• Fentanyl may be used if SBP drops below 100, but is greater than 80, with MD order.
• Vecuronium (MD) 0.1mg/kg, max 10mg to manage airway in presence of advanced airway
• Additional Amio or Lidocaine with MD order
• Dopamine with MD order
• Nitro .4mg (MD) if SBP is >200
• Metoprolol (MD) 5mg IV over 5mins max 4 doses.

Question 4

Acute Coronary Syndrone

Answer 4

• Baby Aspirin 324mg chewable
• Nitro .4mg SL x 5mins , 3 dose max, with SBP >120 or MAP >80
• 250ml bolus Norm Saline if SBP <100

Question 5

STEMI

Answer 5

• Baby Aspirin 324mg chewable
• Nitro .4mg SL x 5mins , 3 dose max, with SBP >120 or MAP >80 (use caution with right side stemi, leads II,III, avF)
• 250ml bolus Norm Saline if SBP 80 and BP >120/MAP >80, max 3 doses.

Question 6

Cardiogenic Shock (STEMI with SBP <90)

Answer 6

• Baby Aspirin 324mg chewable
• 250ml bolus Norm Saline, up to 2 Liters
• Dopamine (if unstable) 5 mcg/kg/min
• Dopamine(MD) up to 20mcg/kg/min

Question 7

Wide Complex Tachycardia

Answer 7

• Cardiovert if unstable, if rhythm converts Amiordarone 150mg in 100ml Normal Saline via 10gtts/set over 10mins
• If stable Amiordarone 150mg in 100ml Normal Saline via 10gtts/set over 10mins
• Adenosine(MD) 6-12mg IV push with rapid flush
• Lidocaine(MD) 1.5mg/kg IV
• Repeat Amio(MD) same dose
• Magnesium 2gm IV over 20 min(stable) or 2min(unstable)

Question 8

Narrow Complex Tachycardia

Answer 8

• Vagal Maneuvers
• Adenosine(regular rate) 6mg, then 12mg IV push with rapid flush
• Diltiazem(stable irregular rate) .25mg/kg IV up to 25mg
• Synchronized cardioversion(unstable irregular rate)
• Additional Adenosine(MD)
• Additional Diltiazem(MD)
• Metoprolol(MD) 5mg slow IV push
• Amiodarone(MD) 150mg in 100ml Normal Saline via 10gtts/set over 10mins

Question 9

Bradycardia

Answer 9

• Atropine .5mg IV x 3min up to 3mg.
• Consider Pacing if unstable
• Dopamine 5mcg/kg/min
• Dopamine (MD) up to 20mcg/kg/min
• Epinephrine (MD) 1mg in 100ml NS at 5mcg/min

Question 10

Agitated Patient Restraint/ Excited Delerium

Answer 10

• Versed (patient age less than 70) 2.5mg IV or 5mg IM or IN, repeat once in 5 mins.
• Additional Versed(MD)

Question 11

Nausea/Vomitting

Answer 11

• 500 ml NS bolus IV, repeat if L.S. remain clear
• Zofran 4mg PO, IV or IM, may repeat once in 10mins
• Versed(MD)
• Diphenhydramine(MD) 12.5IV or 25mgIM

Question 12

Pain Management

Answer 12

• Morphine 2.5 or 5mg IV OR 5 or 10mg IM (may be repeated in 5 min with total not to exceed 10mg)
• Fentanyl 25 or 50mcg slow IV,IM, or IN ( may be repeated in 5 min with total not to exceed 100mcg)
• Ondansetron (zofran) 4 mg IV or IM as needed for nausea
• Additional Morphine IV/IM (MD)
• Additional Fentanyl IV/IM/IN (MD)
• Additional Ondansetron (Zofran) IV/IM (MD)
• Midazolam (versed) IV/IM/IN
• Ketorolac 30mg IV/IM
• Diphenhydramine (Benadryl) 25 or 50mg IM/IV for histamine reaction (MD)

Question 13

Procedural Sedation

Answer 13

• Etomidate 0.1 mg/kg IV for cardioversion or other brief intervention (may not be administered more than once)
• Midazolam (versed) 2.5 mg IV or 5 mg IM/IN for transcutaneous pacing or post-intubation. May be repeated every 5 min at needed if SBP >100 or MAP >65
• Etomidate 0.3 mg/kg for intubation ONLY (MD)
• Morphine IV/IM (MD)
• Fentanyl IV/IM/IN (MD)
• Midazolam (Versed) IV/IM/IN (MD)

Question 14

Allergic Reaction and Anaphylaxis

Answer 14

• Epinephrine 1:1,000 0.5 mg IM only is pt has hypotension develping respiratory distress.
• Albuterol 2.5 mg in 3 mL (unit dose) mixed (w/ atrovent) in nebulizer may repeat to a total of 3 doses for wheezing
• Atrovent 0.5 mg in 2.5 mL (unit dose) mixed (w/ albuterol) in nebulizer may repeat to a total of 3 doses for wheezing
• Diphenhydramine (Benadryl) 50mg IM/IV
• Methylprednisolone (Solu-Medrol) 125 mg IV
• Additional Albuterol via nebulizer (MD)
• Dopamine infusion 5-20 micrograms/kg/min(MD)
• Epinephrine infusion (1mg in 100 mL Normal Saline) at 5 micrograms/min (MD)

-No IV epinephrine without online medical control.

Question 15

Diabetic Emergencies

Answer 15

• Give oral glucose (15-24 grams) if suspect pt glucose to be low and can swallow
• If below 80 and cannot swallow administer Dextros 10% 250 mL, up to 25 gm. May redose if hypoglycemia recurs.
• if glucose is above 400 administer normal saline 250 mL bolus

-Unable to obtain vascular access Glucagon 1 mg IM

• Additional NS IV bolus if pt is hyperglycemic
• Additional Dextrose 10% if pt is hypoglycemic

Question 16

Seizure

Answer 16

• Cardiac Monitor
• Midazolam (versed) 2.5 mg IV or 5 mg IM/IN may be repeated x1 in 5 min
• Magnesium 4 grams IV over 2 min if Pt is pregnant (MD)
• Additional Midazolam (versed) 2.5 mg IV or 5 mg IV/IM/IN (MD)