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Ems SOG > Drugs > Flashcards

Drugs Flashcards

1
Q

Epi 1:10,000

  • Arrest:
  • Peds Arrest and Brady
A
  • 1 mg IV/IO every 3-5 min

* Peds- Arrest and Brady= 0.01 mg/k every 3-5 min

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2
Q

Amiodarone:

  • Arrest
  • Post-Resus/Tachy
  • Peds
A
  • Arrest= 300mg IV/IO repeat once 150mg
  • Post-Resus/Tachy= 150mg/100ml NS over 10min
  • Peds-Pulseless VF/VT 5mg/k may repeat
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3
Q

Sodium Bicarbonate

  • Arrest:
  • Tricyclic Anti-depressant overdose:
  • Crush Injury:
  • Peds Arrest/ TCA overdose:
  • Peds Crush Injury:
A
  • Arrest/TCA= 1mEq/kg IV/IO
  • Crush= 50mEq w/ initial NS liter prior to removal
  • Peds Arrest/TCA= 1mEq/kg (max 50mEq)
  • Peds Crush= 1mEq/kg (max 50mEq) with initial NS liter prior to removalNote: only different is adult crush and ped crush when it comes to administration
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4
Q

Adenosine:

  • Stable SVT
  • Peds
A
  • SVT= 6mg rapid IV push; repeat once at 12mg

* Peds= 0.1mg/kg (max 6) may repeat once 0.2mg/kg (max 12)

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5
Q

Epi 1:1000

  • Asthma & Allergic/ sever distress
  • Brady/Hypotension
  • Peds Asthma & Allergic/ sever distress
  • Peds Croup
A

•Severe Distress= 0.3-0.5mg IM
(0.3mg =>50)

•Brady/Hypotension= 2-10mcg/min 1mg mixed in 100cc NS refractory to everything

•Peds Asthma & Allergic= 0.01mg/kg
IM (max 0.3mg) may repeat 15 min for allergic

•Peds Croup= 0.5mg in 5ml NS/ nebulizer

Note: Peds Asthma/ sever epi is first; Peds allergic reaction/ severe albuterol and atrovent is first then epi
Adult= epi is first on both sever distress

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6
Q

Atropine:

  • Unstable Brady
  • Post-Resus Brady w/ hypotension
  • Organo
  • Peds Organo
A

•Unstable Brady= 1mg IV IO may repeat once in 3 to 5 min

•Post-Resus Brady w/ Hypotension=
0.5mg IV IO repeat every 5 min to max 3mg

  • Organo= 2-4 mg every 3-5 min until dry
  • Organo Peds= 0.05mg/kg max single 2mg

•precautions: ~acute myocardial infarction MI
~wide complex atria-ventricular blocks
~slow administration
~doses less than 0.5mg

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7
Q

Magnesium Sulfate (Mag):

  • Arrest/ Torsade de pointes, Polymorphic V-Tach, Refactory V-fib/V-tach
  • Asthma/COPD
  • Eclampsia (seizure)
  • Peds Arrest
  • Peds Asthma
A
  • Arrest= 2g IV/IO
  • Asthma/COPD= 2g in 100ml NS over 5 min
  • Eclampsia= 4g IV/IO
  • Peds Arrest= 50mg/kg IV/IO max single 2g
  • Peds Asthma= 50mg/kg 100ml NS o/ 10min
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8
Q

Solu-Medrol:

  • COPD
  • Asthma
  • Allergic Reaction
  • Peds
A
  • Adult= 125mg IV/IO/IM

* Peds= 2mg/kg IV/IO/IM max 125mg

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9
Q

Albuterol

  • COPD
  • Asthma
  • Respiratory Distress
  • Allergic Reaction/ Anaphylaxis
  • Peds
A
  • Adult= 5mg repeat once
  • Peds= 5mg repeat once
  • Peds under 10Kg= 2.5mg

:Note- in Respiratory Distress it say known or suspected pneumonia(fever, decreased long sounds, and/or cough) Albuterol and Atrovent

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10
Q

Atrovent:

  • COPD
  • Asthma
  • Respiratory Distress
  • Allergic Reaction
  • Peds
A

•0.5 mg w/ albuterol one dose

~ same on all!!!!!

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11
Q

Benadryl:

•Allergic Reaction/Anaphylaxis:
    ~mild 
    ~moderate 
    ~moderate w/ respiratory compromise 
    ~severe/ Anaphylaxis

•OD/poisoning:
~ acute Dystonic Reaction to Anti-
psychotics

•Peds

A
  • Adult= 25mg IV/IM

* Peds= 1mg/kg IV/IO/IM single max 25mg

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12
Q

Thiamine:

•Alcohol Related Illness:
~alcohol syndrome and
~malnourished

A

•100mg IV/IM

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13
Q

Nitroglycerin (NTG):

  • Chest Pain
  • Acute Heart Failure Pulmonary EdemaNote: consider withholding if PT is 30y or younger without Acute Coronary Syndrome symptoms
A

•Chest Pain= 0.4 mg SL every 5min until pain is resolved or systolic B/P drops below 110

•Acute Heart Failure Pulmonary Edema= 
  ~normotensive(SBP=>110)or hyper 
  ~ 0.4mg SL every 5 min until....
  ~ if CPAP in place apply 1inch Nitropaste 
     to PT left anterior chest  
•Note: contraindications: 
   ~ systolic B/P <110 
   ~ hypovolemia 
   •Precautions: 
      ~ drop in Sys B/P of 20 or more 
      ~ erectile within 24 to 72 hours 
      ~ inferior MI hypotension may result 
      ~ hypotension wipe off paste
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14
Q

Normal Saline:

  • Arrest
  • Hypotension/ Tachy
  • Diabetic BGL>300
  • Chest Pain/ inferior MI prior to NTG
  • Chest Pain/ if prior to Dopamine
  • Peds Arrest
  • Peds Croup
  • Peds Diabetic BGL>300
A 
•Arrest= 20ml/kg max 2L
•Hypotension/Tachy= 20ml/kg 
   SBP of 90
•Diabetic= 20ml/kg max2L
•CP/Inferior MI= 20ml/kg max2L
•CP/prior to dop= NS bolus of 250ML repeat up to 1L to maintain SBP of 90, if PT develops pulmonary edema stop and administer Dopamine
•Peds= 20ml/kg max2L
•Peds Croup= 5ml nebulized 
•Peds Diabetic= 2ml/kg
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15
Q

Dextrose:

  • D50
  • D25
  • D10
A

•D50W 25 grams BGL below 60 after 5min below 50 repeat D50W 12.5g
~stroke BGL below 50 12.5g
Repeat after 5min if below 60
~Adolescent(13-18) D50W 1ml/kg <60

•D25W 2ml/kg= infant/child(1month-12y)
~BGL <60
•D10W 5ml/kg= neonate (0-1month)
~BGL <45

Note: no improvement <50 repeat appropriate dextrose for Pediatric PT

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16
Q

Narcan:

  • Arrest
  • OD/Poisoning w/ respiratory depression
  • Peds Arrest
  • Peds OD/ w/ respiratory depression
A
  • Arrest= 1-2mg IV/IO/IM max 2mg
  • OD w/ resp. dep.= 0.4mg repeat in 2min max total 1mg
  • Peds Arrest= 0.1mg/kg max 2mg
  • Peds OD/ w/ resp. dep.= 0.1mg/k (max single dose 1mg)
17
Q

Dopamine: first line medication for Cardiogenic Shock (pulmonary edema w/ hypotension

  • Acute Heart Failure Pulmonary Edema/ hypotension SBP<90
  • Bradycardia/ if atropine or pacing does not improve BP (SBP <90) & Post-Resuscitation
  • Spinal Trauma/ after 1L NS hypotension persist and neurogenic shock is suspected
  • Chest Pain/ if PT develops pulmonary edema
  • Beta blocker overdose
  • contraindications:
A
  • Acute HFPE= hypo may indicate cardiogenic shock 5-10mcg/kg/min IV titrate to effect
  • Brady= 5-10mcg/kg/min IV/IO titrate to effect
  • Spinal Trauma= 5-10mcg/kg/min IV/IO
  • Chest Pain= 5-10mcg/kg/min IV titrate to effect

•contra. Hypovolemic shock,
Tachydysrythmias

  • Beta blocker OD= if hypotension after 500 ML fluid administration 5-10mcg/kg/min titrate to SBP of 90
  • Calcium Channel Blocker toxicity: use dopamine after Calcium Chloride if hypotensive after 500 ML of fluid
  • precautions: PT’s receiving monoamine oxidase inhibitors
18
Q

Calcium Chloride:

•Arrest H’s and T’s
~ hyperkalemia in dialysis PT’s
~ Calcium channel blocker OD

  • Overdose/ calcium channel blocker
  • Crush injury/ peaked T waves or wide QRS
A

•on all cases 5mg/kg (max dose 500mg)

19
Q

Glucagon:

  • Hypoglycemia
  • Peds Hypo
A

No IV access BGL<50

  • adult 1mg IM
  • Peds 20kg or greater 1mg IM
  • Peds <20kg 0.5mg IM
  • considerations: onset 1min; peak onset 30; most PT’s awake at 15min; repeat BGL after 15min
20
Q

Glucose paste:

•Conscious and Alert PT w/ BGL less than 60

A

•glucose paste 15 grams(1tube)
may repeat once in 20 min if BGL is still below 60

•contra: altered level of consciousness
Difficulty swallowing

21
Q

Aspirin:

  • Chest Pain
  • contraindications
A

•Chest Pain 324mg PO

•Chest Pain w/ history of GI bleed
~ consider half 162mg

•contra: Active GI bleed; allergies to salicylates

•precautions: use of anticoagulant;
~pregnancy: w/ ST elevation give ASA, withhold if no ST elevation

22
Q

Neo-Synephrine:

  • Nose Bleed
  • Contraindications
A

•2 gtts in affected nostril

•contra: nose bleed secondary to hypertension (BP=>160/110)
Nose bleed secondary to head injury and CSF drainage and hypersensitivity

23
Q

Tetracaine:

•contraindications

A

•Chemical/Irritant Exposure(i.e.pepper spray, tear gas)
~ 2 drops to each eye before and after irrigation, may repeat every 10 minutes

•contra: known hypersensitivity or other ophthalmic anesthetic and open ocular Trauma

24
Q

Phenergan:

•Contraindications

A

•Nausea/ Vomiting
~gastrointestinal related
•12.5mg IV diluted 100ml of NS
infused over several min 60gtt/set
•>64 years old 6.25mg
• may repeat once after 15min if vomiting
Persist

Contra: Pediatric patients

25
Q

Midazolam:

  • sedation
  • seizures
  • greater than 64
  • peds
A
  • sedation= 2-5mg Increments slow IV
  • seizures= 2-5mg IV/IO/IM
  • > 64= 2mg increments
  • peds= 0.1mg/kg IV/IO/IM (max 4mg)

•contra: intolerance to benzodiazepines
~ hypotension
Note:it say a lot, not every time! If not successful at completing sedation post etomidate systolic BP greater than 110 administer midazolam!
~ Pediatric nonfatal drowning it says the same thing but instead of 110 it’s 100!! Only one to do this!

26
Q

Ketamine:

  • intubation
  • Sedation for cardiovert & pacing
  • Excited Delirium/ Combative
  • Peds
A
  • Intubation= 2mg/kg IV/IO
  • Sedation= 2mg/kg IV
  • E-D/ Combative= 4mg/kg IM
  • Peds= 2mg/kg IV/IO over 1min
27
Q

Etomidate:

  • Intubation
  • Peds
A
  • Intubation= 0.5mg/kg slow IV push over 30 seconds
  • Peds= 0.5mg/kg slow IV push

Note: peak effect 1min; duration 3-5min
~ wait 1min before trying to intubate

28
Q

Fentanyl:

  • Burns/Electrical
  • Trauma/Crush
  • Chest Pain
  • Peds Trauma/Crush
  • Contraindications
A
  • Burns/Electrical= 1-2mcg/kg IV max single 200mcg
  • Trauma/ Crush= 1mcg/kg IV max single 100mcg (max total 200mcg)
  • Chest Pain= 1mcg/kg slow IV max single 100mcg
  • Peds Trauma/Crush= 1mcg/kg max single dose 100mcg (max total 200mcg)
  • Peds Burns= 1mcg/kg

•Contra: Hypotension(SBP<90)
Respiratory depression

•precaution: rapid administration may cause chest wall rigidity

29
Q
  • Ibuprofen

* Acetaminophen

A
  • Pediatric fever >102.0 and the parent has them
  • Ibuprofen= 10mg/kg not for children under 6
  • Acetaminophen= 15mg/kg
30
Q

Anti-psychotics acute dystonic reaction?

Beta-Blocker OD?

Calcium channel blocker toxicity?

Tricyclic Anti-Depressant OD w/ hypotension, seizures, ventricular arrhythmias, or a wide QRS complex?

A
  • Benadryl
  • Dopamine
  • Calcium Chloride and Dopamine if hypo
  • Sodium Bicarbonate
31
Q

Peds drugs that are 0.1mg/kg:

~MAN

A
  • Midazolam= max 4
  • Adenosine= (max 6) repeat once 0.2
  • Narcan= arrest (max 2mg) Respiratory distress max 0.4
32
Q

Peds drugs that 1mg/kg:

~Bull Shit! God Damnit! Fuck!

A
  • Benadryl= max single 25mg
  • Sodium Bicarb= Crush 1mEq/kg w/ initial NS liter prior to removal, Peds arrest same
  • Glucagon= 20kg or greater, 0.5 if less
  • Dextrose= adolescent 1ml/kg D50 (max25g)

•Fentanyl= trauma/ crush// crush 1-2 mcg/kg
~ it is mcg/kg!!

Ems SOG (5 decks)

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