Medications Flashcards
1
Q
Acetaminophen - Indications (2)
A
Patients 3 months and above with:
(1) Mild to moderate discomfort
(2) Fever (Greater than 100.4F)
2
Q
Acetaminophen - Contraindications (9)
A
(1) Head Injury
(2) Hypotension
(3) Administration of Acetaminophen within previous 4 hours
(4) Inability to swallow
(5) Respiratory Distress
(6) Persistent vomiting
(7) Known or suspected liver disease
(8) Allergy
(9) Patients <3 mos
3
Q
Acetaminophen - Dosage
A
(1) < 3 mos: Not indicated
(2) 3mos to 2 years: (See Chart in protocols)
(3) 2-4 years: 160mg/5ml
(4) 5-12years: 320mg/10ml
(5) 13 years+ 640mg/20ml OR (x2) 325mg pill
4
Q
Activated Charcoal - Pharmocokinetics
A
Absorbs poison and prevents toxins from entering body systems
5
Q
Activated Charcoal - Indications
A
Poisoning by mouth
6
Q
Activated Charcoal - Contraindications (2)
A
(1) Altered Mental Status
(2) Patients who have received an emetic
7
Q
Activated Charcoal - Dosage
A
CONSULT
Adult: 1gm/kg PO
Pediatric: 1gm/kg PO
8
Q
Adenosine - Pharmacology (5)
A
(1) Naturally occurring purine nucleoside
(2) Used to treat narrow complex tachycardia (SVT, PSVT)
(3) Slows conduction through the AV node
(4) No effect on ventricular contractility
(5) Causes peripheral vasodilation
9
Q
Adenosine - Pharmokinetics
A
Onset of action is 5-20 seconds
Half life is 10 seconds
10
Q
Adenosine - Indications (4)
A
(1) Slows the rate of arrow complex tachycardia
(2) Is only effective on SVT/PSVT
(3) No affect on VT. A-FIB. A-Flutter
(4) Stable wide complex tachycardia in pediatrics with caution
11
Q
Adenosine - Contraindications (3)
A
(1) Hypersensitivity
(2) Hx of moderate to severe asthma or active bronchospasms
(3) Polymorphic or irregular wide complex tachycardia
12
Q
Adenosine - Precautions ( 3)
A
(1) Effects antagonized by theophylline (Treats asthma and broncospasms)
(2) Effects enhanced by dipyridamole, digitalis, carbamazepine, calcium channel blockers and benzodiazepines
(3) Be prepared for up to 40 seconds of asystole
13
Q
Adenosine - Dosage
A
ADULT:
(1) 6mg rapid IVP followed by a flush
(2) 12mg rapid IVP if no response within 2 minutes
(3) 12 mg rapid IVP if no response within 2 minutes
PEDIATRIC:
(1) 0.1mg/kg max 6mg rapid IVP followed by a flush
(2) 0.2 mg/kg max 12mg rapid IVP if no response within 2 minutes
(3) 0.2mg/kg max 12mg rapid IVP if no response within 2 mintues
14
Q
Albuterol - Pharmacology
A
Stimulates Beta 2 adrenergic receptors of the bronchioles; bronchodilator
15
Q
Albuterol - Pharmacokinetics (3)
A
(1) Bronchodilation begins within 5-15 minutes after inhalation
(2) Peak effect occurs 30-120 minutes
(3) Duration of action 3-4 hours
16
Q
Albuterol - Indications (3)
A
(1) Signs and symptoms of respiratory distress
(2) Bronchospasms/wheezing associated with:
(A) Asthma
(B) COPD/emphysema
(C) Allergic reaction (Anaphylaxis)
(3) Hyperkalemia
17
Q
Albuterol - Dosage
A
(1) Bronchospasms
(A) < 2yo 1.25mg nebulized
(B) 2yo+ 2.5mg nebulized
(2) Hyperkalemia CONSULT
Adult: 20mg nebulized
Pediatric: See dosing above
18
Q
Amiodarone - Pharmacology
A
Slows duration and refractory period of action potential
Slows electrical conduction and impulse potential through the SA node and accessory pathways
Dilates blood vessels
19
Q
Amiodarone - Pharmacokinetics
A
Primarily alters/blocks sodium and potassium ion permeability across the myocardial membrane, which stabilizes the ion channels and changes impulse conduction through the myocardium. Amiodarone also has some effects on beta receptors and calcium channels.
20
Q
Amiodarone - Indications (4)
A
(1) Prevent recurrence of VF/VT after defibrillation and conversion
(2) Ventricular Tachycardia (VT)
(3) Ventricular Fibrillation (VF)
(4) Atrial Fib/Atrial Flutter with aberrancy (wide QRS) for HR> 130 and SBP >100
21
Q
Amiodarone - Contraindications (9)
A
(1) 2nd degree or 3rd degree AV blocks
(2) Sensitivity
(3) Idioventricular escape
(4) Accelerated idioventricular
(5) Sinus bradycardia/arrest/block
(6) Hypotension
(7) Cardiogenic Shock
(8) Ventricular conduction defects
(9) Iodine hypersensitivity
22
Q
Amiodarone - Adverse effects (3)
A
(1) Bradycardia
(2) Hypotension
(3) Prolonged QT Interval (increases risk of Torsades and VF)
23
Q
Amiodarone - Dosing
A
Adult:
(1) W pulse: 150mg IV/IO (in 50-100ml) over 10 minutes.Repeat x1
(2) W/O pulse(VF/VT/Torsades after Mag): 300mg IV/IO. Repeat x1
Pediatric:
(1) W pulse: 5mg/kg IV/IO (in 50-100ml) over 20 minutes.
(2) W/O pulse: 5mg/kg IV/IO Max 300mg. Repeat (x2) Max total dose 15mg/kg
24
Q
Aspirin - Pharmacology (2)
A
(1) Platelet Inhibitor
(2) Anti-inflammatory
Blocks platelet aggregation
25
Aspirin - Indications (2)
(1) Acute Coronary Syndrome
(2) ST Elevation MI (STEMI)
26
Aspirin - Contraindications (2)
(1) Hypersensitivity
(2) Patients who have received a full dose prior to EMS arrival
27
Aspirin - Dosing
ADULT: 324mg chewed
PEDIATRIC: Not Indicated
28
Atropine - Pharmacology (2)
(1) Parasympatholytic (vagolytic action) (Inhibits action of the vagus nerve)
(2) Anticholenergic ( Accelerates heart rate)
29
Atropine - Pharmacokinetics (4)
(1) Accelerated heart rate within minutes of IV injection
(2) Peak effect within 15 minutes
(3) Atropine disappears rapidly in the blood
(4) Excreted in the urine within first 12 hours
30
Atropine - Indications (3)
(1) Symptomatic bradycardia (If pacing unavailable or ineffective)
(2) Organophosphate Poisoning
(3) Nerve Agent Exposure
31
Atropine - Contraindications (3)
(1) Hypersensitivity
(2) Dysrhytmias in which enhancement of conduction may accelerate the ventricular rate and cause decreased cardiac output (a-fib, a-flutter, PAT with blocks)
(3) Relative contraindications:
(A) 2nd degree Type II or 3rd degree block *CONSULT*
(B) Acute MI or Ischemia
(C) Glaucoma
32
Atropine - Dosing
(1) Adult: Bradycardia 0.5-1mg IV/IO every 3-5 minutes, Max 0.04mg/kg
(2) Pediatric: Bradycardia 0.02mg/kg IV/IO max single dose 0.5mg. Repeat once
(3) Organophosphate Posioning:
(A) Adult: 2-4mg IVP or IM every 5-10 minutes
(B) Pediatric: 0.02mg/kg IVP/IO/IM every 5-10 minutes
33
Calcium Chloride - Pharmacology (2)
(1) Increases cardiac contractile state and ventricular automaticity
(2) Is useful in reversing arrhythmias due to hyperkalemia
34
Calcium Chloride - Pharmokinetics
Rapid onset following IV administration
35
Calcium Chloride - Indications (5)
(1) Hyperkalemia
(2) Hypocalcemia
(3) Treat adverse effects from calcium channel blocker overdose
(4) Hypotension secondary to diltiazem or verapamil
(5) Respiratory depression, decreased reflexes, flaccid paralysis and apnea following magnesium administration
36
Calcium Chloride - Contraindications (2)
(1) Not indicated in cardiac arrest except when hyperkalemia, hypocalcemia or calcium toxicity are highly suspected
(2) Patient currently taking Digoxin with suspected calcium channel blocker overdose
37
Calcium Chloride - Adverse effects (2)
(1) Bradycardia may occur following rapid IV injection
(2) Syncope, cardiac arrest, arrhythmias, bradycardia
38
Calcium Chloride - Precautions (3)
(1) Use with caution on patients taking digitalis as calcium may increase ventricular irritability and precipitate digitalis toxicity
(2) If given with sodium bicarbonate, calcium will precipitate
(3) Calcium salt may produce coronary and cerebral artery spasms
39
Calcium Chloride - Dosing
(1) Adult:
(A) Hyperkalemia, hypocalcemia, calcium channel blocker OD: 0.5-1gm SLOW IVP/IO over 10 minutes. Max 1 gram
(B) Hypotension following diltiazem/verapamil administration or respiratory depression, decreased reflexes, flaccid paralysis and apnea following magnesium administration: 500mg SLOW IVP/IO
(2) Pediatric: 20mg/kg SLOW IVP/IO (50mg/min) Max 1 gram
40
Dexamethasone - Indications (3)
(1) Moderate to severe asthma/COPD exacerbation
(2) Croup
(3) Anaphylaxis
41
Dexamethasone - Adverse effects (10)
(1) Headache
(2) Edema
(3) Vertigo
(4) Fluid retention
(5) Adrenal insufficiency with long term use
(6) HTN
(7) CHF
(8) Nausea and vomiting
(9) Dyspepsia
(10) Anaphylaxis
42
Dexamethasone - Contraindications (3)
(1) Hypersensitivity
(2) Known systemic fungal infection
(3) Premature infants
43
Dexamethasone - Dosing
(1) Adult: 10mg IV (preferred) or PO
(2) Pediatric:
(A) Asthma: 0.5mg/kg PO (preferred) or IV. Max 10mg
(B) Croup: 0.5 mg/kg PO/IM/IV Max 10mg
44
Dextrose - Pharmacology
A water-soluble monosaccharide found in corn syrup and honey
45
Dextrose - Pharmacokinetics (2)
(1) Restores circulating blood sugar and is rapidly utilized following IV administration
(2) Excess dextrose is rapidly excreted in the urine
46
Dextrose - Indications (1)
(1) Correction of altered mental status due to low blood sugar (hypoglycemia) seizures and cardiac arrest
47
Dextrose - Contraindications (1)
(1) Known hyperglycemia
48
Dextrose - Dosing
(1) Adult: Blood glucose < 70mg/DL 25grams in 50 ml or D10 in 50 ml blouses (x5 250mls) until normal mental status or blood glucose in 90mg/DL. Repeat (x1)
(2) <28 days - blood glucose less than 40mg/DL administer 2ml/kg D10W
(3) 28 days - 4 years: blood glucose less than 70mg/DL administer 2-4ml/kg D10W
(4) 5 years - 18 years: blood glucose less than 70 mg/DL administer 2-4ml/kg D10W
49
Diltiazem - Class/Actions
Class: Calcium channel blocker
Actions:
(1) Inhibits the movement of calcium ions across cardiac muscle cells
(2) Decreases conduction velocity and ventricular rate
50
Diltiazem - Indications
Symptomatic A-fib and A-flutter
51
Diltiazem - Contraindications (5)
(1) Hypotension (SBP < 100mmHg)
(2) Heart rate < 130bpm
(3) Second or third degree heart blocks
(4) Hypersensitivity
(5) < 18 yoa
52
Diltiazem - Dosing
Adult:
(A) 0.25mg/kg max of 20mg SLOW IVP over 2 minutes. Reassess then 0.35mg/kg max 25mg SLOW IVP over 2 minutes.
(B) Over 50 yo, borderline BP (100-120 systolic), renal failure or CHF consider 5-10mg administered over 2 mins.
Pediatric:
Contraindicated in patients under 18yo. Consult if needed.
53
Dipenhydramine - Pharmacology
Antihistamine
54
Dipenhydramine - Pharmacokinetics (4)
(1) Effect begins within 15 minutes
(2) Peak effect 1-4 hours
(3) Metabolized by the liver
(4) Half life 2-10 hours
55
Dipenhydramine - Indications (3)
(1) Allergic reaction
(2) Anaphylaxis
(3) Dystonic reactions
56
Dipenhydramine - Contraindications
Known allergy to Dipenhydramine
57
Dipenhydramine - Dosing
Adult: 25-50 mg SLOW IVP or IM
Pediatric: (greater than 6 months) 1 mg/kg SLOW IV or IM
58
Droperidol - Pharmacology
Antipsychotic
59
Droperidol - Pharmacokinetics
Onset of action within 10 minutes of IM administration
60
Droperidol - Indications
Moderate agitation (defined as behavior that puts the patient or clinician at risk of harm) due to suspected psychiatric (schizophrenia) or medical delirium
61
Droperidol - Contraindications (5)
(1) Children under 15 years of age
(2) Pregnancy
(3) Parkinson’s
(4) CNS depression or acute CNS injury
(5) Severe agitation (administer midazolam of ketamine)
62
Droperidol- Adverse Effects (3)
(1) Dystonic Reactions (administer Dipenhydramine)
(2) Hypotension and tachycardia
(3) Torsades de pointes
63
Droperidol - Dosing
(1) Adult:
(A) 18-69: 2.5mg IM
(B) 69+: 1/25mg IM
(C) Consult for additional doses
(2) Pediatric:
(A) 13-18: 2.5mg IM
(B) < 13: Contraindicated
(C) Consult for additional doses
64
Epinephrine - Pharmacology
(1) The administration of epinephrine causes increases in:
(A) Systemic vascular resistance
(B) Systemic arterial pressure
(C) Heart rate (+ Chronotropic effect)
(D) Contractile state (+ Inotropic effect)
(E) Myocardial oxygen requirements
(F) Cardiac automaticity
(G) AV Conduction (+ Dronotropic effect)
(2) Causes bronchial dilation by smooth muscle relaxation
65
Epinephrine - Pharmacokinetics (5)
(1) IV epinephrine has an extremely rapid onset of action
(2) Is rapidly inactivated by the liver
(3) Subcutaneous administration of epi results in slower absorption
(4) Local massage will hasten absorption
(5) Topically applied nebulizer within the respiratory tract, epi has vasoconstrictor properties that result in reduction of mucosal and and submucosal edema. Bronchodilator properties that reduce smooth airway muscle spasms
66
Epinephrine - Indications (6)
(1) Medical cardiac and pediatric trauma arrest
(2) Moderate to severe allergic reaction/anaphylaxis
(3) IV push epi is reserved for cardiac arrest
(4) Epi infusion (IV/IO) should be reserved for patients in shock refractory to fluid bolus of for patients in anaphylactic shock
(5) Severe asthma
(6) Respiratory strider (croup)
67
Epinephrine - Contraindications (3)
(1) Hypertension
(2) Preexisting tachydysrhytmias with a pulse
(3) IV push Epi should not be used on any patient with a pulse
68
Epinephrine - Adverse effects (7)
(1) Tachydysrhytmias
(2) Hypertension
(3) May induce early labor in pregnant women
(4) Headache
(5) Nervousness
(6) Decreased LOC
(7) Rebound edema may occur in 20-30 minutes after administration to croup patients
69
Epinephrine - Precautions
(1) Do not mix with Sodium Bicarbonate as this deactivates Epi
(2) Epi causes a dramatic increase in myocardial oxygen consumption
(3) It’s use in the setting of an acute MI should be restricted to cardiac arrest
(4) *CONSULT* Medical consult must be obtained prior to administering to asthma patient’s with pregnancy or cardiac history. Consult not required for any patient with severe allergic reaction with respiratory distress.
70
Epinephrine - Dosing (Cardiac Arrest and Bradycardia)
(1) Cardiac Arrest
(A) Adult: 1mg IVP/IO every 4mins to a max of 4mg. If arrest reoccurs following ROSC, max 2 additional doses.
(B) Ped/Neonate:
(1) Follow pediatric Epi Chart 0.01mg/kg. Every 4 mins for 4 total doses. If arrest reoccurs following ROSC, max 2 additional doses.
(2) ET administration: 0.01mg/kg diluted with 5ml LRs repeated every 4 mins for 4 doses. If arrest reoccurs following ROSC, administer 2 additional doses
(2) Bradycardia
(A) Adult: (Epi Infusion). 1 mg mixed in 100ml using a 60gtts. Start at 60gtts/min(1ml/min). If pressure remains below 90mmHg, obtain medical consult.
(B) Pediatric:
(1) Administer Epi 0.01mg/kg IV/IO. Repeat every 3-5mins (0.01mg/kg is equivalent to 0.1ml/kg)
(2) ET: Administer Epi 0.1mg/kg diluted with 5ml LRs repeating every 3-5 mins
(C) Neonate:
(1) Administer Epi 0.01mg/kg IVP/IO repeat every 3-5mins.
(2) ET: Administer 0.03mg/kg diluted with 1ml of LRs
71
Epinephrine - Dosing (Allergic Reaction/Anaphylaxis/COPD/Asthma)
(1) Adult:
(A) Mild allergic reaction (with hx of life threatening allergic reaction), moderate allergic reaction or anaphylaxis: 0.5mg IM repeated every 5 mins to a total of 3 doses
(B) Patients who remain hypotensive or impending respiratory failure, administer Epi infusion.
(2) Pediatric:
(A) < 5yo, 0.15mg IM, repeat every 5 mins total 3 doses
(B) 5yo + 0.5 mg IM, repeat every 5 mins total 3 doses
(C) Pediatric Epi Infusion - See chart
72
Epinephrine - Dosing (Croup)
(1) Adult: Not indicated
(2) Pediatric:
(A) 2.5ml of Epi 1mg/ml via nebulizer. Repeat x1 if no improvement
(B) Severe croup/imminent respiratory arrest: 0.01 mg/kg IM. Max 0.5mg IM
(C) Medical consult required for patient's < 1yo
73
Epinephrine - Dosing (Epinephrine Infusion)
(1) Add 1mg Epi in a 100ml bag of approved dilutent
(2) Use a Microdrip (60 drops/ml) for infusion administration
(3) Adult:
(A) Start at 1ml/min (60gtts) IV/IO
(B) Check BP every 5 mins. If MAP < 65mmHg or Systolic BP <90mmHg increase to a maximum rate of 2ml/min (120gtts)
(4) Pediatric:
(A) Follow pediatric dosing chart <50 kg
(B) BP Goals:
(1) 10yo+ systolic BP > 90mmHg
(2) < 10yo systolic BP 70 + (2x age)
74
Fentanyl - Pharmacology (2)
(1) Synthetic opioid that binds with opiate receptors in the CNS that alters both perception and emotional response to pain
(2) Fentanyl is significantly more potent than morphine
75
Fentanyl - Pharmacokinetics
Onset of action is within 2-3 mins and effects last 30 mins - 1 hour
76
Fentanyl - Indications (2)
(1) Patient reports moderate to severe pain
(2) In the clinicians judgement, the patient would benefit from an opioid analgesic
77
Fentanyl - Contraindications (3)
(1) Hypersensitivity
(2) Uncorrected respiratory distress or hypoxemia refractory to supplemental O2
(3) uncorrected hypotension (systolic BP<90mmHg)
78
Fentanyl - Adverse Effects (6)
(1) Respiratory depression/arrest
(2) Altered mental status
(3) Increased vagal tone (slow HR)
(4) Constricted pupils
(5) Increased cerebral blood flow
(6) Chest wall rigidity if pushed too fast
79
Fentanyl - Dosing
(1) Adult: IN (preferred) IV/IO/IM
(A) 1mcg/kg max 200mcg
(B) Reassess in 5-10mins. Administer second dose 1mcg/kg max 200mcg.
(C) Consult required for additional doses
(2) Pediatric: IN/IV/IO/IM
(A) 1mcg/kg max 200mcg
(B) Reassess in 5-10minx. Administer second dose 1mcg/kg max 200mcg
(C) Consult required for additional doses
80
Glucagon - Pharmacology (6)
(1) Hormone synthesized by the pancreas
(2) Increases blood glucose concentration
(3) Inhibits gastric and pancreatic secretions
(4) May increase heart rate and cardiac output
(5) May decrease BP
(6) Increases metabolic rate
81
Glucagon - Pharmacokinetics (5)
(1) Destroyed by GI tract and is not effective orally
(2) Max hyperglycemia effect occurs within 30 mins and disappears within 1-2 hrs
(3) Relaxation of smooth muscle occurs within 8-10 minutes and persists for 12-27 mins
(4) The half-life is 3-10 mins
(5) Degraded in liver and kidneys
82
Glucagon - Indications (2)
(1) Patients with altered mental status with hypoglycemia and no available vascular access
(2) Beta blocker OD
83
Glucagon - Contraindications
Known hypersensitivity
84
Glucagon - Precautions
Only works if liver has significant glycogen stores
85
Glucagon - Dosing
(1) Hypoglycemia w/o IV access
(A) Adult: Administer 1mg IM/IN. Consult for up to 3 doses
(B) Pediatric:
(1) 5yo - 18th birthday: 1mg IM/IN. Consult for additional doses
(2) 28days - 4yo: 0.5mg IM/IN, Consult for additional doses
(2) Beta Blocker Overdose
(A) Adult: 1mg IVP every 5 minutes
(B) Pediatric:
(1) 5yo - 18th birthday: 1mg IVP every 5 minutes
(2) 28days - 4yo: 0.5 mg IVP every 5 minutes
86
Ipatropium - Pharmacology (4)
(1) Anticholenergic (Parasympatholytic) bronchodilator
(2) Bronchodilator is site specific - not systemic
(3) Dries respiratory tract secretions
(4) Most effective in combination with a beta-adrenergic bronchodilator
87
Ipatropium - Pharmacokinetics (3)
(1) Improved pulmonary function within 15-30 mins
(2) Peak effect within 1-2 hrs
(3) Duration of action is usually 4-5 hrs
88
Ipatropium - Indications (3)
(1) Allergic reaction/Anaphylaxis
(2) Bronchial asthma
(3) Reversible bronchospasms associated with chronic bronchitis and emphysema
89
Ipatropium - Contraindications (3)
(1) Hypersensitivity to the drug
(2) Hypersensitivity to atropine
(3) Less than 1 yo
90
Ipatropium - Dosing
(1) Adult: 500mcg Single administration only in combination with Albuterol
(2) Pediatric:
(A) < 1yo: CONTRAINDICATED
(B) 1-2yo: 250mcg single administration
(C) 2yo +: 500mcg single administration
91
Ketamine - Pharmacology
Sedative-hypnotic; analgesic
92
Ketamine - Pharmacokinetics
A rapid non-barbiturate sedative-hypnotic analgesic characterized by normal pharyngeal-laryngeal reflexes, normal or enhanced skeletal muscle tone, and possible cardiovascular and respiratory stimulation.
Onset of action IV/IO: 5-10 mins
Onset of action IN/IM: 15-20 mins
93
Ketamine - Indications (5)
(1) Moderate to severe pain; musculoskeletal, extremity and back pain
(2) Severe agitation
(3) Ventilatory difficulty secondary to bucking or combativeness in intubated patient
(4) CPR- induced awareness
(5) Pain management for synchronized cardioversion and transcutaneous pacing
94
Ketamine - Contraindications (3)
(1) Known hypersensitivity
(2) Penetrating eye injury
(3) Chest pain, abdominal pain, flank pain, headache
95
Ketamine - Adverse Effects (5)
(1) Although respiration is often stimulated, respiratory depression may occur with rapid IV administration
(2) Although hypotension may occur, BP and HR are frequently stimulated
(3) Involuntary myoclonus may mimic seizure activity
(4) Possible enhanced secretions
(5) Possible unpleasant dreams and delirium upon emergence from sedation
96
Ketamine - Precautions (4)
(1) Continuosly monitor cardiac and respiratory function
(2) Control of severe agitation may require advanced airway management
(3) Ketamine is supplied in multiple concentrations
(4) Ketamine 100mg/ml is more appropriate for IM administration. Ketamine 10mg/ml is preferable for IV administration
97
Ketamine - Dosing (Pain Management)
(1) Adult:
(A) 0.2 mg/kg IV/IO max 20mg. Reassess in 5-10 mins. Administer a second dose if needed
(B) If IV/IO unavailable administer 0.5mg/kg IM/IN. Reassess in 15 mins and repeat dosing
(2) Pediatric:
(A) 0.2 mg/kg IV/IO max 20 mg. Reassess in 5-10 mins. Administer a second dose if needed
(B) If IV/IO unavailable administer 0.5 mg/kg IM/IN. Reassess in 15 mins and repeat dosing
98
Ketamine - Dosing (Severe Agitation)
*CONSULT required for first dose unless there is imminent danger to the patient or EMS clinician
*Additional doses always require medical consultation
(1) Adult:
(A) IV: 1mg/kg IV/IO. Max single dose 100mg. If severe agitation persists, repeat dosing. Max total dose 200mg.
(B) IM: 4mg/kg IM. Max single dose 400mg. Additional dose requires medical consultation
(2) Pediatric:
(A) IV: 1mg/kg IV/IO. Max single dose 100mg. If severe agitation persists, repeat dosing. Max total dose 200mg.
(B) IM: 4mg/kg IM. Max single dose 400mg. Additional dose requires medical consultation
99
Ketamine - Dosing (Ventilatory difficulty secondary to bucking or combativeness)
*May be preferred agent for hypotension, hypovolemia or pain response
*MSPAC does not require consultation for additional doses
(1) 2mg/kg IVP/IO over 60 seconds. May repeat 2 additional doses of 1mg/kg IVP/IO every 10-15 mins for a total of 3 doses. Additional doses require medical consult.
100
Ketamine - Dosing (CPR-induced awareness)
(1) Adult: 1mg/kg IV/IO. Repeat dose with medical consult
(2) Pediatric: Obtain medical consultation
101
Lidocaine - Pharmacology (2)
(1) Anesthesia for IO infusion
(2) Nasal Anesthesia
102
Lidocaine - Pharmacokinetics (2)
(1) Extremely rapid following IV administration and lasts approximately 10-20mins
(2) Mucosal anesthesia with onset in 1-5 mins
103
Lidocaine - Indications (2)
(1) Anesthesia for IO infusions
(2) Nasal tracheal intubation
104
Lidocaine - Contraindications (8)
(1) AV blocks
(2) Sensitivity to lidocaine
(3) Idioventricular escape rhythms
(4) Accelerated idioventricular rhythm
(5) Sinus bradycardia/arrest/block
(6) Hypotension
(7) Shock
(8) Ventricular conduction defects
105
Lidocaine - Dosing
(1) Adult/Adolescent: Prevent or treat pain due to IO infusion in patients >= 13yo. 20-40mg of 2% lidocaine IO.
(2) Consult a pediatric base station to treat pain due to IO infusion for patients < 13yo
(3) Nasal Pharyngeal Anesthesia (13yo and greater) 4ml 4% lidocaine. 2ml per nare.
*Do not exceed total dose of 3mg/kg
106
Magnesium Sulfate - Pharmacology
Physiologic calcium channel blocker and also blocks neuromuscular transmission. Hypomagnesemia can cause cardiac dysrhythmias. It is also a CNS depressant effective in the management of seizures during pregnancy by decreasing the amount of acetylcholine liberated from motor nerve terminals.
107
Magnesium Sulfate - Pharmacokinetics
IV administration the onset of anticonvulsant action is immediate and lasts about 30 minutes. Magnesium is excreted solely by the kidney at a rate proportional to the plasma concentration and glomerular filtration rate.
108
Magnesium Sulfate - Indications (4)
(1) Torsades de Pointes
(2) Seizures with pregnancy
(3) Refractory VF/VT after Amiodarone administration
(4) Moderate to severe asthma/bronchospasm exacerbation
109
Magnesium Sulfate - Contraindications (3)
(1) Hearty blocks
(2) Renal impairment
(3) Hypermagnesemia
110
Magnesium Sulfate - Precautions (3)
(1) May exacerbate effects of CNS depressants and neuromuscular blocking agents
(2) Due to concerns of hypotension, IV fluid bolus should be initiated if hypovolemia is suspected
(3) Magnesium toxicity is a concern with higher doses (respiratory depression, decreased reflexes, flaccid paralysis and apnea). Administer calcium chloride 500mg SLOW IVP for indications
111
Magnesium Sulfate - Dosing
(1) Adult:
(A) Seizure w pregnancy: 4 grams IV/IO over 10 mins (mixed in 50-100ml approved dilutent)
(B) Refractory VT/VF: 1-2 grams IV/IO over 2 mins
(C) Torsade de pointes: 1-2 grams IV/IO over 2 mins
(D) *Consult* Moderate to severe asthma/bronchospasm exacerbation: 1-2 grams IV/IO over 10-20 mins (mixed in 50-100ml approved dilutent)
(2) Pediatric:
(A) Seizure w pregnancy: 4 grams IV/IO over 10 mins (mixed in 50-100ml approved dilutent)
(B) Torsades de pointes: 25mg/kg to a max of 2 grams IV/IO over 2 minutes
(C) *Consult* Moderate to severe asthma/bronchospasm exacerbation: 50mg/kg IV/IO max 2 grams over 10-20 mins (mixed in 50-100ml approved dilutent)
112
Midazolam - Pharmacology (3)
(1) Sedative
(2) Hypnotic
(3) Anticonvulsant
113
Midazolam - Pharmacokinetics (3)
(1) Short acting benzodiazepine with strong hypnotic, anticonvulsant and amnestied properties
(2) Onset: IV 1.5 mins, IM 15 minutes
(3) Duration: 1-4 hours with a half life of 1.5-3 hours
114
Midazolam - Indications (9)
(1) Sustained and/or recurrent seizures
(2) Precardioversion to reduce anxiety
(3) Awake patient requiring transcutaneous pacing
(4) Nasal Tracheal Intubation
(5) Implanted Cardioverter Defibrillator (ICD) malfunction
(6) Nerve/Organophosphate exposure
(7) Bucking Endotracheal Intubated patient
(8) Moderate to severe stimulant toxicity
(9) Moderate or severe agitation
115
Midazolam - Contraindications (2)
(1) Hypotension
(2) Hypersensitivity
116
Midazolam - Adverse Effects (2)
(1) Respiratory depression or arrest
(2) Hypotension
117
Midazolam - Dosage (all indications except moderate to severe agitation and bucking intubated patients)
(1) Adult:
(A) 0.1 mg/kg in 2 mg increments SLOW IVP (over 1-2mins) Max 5mg
(B) If IV unavailable, 5mg IM/IN
(C) Additional doses to a max of 10mg require consult
(2) Pediatric:
(A) 0.1 mg/kg in 2 mg increments SLOW IVP (over 1-2mins) Max 5mg
(B) If IV unavailable, 0.2 mg/kg IM/IN max 5mg
(C) Additional doses to a max of 5mg require medical consult
118
Midazolam - Dosing (Moderate to severe agitation)
(1) Patient’s 18-69 years: Midazolam 5mg IM/IV
Patient’s > 69 years: Midazolam 2.5 mg IM/IV
(2) *CONSULT* 18 years +, If severe agitation persists after Ketamine, consider Midazolam 2.5mg IV/IO
(3) *CONSULT* 18 years + and no IV/IO available, If severe agitation persists after IM Ketamine, administer Midazolam 5mg IM
(4) *CONSULT* 5-12 yo, Midazolam 0.1mg/kg IV or 0.2 mg/kg IM/IN Max 5mg
(5) *CONSULT* Patients 13-18 yo
(A) Midazolam 0.1 mg/kg or 0.2 mg/kg IM/IN (max 5mg). Severe agitation with imminent danger, no consult required
(B) If severe agitation persists after Ketamine IV/IO, consider Midazolam 2.5mg IV/IO
(C) If IV/IO unavailable, Midazolam 5mg IM
119
Midazolam - Dosing (Bucking Endotracheal Intubated patient)
(1) Adult: 0.1 mg/kg SLOW IVP over 1-2 mins while maintaining systolic BP greater than 90mmHg. Max 5mg. Stop when bucking has resolved. Additional doses require consult.
(2) Pediatric: Administer 0.05mg/kg SLOW IVP over 1-2mins while maintaining SBP greater than 60 in neonates, 70 in infants and 70 + (2 x age) for patient’s greater than 1yo. Max dose 5mg.
120
Naloxone - Pharmacology
Reverses all effects due to opioid agents. This drug will reverse the respiratory depression and all central and peripheral nervous system effects.
121
Naloxone - Pharmacokinetics (4)
(1) Onset of action is within a few minutes if administered IVP and within 5 minutes if administered IN.
(2) IM and pediatric.neonatal ET administration results in slower onset of action
(3) Patients responding to Naloxone may require additional doses and transportation to the hospital since most opioids last longer than Naloxone
(4) Has no effect in the absence of opiods
122
Naloxone - Indications
To reverse respiratory depression induced by opioids
123
Naloxone - Contraindications
Patients under 28 days
124
Naloxone - Dosing
(1) Adult: 0.4-2mg IVP/IO/IM/IN titrated to respiratory depression. Repeat as necessary to maintain respiratory activity
(2) Pediatric: 0.1mg/kg IVP/IO/IM/IN titrated to respiratory depression. ET dose 0.2-0.25 mg/kg. May repeat as necessary to maintain respiratory activity.
125
Nitroglycerin -Pharmacology (2)
(1) Vasodilatory effects on veins more than arteries
(2) Decreases right heart return (preload) by venous pooling, thereby reducing myocardial workload and oxygen consumption
126
Nitroglycerin - Parmacokinetics (3)
(1) Absorbed through oral mucosa
(2) Antianginal and vasodilation effects within 1-2 mins after administration. Half life is 1-4 minutes.
(3) Duration of action is less than 5 minutes
127
Nitroglycerin - Indications (2)
(1) Treatment of Angina
(2) Congestive heart failure, acute pulmonary edema
128
Nitroglycerin - Contraindications (6)
(1) Known hypersensitivity
(2) Pediatric patient under 13yo
(3) Any patient haven taken medication for Pulmonary Artery Hypertension (Adcirca or Revatio) or Erectile dysfunction (Viagra, Levitra or Cialis) within the past 48 hrs. Medical consultation required to override this contraindication
(4) Asymptomatic hypertension
(5) Blood pressure below 90mmHg
(6) Pulse less than 60 bpm or greater than 150 bpm
129
Nitroglycerin - Precautions (2)
(1) May cause hypotension
(2) If systolic BP drops more than 20mmHg, obtain medical consultation to override
130
Nitroglycerin - Dosing
(1) Adult: Chest Pain
(A) (Prescription or previous history) 0.4 mg SL repeat to a total of 3 doses (1.2mg) at 3-5 minute intervals as long as systolic BP > 90mmHg and pulses is between 60-150bpm
(B) (No prescription/previous history) establish IV first.
(C) Additional doses with medical consultation
(2) Adult: Pulmonary Edema/CHF
(A) Low Dose: 0.4 mg sublingual at 3-5 min intervals. Max dose 1.2mg
(B) High Dose (Until CPAP is applied or not tolerated)
(1) 0.4mg SL w 1in nitro paste
(2) 0.8 mg SL
(3) 0.8mg SL to achieve a 20% reduction in SBP
(3) *CONSULT* for Pediatric patient
131
Ondansetron - Pharmacology
A selective blocking agent of the Serotonin 5HT3 receptor site
132
Ondansteron - Pharmacokinetics
Anti-nausea and anti-emetic with onset of action within 5-15 minutes IV and 30 minutes IM
133
Ondansteron - Indications (2)
(1) Prevention and control of nausea and/or vomiting
(2) Ondansetron can be administered in an effort to reduce the nausea and vomiting complications associated with certain existing injuries, medical illnesses or medication side effects
134
Ondansetron - Contraindications (2)
(1) Known hypersensitivity
(2) Less than 28 days
135
Ondansetron - Adverse Effects (5)
(1) Hypotension
(2) Tachycardia
(3) Extrapyrimidal reactions
(4) Seizures
(5) Prolonged QT Intervals
136
Ondansetron - Dosing
(1) Adult:
(A) 8mg SLOW IVP/IO over 2-5 mins or 4-8mg IM or 8mg ODT.
(B) Repeat once w/o consult.
(C) 3rd dose requires consult to a total of 24 mg.
(2) Pediatric:
(A) 28days - 12yo: 0.1 mg/kg SLOW IVP over 2-5 mins
(B) 13-18yo: 8mg ODT or 8mg SLOW IVP over 2-5 mins
OR
(C) If no IV: 0.1 mg/kg IM (max single dose 8mg)
(D) May repeat once w/o consult
(E) *CONSULT for third dose with a max of 0.3mg/kg or 24mg (whichever is lower)
137
Sodium Bicarbonate - Pharmacology
Corrects acidosis by raising blood pH
138
Sodium Bicarbonate - Phamacokinetics (2)
(1) Rapid onset of action in the blood
(2) Delayed onset of action in the tissues
139
Sodium Bicarbonate - Indications (4)
(1) Acidosis, pre-existing (documented)
(2) Cardiac arrest only when a high clinical suspicion of acidosis, hyperkalemia,NA blocker OD (tricyclic antidepressant or phenobarbital) as a cause of the arrest
(3) Hyperkalemia
(4) NA Channel blocker overdose
140
Sodium Bicarbonate - Contraindications
Pre-existing alkalosis
141
Sodium Bicarbonate - Dosing (Cardiac Arrest)
(1) Cardiac arrest only when a high suspicion of acidosis, hyperkalemia or NA Channel Blocker OD as the cause:
(A) Adult: Administer 1meq/kg IVP/IO
(B) Pediatric: *CONSULT
(1)1meq/kg IVP/IO
(2) For patient’s < 1yo, must be diluted 1:1 with LRs
142
Sodium Bicarbonate - Dosing (Hyperkalemia)
(1) Adult: 50meq/kg SLOW IVP over 5 mins. Flush IV line between sodium and calcium administration
(2) Crush Syndrome (functional kidneys by history)
(A) Adult: 50 men IV/IO SLOW over 5 mins and then initiate a drip of 100meq in 1,000ml LRs over 30-60mins
(B) Pediatric: *Consult
(1) 1 meq/kg IV/IO SLOW over 5 mins.
(2) < 1yo must be diluted 1:1 with LRs
143
Sodium Bicarbonate - Dosing - (NA Channel Blocker OD)
Includes: Tricyclic antidepressant and phenobarbital OD
(1) Adult:
(A) 1 meq/kg IVP/IO bolus initially. Monitor QRS for narrowing.
(B) Repeat dose: 0.5 meq/kg every 10 mins to maintain a narrow QRS (< 100msec)
(2) Pediatric: *CONSULT
(A) 1 meq/kg IVP/IO
(B) < 1yo must be diluted 1:1 with LRs
144
Terbutaline - Pharmacology (2)
(1) Stimulates beta-2 receptors located in smooth muscle bronchioles
(2) Causes relaxation of bronchioles
145
Terbutaline - Pharmacokinetics
Relieves bronchospasm in acute and chronic airway disease with minimal cardiovascular effects
146
Terbutaline - Indications (2)
(1) Asthma
(2) Reversible airway obstruction associated with bronchitis or emphysema
147
Terbutaline - Contraindications (1)
(1) Patients under 12 yo
148
Terbutaline - Dosing
(1) 12 yo +:
(A) 0.25mg IM
(B) Repeat after 15 mins if no adequate improvement. (Max total 0.5mg)
(2) <12yo
(A) Not indicated
149
Tranexamic Acid - Pharmacology
Anti-fibrinolytic
150
Tranexamic Acid - Pharmacokinetics
Onset: variable
Peak effect: 2 hours
Duration: 10 hours
151
Tranexamic Acid - Indications (2)
(1) Suspected hemorrhagic shock (SBP < 90mmHg) and within 1 hour of injury
(2) Postpartum hemorrhage (SBP < 90mmHg and pulse >110bpm) with ongoing blood loss despite uterine massage
152
Tranexamic Acid - Contraindications (4)
(1) Less than 15 yo
(2) Hypersensitivity/allergy
(3) Known arterial or vein thromboembolism (PE, DVT) (obstruction of a blood vessel by a blood clot that has become dislodged elsewhere)
(4) Patients more than 1 hour from injury or childbirth
153
Tranexamic Acid - Precautions (2)
(1) Administer over 10 minutes to reduce risk of hypotension
(2) Do not delay transport to administer TXA
154
Tranexamic Acid - Dosing
(1) Greater than 15yo
(A) 1 gram in 100ml IV/IO over 10 minutes
