Medications

Question 1

Oxygen

Answer 1

Ind: Suspected hypoxia, SPO2 <95%, Appears SOB (AMS, restlessness, blueish color), c/o dyspnea, rate <12 or >20, on home O2 therapy

Contra: Ignition risk, use caution in COPD

Dose:
Maintain home O2 rate
If hypoxic (SPO2 <95%), 6L via NC or 10L via NRB

Question 1

Oral glucose

Answer 1

Ind: AMS, BS < 60 or <80 w/ signs of hypoglycemia

Contra: Unresponsive / cannot swallow, no gag

Dose: 1 or 2 strips applied between cheek and gum via finger or tongue depressor

Good practice: Suction on standby

Question 2

Adenosine

Answer 2

Ind: Pulse producing narrow complex regular tachycardia >150 bpm

Contra: Second or third-degree AV block, or Sick Sinus Syndrome. Avoid in WPW

Dose: Vagal first. Then 12mg rapid IV, chased by 20mL NS , may repeat once after 3m

IV: onset “rapid,” duration “brief”

Question 3

Albuterol

Answer 3

Ind: Wheezing, dyspnea in known COPD or asthmatic, crush injury with extrication > 1hr

Contra: hypersensitivity. (Tachycardia, digitalis OD)

Adult and ped Dose: 5mg (6mL) via continuous neb or 2 puffs q2hr via MDI

Neb: Onset within 5min, duration 1-2 hours

Question 4

Amiodarone

Answer 4

Ind:
1) Pulse producing unstable VT
2) Pulseless VT or VF

Contra: Allergy to iodine, sick sinus syndrome, second- or third-degree atrioventricular block, bradycardia leading to syncope without a functioning pacemaker; Cardiogenic shock; Torsades de Pointes

Adult Dose:
1) 150mg slow IV, may repeat once after 3m
2) 300mg IV/IO, may repeat @ 150mg once after 3m

Ped Dose:
1) ?
2) 5mg/kg IV/IO (max 450mg), may repeat once in 5-10m

IV: onset within hours, duration weeks to months

Question 5

ASA

Answer 5

Ind: CP of suspected cardiac origin

Contra: Blood thinner, mid-back / mid-line pain, hypersensitivity (CVA, GI or other bleed?)

Dose: 324mg chewed or swallowed once

Non coated onset: <1 hr, duration platelet lifetime (~10 days)

Question 6

Atropine

Answer 6

Ind:
1) Symptomatic bradycardia
2) OP poisoning

Contra: Hypersensitivity

Adult dose:
1) 1mg IV/IM, repeated after 3m up to a max dose of 3mg
2) 2mg IV/IM, may repeat once

Ped dose:
1) 0.2mg/kg (min. 0.1mg, max 0.5mg) repeated once
2) ?

IV: onset immediate, duration 4 hrs
IM: onset 15-30min

Question 7

Dextrose (10%)

Answer 7

Ind: AMS, BS < 60 or <80 w/ signs of hypoglycemia, known diabetic in PEA or asystole & suspected hypoglycemia

Contra: Hyperglycemia, intracranial hemorrhage, delirium tremens. Corn allergy

Dose:
Adult: 250mL d10 IV / IO infusion
Ped: 5mL/kg d10 (max of 250mL)

Question 8

Diphenhydramine

Answer 8

Ind: Allergic reaction, dystonic reaction

Contra: Asthma, glaucoma, pregnancy, HTN, infant pts

Dose:
Adult: 50mg IV/IM/IO once (withhold if taken prior to arrival)
Ped: 1mg/kg IM/IV/IO (max 50mg) once (withhold if taken prior to arrival)

Question 9

IM Epinephrine

Answer 9

Ind: Allergic reaction

Contra: Non-anaphylactic shock (particularly hypovolemic shock), coronary insufficiency, hypothermia, pulmonary edema, HTN

Dose:
Adult: 0.5mg (1mg/1mL solution) IM lateral thigh, may repeat once after 5m

Ped: 0.01mg/kg IM (1mg/1mL solution) IM lateral thigh, may repeat once after 5m

Question 10

IV/IO Epinephrine

Answer 10

Ind:
1) Allergic reaction
2) Cardiac arrest (but withold if the cause of the arrest is trauma)

Contra: Non-anaphylactic shock (particularly hypovolemic shock), coronary insufficiency, hypothermia, pulmonary edema, HTN

Adult Dose: 1mg IV/IO, (0.1mg/1mL solution) repeated at 3m intervals
Ped dose: 0.01mg/kg IV/IO (0.1mg/1mL solution, max 0.3mg)

Question 11

Fentanyl

Answer 11

Ind: Pain, cardiac pain not relieved by NTG

Contra: ***

Adult Dose:
1) 50mcg IV, may repeat once after 3m
2) 100mg IN (1mL each nostril), may repeat once after 3m

Ped dose:
2mcg/kg IV/IM/IN (max of 50mcg) may repeat once after 3m

Question 12

Glucagon

Answer 12

Ind: Unable to establish IV for d10 and AMS, BS < 60 or <80 w/ signs of hypoglycemia

Contra: Hyperglycemia***

Dose:
Adult: 1mg IM once
Ped: 0.5mg IM once

Question 13

Lidocaine

Answer 13

Ind:
1) IO pain
2) Pulseless VT or VF

Contra: WPW, or SA/AV/intraventricular block

Adult Dose:
1) 20mg IO, may repeat once after 3m
2) 1mg/kg IV/IO, may repeat once @ 0.5mg/kg IV/IO after 3m

Ped Dose:
1) ?
2) 1mg/kg IV/IO (max 100mg) only onc

IV: Onset 45-90 sec, duration 10-20min

Question 14

Midazolam / versed for SZ

Answer 14

Ind: Seizure control

Contra: BP < 90

Adult Dose:
10mg IM (preferred) once OR
5mg IV, repeated once after 3m OR
5mg IN (half in each nostril) repeated once after 3m

Ped dose:
0.2mg/kg IM (preferred) once OR
0.1mg/kg IV/IO/IN repeated once after 3m

Question 15

Midazolam / versed for procedures

Answer 15

Ind:
1) Aid in ETI or during transport of an intubated pt
2) Anxiety with cardiac pacing

Contra: BP < 90

Dose:
1) 5mg IV once
2) 5mg IV titrated to sedation

Question 16

Midazolam / versed for behavioral emergencies

Answer 16

Ind: Excited delerium, dangerous stimulant intoxication

Contra: BP < 90

Dose: 5mg IM (preferred) / IV / IN once

Question 17

Morphine

Answer 17

Ind: Pain, cardiac CP not relieved by NTG, severy pain (eg. crush or burn)

Contra: BP < 90

Dose:
Adult: 5mg IV/IM/IO, repeated once after 3m
If using carpuject, 4mg IV/IM/IO, repeated once after 3m

Ped: 0.1mg/kg IV/IM (max of 5mg) may repeat once after 3m

Question 18

Narcan

Answer 18

Ind: Narcotic OD, RR 12 or less

Contra: ***

Adult Dose: Physically stimulate first.
0.8, 1.0, or 2.0mg IM/IN, repeat PRN to maintain resp. drive
0.4, 0.8, or 1.0mg IV, repeat PRN to maintain resp. drive
4.0 mg IN single nostril of preloaded device
Max dose 12mg if patient not responding

Ped Dose: Physically stimulate first.
0.1mg/kg IM/IV/IN, repeat q3m PRN to maintain resp. drive
4.0 mg IN single nostril of preloaded device
Max dose 12mg if patient not responding

Question 19

NTG

Answer 19

Ind:
1) Cardiac CP
2) Pulmonary rales / suspected CHF w/ BP 100-150
3) Pulmonary rales / suspected CHF w/ BP >150

Contra: PDE-5s w/in the last 24 hours, BP <100

Dose:
1 &2 ) 0.4mg single SL spray or tab, repeated after 3m to a max of 3 doses or 1.2mg
3) 0.8mg double SL spray or tab, repeated after 3m to a max of 3 doses or 2.4mg

Question 20

NS

Answer 20

Ind:
1) Hypotension (BP < 90 sys)
2) Shock
3) Crush with extrication > 1hr
4) Stimulant intoxication (eg. excited delerium 2/2 OD)
5) Sinus tach (100-150 bpm) d/t suspected dehydration and w/o rales
6) Cardiac arrest w/ PEA or asystole

Contra: Rales / signs of CHF

Dose:
Adult: 250mL Bolus, repeated to a total of 1L
Ped: 20mL/kg (max of 250mL), may repeat twice

Question 21

Zofran

Answer 21

Ind: N/V

Contra: Pregnancy or suspected pregnancy

Adult Dose:
8mg ODT once
4mg IV, repeated once after 3m

Ped dose:
4mg ODT once

Question 22

Sodium Bicarb

Answer 22

Ind: Crush inj >1 hr

Contra: Significant chloride loss

Dose:
Adult: 50mL of prefilled 8.4% solution IV/IO once
Ped: 1meq/kg IV/IO

Onset IV: “Rapid”