Medications Flashcards
Oxygen
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
Oral glucose
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
Adenosine
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”
Albuterol
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
Amiodarone
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
ASA
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)
Atropine
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
Dextrose (10%)
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)
Diphenhydramine
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)
IM Epinephrine
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
IV/IO Epinephrine
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)
Fentanyl
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
Glucagon
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
Lidocaine
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
Midazolam / versed for SZ
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
Midazolam / versed for procedures
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
Midazolam / versed for behavioral emergencies
Ind: Excited delerium, dangerous stimulant intoxication
Contra: BP < 90
Dose: 5mg IM (preferred) / IV / IN once
Morphine
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
Narcan
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
NTG
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
NS
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
Zofran
Ind: N/V
Contra: Pregnancy or suspected pregnancy
Adult Dose:
8mg ODT once
4mg IV, repeated once after 3m
Ped dose:
4mg ODT once
Sodium Bicarb
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”
