meds indcation Flashcards
Albuteral
- any wheezing
- allergic reactions with resp signs and sympmtoms
Adenosine
- adult complex SVT equal or greater150
- unknown origin wide complex tachycardia (not thought to be V. tac)
- not used to identified a.fib/a.flutter
- pediatric rates for SVT begin 200
Albuteral
For Severe hyperkalemia associated with those patients that undergo dialysis or whose kidney are beginning to function poorly. The need for drug treatment by fire rescue on medical advisor order only, will be based on widening of the QRS on EKG: note sodium bicarb/calcium chloride are also indicated for high potassium
Amiodarone
- v.fib/v.tac pulseless >150 not responsive to shock or epi; works especially well in arrest due to acute MI
- Conscious v.tac with a pulse >150 not responding to Lido hemodynamically stable(if hypotensive sedate and cardiovert)
- Wide complex tachycardia with pulse> 150 unknown rhythm (orgin)
- Patients known to have WPW and now have to tachycardia greater than 150 with a pulse
- A.fib/a.flutter and unstable( >150) after Cardioversion has failed and BP>90
Amiodarone
- Wide complex tachycardia with pulse> 150 unknown rhythm (orgin)
- Patients known to have WPW and now have to tachycardia greater than 150 with a pulse
- A.fib/a.flutter and unstable( >150) after Cardioversion has failed and BP>90
Amiodarone (Pedi)
- Stable or unstable narrow complex SVT tachyarrhythmia (>220 infants >180 children)not responsive to vagal maneuvers/adenosine/ cardioversion
- Stable v.tach or wide complex(>0.9sec) regular rate and monomorphic tachycardia after adenosine with medical advisor order only
- unstable v.tach or wide complex(0.9sec) unkown orgin, not responsive to cardioversion with med.adv. only
- v.fib/ pulseless v.tach; not responding to shock or epi
Amiodrone (pedi)
- unstable v.tach or wide complex(0.9sec) unkown orgin, not responsive to cardioversion with med.adv. only
- v.fib/ pulseless v.tach; not responding to shock or epi
asprin
Chest pain/pressure or other signs and symptoms suggesting the possibility of an MI or ischemia heart event
asaprin (notes)
patients taking their own Anti-coagulant medication (aspirin plavix etc.) except Coumadin, should still have aspirin administer by EMS. If they reported having taken aspirin prior to EMS arrival confirm by checking the bottle that it was just not 80mg, enteric coated or a nonaspirin products such as Tylenol or ibuprofen yeah EMS administration of aspirin should be given as soon as contraindications are ruled out
aspirin (notes)
such as Tylenol or ibuprofen yeah EMS administration of aspirin should be given as soon as contraindications are ruled
atropine
- Symptomatic bradycardia
- Bradycardia with PVCs (goal heart rate of 600)/ brady PEA
- Asytole
- chemical exposures (organophoste)with p.control /med.adv.order only
Benadryl
Acute allergic reaction including anaphylaxis upper airway response hives/itching(W.Meynard bee sting)
note The use of Benadryl and anaphylaxis or respiratory distress allergic reaction should not delete or take the place of subq epi
Calcium chloride
- Dialysis patients with symptomatic whide complex brady/ cardia arresst asystole PEA EMD (particularly slow)
calcium chloride
2.For Severe hyperkalemia associated with those patients that undergo dialysis or whose kidney are beginning to function poorly. The need for drug treatment by fire rescue on medical advisor order only, will be based on widening of the QRS on EKG: note sodium bicarb/calcium chloride are also indicated for high potassium
calcium chloride
3.Calcium channel blocker overdose
note when given before and after sodium bicarb there must be a 20 cc flush
cardizem
- Conscious a.fib or flutter ventricular response =or>150 &BP =or>90.
- Unconscious a.fib or flutter and vent response =or >150& BP =or>90 after initial cardiovers. sequence a.fib200 300 360–a.flutter100 200 300 360
cardeziem
- Other SVT narrow complex rhythm with vent. resp. =or>150& BP =/> 90 in which adenosine is not effective or effect has been temporary
charcoal(activated)
Completely conscious pt. and able to maintain airway after oral ingesting of a non-caustic substance; does not routinely cause vomiting now flavored and tolerate it well by patients
cyanokit
high suspicious of smoking inhalation
or probable exposure to cyanide.
+
- unconscious wtih glucose >60 mg/ml after adm of 2mgs of narcan
- Persistent shock after 100 ml NS (Pedi 20cc/Kg boluses of NS/LR)
- cardiac arrest along with appropriate treatment according to presenting rhythm also give early sodium bicarb
cyanokit notes
high suspicion for smoke inhalation(cyanide is common in house fires and can form any time there is a combustion of materials contain carbon or nitrogen some Plastics particularly arclylonitries release significant amount when burn)
cyanokit notes
Provable exposure to industrial cyanide(i.e. jewelry making glass etching, chemical production, electroplating, dyeing, printing manufacture of plastic paper and textiles)
dextrose
Unconscious or AMS GCS <60
note; if suspected stroke or head injury glucometer readings must be done before any sugar is given and the results must be below 50
Dopamine
Hypotension BP <90 after Fluid challenges with S/S; not indicated when shock is caused by severe hemorrhage until fluids have been given (persistent hypotension may indicate internal hemorrhage so considerate IV fluids first.) infusion rate Star low end when patient is in PE or renal failure
Dopamine
for PE after initial attempts with appropriate for boluses and attempt to identify manage underlying cause
EPI
- Any cardiac arrest
- Severe anaphylaxis not responsive to other measures
- Severe nonresponsive bronchospasm
EPI sub q or im
- Allergic reaction with respiratory or circulatory compromise
- Status asthmatic diminish or absent breaths sound (use with albuetral aerosol)
Epi drip
For critically adults with anaphylactic bradycardic shock not responding to other treatments
etomidate
- Intubation needed but clenched or fighting or otherwise unable to manage(pedi/adult)
- Procedural sedation such as Cardioversion or not tolerated patient(pedi/adult)
- shivering Post Rosc induce hypothermia(adult only)
Glucagon
- Symptomatic hypoglycemia with GCS < 60 unless S/Ss suggest a stroke or head injury then < 50 and no IV access after two attempts
- Beta blocker overdose by medical advisor or poison control only
Glutose
Appropriate in the hypoglycemic patient when the patient has a GCS of 14 or 15 is capable of swallowing and maintaining their own airway
Hurricane spray
- To suppress gag flex for orotracheal/nasotracheal intubation
hurricane spray notes
Note this is not a meter dose spray and the amount of spray determine by position of the canister and force applied to the spray nozzle and the content in the canister time must be the limiting factor never administer more than one second total of spray, you special precaution with the elderly/children
Lasix
CHF, cardiogenic pulmonary edema with normal to High BP after at least two doses of nitro and CPAP have not provided adequate relief not to be giving if hypotensive BP <110 or for HTN only
lidocaine
- PVCs and multiform and >5 minutes , 3 in a row/runs of v tach or increasing and in spite of other treatment
- adult only: v.tach with a pulse non-polymorphic (first-line except for torsades)
- v.fib or pulseless v.tachycardia second line after Amiodarone
Morphine sulfate
1 severe pain management when not contraindicated according pain management/palliative protocol; consult with radio and before giving for abdominal pain
2. Chest pain relieved by second dose of nitro (third dose of nitro should still be giving if indicated)
3. Pedi; if unable to obtain IV/IO: instead of etomidate for procedural sedation (to gain necessary immobilization)
for all but intubation (which would use percent if no IV/IO)
4. Not to be used cardiogenic PE
narcan
- Unconscious or depressed mental status with blood sugar >60 GCS< 12
- known or suspected OD with depressed mental status or unconscious; give to maintain airway establish adequate breathing
nitro
- CP (to complete or near complete relief)
2. Cardiogenic PE with or without CP
sodium bicarb
- Uses a second line tx renal failure patients with symptomatic brady cardia ventricular dysrhythmias, v.fib/ pulseless v.tach, asystole, PEA that do not respond to standard protocol
- Victim with weight crushing legs for more than one hour
sodium bicarb
3.Use early in C.A. algorithms to treat drowing/ known tricyclic antidepressant OD or other scenarios where there was prolonged hypoxia metabolic acidosis before c.a.(i.e.obstruction choking strangulation,status asthmatic,resp involved anaphylaxis; ketoacidosis, siezure long intraptment)
sodium biacarb
- After initial algorithm approaches in cardiac arrest are not working and there is good respiratory support ET or combi in place 100%02 and adequate ventilation 8-10 breaths/min for adults;14-16 for child/infant;20/min for neonate
Sodium bicarb
- Consult with med. advice for bicarb order in Pre arrest scenarios (i.e known tricyclic OD will prolong QT intervals, widening QRS >100ms, coma, seizure, ventricular arrhythmias, treatable hypotension)or for patients who may have been lying in one position (typically a hard surface) and unable to move/shift body weight
sodium Thiosulfate: cyanide antidote
-High suspicion for smoke in halation
-Probable exposure to industrial cyanide
&
- Unconscious will blood glucose >60 after adm.to 2mgs of Narcan
- Persistent shock after 1000 ml NS/LR
- Cardiac arrest along with other appropriate tx. according Presenting rhythm also give early sodium bicarb(cyanide victims have lactic acidosis)
versed (when etomidate not available)
- Seizure activity /excited delirium /wildly agitated
- Procedural sedation
- Assist intubation
- Post ROSC. induce hypothermia
D5w 100 m
- As a mixed with amiodarone for infusion with Maxi drip tubing
- As a mixed with Hydroxocobalamin (cyanokit) with kit supplied vented tubing(20drops/ml)
Normal saline
1 appropriate for all patients except PE or HTN
2 hypotension other S/Ss of shock
3 thermal illnesses or (injuries including dehydration)
4 any pedi pt
5 suspected stroke or head injury
6 electrolyte imbalance
7 trauma
8 any patient who has potential for
9 pregnancy what IV is indicating
10 can use as they diluent/flush for all meds including amiodarone (which is not to be mixed with LR)
normal saline
5 suspected stroke or head injury
6 electrolyte imbalance
7 trauma
normal saline
8 any patient who has potential for rapid decompsation
9 pregnancy when IV is indicating
10 can use as they diluent/flush for all meds including amiodarone (which is not to be mixed with LR)
lacated ringers
1 appropriate for all patients
2 hypertension or other signs and symptoms of shock
3 thermal illnesses or injuries (including dehydration)
4 trauma when IV is indicated
5 any patient has the potential for rapid decompensation
6 suspected stroke or head
7 electrolyte imbalance
lactated ringers
5 any patient has the potential for rapid decompensation
6 suspected stroke or head injury
7 electrolyte imbalance
