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SD county protocols > Meds - Indications/ Dose/ Route/ PACS > Flashcards

Meds - Indications/ Dose/ Route/ PACS Flashcards

1
Q

Benadryl Dose/Route

A

ADULT:
50mg Slow IV/IM push

PEDS:
PDC IV/IM

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2
Q

Calcium Chloride Cautions & Considerations

A

Tissue necrosis occurs w/ infiltration. Check IV patency before and during administration watching for signs of infiltration. If this occurs D/C the IV, circle infiltrated area, and inform the receiving hospital.

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3
Q

Acetaminophen Packaging

A

1000mg/100ml

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4
Q

Dextrose Administration

A
  • IVP ; Assure IV patiency by aspirating before and halfway through administration
  • Oral glucose is preferred for awake patient w/ gag relfex
  • D10 can be created by injecting D50 into a 250ml NS bag, discard 50ml prior to adding D50
  • D25 can be created by wasting 25ml (12.5gm) of D50 then adding 25 of NS
  • If D50 is not available, may use D10, administer full 250ml
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5
Q

Adenosine Dose/Route (Adult)

A

ADULT:

  • 6mg rapid IV/IO : follow with a rapid 20mL NS
  • 12mg rapid IV/IO : follow with a rapid 20 mL NS
  • If no sustained rhythm changes MR x1 in 1-2 min

-If patients has Hx of bronchospasm or COPD:
Dosing as above per BHO

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6
Q

Sodium Bicarb Administration

A
  • Flush tubing between administration of meds:
    • Effectiveness of EPI will be decreased if it’s mixed with bicarb
    • Calcium Chloride will precipitate with Bicarb. Be sure to flush tubing between drugs
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7
Q

Epi Dose/Route:

  • Adult Dysrhythmias (Cardiac Arrest)
  • PEDS: Dysrhythmias (Unstable Bradycardia)
A

ADULT:
1mg IV/IO 1:10,000 ; MR q3-5”

PEDS:
PDC - IV/IO 1:10,000 ; MR x2 q3-5” ; MR q3-5” BHO

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8
Q

Versed Dose/Route for
Overdose:
- Stimulant Intox w/ excited delirium

Psychiatric / Behavioral Emergencies:
- Combative patients

A

Adult Only:

  • IM,IN,IV 5mg
  • MR x1 in 10 min
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9
Q

Lidocaine Packaging

A

100mg/5ml

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10
Q

Atropine Dose/Route

-PEDS: Dysrhythmias - Bradycardia

A

<9 w/ HR <60 or 9-14 w/ HR <60

PDC IV/IO MR x1 in 5”

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11
Q

Morphine Special Info

A
  • Morphine is a controlled substance & must be kept locked and signed for when used
  • Pain level should be documented at administration and q5”
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12
Q

Epi Cautions Considerations

A
  • Use caution in respiratory patients if:
    known cardiac Hx, or Hx of HTN
    BP >150 or Age >40
  • Monitor ECG, may aggravate pre-existing tachycardia
  • Patients who meet Anaphylaxis Criteria, Epinephrine is administered first. Not indicated for mild allergic reactions
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13
Q

Lidocaine Dose/Route for:

  • Reported/Witnessed ≥2 AICD firing or ≥1 AED shock delivery w/ pulse >60
  • Stable VT
A

ADULT ONLY:
1.5mg/kg IV/IO SO
MR 0.5mg/kg IV/IO q8-10” SO
Max 3 mg/kg (including initial bolus SO)

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14
Q

Adenosine Dose/Route (PED)

A

PEDS:

  • 1st dose PDC rapid IV BHPO : follow with NS 20mL rapid IV
  • 2nd dose PDC rapid IV BHPO : follow with NS 20mL rapid IV
  • If no sustained rhythm change, MR x1 BHPO
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15
Q

Lidocaine Special Info

A

Toxicity and delayed effect is more likely in elderly, CHF, Liver Disease due to reduced ability to metabolize drug. Repeat doses in this population should be at 10 min intervals

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16
Q

Amiodarone Cautions & Considerations

A

May interact with:

  • Beta Blockers - results in excessively slow heart rate or an AV block
  • Digoxin - increases blood level of digoxin to toxic
  • Tricyclic antidepressants - causes serious arrhythmias
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17
Q

Amiodarone Dose/Route

A

Stable Ventricular Tachycardia:
-150mg in 100mL of NS over 10” IV/IO SO
MR x1 in 10” SO

Reported/witnessed ≥2 AICD firing or ≥1 AED shock delivered with pulse ≥60:
-150mg in 100mL of NS over 10” IV/IO SO

VF/Pulseless VT: After 1st shock if still refractory:
ADULT:
-300mg IV/IO SO ; MR 150 (max 450mg) SO
PEDS:
-PDC IV/IO SO ; MR x1 in 3-5” SO
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18
Q

Fentanyl Dose/Route

for PED patients

A 
≥10kg:
Fentanyl IV/IN PDC SO
  - MR PDC BHO, max of 75mcg
<10kg:
Fentanyl IV/IN PDC BHO
  - MR PDC BHO
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19
Q

Ketamine Administration

A 
IV Dosing:
  - Add 0.2mg/kg to 100ml NS IV bag
  - Administer Slow IV Drip over 15”
  - Max single IV dose is 20mg
IN Dosing:
  - Administer 0.5mg/kg via 1ml syringe w/ MAD attached 
  -Max single IN dose is 50mg

Ketamine dosing chart is recommended using 5mg/.1ml incremental measurements. Round dose to next 5mg amount from weight based calculation.

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20
Q

Albuterol Cautions & Considerations

A
  • Consider anaphylaxis if wheezing in the patient with distress, especially if no Hx of asthma
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21
Q

Atrovent (Ipatropium Bromide) Special Info

A
  • Cholinergic effects are site specific in lungs - no systemic effects
  • If a patient has self medicated w/ bronchodilator prior to paramedic intervention, Atrovent should still be given with first pre-hospital Albuterol treatment
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22
Q

Calcium Chloride Administration

A
  • In Dialysis patients: Give IV/IO over 30 sec w/ Albuterol
  • In crush injury patients: GIve IV/IO over 30 sec w/ end of fluid bolus
  • Precipitates if mixed w/ NaHCO3, flush IV tubing between administration of drugs
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23
Q

Acetaminophen Special Info

A

Daily max dose is 4000mg in 24 hrs

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24
Q

Morphine Dose/Route (PED)

  • For treatment of pain as needed:
    • Abdominal pain
    • Burns
    • Envenomation injury
    • Trauma
A
  • With signs of adequate perfusion:

- PDC IV/IM ; MR BHO

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25
Q

Ketamine Special Info

A
  • Cardiac function should be continually monitored during administration in patients w/ HTN or cardiac instability. Arrhythmia has occurred w/ administration
  • Although respiration is frequently stimulated, severe respiratory depression may occur w/ high doses and too rapid of IVP. If this occurs supportive ventilation should be initiated
  • There is no antidote for Ketamine
  • “Emergence Reactions” may occur during recovery period
  • Consider BLS methods of pain mgmt prior to narcotics
  • Pain level should be documented at administration and q5”
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26
Q

Charcoal Administration

A

PO, assure that the patient can swallow and is cooperative. Most effective if administered immediately after ingestion

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27
Q

Albuterol Dose/Route

A

ADULT:
6ml (0.083%) via nebulizer MR

PEDS:
PDC via nebulizer MR

ADULT: Hyperkalemia 
Continuous 6ml (0.083%) via nebulizer MR
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28
Q

Amiodarone Special Info

A

Amiodarone is an optional drug and may not be carried by some agencies

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29
Q

Naloxone Cautions & Considerations

A
  • Manage airway w/ BLS prior to Narcan. Advanced airways are contraindicated prior to Narcan. Narcan should not be given once an advanced airway is in place
  • When giving to opioid dependent pain mgmt patients the goal is to increase the respiratory drive & not necessarily make them fully conscious
  • Duration of Narcan is generally less than of that opioid. Watch for relapse as long as opioid is still in patients system
  • Narcan can precipitate withdrawal syndrome or Combative behavior
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30
Q

Epi Indications

A

Allergic Reaction / Anaphylaxis:
-Anaphylaxis / Angioedema

Respiratory Distress:
-Severe Respiratory Distress
OR
-Inadequate response to Albuterol / Atrovent

PEDS: Respiratory Distress:
-w/ stridor at rest

PEDS: Burns:
-w/ respiratory distress w/ stridor

Adult Dysrhythmias:
-Cardiac arrest

PEDS: Dysrhythmias:
-Unstable bradycardia : after bvm for 30 sec

PEDS: Newborn Deliveries:
-If HR remains <60 after 30 sec of CPR

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31
Q

Aspirin Dose/Route

A

Adult Only: 324mg PO (4 81mg tablets)

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32
Q

Sodium Bicarb Dose/Route for

- Tricyclic OD w/ cardiac effects

A

ADULT:
1mEq/kg IV/IO

PEDS:
PDC IV/IO x1 BHO

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33
Q

Versed Dose/Route for

- Seizures for Adults / PEDS

A

Adult:
IM, IN, IV, IO to a max 5mg
(d/c to IV/IO dose if seizure stops)
MR x1 in 10 min Max 10mg total

PEDS:
PDC IM,IN,IV

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34
Q

Dopamine Cautions & Considerations

A

Tissue necrosis occurs w/ infiltration. Check IV patency before and during administration watching for signs of infiltration. If this occurs D/C the IV, circle infiltrated area, and inform the receiving hospital.

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35
Q

Naloxone Special Info

A
  • IN route produces a more gradual improvement of LOC than Respiratory effort. If IN dose ineffective, repeat dose should be IM/IV
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36
Q

Glucagon Dose/Route

A

ADULT:
1mg/ml IM SO

PED’s:
PDC IM SO

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37
Q

Fentanyl Packaging

A

100mcg/2ml

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38
Q

Atropine Indications

A

Adult: Dysrhythmias:

  • Unstable Narrow Complex Bradycardia
  • Unstable Wide Complex Bradycardia when external pacemaker unavailable

PEDS: Dysrhythmias
-Unstable Bradycardia: After BVM for 30sec and 3rd dose of Epi

-Poisoning / OD
Symptomatic organophosphate poisoning

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39
Q

Epi Dose/Route:

-PEDS: Respiratory Distress

A

1:1,000 PDC - via nebulizer ; MR x1

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40
Q

Dextrose Special Info

A

Repeat BS not indicated enroute if patient is improving. Repeat BS must be done if the patient is left on scene and initial was abnormal. (AMA, requires BH contact)

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41
Q

Acetaminophen Administration (PED)

A
  • Identify dose from the PDC. Draw patients dose from the medication vial using a syringe
  • Inject this dose into a 50 or 100ml normal saline bag and label it
  • Insert IV tubing into medication bag and fill IV tubing
  • Administer as IV piggyback into port in main IV line, closing main line as needed
  • Adjust flow rate to administer medication over 15 min
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42
Q

Atropine Administration

A

Pacing is the treatment of choice for wide complex bradycardias. Use atropine only if pacing is unavailable

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43
Q

Amiodarone Packaging

A

150mg/3mL

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44
Q

Nitro Indications

A

Discomfort / Pain ?Cardiac Origin

Fluid Overload w/ rales:
- Hemodialysis patients

Respiratory Distress:
- Respiratory Distress ?CHF / Cardiac Origin

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45
Q

Zofran Packaging

A

4mg/2ml vial or 4mg/1 tablet

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46
Q

Charcoal Indication (PED)

A

Poisoning / OD: If ingestion within 60 min and recommended by Poison Control Center (assure patient has a gag reflex and is cooperative)

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47
Q

Benadryl Indications

A

Allergic Reaction / Anaphylaxis
-Urticaria / Angioedema / Allergic Reaction

Poisoning / OD
-Extrapyramidal Reactions

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48
Q

Calcium Chloride Dose/Route

  • Hyperkalemia
  • Crush Injury
A

Hyperkalemia:
-500mg IV/IO over 30 sec

Crush Injury:
- 500mg IV/IO over 30 sec BHO

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49
Q

Dopamine Special Info

A

Approved optional premix solution of 400mg dopamine in 250ml D5W

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50
Q

Epi Dose/Route:

-PEDS: Newborn Deliveries

A

PDC - IV/IO 1:10,000 ; MR x2 q3-5” ; MR q3-5” BHO

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51
Q

Adenosine Indications

A

Adult: Dysrhythmias
-Stable SVT

PEDS: Dysrhythmias
-Unstable SVT

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52
Q

Zofran Administration

A
  • ODT are quickly dissolving but are somewhat fragile
  • Do not push tablet through foil package
  • Do not remove tablets from packaging until ready to administer
  • Place on patients tongue and encourage to allow to dissolve; can be swallowed with small amounts of water
  • For PED patients 6mo - 3 years give 2mg ODT which is half the tablet
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53
Q

Albuterol Indications

A
  • Respiratory Distress
    • Suspected non-cardiac
  • Allergic Reaction / Anaphylaxis
    • Acute allergic reactions or anaphylaxis
  • Burns
    • Respiratory Distress w/ Bronchospasm
  • Hemodialysis Patient
    • Symptomatic, suspected hyperkalemia if ≥72 hours since last dialysis
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54
Q

Amiodarone Administration

A

Piggyback infusion in 100mL of NS given over 10min ; (drip rate with 60gtts/min tubing = 10gtts/sec)

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55
Q

Dopamine Indications

A

Discomfort/Pain of suspected cardiac origin
-w/ associated shock if BP is refractory to 2nd fluid bolus
Shock suspected Cardiac
-If BP is refractory to 2nd fluid bolus
Sepsis
-If BP refractory to fluid boluses
Shock suspected Anaphylactic/Neurogenic?
-If BP refractory to fluid boluses
Anaphylaxis
-Shock refractory to fluid boluses and Epi IV/IO
Dysrhythmias
-Bradycardia: after max Atropine or initiation of TCP

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56
Q

Fentanyl Dose/Route

for patients <65

A 
Titrate to pain and vital signs
Fentanyl up to 50mcg IV SO
  - MR x2 25mcg IV q5” SO
  - Max SO dose is 100mcg
OR
Fentanyl 50mcg IN x2 q15” SO
  - 3rd IN dose 50mcg BHO
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57
Q

Aspirin Cautions & Considerations

A

Administer if patient had pain or discomfort of suspected cardiac origin that has been relieved PTA

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58
Q

Epi Dose/Route:

-Allergic Reaction / Anaphylaxis

A

ADULT:

  1. 3mg IM 1:1,000 ; MR x2 q5”
  2. 1mg IV/IO 1:10,000 BHO ; MR x2 q3-5 BHO

PEDS:
PDC - IM 1:1,000 ; MR x2 q5”
PDC - IV/IO 1:10,000 BHO ; MR x2 q3-5 BHO

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59
Q

Naloxone Indications (Adult/PED)

A

Adult: Poisoning / OD:
Adult: Altered Nero:
Symptomatic suspected opioid OD w/ RR <12

PED: Poisoning / OD:
PED: Altered Nero:
Symptomatic suspected opioid OD

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60
Q

Atropine Packaging

A

1mg/10ml (pre-load) or 0.4mg/1ml (multi-dose vial)

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61
Q

Zofran Special Info

A

PED patients with associated head injury require BHPO

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62
Q

Glucagon Cautions & Considerations

A
  • Exerts positive Chronotropic & Inotropic effects on the heart, which may cause tachycardia & HTN
  • Glucagon depletes glycogen stores. The patient should be given supplemental carbohydrates after he/she is awake and able to swallow
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63
Q

Dopamine Packaging

A

400mg/250ml NS (1,600mcg/1ml)

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64
Q

Aspirin Special Info

A
  • Can give if patient is on anticoagulants

- Should be given regardless of prior daily dose

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65
Q

Dopamine Administration

A
  • Always confirm calculations & dose according to Dopamine drip chart
  • Titrate dosing to maintain BP ≥90, not to exceed 120
  • Always run as a piggyback drip, never run as a primary IV. Turn primary line off during Dopamine infusion
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66
Q

Zofran Dose/Route (PED)

A
  • 6mo - 3 years: 2mg ODT/IV
  • > 3 years: 4mg ODT/IV

If suspected head injury: BHPO

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67
Q

Epi Packaging

A

1:10,000= 1 mg/10 ml ; 1,000= 1 mg/1 ml

68
Q

Dextrose Cautions & Considerations

A
  • Tissue necrosis occurs w/ infiltration. Watch for signs of infiltration. If this occurs D/C the IV, circle infiltrated area, and inform the receiving hospital.
  • If you cannot access an IV or EJ then consider glucagon
69
Q

Benadryl Packaging

A

50mg/1ml

70
Q

Aspirin Packaging

A

81mg tablets

71
Q

Versed Dose/Route for

  • Dysrhythmias:
    • Conscious SVT pre-cardioversion
A

Adult:

  • 1-5mg slow IV/IO (1mg/min) BHO
  • If age ≥60 consider lower dose with attention to age and hydration status

PEDS:
- PDC Slow IV (1mg/min) BHPO

72
Q

Charcoal Indication (Adult)

A

Poisoning / OD: Ingestion of any of the following within 60 min, if no vomiting.

Acetaminophen, Amanita Mushrooms, Beta Blockers, Calcium channel blockers, Colchicine, Oral Anticoagulants (including rodenticides), Paraquat, Salicylates, Valproate

73
Q

Acetaminophen Dose/Route (Adult/PED)

A

ADULT:
1000mg IV x1 SO
Infuse over 15 min

PEDS:
≥2 years PDC x1 SO
Infuse over 15 min

74
Q

Sodium Bircarb Indications

A

Hemodialysis Patient:
- Symptomatic suspected Hyperkalemia if ≥72 since last dialysis

Poisoning/OD:
- Tricyclic OD w/ cardiac effects

Trauma:
- Crush injury of extremity or torso with extended entrapment ≥2 hours just prior to extremity being released

75
Q

Charcoal Cautions & Considerations

A
  • Anticipate vomiting complications, consider Zofran

- Use caution w/ drugs known to cause a rapid onset of seizures. Due to increased risk of vomiting/aspirating

76
Q

Calcium Chloride Indications

A

Hemodialysis Patient:
-Symptomatic, suspected Hyperkalemia if ≥72 hrs since last dialysis (wide QRS or Peak T waves)

Trauma:
-Crush injury of extremity or torso with compression >2hrs. Give just prior to being released

77
Q

Calcium Chloride Packaging

A

1gm/10ml

78
Q

Epi Administration

A

IV/IO/IM

79
Q

Benadryl Special Info

A
  • Anticholinergic properties may help to correct drug induced cholinergic and dopaminergic imbalances that cause extrapyramidal reactions
  • Extrapyramidal reactions may be seen 7-10 days after ingestion of medication
80
Q

Glucagon Indications

A

Altered Neuro:

-Symptomatic Hypoglycemia patient w/ ALOC or Unresponsive to oral glucose, If no IV and BS <60 (neonate <45)

81
Q

Zofran Dose/Route (Adult)

A

4mg IV/IM/ODT

MR x1 in 10”

82
Q

Lidocaine Administration

A

Do not push more than 50mg/min in an awake patient

- Recommended that all adult patient doses be rounded to the nearest 20mg

83
Q

Morphine Cautions & Considerations

A
  • When changing route, BHO is required
  • When changing analgesic, BHO required
  • NTG is the priority for cardiac patients and should be continued as Morphine is added
  • Consider BLS pain mgmt methods prior to narcotic administration
  • If Respiratory Arrest occurs, assist ventilations & obtain an order for Narcan
  • If Hypotension occurs, consider fluid bolus. Request order for Narcan if BP is refractory to fluid bolus
  • Rapid infusion may increase Nausea/Vomiting after administration. Consider Zofran
  • During National drug shortages, contact BH & EMS coordinator to consider using expired Morphine - must inform patient & document thoroughly
84
Q

Atrovent (Ipatropium Bromide) Indications

A

Respiratory Distress:
-Suspected non-cardiac
Allergic Reaction / Anaphylaxis:
-Acute Allergic reactions or Anaphylaxis

85
Q

Ketamine Packaging

A

500mg/10ml vial (50mg/1ml or 5mg/0.1ml)

86
Q

Lidocaine Dose/Route for:

- Pulseless VT / VF

A

ADULT:

  • 1.5mg/kg IV/IO SO
  • MR x1 in 3-5” IV/IO SO (max 3mg/kg)

PED’s:

  • PDC IV/IO
  • MR x1 in 3-5” SO
87
Q

Atrovent (Ipatropium Bromide) Administration

A
  • Use 4-6Lpm of O2 for handheld mouthpiece

- Use 6-10Lpm of O2 for Neb, CPAP & ET tube

88
Q

Naloxone Packaging

A

1mg/1ml (Preload 2mg/2ml)

89
Q

Glucagon Special Info

A

Glucagon will not work if patients Liver glycogen stores are depleted, which may be seen in Severe Hypoglycemia, Malnutrition & Adrenal Insufficiency

90
Q

Atropine Cautions & Considerations

A
  • Use caution for patient w/ possible MI (may extend infarct area)
  • May worsen bradycardia associated w/ 2nd degree type II and 3rd degree heart blocks
91
Q

Atropine Dose/Route

-Adult: Dysrhythmias - Bradycardia:

A

0.5mg IV/IO for HR <60

MR q3-5” to max of 3mg

92
Q

Nitro Cautions & Considerations

A
  • NTG is used for ADULTS ONLY
  • If patient becomes hypotensive, lay supine and consider fluid bolus
  • Avoid application of dermal NTG to areas that may be used for cardioversion
  • Remove any existing NTG patch prior to any use of your NTG
  • Avoid irritated / broken skin and consider taping patch to prevent movement of paste
  • If patients chest pain is resolved on medic arrival (self-medicated with own NTG), continue treatment with NTG Ointment and ASA.
93
Q

Ketamine Cautions & Considerations

A

USE CAUTION: BHPO ONLY FOR THE FOLLOWING

  • Isolated head injury
  • Multiple trauma w/ GCS <15
  • Drug / Alcohol intoxication
  • Acute onset of severe headache
  • Suspected active labor
94
Q

Benadryl Cautions & Considerations

A
  • Cumulative depressant effects occur in the presence of alcohol and/or other sedatives
  • Priority in mild allergic reactions; Epi is priority in moderate/acute reactions
  • See S-122 and S-162 for Anaphylaxis criteria Angioedema definition
95
Q

Versed Dose/Route for

  • Dysrhythmias:
    • Unstable Bradycardia: Discomfort associated TCP capture , after Morphine if BP 100
    • Unstable Conscious VT pre-cardioversion
A

Adult Only:

  • 1-5mg slow IV/IO (1mg/min)
  • If age ≧60 consider lower dose with attention to age and hydration status
96
Q

Morphine Administration

A
  • Slow IVP, Morphine has a rapid onset

- Document V/S & pain scale before & after each administration

97
Q

Charcoal Dose/Route

A

ADULT:
50gm PO

PED’s:
PDC PO

98
Q

Fentanyl Special Info

A
  • Fentanyl is a controlled substance & must be kept locked and signed for when used
  • Pain level should be documented at administration and q5”
99
Q

Aspirin Administration

A

Tablets can be chewed or swallows with small amounts of water

100
Q

Sodium Bicarb Packaging

A

50mEq/50ml

101
Q

Albuterol Special Info

A
  • Continuous nebulized Albuterol is the goal for Hyperkalemia and patients in respiratory distress.
  • Decreases Hyperkalemia associated with dialysis patients by facilitating the movement of potassium back into cells.
  • Fireline Paramedics (FEMP) without access to O2 may use MDI delivery for albuterol in place of nebulizer. (2.5mg inhaler = 2 puffs)
102
Q

Atropine Dose/Route

-Poisoning / OD:

A

2mg IV/IO/IM ; MR x2 q3-5” SO ; MR q3-5” BHO

PEDS:
PDC IV/IO/IM ; MR x2 q3-5” SO ; MR q3-5” BHO

103
Q

Morphine Indications

A

For treatment of Pain as needed:

  • Abdominal discomfort
  • Burns
  • Environmental
  • Trauma

For treatment of Pain as needed:

  • Discomfort/Pain of suspected cardiac origin
  • Pain associated w/ external pacing
104
Q

Glucagon Packaging

A

1mg/1ml

105
Q

Versed Indications for

  • Overdose
  • Psychiatric / Behavioral Emergencies
A

Overdose:
- Stimulant Intox w/ excited delirium

Psychiatric / Behavioral Emergencies:
- Combative patients

106
Q

Zofran Indications

A

Abdominal Discomfort - GI/GU:
- For nausea or vomiting

PED: GI/GU:
- For nausea or vomiting

Pain mgmt:
- For nausea or vomiting after Morphine

107
Q

Amiodarone Indications

A

Dysrhythmias:
-Stable Ventricular Tachycardia

  • Reported/witnessed ≥2 AICD firing or ≥1 AED shock delivered with pulse ≥60
  • VF/Pulseless VT: After 1st shock if still refractory
108
Q

Epi Dose/Route:

-PEDS: Burns

A

1: 1,000 PDC - via nebulizer ; MR x1 SO
1: 1,000 PDC - IM SO ; MR x2 q5” SO

109
Q

Zofran Cautions & Considerations

A

Anticipate the need for Zofran to treat nausea/vomiting side effect of morphine administration

110
Q

Charcoal Special Info

A
  • Contraindications are due to marginal effectiveness and potential to cause harmful vomiting or burns
  • PED’s: contact poison control early and administer promptly if recommended
111
Q

Versed Packaging

A

5mg/1ml or 10mg/2ml

112
Q

Naloxone Administration

A
  • If giving IV, titrate to effect of controlling respirations
  • For titrated dosing:
    • Adult: Dilute 2mg to 10ml w/ NS (0.2mg/1ml)
    • PED: Dilute 1mg to 10ml w/ NS (0.1mg/1ml)
113
Q

Naloxone Dose/Route (Adult/PED)

A

ADULT:
2mg IN/IM/IV
MR titrate IV dose to effect to drive the RR

If patient refuses Transport:
Additional 2mg IM dose

PED:
PDC IN/IM/IV ; MR

ADULT/PED:
For opioid dependent pain mgmt patient “use caution & titrate”

114
Q

Morphine Dose/Route (Adult)

  • For treatment of pain as needed:
    • Abdominal pain
    • Burns
    • Envenomation injury
    • Trauma
A

ADULT:
MORPHINE, If Fentanyl unavailable :
IV Dosing:
- 0.1mg/kg IV SO
- MR 5” at half the initial IV dose SO
- MR 5” at half the initial IV dose BHO
IM Dosing:
- 0.1mg/kg IM SO
- MR 15” at half the initial IM dose SO
- MR 15” at half the initial IM dose BHO

115
Q

Epi Dose/Route:

-Respiratory Distress

A

ADULT:
0.3mg IM 1:1,000 ; MR x2 q5”
If no definite history of asthma:
Dosing as above per BHPO

PEDS
PDC - IM 1:1,000 ; MR x2 q5”

116
Q

Nitro Administration

A
  • Preparing the patient for administration of NTG
    • Start an IV before or soon after first dose
    • Place patient in a supine or semi fowlers whenever possible
  • If using tablet, place under tongue and allow to dissolve
  • If unable to spray under tongue, spray inside mouth; is well absorbed. Do not shake NTG spray
  • Document vitals signs and pain scale before and after each administration
117
Q

Adenosine Packaging

A

6mg/2ml & 12mg/4ml

118
Q

Acetaminophen Indications

A

For treatment of pain as needed:

  • Abdominal pain
  • Burns
  • Envenomation injuries
  • Trauma
119
Q

Ketamine Dose/Route

A 
ADULT ONLY:
IV Dosing:
  - 0.2mg/kg in 100ml of NS SO
  - Slow IV drip over 15”
  - Max single IV dose 20mg
  - MR x1 in 15” if pain remains Moderate-Severe SO

IN Dosing:

  • 0.5mg/kg SO (50mg/1ml concentration)
  • Max single IN dose is 50mg
  • MR x1 in 15” if pain remains Moderate-Severe SO
120
Q

Versed Dose/Route for

  • Dysrhythmias:
    • Unstable Conscious A-Fib / A-Flutter pre-cardioversion
A

Adult:

  • 1-5mg slow IV/IO (1mg/min) BHPO
  • If age ≧60 consider lower dose with attention to age and hydration status
121
Q

Aspirin Indications

A

Discomfort/Pain of suspected cardiac origin

122
Q

Atrovent (Ipatropium Bromide) Dose/Route

A

ADULT:
2.5ml (0.02%) via Neb, added to first dose of Albuterol

PEDS:
PDC (0.02%) via Neb, added to first dose of Albuterol

123
Q

Fentanyl Dose/Route

for Chest pain/pain associated w/ pacing

A

ADULT ONLY:

Fentanyl 25mcg IV x1 SO

124
Q

Nitro Packaging

A

1 spray or 1 tablet = 0.4mg

1 inch paste = 15mg

125
Q

Glucagon Administration

A
  • IM
  • Inject syringe fluid into medication vial
  • To reconstitute rub vial back and forth in hands
  • Be sure to check that solution is transparent & does not have any undissolved medication
126
Q

Cyanide Kit Indications

A

Significant symptoms such as:

  • Seizures
  • LOC
  • Cardiac Arrest
127
Q

Atrovent (Ipatropium Bromide) Packaging

A

0.5mg/2.5ml (0.02% unit dose vial)

128
Q

Sodium Bicarb Cautions & Considerations

A

TCA cardiac effects are Hypotension, Heart block or widened QRS

129
Q

Dextrose Dose/Route

A

ADULT / PED:
If patient is awake and has a Gag reflex:
Oral Glucose (15g)

ADULT:
D50 25gm IV
MR if patient remains symptomatic and BS <60

PED’s:
D10 PDC IV
MR if patient remains symptomatic and BS <60 (neonate <45)

130
Q

Sodium Bicarb Dose/Route for

- Symptomatic suspected Hyperkalemia if ≥72 since last dialysis

A

ADULT ONLY:

1mEq/kg IV/IO

131
Q

Epi Special Info

A
  • Use IV Epinephrine in Anaphylaxis w/ S/S of poor perfusion:
    • Weak Pulses / Hypotension
    • Pale, Cyanotic skins
    • Dizzy, Faint / Syncope
  • Nebulized Epinephrine 1;1,000 concentration only:
    Can cause sensitivity to providers; may need goggles and face shield
  • Is used full strength in nebulizer; Do not dilute
  • Up to 5 single dose ampules may be required if no multi dose vials are available
  • In Allergic / Anaphylaxis PT, S/S can occur minutes to hours after exposures
132
Q

Fentanyl Cautions & Considerations

A
  • When changing route, BHO is required
  • When changing analgesic, BHO required
  • Consider BLS pain mgmt methods prior to narcotic administration
  • Consider dosing based on Age, Body weight, Physical status, Medical Hx
  • If Respiratory Arrest occurs, assist ventilations & obtain an order for Narcan
  • If Hypotension occurs, consider fluid bolus. Request order for Narcan if BP is refractory to fluid bolus
  • Fast IVP may increase Nausea/Vomiting after administration. Consider Zofran
133
Q

Benadryl Administration

A

IV / IM

134
Q

Lidocaine Cautions & Considerations

A

In conscious adult IO initiations, Slowly infuse Lidocaine 2% (preservative free) 40mg prior to fluid administration. This does count towards max dose of 3mg/kg so reduce initial dose by 40mg.

135
Q

Adenosine Special Info

A

Half life of adenosine is <10 sec

136
Q

Adenosine Cautions & Considerations

A
  • Adenosine does not convert A-fib/A-flutter; a transient modest slowing of ventricular response may occur. Obtain a 12 Lead EKG prior to administration of A-fib/A-flutter is suspected
  • Antagonized by caffeine and theophylline. Adenosine may be ineffective or larger doses may be required
137
Q

Cyanide Kit Dose/Route

A

Amyl Nitrate:
- Given over 30sec BHPO

Sodium Thiosulfate 25%:
- 12.5gm IV BHPO

Hydroxocobalamin:
- 5gm IV over 15 min BHPO

138
Q

Nitro Special Info

A
  • Alcohol ingestion potentiates the hypotensive side effect
  • Orthostatic hypotension more commonly seen in patients taking beta blockers
  • Patients taking Viagra/Cialis/Levitra or other medication for sexual enhancement OR patients taking similar medication for pulmonary hypertension (Revatio/Flolan/Veletri) may have a fatal drop in pressure 50-60 mmHg. Suspect patient may be on these medication if they have unexplained LOC.
139
Q

Dextrose Indications

A

Altered Neuro:
Symptomatic Hypoglycemia patient w/ ALOC or unresponsive to oral glucose and blood sugar
-Adult/ Ped / Infant : <60
-Neonate : <45

140
Q

Acetaminophen Cautions & Considerations

A
  • Use w/ caution on patients w/ Hx of alcoholism, chronic malnutrition, severe hypovolemia, renal impairment and hepatic impairment/disease
  • Rare side effect of skin reaction - D/C use if skin rash develops, this reaction could be fatal
  • Dosing errors of IV Tylenol could result in hepatic injury, risk of liver failure, overdose and death
141
Q

Versed Indications for

- Seizures for Adults / PEDS

A

Adult Seizures:
- Generalized seizures lasting ≥5 min including PTA
- Recurrent Tonic-clonic seizures w/o lucid interval
- Eclamptic seizures of any duration
PEDS Seizures:
- Generalized seizures lasting ≥5 min including PTA
- Recurrent Tonic-clonic seizures w/o lucid interval
- Partial seizure with Resp. compromise

142
Q

Fentanyl Dose/Route

for patients >65

A 
Titrate to pain and vital signs
Fentanyl up to 25mcg IV SO
  - MR x2 25mcg slow IVP q5” SO
  - Max SO dose is 75mcg
OR
Fentanyl 25mcg IN x2 q15” SO
  - 3rd IN dose 25mcg BHO
143
Q

Sodium Bicarb Dose/Route for

- Crush injury of extremity or torso with extended entrapment ≥2 hours just prior to extremity being released

A

ADULT:
1mEq/kg IV/IO BHO

PEDS:
PDC IV/IO x1 BHO

144
Q

Adenosine Administration

A
  • Use large bore in proximal vein to assist administration of rapid (within 1 to 2 seconds) IV push
  • Pinch IV tubing, inject in port closest to patient and immediately follow with NS flush use a 20mL syringe
  • Obtain ECG documentation before, during and after administration
145
Q

Calcium Chloride Special Info

A

Calcium is given to crush injury patients to reverse the effects of Hyperkalemia associated w/ muscle cell death

146
Q

Versed Cautions & Considerations

A
  • 5 min seizure time includes time prior to arrival of prehospital providers
  • Carefully monitor Respiratory Rate, Tidal Volume, O2 sat and ETCO2 during administration
  • Side effects of versed Respiratory Failure may be potentiated when combined with ETOH and other sedative hypnotics and other CNS Depressions resulting in Apnea
  • When using for pre-cardioversion patients: Amnesia is the desired effect, not sedation. Therefore the dosage administered will not necessarily produce lethargy
  • In the combative patient, IM route is usually safer and preferred in order to prevent injury to patient and personnel. If unable or patient is too violent for needles consider IN route
  • Injection may be given through clothing into the thigh for crew safety issues
147
Q

Fentanyl Administration

A
  • Slow IVP, Fentanyl has a rapid onset

- Document V/S & pain scale before & after each administration

148
Q

Versed Indications for

- Dysrhythmias

A

Dysrhythmias:

  • Unstable Bradycardia: Discomfort associated TCP capture , after Morphine if BP 100
  • Unstable Conscious VT pre-cardioversion
  • Conscious SVT pre-cardioversion
  • Unstable Conscious A-Fib / A-Flutter pre-cardioversion
149
Q

Versed Administration

A
  • Versed given IV/IO should be given at a slow rate of 1mg/min to prevent respiratory failure
  • D/C IV/IO administration if/when seizure activity stops
  • Versed is not indicated for simple febrile seizures
150
Q

Albuterol Administration

A
  • Use with 4-6 liters of O2 for hand held mouthpiece

- Use with 6-10 liters of O2 for aerosol mask, CPAP, and ET tube

151
Q

Acetaminophen Administration (Adult)

A

Adults:

  • Must use vented IV tubing for IV drip directly from medication vial
  • Place vial on a flat surface and insert vented IV set. open vent, hang vial and fill IV tubing
  • Administer as IV piggyback into port in main IV line, closing main line as needed
  • Adjust flow rate to administer medication over 15 min
152
Q

Morphine Dose/Route (Adult)

  • For treatment of pain as needed:
    • Discomfort/Pain of suspected cardiac origin
    • Pain associated w/ external pacing
A

ADULT ONLY:

- Morphine 0.05mg/kg IV x1 SO

153
Q

Albuterol Packaging

A

2.5mg/ml or (0.083%)

154
Q

Dopamine Dose/Route

A

ADULT ONLY:
10 - 40mcg/kg/min IV/IO drip
Titrate to maintain systolic BP ≥90, not to exceed 120 BHO

BHPO for Sepsis

155
Q

Atropine Special Info

A
  • Atropine will not reverse the muscle weakness associated w/ OPP; 2-PAM is used
  • May not work with cardiac transplant patient or artificial hearts as the vagus nerve has been severed
156
Q

Morphine Packs

A

10mg/1ml

157
Q

Lidocaine Indications

A

Dysrhythmias

  • Reported/Witnessed ≥2 AICD firing or ≥1 AED shock delivery w/ pulse >60
  • Stable VT

Dysrhythmias
- Pulseless VT / VF

ALS Skills
- In conscious IO prior to infusion

158
Q

Atrovent (Ipatropium Bromide) Cautions & Considerations

A

Do not add to albuterol in Hyperkalemia and Burn patients as it is not indicated

159
Q

Charcoal Packaging

A

50gm/240ml (AMR: 25gm/120ml)

160
Q

Dextrose Packaging

A

Adult / Ped: Oral paste/tablets (3) 15gm
Adult: D50 25gm/50ml
Ped: D10 25gm/250ml

161
Q

Sodium Bicarb Special Info

A
  • In hyperkalemia: Slight alkalosis causes potassium to shift from the extracellular to the intracellular space causing a reduction of serum potassium levels.
  • In crush injuries, reverses effects of acidosis as lactic acid moves from crushed part to circulation. Increases the urine pH thus decreasing the amount of myoglobin precipitated in the kidneys.
  • In TCA OD, slight alkalosis promotes binding of tricyclic to plasma protein, thus reducing the toxic effects on the body.
162
Q

Fentanyl Indications

A

For treatment of Pain as needed:

  • Abdominal discomfort
  • Burns
  • Environmental
  • Trauma

For treatment of Pain as needed:

  • Discomfort/Pain of suspected cardiac origin
  • Pain associated w/ external pacing
163
Q

Versed Special Info

A
  • Versed is treated as a controlled substance and is to be secured / signed for when used
  • ** Emergency drug shortage concentration 1mg/1ml is inappropriate for IN/IM doses & cannot be used with the PDC ***
164
Q

Nitro Dose/Route for

  • Fluid Overload w/ rales
  • Respiratory Distress ?CHF / Cardiac Origin
A

Adult Only

  • If BP >100:
    • Topical Ointment / 1” paste
  • If BP >100 but <150:
    • 0.4mg SL ; MR q3-5”
  • If BP >150:
    • 0.8mg SL ; MR q3-5”
  • If BP <100:
    • 0.4mg SL BHO ; MR BHPO
165
Q

Lidocaine Dose/Route for:

- In conscious IO prior to infusion

A

ADULT ONLY:

- 40mg IO prior to fluid administration

166
Q

Nitro Dose/Route for

- Discomfort / Pain ?Cardiac Origin

A

Adult Only:

  • If BP >100:
    • 0.4mg SL ; MR q3-5”
  • Topical Ointment / 1” paste
  • If BP <100:
    • 0.4mg SL BHO ; MR BHPO
167
Q

Ketamine Indications

A

For Moderate-Severe pain (score ≥5):

  • Burns
  • Environmental
  • Trauma

SD county protocols (1 decks)

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