Meds - Indications/ Dose/ Route/ PACS Flashcards
Benadryl Dose/Route
ADULT:
50mg Slow IV/IM push
PEDS:
PDC IV/IM
Calcium Chloride Cautions & Considerations
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.
Acetaminophen Packaging
1000mg/100ml
Dextrose Administration
- 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
Adenosine Dose/Route (Adult)
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
Sodium Bicarb Administration
- 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
Epi Dose/Route:
- Adult Dysrhythmias (Cardiac Arrest)
- PEDS: Dysrhythmias (Unstable Bradycardia)
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
Versed Dose/Route for
Overdose:
- Stimulant Intox w/ excited delirium
Psychiatric / Behavioral Emergencies:
- Combative patients
Adult Only:
- IM,IN,IV 5mg
- MR x1 in 10 min
Lidocaine Packaging
100mg/5ml
Atropine Dose/Route
-PEDS: Dysrhythmias - Bradycardia
<9 w/ HR <60 or 9-14 w/ HR <60
PDC IV/IO MR x1 in 5”
Morphine Special Info
- Morphine is a controlled substance & must be kept locked and signed for when used
- Pain level should be documented at administration and q5”
Epi Cautions Considerations
- 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
Lidocaine Dose/Route for:
- Reported/Witnessed ≥2 AICD firing or ≥1 AED shock delivery w/ pulse >60
- Stable VT
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)
Adenosine Dose/Route (PED)
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
Lidocaine Special Info
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
Amiodarone Cautions & Considerations
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
Amiodarone Dose/Route
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
Fentanyl Dose/Route
for PED patients
≥10kg: Fentanyl IV/IN PDC SO - MR PDC BHO, max of 75mcg <10kg: Fentanyl IV/IN PDC BHO - MR PDC BHO
Ketamine Administration
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.
Albuterol Cautions & Considerations
- Consider anaphylaxis if wheezing in the patient with distress, especially if no Hx of asthma
Atrovent (Ipatropium Bromide) Special Info
- 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
Calcium Chloride Administration
- 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
Acetaminophen Special Info
Daily max dose is 4000mg in 24 hrs
Morphine Dose/Route (PED)
- For treatment of pain as needed:
- Abdominal pain
- Burns
- Envenomation injury
- Trauma
- With signs of adequate perfusion:
- PDC IV/IM ; MR BHO
Ketamine Special Info
- 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”
Charcoal Administration
PO, assure that the patient can swallow and is cooperative. Most effective if administered immediately after ingestion
Albuterol Dose/Route
ADULT:
6ml (0.083%) via nebulizer MR
PEDS:
PDC via nebulizer MR
ADULT: Hyperkalemia Continuous 6ml (0.083%) via nebulizer MR
Amiodarone Special Info
Amiodarone is an optional drug and may not be carried by some agencies
Naloxone Cautions & Considerations
- 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
Epi Indications
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
Aspirin Dose/Route
Adult Only: 324mg PO (4 81mg tablets)
Sodium Bicarb Dose/Route for
- Tricyclic OD w/ cardiac effects
ADULT:
1mEq/kg IV/IO
PEDS:
PDC IV/IO x1 BHO
Versed Dose/Route for
- Seizures for Adults / PEDS
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
Dopamine Cautions & Considerations
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.
Naloxone Special Info
- IN route produces a more gradual improvement of LOC than Respiratory effort. If IN dose ineffective, repeat dose should be IM/IV
Glucagon Dose/Route
ADULT:
1mg/ml IM SO
PED’s:
PDC IM SO
Fentanyl Packaging
100mcg/2ml
Atropine Indications
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
Epi Dose/Route:
-PEDS: Respiratory Distress
1:1,000 PDC - via nebulizer ; MR x1
Dextrose Special Info
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)
Acetaminophen Administration (PED)
- 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
Atropine Administration
Pacing is the treatment of choice for wide complex bradycardias. Use atropine only if pacing is unavailable
Amiodarone Packaging
150mg/3mL
Nitro Indications
Discomfort / Pain ?Cardiac Origin
Fluid Overload w/ rales:
- Hemodialysis patients
Respiratory Distress:
- Respiratory Distress ?CHF / Cardiac Origin
Zofran Packaging
4mg/2ml vial or 4mg/1 tablet
Charcoal Indication (PED)
Poisoning / OD: If ingestion within 60 min and recommended by Poison Control Center (assure patient has a gag reflex and is cooperative)
Benadryl Indications
Allergic Reaction / Anaphylaxis
-Urticaria / Angioedema / Allergic Reaction
Poisoning / OD
-Extrapyramidal Reactions
Calcium Chloride Dose/Route
- Hyperkalemia
- Crush Injury
Hyperkalemia:
-500mg IV/IO over 30 sec
Crush Injury:
- 500mg IV/IO over 30 sec BHO
Dopamine Special Info
Approved optional premix solution of 400mg dopamine in 250ml D5W
Epi Dose/Route:
-PEDS: Newborn Deliveries
PDC - IV/IO 1:10,000 ; MR x2 q3-5” ; MR q3-5” BHO
Adenosine Indications
Adult: Dysrhythmias
-Stable SVT
PEDS: Dysrhythmias
-Unstable SVT
Zofran Administration
- 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
Albuterol Indications
- 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
Amiodarone Administration
Piggyback infusion in 100mL of NS given over 10min ; (drip rate with 60gtts/min tubing = 10gtts/sec)
Dopamine Indications
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
Fentanyl Dose/Route
for patients <65
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
Aspirin Cautions & Considerations
Administer if patient had pain or discomfort of suspected cardiac origin that has been relieved PTA
Epi Dose/Route:
-Allergic Reaction / Anaphylaxis
ADULT:
- 3mg IM 1:1,000 ; MR x2 q5”
- 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
Naloxone Indications (Adult/PED)
Adult: Poisoning / OD:
Adult: Altered Nero:
Symptomatic suspected opioid OD w/ RR <12
PED: Poisoning / OD:
PED: Altered Nero:
Symptomatic suspected opioid OD
Atropine Packaging
1mg/10ml (pre-load) or 0.4mg/1ml (multi-dose vial)
Zofran Special Info
PED patients with associated head injury require BHPO
Glucagon Cautions & Considerations
- 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
Dopamine Packaging
400mg/250ml NS (1,600mcg/1ml)
Aspirin Special Info
- Can give if patient is on anticoagulants
- Should be given regardless of prior daily dose
Dopamine Administration
- 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
Zofran Dose/Route (PED)
- 6mo - 3 years: 2mg ODT/IV
- > 3 years: 4mg ODT/IV
If suspected head injury: BHPO
Epi Packaging
1:10,000= 1 mg/10 ml ; 1,000= 1 mg/1 ml
Dextrose Cautions & Considerations
- 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
Benadryl Packaging
50mg/1ml
Aspirin Packaging
81mg tablets
Versed Dose/Route for
- Dysrhythmias:
- Conscious SVT pre-cardioversion
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
Charcoal Indication (Adult)
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
Acetaminophen Dose/Route (Adult/PED)
ADULT:
1000mg IV x1 SO
Infuse over 15 min
PEDS:
≥2 years PDC x1 SO
Infuse over 15 min
Sodium Bircarb Indications
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
Charcoal Cautions & Considerations
- Anticipate vomiting complications, consider Zofran
- Use caution w/ drugs known to cause a rapid onset of seizures. Due to increased risk of vomiting/aspirating
Calcium Chloride Indications
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
Calcium Chloride Packaging
1gm/10ml
Epi Administration
IV/IO/IM
Benadryl Special Info
- 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
Glucagon Indications
Altered Neuro:
-Symptomatic Hypoglycemia patient w/ ALOC or Unresponsive to oral glucose, If no IV and BS <60 (neonate <45)
Zofran Dose/Route (Adult)
4mg IV/IM/ODT
MR x1 in 10”
Lidocaine Administration
Do not push more than 50mg/min in an awake patient
- Recommended that all adult patient doses be rounded to the nearest 20mg
Morphine Cautions & Considerations
- 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
Atrovent (Ipatropium Bromide) Indications
Respiratory Distress:
-Suspected non-cardiac
Allergic Reaction / Anaphylaxis:
-Acute Allergic reactions or Anaphylaxis
Ketamine Packaging
500mg/10ml vial (50mg/1ml or 5mg/0.1ml)
Lidocaine Dose/Route for:
- Pulseless VT / VF
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
Atrovent (Ipatropium Bromide) Administration
- Use 4-6Lpm of O2 for handheld mouthpiece
- Use 6-10Lpm of O2 for Neb, CPAP & ET tube
Naloxone Packaging
1mg/1ml (Preload 2mg/2ml)
Glucagon Special Info
Glucagon will not work if patients Liver glycogen stores are depleted, which may be seen in Severe Hypoglycemia, Malnutrition & Adrenal Insufficiency
Atropine Cautions & Considerations
- 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
Atropine Dose/Route
-Adult: Dysrhythmias - Bradycardia:
0.5mg IV/IO for HR <60
MR q3-5” to max of 3mg
Nitro Cautions & Considerations
- 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.
Ketamine Cautions & Considerations
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
Benadryl Cautions & Considerations
- 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
Versed Dose/Route for
- Dysrhythmias:
- Unstable Bradycardia: Discomfort associated TCP capture , after Morphine if BP 100
- Unstable Conscious VT pre-cardioversion
Adult Only:
- 1-5mg slow IV/IO (1mg/min)
- If age ≧60 consider lower dose with attention to age and hydration status
Morphine Administration
- Slow IVP, Morphine has a rapid onset
- Document V/S & pain scale before & after each administration
Charcoal Dose/Route
ADULT:
50gm PO
PED’s:
PDC PO
Fentanyl Special Info
- Fentanyl is a controlled substance & must be kept locked and signed for when used
- Pain level should be documented at administration and q5”
Aspirin Administration
Tablets can be chewed or swallows with small amounts of water
Sodium Bicarb Packaging
50mEq/50ml
Albuterol Special Info
- 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)
Atropine Dose/Route
-Poisoning / OD:
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
Morphine Indications
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
Glucagon Packaging
1mg/1ml
Versed Indications for
- Overdose
- Psychiatric / Behavioral Emergencies
Overdose:
- Stimulant Intox w/ excited delirium
Psychiatric / Behavioral Emergencies:
- Combative patients
Zofran Indications
Abdominal Discomfort - GI/GU:
- For nausea or vomiting
PED: GI/GU:
- For nausea or vomiting
Pain mgmt:
- For nausea or vomiting after Morphine
Amiodarone Indications
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
Epi Dose/Route:
-PEDS: Burns
1: 1,000 PDC - via nebulizer ; MR x1 SO
1: 1,000 PDC - IM SO ; MR x2 q5” SO
Zofran Cautions & Considerations
Anticipate the need for Zofran to treat nausea/vomiting side effect of morphine administration
Charcoal Special Info
- 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
Versed Packaging
5mg/1ml or 10mg/2ml
Naloxone Administration
- 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)
Naloxone Dose/Route (Adult/PED)
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”
Morphine Dose/Route (Adult)
- For treatment of pain as needed:
- Abdominal pain
- Burns
- Envenomation injury
- Trauma
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
Epi Dose/Route:
-Respiratory Distress
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”
Nitro Administration
- 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
Adenosine Packaging
6mg/2ml & 12mg/4ml
Acetaminophen Indications
For treatment of pain as needed:
- Abdominal pain
- Burns
- Envenomation injuries
- Trauma
Ketamine Dose/Route
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
Versed Dose/Route for
- Dysrhythmias:
- Unstable Conscious A-Fib / A-Flutter pre-cardioversion
Adult:
- 1-5mg slow IV/IO (1mg/min) BHPO
- If age ≧60 consider lower dose with attention to age and hydration status
Aspirin Indications
Discomfort/Pain of suspected cardiac origin
Atrovent (Ipatropium Bromide) Dose/Route
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
Fentanyl Dose/Route
for Chest pain/pain associated w/ pacing
ADULT ONLY:
Fentanyl 25mcg IV x1 SO
Nitro Packaging
1 spray or 1 tablet = 0.4mg
1 inch paste = 15mg
Glucagon Administration
- 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
Cyanide Kit Indications
Significant symptoms such as:
- Seizures
- LOC
- Cardiac Arrest
Atrovent (Ipatropium Bromide) Packaging
0.5mg/2.5ml (0.02% unit dose vial)
Sodium Bicarb Cautions & Considerations
TCA cardiac effects are Hypotension, Heart block or widened QRS
Dextrose Dose/Route
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)
Sodium Bicarb Dose/Route for
- Symptomatic suspected Hyperkalemia if ≥72 since last dialysis
ADULT ONLY:
1mEq/kg IV/IO
Epi Special Info
- 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
Fentanyl Cautions & Considerations
- 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
Benadryl Administration
IV / IM
Lidocaine Cautions & Considerations
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.
Adenosine Special Info
Half life of adenosine is <10 sec
Adenosine Cautions & Considerations
- 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
Cyanide Kit Dose/Route
Amyl Nitrate:
- Given over 30sec BHPO
Sodium Thiosulfate 25%:
- 12.5gm IV BHPO
Hydroxocobalamin:
- 5gm IV over 15 min BHPO
Nitro Special Info
- 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.
Dextrose Indications
Altered Neuro:
Symptomatic Hypoglycemia patient w/ ALOC or unresponsive to oral glucose and blood sugar
-Adult/ Ped / Infant : <60
-Neonate : <45
Acetaminophen Cautions & Considerations
- 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
Versed Indications for
- Seizures for Adults / PEDS
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
Fentanyl Dose/Route
for patients >65
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
Sodium Bicarb Dose/Route for
- Crush injury of extremity or torso with extended entrapment ≥2 hours just prior to extremity being released
ADULT:
1mEq/kg IV/IO BHO
PEDS:
PDC IV/IO x1 BHO
Adenosine Administration
- 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
Calcium Chloride Special Info
Calcium is given to crush injury patients to reverse the effects of Hyperkalemia associated w/ muscle cell death
Versed Cautions & Considerations
- 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
Fentanyl Administration
- Slow IVP, Fentanyl has a rapid onset
- Document V/S & pain scale before & after each administration
Versed Indications for
- Dysrhythmias
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
Versed Administration
- 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
Albuterol Administration
- 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
Acetaminophen Administration (Adult)
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
Morphine Dose/Route (Adult)
- For treatment of pain as needed:
- Discomfort/Pain of suspected cardiac origin
- Pain associated w/ external pacing
ADULT ONLY:
- Morphine 0.05mg/kg IV x1 SO
Albuterol Packaging
2.5mg/ml or (0.083%)
Dopamine Dose/Route
ADULT ONLY:
10 - 40mcg/kg/min IV/IO drip
Titrate to maintain systolic BP ≥90, not to exceed 120 BHO
BHPO for Sepsis
Atropine Special Info
- 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
Morphine Packs
10mg/1ml
Lidocaine Indications
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
Atrovent (Ipatropium Bromide) Cautions & Considerations
Do not add to albuterol in Hyperkalemia and Burn patients as it is not indicated
Charcoal Packaging
50gm/240ml (AMR: 25gm/120ml)
Dextrose Packaging
Adult / Ped: Oral paste/tablets (3) 15gm
Adult: D50 25gm/50ml
Ped: D10 25gm/250ml
Sodium Bicarb Special Info
- 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.
Fentanyl Indications
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
Versed Special Info
- 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 ***
Nitro Dose/Route for
- Fluid Overload w/ rales
- Respiratory Distress ?CHF / Cardiac Origin
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
Lidocaine Dose/Route for:
- In conscious IO prior to infusion
ADULT ONLY:
- 40mg IO prior to fluid administration
Nitro Dose/Route for
- Discomfort / Pain ?Cardiac Origin
Adult Only:
- If BP >100:
- 0.4mg SL ; MR q3-5”
- Topical Ointment / 1” paste
- If BP <100:
- 0.4mg SL BHO ; MR BHPO
Ketamine Indications
For Moderate-Severe pain (score ≥5):
- Burns
- Environmental
- Trauma
