Meds per Protocol Flashcards
Arrest: PEA/Asystole
- NS 500 ml
- Epi 1:10,000 1 mg/3-5 min
- Suspected Acidosis or Hyperkalemia: 50 mEq BiCarb, 1 g CaCl
Arrest: V-Fib/Pulseless V-Tach
- Defib
- NS 500 ml
- Epi 1:10,000 1 mg/3-5 min
- Ami 300 mg/20 ml NS, after 5 min 150 mg more
- Torsades: 2 g Mag
- 50 mEq BiCarb, 1 g CaCl
MC: Lido 1.5 mg/kg, Ami drip 150 mg/100ml/10 min
Arrest: ROSC
- 2 IVs
- Retain SBP > 100 MAP > 65: 2 mcg/min titrated to 20mcg/min if needed Norepi
MC:
- Ami 150 mg/100 ml/10 min and Lido 1.5 mg/kg for dysrrhythmia
- Metoprolol 5 mg/5 min up to 4 doses for HTN
Asthma
- Albuterol 2.5 mg/3ml and Ipratropium 0.5 mg/2.5 ml together up to 3 doses (MC for more)
- 10 mg Dex
- Epi 1:1,000 0.3 mg IM for severe
- Mag 2g/100ml/20 min (MC for more)
MC:
-3 mg Epi Neb
Chest Pain
- ASA 324 mg
- Nitro 0.4 mg SL/5 min w/ SBP > 120 MAP > 90 as needed
- if SPB < 100, 500 ml bolus NS
Agitated Pt
-2.5 mg IV - 5 mg IM (may repeat up to 10 mg) Versed
MC:
- Additional Versed
- 2.5-5 mg IV/IM Haldol
- 250 mg IM loading, 0.5-2 mg/kg IV/IM Ketamine
Ax Rxn
- if SBP < 90 MAP < 60, 500 ml NS
- 0.3 mg IM Epi 1:1,000 if wheezing/ 5 min as symptoms persist
- DuoNeb up to x3 for wheezing
- 50 mg IV/IM Benadryl
- 10 mg PO/IM/IV Dex
- if after NS SBP < 100 MAP <65, consider 2-20 mcg/min Norepi
MC:
-1 mg/1000 ml Epi at 5 mcg/min
Brady/Symptomatic Brady
- Atropine 0.5 mg IV/3 min up to 3 mg
- NS bolus up to 2 L
- Transcutaneous Pacing
- Consider 2-20 mcg/min Norepi after NS to get SBP > 100 MAP > 65
Cardiogenic Shock
to be used with STEMI confirmed
- ASA 324 mg
- 500 ml NS
- if unstable or pulm edema: 2-20 mcg/min Norepi to get MAP > 65 SBP > 100
COPD/Bronchospasm
- DuoNeb up to x3 (MC for more)
- Consider 10 mg Dex
- Consider CPAP
MC:
-2 g/100 ml/10 min Mag
Crush Injury
-If 1 ext crushed > 2 hr or 2 ext crushed > 1 hr: 50 mEq BiCarb/30 min, 1 dose 1 min prior to extrication
MC:
-if hyperkalemia w/EKG changes: 1 g/5 min CaCl, repeat in 5 min if no resolution
Eye Injury
-Tetracaine 0.5% 2 drops per eye/3 min as needed
Excited Delerium
- 10 mg Versed or 250 mg Ketamine
- can give another 250 mg Ketamine after either one of those
MC:
- 2.5-5 mg Haldol
- 2.5-10 mg more Versed
- 0.5-2 mg/kg IV or 3-5 mg/kg IM more Ketamine
Hyperglycemia
-BGL > 400 mg/dL: 500 ml NS, may repeat once
MC for more
Hyperkalemia
- 500 ml NS
- Cardiac Arrest/Rhythm changes during RSI: 50 mEq BiCarb, 1 g CaCl if QTc prolong or QRS widening
MC:
- Albuterol 2.5 mg/3 ml Neb every 10 min
- The BiCarb and CaCl in Pts that don’t meet standing order criteria
Hypoglycemia
- 15-24 g oral glucose
- BGL < 60: D10 up to 25 g, can be redosed (MC for more)
- if no IV, 1 mg IM Glucagon
Nausea/Vomiting
- 4 mg Zofran, can repeat in 10 min
- 25 mg Benadryl for motion sickness
MC:
-Versed
Opioid Overdose
-2 mg doses IN/IV/IM if hypoventilation or resp arrest
Organophosphate Exposure
- Symptomatic Pts: Atropine 2 mg per dose IV / 5 min until secretions dry
- 5 mg IV/IN/IM Versed for seizures
Pain Management
MC for More:
- Morphine 0.05 mg/kg IV or 0.1 mg/kg IM, can repeated up to 10 mg
- Fentanyl 1-1.5 mcg/kg IN/IV/IM, can be repeated up to 200 mcg
MC:
- Ketamine 25 mg IV/5min or 50 mg IM OR 0.1-0.3 mg/kg IV
- Versed IV/IM/IN
- Ketorolac 20 mg IV or 30-60 mg IM
Post-Intubation Management
- Fentanyl 100 mcg IV once then 50 mcg IV/5 min, as needed
- Versed up to 5 mg IV/10 min as needed -can substitute Ketamine up to 100 mg/5 min as needed
Procedural Sedation
- Versed 2.5 mg IV or 5 mg IM, can be repeated / 5 min SBP > 100 MAP > 65
- Fentanyl 1-1.5 mcg/kg IN/IV/IM, can be repeated / 5 min up to 200 mcg
MC:
- Morphine
- Ketamine 0.5-2 mg/kg IV or 3.5 mg/kg IM
- Etomidate 0.1 mg/kg IV ONCE, 0.3 mg/kg for induction
Pulmonary Edema
-CPAP as needed
-Nitro 0.4 mg SL:
x1/5 min if SBP 120-160
x2/5 min if 160-200
x3/5 min if > 200
-if wheezes, DuoNeb, MC for more albuterol after
Seizures
- Versed 5 mg IV/IN/IM, may repeat once (MC for more)
- Mag 4 g IV over 20 min if Pt is pregnant
Sepsis
-NS so MAP > 65
MC:
-Norepi to help MAP: 2-20 mcg/min to keep MAP > 65 SBP > 100
Shock
- NS
- Norepi 2-20 mcg/min for MAP > 65 SBP > 100
MC:
-Decadron 10 mg PO/IM/IV
Stroke
- maintain SBP > 120 MAP > 90
- if SBP > 220 or DBP > 120, contact MC
MC:
-Metoprolol 5 mg slow IV push
STEMI
- ASA 4x81 mg
- Nitro 0.4 mg SL as needed/5 min (SBP > 120 MAP > 90)
- Consider NS if SBP < 100
MC:
-Metoprolol 5 mg slow IV (HR > 80 BP > 120 or MAP > 90) up to 4 doses
Narrow Complex Tachy
- NS
- Unstable and Reg: Sedation, synchronized cardioversion starting at 100 J or equivalent biphasic
- Unstable and Irreg: same but start at 200 J
- Stable and Reg: Adenosine 6 mg then 12 mg IV (MC for another 12 mg IV)
- Stable and Irreg: Cardizem 0.25 mg/kg (max 25 mg) IV/2 min, if no change 0.35 mg/kg (max 35 mg) IV/2 min, MC for more if Pt is on Beta blocker, metoprolol 5 mg/2 min IV for both doses instead
MC:
-Ami 150 mg/100 ml NS/10 min (10 ml/min or 3 drops/5 sec using a 10 drop set)
Wide Complex Tachy
- Stable: Ami 150 mg/100 ml NS/10 min (3 drops / 5 sec using 10 set)
- Unstable: Consider sedation, synch. cardioversion starting at 100 J or biphasic equivalent, may repeat up to x3 times total
MC:
- unsynch. cardioversion
- Adenosine 6 or 12 mg IV
- Lido 1.5 mg/kg IV
- Ami if rhythm converted
- Mag 2 g IV/10 min (stable) or /2 min (unstable)
Trauma
- Compensated: NS 1 L, then 500 ml/hr
- Decompensated: NS 2 L, then 500 ml/hr
MC:
-Norepi 2-20 mcg/min after fluid bolus (for MAP > 65, SBP > 100)
