Quiz 10/16 Flashcards
Glucagon dosage
Antihypoglycemic: 1mg IM, large doses Beta blocker, calcium channel blocker: 3mg-10mg IV
Dextrose (D50) class
Carbohydrate
Nitroglycerin: Precautions
Check vitals after each administraton, NTG induced hypotension responds well to supine positioning and fluids. It is preferable to establish IV access prior to adminstering NTG. Right-sided MI and use of NTG can result in sever hypotension
Dextrose (D50) side effects
Nausea if given too rapidly.
Dextrose (D50) contraindications
None when used in emergency situations
aspirin
dosage
324 mg
(four baby chewable aspirin)
aspirin
note
Aspirin given at the onset of an acute MI reduces mortality and is one of the most effective treatments medics can offer. Don’t forget to give aspirin to patients with cardiac chest pain!
activated charcoal
class
adsorbent
activated charcoal
contraindications
Altered mental status unless administered by NG tube and airway protected with ET tube.
aspirin
indications
Acute chest pain of suspected cardiac origin.
Dextrose (D50) interactions
None
Asprin
Classes
platelet inhibitor EMS use,
analgesic,
antipyretic,
nonsteroidal anti-inflammatory
Glucagon pharmacokinetics
onset: 5-20 min (IM)
Atropine Sulfate: Pharmacokinetics
Onset: immediate
activated charcoal
indications
Selected indications. because activated charcoal will not bind to all substances (for example; not to alcohol or petroleum products), treatment is best dictated by OLMC and/or poison center. Treatment is usually not indicated unless it has been less than two hours since ingestion.
aspirin
pharmacokinetics
Onset: 5– 30 min.
Peak: 15 min.-2 hours
aspirin
side effects
There are few significant side effects to one dose of aspirin.
Glucagon precautions
Ineffective with patients who have reduced glycogen stores
Atropine Sulfate: Precautions
Paradoxical bradycardia can occur after slow administration or with small doses (minimum dose 0.5mg adults. 0.1mg children). Avoid in hypothermic bradycardia.
Atropine Sulfate: Contraindications
None when used in emergency situations.
Glucagon side effects
Nausea/vomiting if given rapid IV
Dextrose (D50) indications
Hypoglycemia, hyperkalemia, (if given concurently with insulin)
Nitroglycerin: Side effects
Hypotension, headache, dizziness, dry mouth.
Nitroglycerin: Note
Nitroglycerin paste is not indicated for the treatment of acute chest pain. some protocols will use paste in conjunction with sublingual doses.
Atropine Sulfate: Mechanism of Action
Atropine is a competitive antagonist for acetylcholine at the muscarinic receptors on the target organs of the parasympathetic system (e.g. heart, lungs. salivary glands etc.). In this way, atropine blocks the action of the parasympathetic system.
Glucagon Mechanism of Action
Causes a breakdown of glycogen stores in the liver into glucose, raising circulating blood glucose. Glucagon has positive inotronic and chronotropic effects on the heart that are independent of beta-adrenergic receptors which is why it is useful with beta blocker overdose.
Nitroglycerin: Indications
Chest pain thought to be cardiac in origin, acute pulmonary edema, may be used in hypertensive crisis.
Atropine Sulfate: Supplied
1mg/10ml preloaded syringe.
aspirin
precautions
None in prehospital setting.
Dextrose (D50) pharmacokinetics
Onset: immediate if given IV
Nitroglycerin: Dosage
1 tablet (0.4 mg) given sublingually q 5 minutes. 1 metered dose spray (0.4mg) sublingually q 5 minutes. 1-2” of paste. 5mcg/min IV (titrate to 5mcg/min q 5 minutes untill desired effect is achieved.)
aspirin
contraindications
confirmed allergy, active G.I. bleeding, suspected aortic dissection
(Local protocols may permit administration of ASA to patients on anticoagulants, although it is not an actual contraindication since warfarin does not inhibit platelet aggregation).
Children or adolescents with viral infection should not take aspirin (Reye’s syndrome).
Atropine Sulfate: Class
Parasympathetic, anticholinergic, antimuscarinic, vagolytic
Glucagon Indications
Hypoglycemia when IV is unobtainable, beta blocker overdose, calcium channel blocker overdose.
Atropine Sulfate: Interactions
Additive anticholinergic effects with other anticholinergic compounds, including antihistamines,TCA’s.
Dextrose (D50) dosage
Adult: initial dose 25g, slow bolus. Second dose of 25g may be given if needed. Pediatric: 0.5 g/kg given as D50 to children older than infancy, as D25 to infants and as D10 to neonates
Nitroglycerine: Class
Nitrate
Nitroglycerne: Mechanism of action
Causes vasodialation that reduces preload, reducing cardiac workload and myocardial oxygen demand. Dialates coronary arteries, resulting in improved perfusion to ischemic myocardium. Relief of ischemia alleviates chest pain.
activated charcoal
dosage
1 g per kilogram
Activated charcoal comes in bottles of 25 – 50 g in slurry with water or sorbitol.
Glucagon supplied
Powder form, must be reconstituted
Glucagon Class
Hormone, antihypoglycemic
activated charcoal
side effects
abdominal cramping, constipation
Glucagon contraindications
None in prehospital setting
activated charcoal
mechanism of action
Adsorbs toxin molecules to the outside surface of charcoal. The combined complex is then excreted from the body.
Atropine Sulfate: Side effects
Acute psychosis, vasodialation, dehydration, elevated temperature, and mydriasis (pupil dialation). Hint: Mad as a hatter, hot as a hare, red as a beet, dry as a bone, and blind as a bat.
Atropine Sulfate: Dosage
Bradycardia: 0.5-1mg every 3-5 minutes (max dose is 0.04mg/kg). Poisoning: 1-2mg initially, can be repeated every 5-60 minutes as needed.
Dextrose (D50) mechanism of action
Increases blood glucose
Dextrose (D50) precautions
Infiltration causes tissue necrousis Use large bore IV if available. Give thiamine before D50 if patient is suspected to be malnourished e.g. alcoholic, homeless, elderly (protocol dependent)
Nitroglycerin: Contraindications
Hypotension (generally systolic
Atropine Sulfate: Indications
Symptomatic bradycardia, organophosphate poisoning, nerve agent poisoning. Atropine is considered ineffective for bradycardia associated with high-level AV blocks (2nd degree type II and 3rd degree). In these cases , consider pacing or dopamine first.
aspirin
mechanism of action
Inhibits the production of certain prostaglandins, which accounts for it’s antiplatelet, anti-inflammatory, antipyretic, and analgesic actions.
Aspirin inhibits platelet aggregation for the life of the platelet (7 to 10 days).
Nitroglycerin: phamacokineics
Onset:1-2 minutes
