teexmediccards1

Absorbant

Absorbs toxic substances from the gastrointestinal tract; onset of action is immediate.

most oral poisonings and medication overdoses. Can be used after evacuation of poisonings.

• oral administration to a comatose patient
• after ingestion of corrosives, caustics, or petroleum distillates (ineffective and may induce vomitting)
• simultaneous administration with other oral drugs

• May induce nausea / vomitting
• may cause constipation
• may cause black stool (dark dookie)

Bonds with and generally inactivates anything it mixes with (ex syrup of ipecac)

25 or 50 gram black powder

Note: if not in premixed slurry dilute and mix with 4 parts water (1:4 ratio)

1 to 2 grams per kilogram PO (oral) or via Nasal gastrointestinal tube

1 to 2 grams per kilogram PO (oral) or via Nasal gastrointestinal tube

Depends on the gastrointestinal function. Will act until excreted.

• Often used in conjunction with magnesium citrate.
• Must be stored in a close container
• Does not absorb cyanide, lithium, iron, lead, or arsenic

Sympathomimetic, Bronchiodilator

Selective Beta-2 agonist that stimulates adrenergic receptors of the sympathomimetic nervous system resulting in smooth muscle relaxation in the bronchial tree and peripheral vasulature

• Treatment of bronchospasm in patient's with reversable obstructive airway disease (COPD / Asthma).
• Prevention of excersise induced bronchospasm

• Known prior hypersensitivity to albuterol
• Tachicardia Arrhymmias, especially those caused by digitalis
• Synergistic with other sympathominetics

Often dose related and include: restlessness, tremors, dizziness, palpitations, tachicardia, nervousness, peripheral vasodilation, nausea, vomitting, hyperglycemia, increase blood pressure, paradoxial bronchospasms.

Trycyllic Antidepressant may potentiate vasculature effects.Beta Blockers are antagonistic. May potentiate hypokalemia caused by diruetics.

• Solution of aerosolization; .05% (5mg per mL.)
• Metered dose inhaler: 90ug per metered spray (17g canister with 200 inhalations)
• Syrup 2 mg per 5mL

Adult: Administer 2.5mg. Dilute .5mL of .5% solution with 2.5mL normal saline in nebulizer and administer over 10 to 15 minutes.

Metered dose inhaler: 1 to 2 inhalations (90 to 180ug.) 5 minutes between inhalations

Administer solution of .01 to .03mL (.05 to .15mg per Kg per dose) diluted in 2mL of 0.9% normal saline. May repeat every 20 minutes 3 times.

Onset in 5 to 15 minutes with peak effect in 30 minutes to 2 hours and duration of 3 to 4 hours.

• Pregnancy Safety: Category C antagonized by beta blockers (examples inderal, lopressor)
• May precipitate angina pectoris and arrhythmias.
• Should only be administered by inhalation methodogy in prehospital management

Platelet inhibitor / Anti inflamatory agent.

Prostaglandin inhibition

New onset chest pain suggestive of acute myocardial infarction. Signs and symptoms suggestive of recent CVA

Hypersensitivity and relatively contraindicated with active ulcer disease or asthma

• Heartburn, GI Bleeding, Prolonged bleeding, nausea / vomitting.
• Wheezing in allergic patients

Use caution in patient's allergic to NSAIDs

81mg, 160mg or 325mg tablets. Chewable and standard

• Onset: 30 to 45 Minutes
• Peak effect: variable
• Duration: variable

• Pregnancy Safety: Category D
• Not recommended in pediatric population

Sympathometic

• Direct acting alpha and beta agonist.
• Alpha: Vasoconstriction.
• Beta-1: Positive inotropic, chronotropic and dromotropic effects.
• Beta-2: Bronchial Smooth muscle relaxation and dilation of skeletal vasculature.

• Cardiac Arrest (V-Fib / Pulseless V-Tac, Asystole, Pulseless electical activity)
• Symtomatic Bradicardia: As an alternative infusion to dopamine
• Severe Hypotension secondary to bradicardia when atropine and transcutaneous pacing are unsuccessful
• Allergic Reactions: anaphalaxis
• Asthma

• Hypertension
• Hypothermia
• Pulmonary edema
• Myocardial Ischemia
• Hypovolemic Shock

• Hypertension
• Tachicardia
• Arrhymmias
• Pulmonary Edema
• Anxiety
• Restlessness
• Psychomotor agitation
• Nausea
• Headache
• Angina

Potentiates Other symphathomimetics deactivated by alkaline solutions (ex: sodium bicarbonate), Monomine oxidase inhibitors (MAOIs) may potentiate effects, beta blockers may blunt effects.

• 1 to 1000 solution: ampules and vials containing 1mg per mL
• 1 to 10,000 solution: prefilled syringes containing 1mg in 10mL
• Autoinjector (epipen) .05mg per mL (1 to 2000)

.3 to .5mg of 1:1000 SC

.1mg (1mL of 1:10,000) IV/IO over 5 minutes

• IV/IO Dose: 1mg (10mL of 1:10,000 solution) every 3 to 5 minutes during resusitation. Follow each dose with 20mL flush and elevate arm for 10 to 20 seconds after dose.
• Higher Dose: (up to .2mg per Kg) may be used for specific indiacations (beta blocker or calcium channel overdose).
• Continuous infusion: Add 1mg(1mL of 1:1000 solution) to 500mL normal saline or d5w. Initial infusion rate of 1ug per minute titrated to effect. (typical dose: 2 to 10ug per minute).
• Endotrachial Dose: 2 to 2.5mg diluted in 10mL normal saline.

2 to 10ug per minute: titrate to patient response

0.01mg per kg (0.01mL per kg) of 1:1000 solution SC (maximum of .3mL)

• IV/IO Dose: .01mg per kg (.1mL per kg) of 1:10,000 solution every 3 to 5 minutes during arrest
• All endotracial doses .1mg per kg (.1mL per kg) of 1:1000 solution

• IV/IO Dose: .01mg per kg (.1mL per kg) of 1:10,000 solution
• All endotrachial doses: .1mg per kg (.1mL per kg) of 1:1000 solution

Begin with rapid infusion then titrate to response. Typical initial infusion .1 to 1ug per minute. Higher doses may be effective.

• Onset: Immediate
• Peak effect: Minutes
• Duration: Several Minutes

• Pregnancy Safety: Category C
• May cause syncope in asthmatic children
• May increase myocardial oxygen demand

Vasodilator

• Smooth muscle relaxant acting on vascular, bronchial, uterine, and intestinal smooth muscle
• Dilation of arterioles and veins in the periphery
• Reduces preload and afterload
• Decreases the workload of the heart and thereby myocardial oxygen demand

• Acute angina pectoris
• Ischemic Chest Pain
• Hypertension
• CHF
• Pulmonary Edema

• Hypotension
• Hypovolemia
• Intercranial bleeding or head injury
• Previous administration of viagra, revatio, levitra, cialis, or similar agents within past 24 hours

Headache, hypotension, syncope, relex tachicardia, flushing, nausea, vomitting, diaphoresis, muscle twitching

• Additive effects with other vasodialators
• incapadible with other drugs IV

• Tablets: .15mg, .3mg, .4mg, .6mg
• NTG Spray: .4mg to .8mg under the tounge
• NTG IV (tridil)

• Adult
• Tablets: .3 to .4mg sublingually. May repeat every 3 to 5 minutes with a maximum dose of 3 doses
• NTG Spray: .4mg under the tounge. 1 to 2 sprays.
• NTG IV Infusion: Begin at 10 to 20ug per minute. Increase by 5 to 10 drips per minute until desired effect
• Pediatrics: Not recommended

• Onset: 1 to 3 minutes
• Peak Effect: 5 to 10 minutes
• Duration: 20 to 30 minutes or if IV 5 to 10 minutes after discontinuation of infusion

• Pregnancy Safety: Category C
• Hypotension more common in geriatric population
• NTG decomposes if exposed to light or heat. Must be kept airtight
• Active ingredient may have a stinging effect when administered.

Hyperglycemic

Provides quickly absorbed glucose to increase blood glucose levels

Conscious patient's with suspected hypoglycemia

• Decreased level of consciousnes
• Nausea / vomitting

Nausea / Vomitting

None

• Glucola 300mL bottles
• Glucose Pastes and Gels in various forms

Sipped slowly by patient until clinical improvement noted

• ONset: Immediate
• Peak Effect: Variable
• Duration: Variable

Naturally occuring atmospheric gas

reverses hypoxia

• Confirmed or expected hypoxia
• Ischemic Chest pain
• respiratory insufficiency
• Prophylactically during air transport
• Confirmed or suspected carbon monoxide poisoning
• All other causes of tissue oxygenation
• decreased level of consciousness

• Certain patient's with COPD or emphysema who will not tolerate oxygen concentrations over 35%
• Hyperventilation

• Decreased level of consciousness and respiratory depression in patients with chronic carbon monoxide retention
• Retrolental fibroplasia if given high concentrations to premature infants. Maintain 30 to 40% oxygen

None

Oxygen cylinders usually green and white of 100% compressed oxygen gas

• Adult: Cardiac Arrest and Carbon Monoxide Poisoning: 100%
• Hypoxemia: 10 to 15L per minute via NRB
• COPD: 1 to 6L per minute via NC or 28-35% via Venturi Mask
• Be prepared to supply ventilatory support if higher concentrations of oxygen are needed
• Pediatrics: Same as adult with exception of premature infant

• Onset: Immediate
• Peak Effect: N/A
• Duration: Less than 2 minutes

Endogenious Nucleotide

• Slows conduction time through the AV node
• Can interupt reentry pathways
• Slows heartrate
• Actions directly on the sinus pacemaker cells
• Is drug of choice or reentry SVT
• Can be used diagnosticly for stable, wide complex, tachicardias of unknown type after two doses of lidocaine

• Conversion of PSVT to sinus rhythm
• May convert reentry SVT due to wolff-parkinson-white syndrome
• Not effective in converting atrial fibrilation / flutter or Ventricular tachicardia

• Second or third degree block or sick sinus syndrome
• atrial flutter / fibrilation
• ventricular tachicardia
• hypersensitivity to adenosine
• Poison induced tachicardia

• Facial Flushing
• Shortness of breath
• Chest Pain
• Headache
• Paresthesia
• Diaphoresis
• Palpitations
• Hypotension
• Nausea
• Metallic Taste

• Methylxanthines (theophylline-like drugs) antagonize the effects of adenosine
• Dipyridamole (persantine) potensiates the effects of adenosine
• Carbamazepine (tegretal) may potensiate the AV node blocking the effects of adenosine
• May cause bronchoconstriction in asthmatic patients

3mg per mL in 2 mL flip top vials for IV injection

Adults: 6mg over 1 to 3 seconds followed by a 20mL saline flush and elevate extremity; If no response after one to two minutes administer 12mg over 1 to 3 seconds. Maximum total dose of 30 mg.

.1 to .2mg per kg rapid IV; maximum single dose 12mg

• Onset and peak effects in seconds
• Duration is 12 seconds

• Short half life limits side effects in most patients
• Pregnancy Safety: Category C

Antiarrhythmic

Blocks sodium channels and myocardial potasium channels

V-Fib / Pulseless V-Tac and unstable V-Tac in patient's refractory to other therapy

• Known hypersensitivity
• Cardiogenic Shock
• Sinus Bradicardia
• Second or third degree AV Block (unless a functional pacemaker is available)

• Hypotension
• Bradicardia
• Prolongation of the P-R, QRS, and QT intervals

• Use with digoxin may cause the digitalis toxicity
• Antiarrhymtics may cause increased serum levels
• Beta Blockers and calcium channel blockers may potensiate bradicardia, sinus arrest, and AV heartblocks.

Ampules containing 150mg per 3mL and prefilled syringes containing 150mg per 3mL

• V-Fib / Pulseless V-Tac (unresponsive to CPR, defibrilation, or vasopressors): 300mg IV/IO Push (recommended dilution in 20 to 30mL of D5W). INitial dose can be followed 1 time in 3 to 5 minutes at 150mg IV/IO push.
• Recurrent Life threatening ventricular arrhythmias: Maxium cumulative dose is 2.2g per 24 hours and administered as follows: Rapid Infusion: 150mg IV/IO over 10 minutes (15mg per minute). May repeat rapid infusion every 10 minutes as needed. Slow infusion: 360mg IV/IO over 6 hours which is 1mg per minute. Maintainence infusion: 540mg IV/IO over 18 hours at .5mg per minute

• Refractory V-Fib/ pulseless V-Tac: 5mg per kg IV/IO bolus. Can repeat the same dosage up to a total dose of 15mg per kg per 24 hour. Maximum single dose 300mg.
• Perfusing supraventricular and ventricular tachicardias: Loading Dose of 5mg per kg IV/IO over 20 to 60 minutes (maximum single dose of 300mg) Can repeat to a maximum of 15mg/kg per day

• Onset: Immediate with peak effect in 10 to 15 minutes
• Duration of Action: 30 to 45 minutes

• Pregnancy Safety- Category D
• Monitor patient for hypotension
• May worsen arrhythmias or precipitate new arrthymias.

Anticholinergic Agent

• Parasympatholytic: Inhibits action of acetycholine at postganglionic parasympathetic neuro effector sites
• Increases heartrate in life threatening brady arrhythmias

• Hemodynamicly unstable bradicardia
• Asytole
• Bradicardia (Less than 60bpm)
• Pulseless Electrical Activity
• Organophosphate poisoning
• Bronchospastic pulmonary disorders

• Tachicardia
• Hypersensitivity
• Unstable cardiovascular status in acute hemorrage
• Myocardial Ischemia
• Narrow angle glaucoma

• Headache
• Dizziness
• Palpitations
• Nausea / Vomitting
• Tachycardia
• Arrhythmias
• Anticolonergic Effects (blurred vision, dry mouth, urinary retention)
• Paradoxical bradicardial when pushed slowly or at low doses
• Flushed hot dry skin

• Potensial adverse effects when administered with digoxin, cholinergics, physostigmine.
• Effects enhanced by antihistimines, procainamide, quinidine, antipsychotics, benzodiazapines, and antidepressants

• Prefillled syringes: 1mg in 10mL (.1mg per mL)
• Nebulizer: .2% (1mg in .5mL) .5% (2.5mg in .5mL)

• Asystole, bradicardic PEA: 1mg IV/IO push. May repeat every 3 to 5 minutes if asystole or PEA persists to a maximum of 3 doses (3mg)
• Endotrachial Administration: 2-3mg diluted in 10mL of water or normal saline
• Unstable Bradicardia: .5mg IV/IO every 3 to 5 minutes as needed not to exceed total dose of 3mg. Use shorter dosing intervals (3 minutes) and higher doses in severe clincal condtions
• Organophosphate poisoning: Extremely large doses (2-3mg or higher) may be needed

• .02mg/kg via IV/IO push; may double this dose for second IV/IO dose
• minimum single dose .1mg
• maximum doses: (child single dose: .5mg) (child total dose: 1mg) (adolescent single dose: 1mg) (adolescent total dose 2mg)
• endotrachial administration: .3mg / kg. Absorbtion may be unreliable

• Onset: Immediate
• Peak Effect: Rapid (1 to 2 minutes)
• Duration: 2 to 6 hours

• Pregnancy Safety-C
• Moderate doses may cause pupilary dilation

Calcium Channel Blocker

• Block influx of calcium ions into cardiac muscle
• Prevent spasm of corronary arteries
• Arteriol and Venous vasodilator
• Reduces preload and afterload
• Reduces myocardial oxygen demand

Control of rapid ventricular rates due to atrial flutter / A-Fib / Reentry SVT / Angina Pectoris

• Hypotension
• Sick Sinus Syndrome
• Second or Third degree AV Block
• Cardiogenic shock
• Wide Complex tachicardias
• Poison / Drug induced Tachicardia

• Bradicardia
• Second or Third Degree AV Block
• Chest Pain
• CHF
• Syncope
• V-FIb
• V-Tac
• Nausea
• Vomitting
• Dizziness
• Dry Mouth
• Dyspnea (difficulty breathing)
• Headache

Caution in patient's using medications that affect cardiac contractility. In general should not be used on patient's taking beta blockers.

• 25mg per 5mL vial
• 50mg per 10mL vial
• Non refrigerated; lyo-ject syringe

• Initial Bolus: .25mg per kg. (average dose 15-20mg) IV over 2 minutes
• If inadequate response may rebolus in 15 minutes: .35mg per kg (average dose 20 to 25mg) IV over 2 minutes
• Maintainance Infusion of 5 to 15mg per hour
• Not recommended for pediatrics

• Onset: 2-5 minutes
• Peak Effect: Variable
• Duration: 2-3 hours

• Pregnancy Safety Category C.
• Use with caution in patient's with renal or hepatic disfunction
• PVC's may be noted at time of converstion of PSVT to sinus rhythm

• Sympthomimetic
• Inotropic Agent

Immediate metabolic precursor to norepinephrine. Increases systemic vascular reisistance, dialates renal and splanchnic vasculature. Increases myocardial contractility and stroke volume

• Cardiogenic, septic, or spinal shock
• Hypotension with low cardiac output states
• Distributive shock

• Hypovolemic Shock
• Pheochromocytoma
• Tachyarrhythmias
• V-Fib

• Cardiac Arrthymias
• Hypertension
• Increased Myocardial oxygen demand; extravasation may cause necrosis

• Incapatible in alkaline solutions. MAOI's will enhance effects of dopamine
• Pretylium may potentiate the effect of dopamine.
• Beta Blockers may antagonize effects of dopamine
• When administered with phenytoin; may cause hypertension, bradicardia, seizures

• 250mg per 5mL to 400mg per 500mL prefilled syringes,
• ampules for IV infusion 400mg in 250mL D5W premixed solutions

• Adult: 2 to 20 drips per kg per minute titrated to patient response
• Pediatric is the same

• Onset- 1 to 4 minutes
• Peak Effect- 5 to 10 minutes
• Duration- Effects cease almost immediately after infusion is shut off

• Pregnancy Safety not established
• Effects are dose dependant
• Dopaminergic response: 2-4 drips per kg per minute: dialates vessels in kidneys; increased urine output
• Beta-adregergic response: 4 to 10 drips per kg per minute: positive chronotropic and inotropic adregergic response: 10 to 20 drips per kg per minute: primary alpha stimulant / vasocontriction
• Greater than 20 drips per kg per minute: Reversal of renal effects / override alpha effects
• Always monitor drip rate
• Avoid extravasation injury

Antiarrhythmic

Decreases automaticity by slowing the rate of phase 4 depolariztion

Alternative to amiodarone in cardiac arrest from V-Fib to pulseless V-Tac, stable monomorphic V-Tac, Stable polymorphic V-Tac with normal baseline QT interval

• Hypersensitivity
• Second and Third degree AV blocks in the absense of artificial pacemaker
• Stokes Adams Syndrome
• Profalactic use in AMI
• Wide Complex Ventricular escape beats with bradicardia

• Slurred Speech
• Seizures with high doses
• Altered Mental Status
• Confusion
• Lightheadedness
• Blurred Vision
• Bradicardia

• Apnea induced with succinylcholine may be prolonged with high doses of lidocaine. Cardiac Depression may occur in conjunction with IV Phenytoin (Dilatin)
• Procainamide may exaserbate central nervous system effects
• Metabolic clearance is decreased in patient's with liver disease or patient's taking beta blockers

• 100mg in 5mL prefilled syringes and ampules (20mg per mL)
• 1g and 2g additive syringes, 1 and 2 gram vials in 30mL of solution

• Cardiac Arrest (V-FIb/Pulseless V-Tac): Initial Dose: 1-1.5mg per kg IV/IO. Repeat dose .5-.75mg per kg, repeated in 5 to 10 minutes to maximum dose of 3mg per kg.
• Endotrachial Dose: 2-4mg per kg
• Stable V-Tac, Wide Complex Tachicardia of uncertain type, Signifigant ectopy: Doses ranging from .5-.75mg per kg and up to 1-1.5mg per kg may be used. Repeat .5 to .75mg per kg every 5 to 10 minutes. Max total dose is 3mg per kg
• Maintainence infusion: 1 to 4mg per minute (30 to 50 drops per kg per minute); can dilute in D5W or Normal Saline

• IV/IO Dose: 1mg per kg rapid IV/IO Push. Max Dose 100mg. Continuous IV/IO infusion: 20to50 drops per kg per minute. Administer bolus dose (1mg per kg) when infusion is initiated if bolus has not been given within previous 15 minutes.
• Endotrachial dose: 2-3mg per kg

• Onset: 1-3 minutes
• Peak Effect: 5 to 10 minutes
• Duration: Variable (15 minutes to 2 hours)

• Pregnancy Safety Category B
• Reduce Maintanence infusions by 50% if patient is over 70 years of age, has liver or renal disease, or is in CHF or shock.
• A 75 to 100mg bolus maintains blood levels for only 20 minutes if not in shock.
• Exceedingly high doses of lidocaine can result in coma or death.
• Avoid lidocaine for reprofusion arrhythmias after fibrinolytic therepy.
• Cross / Reactivity with other forms of local anethesics.

Electrolyte

Reduces striated muscle contractions and blocks peripheral nuero muscular transmission by reducing Acetylcholine release at the myonueral junction, manages seizures in toxemia of pregnancy, induces uterine relaxation, cause bronchodilations after betagnists and anticolonerigcs have been used.

• Seizures of ecclampsia (toxemia of pregnancy)
• Torsade de Pointes
• Hypomagnesia
• Class 2A agent for V-Fib/pulseless V-Tac that is refractory to lidocaine

Heart blocks and myocardial damage

• CNS Depression
• Facial Flushing
• Diaphoresis
• Depressed reflexes
• Circulatory Collapse
• Hypotension

• May enhance effects of other CNS depressants
• serious changes in overall cardiac function may occur with cardiac glycosides

10%, 12.5%, 50% solution in 40, 80, 100, 250mg per mL

• Seizure activity associated with pregnancy: 1 to 4g IV/IO over 3 minutes; maximum dose of 30 to 40 grams per day
• Cardiac Arrest due to hypomagnesemia or Torsade de Pointes: 1 to 2 grams (2 to 4mL of a 50% solution) diluted in 10mL of D5W IV/IO over 15 to 20 minutes
• Torsade de Pointes with a pulse or acute myocardial infarction with hypomagnesemia: Loading dose of 1 to 2 grams mixed in 50 to 100mL D5W over 5 to 6 minutes IV. Follow with .5 to 1g per hour IV (titrate to control Torsade de pointes)

• IV/IO infusion 25 to 50mg per kg (maximum dose 2g) over 10 to 20 minutes; faster for Torsade de Pointes
• For asthma: 25 to 50mg per kg (maximum dose 2g) over 10 to 20 minutes

• Onset: IV/IO: Immediate
• IM: 3 to 4 hours
• Duration: IV/IO: 30 minutes
• IM: 3 to 4 hours

• Pregnancy Safety Category B
• Recommended that the drug not be given in the 2 hours before delivery if possible
• IV calcium chloride or calcium gluconate should be available as a magnesium antagonist if needed.
• Use with caution in patient's with renal failure

Sympathomimetic

• Potenent alpha agonist resulting in intense vaso contriction
• Positive chronotropic and increased inotropic effects (from 10% beta effects) with increased cardiac output

Cardiogenic Shock and Significant hypotensive states (less than 70mmHg)

• Hypotensive patient's with hypovolemia
• Pregnancy (which is a relative contraindication)

• Headache
• Arrythmias
• Tachicardia
• Reflex Bradicardia
• Angina Pectoris
• Hypertension
• Decreased blood flow to gastro intestinal tract, kidneys, skeletal muscles, skin

• Can be deactivated by alkaline solutions, sympathomimetics, and phosphodiesterase inhibitors may exaserbate arrhythmias
• Bretylium may potensiate the effects catachomines

1mg per mL, 4mL ampules

• Dilute 8mg in 500mL of D5W or 4mg in 250mL of d5W (16mg per mL)
• Infuse by IV piggyback at .5 to 1 drips per minute titrated to improved blood pressure (up to 30 drips per minute

.1 to 1 drop per minute IV infusion, titrated to patient response.

• Onset: 1 to 3 minutes
• Peak Effect: Variable
• Duration: 1 to 10 minutes (lasts only 1 minute after infusion is discontinued)

• Pregnancy Class: Not established
• May cause fetal anoxia when used in pregnancy. Must be infused through a large stable vein to avoid tissue necrosis (antidote: local phentolamine injection)
• Often used with low dose dopamine to spare renal and mesenteric blood flow

Antidiuretic hormone

• Stimulation of the V1 smooth muscle receptors.
• Potent vasocontrictor when given in high doses

Alternate vasopressor to the first or second dose of epinephrine in cardiac arrest, may be useful in cases of vasodialatory shock (example: septic shock)

Responsive patient's with coronary artery disease

Bronchoconstriction, Ischemic Chest Pain, Nausea/vomitting, abdominal pain

None

1mL vials containing 20 units (20 u per mL)

• Adult: 40 unit 1 time dose IV/IO to replace the first or second dose of epinephrine in cardiac arrest
• Pedi: Not recommended

• Onset: Immediate
• Duration: Variable

• Pregnancy Safety: Category C
• May increase peripheral vascular resistance and provoke cardiac ischemia and angina

Hypotonic dextrose-containing solution

D5W provides nutrients in the form of dextrose as well as free water

IV Access for emergency drugs; for dilution of concentrated drugs for intravenous infusion

D5W should not be used as a fluid replacement for hypovolemic state

Rare in therapeutic doses

D5W should not be used with phenytoin (dilantin) or ammrinon (Incor)

D5W is supplied in bags of 50, 100, 150, 250, 500, 1000mL

D5W is usually administered through a mini drip (60 drops per mL) at a rate of TKO (To keep vein open)

Short term therapy

None

Isotonic Crystaloid Solution

Lactated Ringers replaces water and electrolytes

Hypovolemic Shock and TKO IV

CHF or Renal Failure Patient's

Rare in therapeutic Doses

Few in the emergency setting

LR is supplied in 250, 500, 100mL bags for IV infusion

For hypovolemic shock: titrated according to patient's physiological response

Short Term Therapy

None

Isotonic Crystaloid Solution

Normal saline replaces water and electolytes

• Heat related problems (heat exhaustion, head stroke)
• Fresh Water drowning
• Hypovolemia
• Diabetic Ketoacidosis
• TKO

Use of NS should not be considered in patient's with CHF as circulatory overload can be easily induced.

Rare in therapeutic doses

Few in Emergency setting

• NS is supplieed in 250, 500, 1000mL bags.
• Sterile normal saline for irrigation should not be confused with that designed for IV administration

• The specific situation being treated will dictate the rate in which NS will be administered.
• In severe heat stroke, diabetic ketoacidosis, and fresh water drowning it is likely that you will be called on to administer the fluid quite rapidly. In other cases it is advisable to administer the fluid at a moderate rate (for example 100mL per hour)

Short term therapy

None

Electrolyte

Increases cardiac contractile state (positive inotropic effect). May enhance ventricular automaticity

Hypocalcemia, Hypercalemia, Magnesium Sulfate Overdose, Calcium Channel Blocker Overdose, Adjunctive therapy of insects bits and stings

Hypercalcemia, V Fib, digitalis toxicity

Bradicardia, Asystole, Hypotension, peripheral vasodilation, metallic taste, local necrosis, choronary and cerbral artery spasm, nausea, vomitting

• May worsen arrythmias secondary to digitalis toxicity.
• May antagonize the effects of verapamil
• Do not mix or infuse immediately before or after sodium bicarbonate without intervening flush

Prefilled syringes containing a 10% solution in 10mL (100mg per mL)

500mg to 1000mg (5 to 10mL of a 10% solution) IV/IO Push for hyperkalemia and calcium channel blocker overdose. May be repeated as needed

20mg per kg (.2mL per kg) slow IV/IO push. Maximum 1g dose. May repeat in 10 minutes

• Onset: 5 to 15 minutes
• Peak Effect: 3 to 5 minutes
• Duration : 15 to 30 minutes but may persist to 4 hours (dose dependant)

• Pregnancy Safety Category C
• Do not use routinely in cardiac arrest

Carbohydrate, hypertonic solution

Rapidly increases serum glucose levels. Short term osmotic diuresis.

Hypoglycemia, Altered levels of consciousness, Coma of unknown etiology, Seizure of unknown etiology. Staus epilepticus.

Intracranial hemmorhage

• Extravasation leads to tissue necrosis
• Warmth
• Pain
• Burning
• thrombophlebitis
• Rhabdomyolysis
• Hyperglycemia

• Sodium Bicarbonate
• Coumadin

25g per 50mL prefilled syringes (500mg per mL)

• 12.5 to 25 grams slow IV .
• May be repeated as nessicary

.5 to 1g per kg per dose slow IV. May be repeated as nessicary

• Onset: Less than 1 minute
• Peak Effect: Variable
• Duration: variable

• Administer thiamine prior to D50 in known alcoholic patient's.
• Draw blood to determine glucose level before administering
• Do not administer to patient's with known CVA unless hypoglycemia documented.

Antihistamine, Anticholinergic

Blocks cellular histamine receptors. Decreases vasodialation. Decreases motion sickness, and reverses extrapyramidal reactions.

Symptomatic Relief of allergies, allergic reactions, anaphalaxis, Acute distonic reactions (phenothiazines), Blood administration reactions; used for motion sickness, hay fever

Asthma, Glaucoma, Pregnancy, Hypertension, Narrow angle glaucoma, infants, patient's taking MAOI's

Sedation, hypotension, Seizures, Visual disturbances, vomitting, urinary retention, palpitations, arrhythmias, dry mouth and throat, paradoxial CNS excitation in children

Potentiates effects of alcohol and other anticholonergics, May inhibit corticosteroid activity; MAOI prolong anticholonergic effect of diphenhydramine

• tablets; 25 and 50mg
• capsules: 25 and 50mg
• Prefilled syringes: 50 or 100mg
• Vials: IV or IM; elixir: 12.5mg per 5mL

• Adult: 25 to 50 mg IM/IV/PO
• Pediatric: 1 to 2mg per kg IV/IO(slowly)/ IM
• If given PO 5mg per kg for 24 hours

• Onset: 15 to 30 minutes
• Peak Effect: 1 hour
• Duration: 3 to 12 hours

• Not used in infants or pregnancy (Category B)
• If used in anaphylasis will be in conjunct with epinephrine, coritcosteroids

Loop Diruetic

Inhibits electrolyte reabsorbtion and promotes excretion of sodium, potasium, and chloride

CHF, Pulmonary Edema, Hypertensive Crisis,

• Hypovolemia
• Anuria
• Hypotension (relative contraindication)
• Hypersensitivity
• Hepatic Coma

• Exacerbate hypovolemia
• hypokalemia
• ecg changes
• dry mouth
• hypochloremia
• hyponatremia
• hyperglycemia (due to hemoconcentration)

• Lithium toxicity may be potentiated by sodium depletion
• Digitalis toxicity may be potentiated by potassium depletion

100mg per 5mL, 20mg per 2mL, 40mg per 4mL vials

Adult: .5 to 1mg per kg injected IV over 1 to 2 minutes. If no response double the dose to 2mg per kg over 1 to 2 minutes.

Pediatrics: 1mg per kg per dose IV/IO

• Onset: 5 minutes
• Peak Effects: 20 to 60 minutes
• Duration: 4 to 6 hours

• Pregnancy Safety: Category C
• Ototoxicity and deafness can occur with rapid administration. Should be protected from light.

• Hyperglycemic Agent
• Pancreatic Hormone
• Insulin antagonist

Increases blood glucose level by stimulating glycogenolysis. Unknown mechanism of stabilizing cardiac rhythm in beta blocker overdose. Minimal positive inotropic and chronotropic response. Decreases gastrointestinal motility and secretion

• Alerted levels of consciousness when hypoglycemia is suspected
• May be used as a inotropic agent in beta blocker overdose.

• Hyperglycemia
• Hypersensitivity

Nausea, vomitting, tachycardia, hypertension

• Incompatible in solution with most other substances.
• No signifigant drug interactions with other emergency medications

1mg ampules (requires reconstitution with diluent provided)

• Hypoglycemia: .5 to 1mg IM: may repeat in 7 to 10 minutes
• Calcium Channel Blocker / Beta Blocker Overdose: 3mg initially followed by infusion at 3mg per hour as nessicary

• For Hypoglycemia: .5 to 1mg IM for children less than 20kg.
• Calcium Channel Blocker / Beta Blocker Overdose: Not recommended

• Onset: 1 Minute
• Peak Effect: 30 minutes
• Duration: Variable (generally 9 to 17 minutes)

• Pregnancy Category C
• Ineffective if glycogen stores is depleted
• Should always be used in conjunction with 50% dextrose whenever possible
• If patient does not respond to second dose of Glucagon, 50% dextrose must be administered

Narcotic Antagonist

Competive inhibition at narcotic receptor sites. Reverse respiratory depression secondary to opiate drugs. Completely inhibits the effects of morphine

• Opiate Overdose, Coma
• Complete or partial reversal of CNS or respiratory depression induced by opioids
• decreased level of consciousness
• coma of unknown origin
• Narcotic Agonist for the following: Morphine, Heroin, Hydomorphone (Dilaudid), Methodone, Meperidine (Demerol), Paregoric, Fentanyl (sublimase), oxycodone (percodan), Codeine, Propoxyphene (Darvon),
• Narcotic Agonist and Antagonist for the following: Butorphanol (stadol), Pentazocine (talowin), Nalbuphine (nubain).

Use caution with narcotic dependent patient's. Use with caution with neonates with narcotic addicted mothers

• Withdrawl symptoms in the addicted patient
• hypertension
• tachycardia
• arrhythmias
• nausea
• vomitting
• diaphoresis

Incompatible with bisulfite and alkaline solutions

• .2mg per mL (neonate) ampules
• .4mg per mL ampules
• 1mg per mL ampules
• 2mg per 5mL ampules
• 2mg per 5mL prefilled syringe

• .4 to 2mg IV/IM/SC/ET (diluated)
• Minimum recommended dose 2mg
• repeat at 5 minute intervals to a maximum dose of 10mg
• Medical control may request higher amounts,.

• Infusion: 2mg in 500mL of D5W at (4 drips per mL)
• Infuse at .4mg per house (100mL per hour)

• .1mg per kg per dose IV/IM/SC/ET (diluted for ET)
• Maximum dose of .8mg if no response in 10 minutes administer an additional .1mg per kg per dose.

• Onset: within 2 minutes
• Peak Effect: Variable
• Duration: 30 to 60 minutes

• Pregnancy Safety: B
• Seizures without casual relationship have been reported
• May not reverse Hypotension
• Use caution when administering to narcotic addicts (potential violent behavior)

Paralytic Agent

Nondepolarizing nueromuscular blocking agent.

• To facilitate intubation,
• to terminate laryngospasm
• To promote muscle relaxation
• To facilitate electroconvulsive shock therepy

• Acute Narrow angle glaucoma
• Penetrating eye injuries
• Inability to ventilate or support airway with oxygen and positive pressure
• Newborns: Myasthenia gravis, hepatic or renal failure

• Apnea
• Weakness
• Salivation
• Premature ventricular contractions
• tachycardia
• Increased blood pressure

Use of inhalation anestetics will enhance nueromuscular blockade

• 10mg per 10mL vercuronium bromide vials with diluent.
• 20mL vials (20mg vercuronium) without diluent

• .1mg per kg IV push
• Maintainence Dose within 25 to 40 minutes: .01-.05mg per kg IV push

.1mg per kg IV/IO; maintainence dose with in 20-35 minutes (.01 to .05mg per kg IV push)

• Onset: 30 seconds
• Peak Effects: 2.5 to 3 minutes
• Duration: 25 to 30 minutes

• Pregnancy Safety Category C
• If patient is conscious explain the effect of the medication before administering.
• Always sedate the patient before using this medication

• Intubation: Involuntary support must be readily available.
• Vecuronium has no effect on consciousness or pain.
• Will not stop nueral seizure acitivity.
• Pulse rate / cardiac output are increased
• Decreased doses with patient's with renal disease.

Anti-inflammatory glucocorticoid

• Synthetic corticosteriod that suppresses acute and chronic inflammation.
• Potentiates vasular smooth muscle relaxation by beta adrenergic agonists

• Acute Spinal Cord trauma
• Anaphalaxis
• Broncho-dialator for unresponsive asthma

• Premature infants
• systemic fungal infections
• use with caution in patient's with gastro intestinal bleeding

• Heachache
• Hypertension
• Sodium and Water Retention
• CHF
• Hypokalemia
• alkolosis
• peptic ulcer disease
• nausea
• vomitting

• Hypoglycemic reponses to insulin and hypoglycemic agents may be blunted
• Potassium depleting agents may exasserbate hypokalemic effects

40, 125, 500, 1000mg vials

• Acute spinal cord injury: 30mg per kg IV over 30 minutes followed by infusion: 5.4mg per kg per hour.
• Asthma/COPD: 1-2mg per kg IV

• Acute Spinal Cord Trauma: 30mg per kg IV over 30 minutes (infusion 5.4mg per kg per hour)
• Asthma: 1 to 2mg per hour per dose IV

• Onset of Action: 1 to 2 hours
• Peak Effect: Variable
• Duration of Action: 8-24 hours

• Pregnancy Safety Not established
• Not effective with spinal cord injuries over 8 hours
• Crosses the placenta and may cause fetal harm

Vitamin B-1

Combines with ATP to form thiamine protophosphate coenzyme, a nessecary component for carbohydrate metabolism. The brain is extremely sensitive to thiamine deficieincy

• Coma of unknown origen
• Delirium Tremens
• Beriberi
• Wernicke's Encephalopathy

None

• Hypotension from too rapid of an injection or too high of a dose
• Anxiety
• Diaphoresis
• Nausea
• Vomitting
• Allergy (rare)

Give thiamine before glucose under all circumstances

1000mg in 10mL vial (100mg per mL)

• Adult: 100mg slow IV/IM
• Pediatric: 10-25 slow IV/IM

• Onset: Rapid
• Peak Effects: Variable
• Duration: Dependent upon the degreee of deficiency

• Pregnancy Safety Category A
• Large IV doses may cause respiratory difficulties and anaphalaxis reactions reported

Benzodiazepine / Sedative-hypnotic / anti-convulsant

• Potentiates effects of inhibitory nuerotransmitters
• Raises seizure threshold
• Induces amnesia and sedation

• Acute anxiety states
• Acute alcohol withdrawl (delerium tremens)
• Muscle Relaxant
• Seizure Activity
• Agitation
• Analgesia
• For medical procedures (fracture reduction / cardioversion)

• Hypersensitivity
• Glaucoma
• Coma
• Shock
• Substance Abuse
• Head injury

• Respiratory Depression
• Hypotension
• Drowziness
• Ataxia
• Reflex tachycardia
• nausea
• confusion
• thrombosis
• phlebitis

Incompatible with most drugs, fluids

10mg per 5mL prefilled syringes, ampules, vials, Tubex

• Adult: Seizure Activity: 5-10mg IV q 10-15minutes PRN (5mg over 5 minutes)(Max dose 30mg)
• Pediatric Seizure Activity: .2-.5mg slowly q 2-5 minutes up to 5mg (max dose 10mg per kg)

Rectal diazepam: .5mg per kg via 2" rectal cathether and flush with 2-3mL air after administration

Sedation for cardioversion: 5-15mg IV over 5 to 10 minutes prior to cardioversion

• Onset: 1-5 minutes
• Peak Effect: Minutes
• Duration: 20-50 minutes

• Pregnancy Safety: Category D
• Short duration of anticonvulsant effect. Reduce dose by 50% in elderly patient

Short Acting Benzodiazepine / CNS depressant

Anxiolytic and sedative properties similar to other benzodiazepines, memory impairment

• Sedation
• Anxiolytic Prior to endotrachial or nasotracheal intubation; Administer for conscious sedation

• Glaucoma
• Shock
• Coma
• Alcohol intoxication
• Overdose
• Depressed Vital Signs
• Concomitant use with other CNS depressants
• Barbituates
• Alcohol
• Narcotics

Hiccough, cough, oversedation, nausea, vomitting, injection site pain, headache, blurred vision, hypotension, respiratory depression, arrest

Should not be used in patient's who have taken a CNS depressant

2, 5, 10mL vials (1mg per mL) and 1, 2, 5, 10mL vials (5mg per mL)

Adult: 2-2.5mg slow IV over 2-3 minutes; may be repeated to a total maximum of .1mg per kg

Pediatric: Not recommended

• Onset: 1-3 minutes IV and dose dependent
• Peak Effect: Variable
• Duration: 2-6 hours, dose dependent

• Pregnancy Safety Category D
• Administer immediately after intubation procedure
• Requires continuous monitoring of respiratory and cardiac function
• Never administer as IV bolus

Opioid / analgesic (schedule II narcotic)

• Alleviates pain through CNS action
• Suppresses fear and anxiety centers in brain
• Depresses brain stem respiratory centers
• Increases periperal venous capacitanec and decreases venous return
• Decreases preload and afterload which decreases myocardial oxygen demand

• Severe CHF
• Pulmonary edema
• Chest Pain associated with acute MI
• Analgesia for moderate to severe acute and chronic pain (use with caution)

• Head injury
• Exaserbated COPD
• Depressed respiratory drive
• hypotension
• undiagnosed abdominal pain
• decreased level of consciusness
• suspected hypovolemia
• patients who have taken MAOI's in the past 14 days

• Respiratory Depression
• Hypotension
• Decreased level of consciousness
• Nausea
• Vomitting
• Bradicardia
• Tachycardia
• Syncope
• Facial Flushing
• Euphoria
• Bronchospasm
• Dry Mouth

• Potentiates sedative effects of phenothiazines
• CNS depressant
• may potentiate effects of morphine
• MAOI's may cause paradoxical excitation

10mg in 1mL of solution, ampules, and Tubex syringes

INitial Dose: 2-4mg IV over 1 to 5 minutes every 5 to 30 minutes. Repeat dose 2-8mg at 5 to 10 minute intervals

• .1 to .2mg per kg per dose via IV/IO/IM/SC
• Max dose of 5mg

• Onset: Immediate
• Peak Effect: 20 minutes
• Duration: 2-7 hours

• Prenancy Safety: Category C
• Morphine rapidly crosses the placenta
• Safety in neonate not established
• Use with caution in geriatric population and those with COPD, Asthma,
• vagotonic effect in patient wtih acute inferior MI (bradycardia, heart block)
• Naloxone should be readily available as an antidote

Depolarizing nueromuscular blocker, paralyzing agent

Bind to the receptors for Acetylcholine

• To faciliate intubation, to terminate laryngospasm
• To promote muscle relaxation
• To faciliate convulsive shock therapy

• Acute narrow angle glaucoma
• Penetrating eye injuries
• Inability to control airway or support ventilations with oxygen and positive pressure

• Apnea
• Malignant Hyperthermia
• Arrhythmias
• Bradycardia
• Hypertension
• Hypotension
• Cardiac Arrest
• Hyperkalemia
• Increased intraoccular pressure
• Fasciculations
• Exacerbation of Hyperkalemia in trauma patient's

• Effects potentiated by oxytosin, beta blockers, and organophosphates.
• Diazepam may reduce duration of action

• 40mg in 2mL ampules (20mg per mL)
• 100mg in 5mL ampules (20mg per mL)
• Multidose vial

Adult: 1-2mg per kg rapid IV, repeat once if needed

Pediatric: 1-1.5mg per kg dose rapid IV/IO; repeat once if neede

• Onset: 1 minute
• Peak Effect: 1 to 3 minutes
• Duration: 5 minutes

• Pregnancy Safety Category C
• EMS use primarily to facilitate endocrachial intubation
• If the patient is conscious explain the effects of the drug prior to administration
• Consider premedication with atropine especially with pediatric age group
• Premedication with lidocaine may blunt any increase in intracranial pressure during intubation
• Diazepam or midazolam should be used in any conscious patient undergoing nuero muscular blockade.

Hypnatic