What is the generic name for Epinephrine?
What is the brand name for Epinephrine?
What is the class for Epinephrine?
What is the mechanism of action for Epinephrine?
Alpha and Beta agonist
Alpha -1 agonist Peripheral vasoconstriction increasing systemic vascular resistance
Beta-1 agonist Positive inotrope Positive chronotrope Postivive dromotrope Reduces defribrillation threshhold Renin release from kidneys
Beta -2 agonist Bronchial smooth muscle relaxation Skeletal vasculature dilation Block histamine release
Indications and field use for Epinephrine?
Cardiac arrest, all rythms (1st drug for dead people) Increases SVR increasing cerebral & myocardial perfusion pressure during CPR Positive dromotrope can increase success rate of defibrillation Positive dromotrope can increase electrical activity in heart in asytole
Refractory bronchospasm not relieved with other medication Bronchial smooth muscle relaxation increases bronchial airway diameter
Anaphylaxis Increased SVR increases blood pressure Peripheral vasoconstriction reduces edema Bronchial smooth muscle relaxation increases bronchial airway diameter Histamine release from mast cells inhibited Hypotension not relieved by other therapy Increased SVR increases blood pressure Positive chronotropic and inotropic effects increases cardiac output
Croup Peripheral vasoconstrition reduces edema
Dosage for Epinephrine?
Dosage via IV/IO, IM, Sub-Q, SVN, or ETT
Cardiac arrest, all rhythms (for dead people)Epi 1mg of 1:10,000 IV push with 20cc NS flush q 3-5 minutes, no limit ETT route Epi 2mg of 1:1,000 diluted in syringe with 8cc
Anaphylaxis, Refractory bronchospasm Epi 0.3mg of 1:1,000 IM
Infusion for hypotension Epi 1, 2, or 4mg 1:1,000 added to 250cc NS at 2-10mcg/min Use after other treatment
Contraindications for Epinephrine?
None for normal cardiac arrest Hyperthermia arrest (relative) Adult with pulse, age <35 (relative, patch)
What is the generic name for Verapamil?
What is the brand name for Verapamil?
What is the class for Verapamil?
Calcium channel blocker
Mechanism of action for Verapamil?
Blocks calcium channels in myocardial cell slowing influx of calcium ions Reduces force of contraction Slows heart rate Slows AV node conduction Slows ventricular response from atrial fibrillation/atrial flutter Interrupts reentry in SVT
Indications and field use for Verapamil?
Rapid ventricular response from A-Fib/A-Flutter Slows influx of calcium ions reducing ventricular response
SVT refractory to Adenosine (no WPW) Slows influx of calcium ions reducing heart rate and interrupts reentry pathways
Dosage for Verapamil?
All doses are VERY slow IV push over 2-5 minutes with the patient supine
Verapamil 2.5-5.0mg VERY slow IV push over 2-5 minutes. May repeat in 15-30 minutes with 5-10mg
What are the contraindications for Verapamil?
Wolf-Parkinson-White (WPW) Any wide QRS tachycardia Hypotension Cardiogenic shock Concurrent IV beta-blocker use
Generic name for Aspirin?
Acetylsalicylic Acid, Aspirin
Brand names for Aspirin:
Aspirin, Bayer, Bufferin, Anacin, Children's flavored chewable aspirin
Class for Aspirin:
Analgesic Anti-Thrombotic Anti-Pyretic Anti-Inflamatory
What is the mechanism of Action for Aspirin:
Blocks Thromoxane 2 Decreased platelet aggregation and thrombus formation Use in management of MI
Indications and Field Use of Aspirin:
Chest pain Signs/Symptoms or MI ECG suggestive of MI Unstable angina
Contraindications of Aspirin:
Bleeding ulcer Hemorrhagic state Hemophilia Known allergies to salicylates Childern or adolescents
Adult Dosage with Aspirin:
Cardiac: 325 (4 x 81mg pediatric chewable tabs), chew or swallow
Not indicated for prehospital
Generic name for Adenosine?
Brand name for Adensoine?
Class of Adenosine?
Mechanism of Action of Adenosine?
Slows Sinus rate Slows conduction through the AV node Interrupts reentrant pathways
Indications and field use for Adenosine?
SVT refractory to vagal maneuvers (including WPW syndrome) Why? Interrupts reentry pathways Wide QRS tachycardia of unknown origin refractory to lidocaine/amiodarone Why? Interrupts reentry pathways
Dosage for Adenosine?
All dosage VERY rapid IV push over 1-3 seconds followed by 20cc NS flush with patient supine. 16 or 18 guage in the AC Use injection port closest to hub Have ECG printing during administration Adult 6mg rapid IV push with 20cc NS flush. May repeat twice every two minutes wtih 12 mg
Contraindications of Adenosine?
Known allergy/hypersensitivity Sick sinus syndrom or 2nd/3rd degree block Asthma Carbamazepine (Tegretol) use Known A-Fib/A-Flutter Pregnancy (patch) Heart transplants (reduce dose)
Generic name for Lidocaine?
Brand name for Lidocaine?
Class of Lidocaine?
Sodium channel blocker Antiarrythmic
Mechanism of Action for Lidocaine?
Blocks sodium channels decreasing automaticity Prolongs phase 4 depolarization Terminates re-entry Increases v-fib threshhold
Indications and Field Use for Lidocaine?
Cardiac arrest Ventricular fibrillation/pulsless Ventricular Tachycardia only Why? Blocks sodium channels decreasing depolarization Supression of ventricular arrythmias Ventricular techycardia with pulse Wide QRS tachycardia of unknown origin Prevent recurrance of VFib/VTach Frequent PVCs >6/min R on T Couplets Multiform Why? Blocks sodium channels decreasing depolarization
Dosage for Lidocaine?
IV push, ETT, or infusion Adult - 1.0 - 1.5mg/kg IV push Every 5-10 minutes at 1/2 original dose up to 3mg/kg max If successful - infusion at 2-4mg/min by adding 1gm to 250cc NS Cardiac arrest - 20cc NS flush after giving ETT dose - double IV dose
Contraindications of Lidocaine?
Known allergy / hypersensitivity 3rd degree heart block Extreme caution in 2nd degree heart block Idoventricular rythym Ventricular arrythmias with pulse <60
Generic name for Atropine?
Brand name for Atropine?
Class for Atropine?
Mechanism of Action for Atropine?
Competitive antagonist to ACh at muscarinic receptor site Blocks parasypathetic response & allows sysmpathetic response to take over Heart Atrial effects Positive chronotrope Postive dromotrope Positive inotrope Slight effect Lungs Decreased mucous production Increased bronchial smooth muscle relaxation GI Decreased secretions Decreased motility Urinary Decreased bladder tone Other Pupil dilation Decreased sweat production
Indications and field use for Atropine?
Symptomatic Bradycardia Atrial mechanisms only Why? Blocks parasympathetic response increasing heart rate Acetylcholinesterase inhibitor poisoning Organophosphate poisoning Nerve agent poisoning Cholinergic posoning Why? Blocks the muscarinic receptors reducing the effects of ACh
Dosage for Atropine?
All Dosages are IV Push or ETT - FAST Adult Symptomatic Bradycardia Atrial mechanisms only Atropine 0.5mg IV Push - q 5 min - max 0.04mg/kg Acetylcholinestrase inhibitor poisoning Cholinergic poisoning Atropine 2.0 - 5.0 mg IV Push - q 5 min - until symptoms resolved
Contraindications for Atropine?
Allergy Wide complex 2nd Degree type II heart block 3rd degree heart block Acute narrow angle glaucoma Painful glaucoma probably narrow type
Generic name for Dopamine?
Brand name for Dopamine?
Class for Dopamine?
Dopamine agonist Sympathomimetic
Mechanism of Action for Dopamine?
MOA depends upon dosage Dopamine dose 1-2mcg/kg/min Activates dopamine receptors causing cerebral, renal, mesenteric vasodilation May increase urine output May drop BP Beta-1 Dose 2-10mcg/kg/min Activates Beta-1 receptors stimulates heart increasing cardiac output & BP Postive inotrope Positive chronotrope Postivite dropmotrope Alpha-1 dose 10-20mcg/kg/min Activates Alpha-1 receptors causing renal, mesenteric, & peripheral vasoconstriction Increases PVR increases BP Increased Preload >20mcg/kg/min similar to norepi with massive vasoconstriction
Indications and field use for Dopamine?
Hypotension without fluid loss Symptomatic bradycardia with hypotension Cardiogenic shock Septic shock Neurogenic shock
Dosage for Dopamine?
All doses via IV infusion Add 400mcg to 250cc NS bag giving 1600mcg/cc Symptomatic bradycardia with hypostension &/or non-hypovolemic shock Dopamine 5mcg/kg/min initial infusion, increase if no repsonse
Contraindication for Dopamine?
Hypovolemic shock Pheochromocytoma (tumor of the adrenal gland) MAOI's
What is the generic name for Glucagon?
What is the brand name for Glucagon?
What is the class for Glucagon?
What is the mecahnism of action for Glucagon?
Converts liver glycogen to glucose raising serum glucose levels Reverses effects of hypoglycemia Smooth muscle relaxant Cardiac inatrope
What are the indications and field use for Glucagon?
Hypoglycemia if IV unattainable Why? Raises blood sugar levels by converting glycogen to glucose
Trapped food bolus in esophagus Why? Smooth muscle relaxant may allow food to pass to stomach
Beta-Blocker OD Why? Positive cardiac inotrope
Doseage for Glucagon?
All hytpoglycemic doses are IM. Other indications may be given IV.
Adult: Hypoglycemia Glucagon 1mg IM Smooth muscle relaxant/Beta-blocker OD Per agency or patch with medical control
Contraindications for Glucagon?
Known hypersensitivity / allergy Pheocromocytoma Insulinoma
Generic name for Pitocin?
Class for Pitocin?
Mechanism of action for Pitocin?
Oxytocin receptor agonist Increases force & frequency of urinary contractions
Indications and field use for Pitocin?
Postpartem hemorrhage AFTER delivery of placenta and twins/triplets if any Why Stimulates uterus to contract which slows bleeding
Dosage for Pitocin?
All dosages via IV infusion or IM
Adult Infusion Pitocin 10 units added to 10000cc LR infused at rate necessary to control bleeding
Contraindications for Pitocin?
Known hypersensitivity/allergy Baby/Babies have not yet delivered Placenta has not yet delivered