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Diazepam
trade name
Valium
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Diazepam
class
- Anticonvulsant
- Benzodiazepine
- sedative-hypnotic
- anti-anxiety (anxiolytic)
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Diazepam
mechanism of action
- Suppresses the spread of seizure activity and raises the seizure threshold in the motor cortex
- Sedative effects depress the CNS and reduce anxiety
- Skeletal muscle relaxant
- Induces amnesia
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Diazepam
indications
- Generalized seizure activity and status epilepticus
- Sedation prior to cardioversion or pacing of a conscious patient
- Acute anxiety
- Muscle relaxer
- Chemical restraint
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Diazepam
contraindications
- Head injury/CNS Depression
- Respiratory depression
- Hypotension / depressed vital signs
- Shock
- Infants < 30 days old
-
Diazepam
side effects
- Cardiovascular: bradycardia, hypotension, rebound tachycardia
- Neurological: dizziness, drowsiness, headache
- Respiratory: respiratory depression/arrest
- Gastrointestinal: nausea/vomiting
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Diazepam
precautions
Use with caution in the elderly and very ill patients due to paradoxical effects
-
Diazepam
interactions
Use with caution when patient is taking antihistamines, antidepressants, alcohol, narcotics, barbiturates, sedatives and hypnotics as these drug classifications may potentiate the effects
-
Diazepam
routes
IV, IO, IM, PR
-
Diazepam
onset and duration
Onset in 5 minutes with an unknown duration
-
Diazepam
dosages
- Adult:
- Seizures: 5-10 mg IV/IM. May repeat every 5-15 minutes prn to maximum dose of 20 mg
- Anxiety: 5-10 mg IV/IMCardioversion: 5-10 mg IV titrated to effect
Pediatric: 0.1 mg/kg IV/PR. May repeat every 5-15 minutes prn to maximum dose of 20 mg
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Diazepam
notes
not in riverside
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Midazolam
trade name
Versed
-
Midazolam
class
- Amnesic Agent
- Sedative/hypnotic
- Anticonvulsant
- Benzodiazepine
- Tranquilizer
- Anti-anxiety (anxiolytic)
-
Midazolam
mechanism of action
- Reduces anxiety
- Relaxes skeletal muscles
- Produces short term CNS depression and amnesia
-
Midazolam
indications
- Seizures
- Premedication for synchronized cardioversion/TCP
- One of the premeditations for RSI
-
Midazolam
contraindications
- Acute narrow-angle glaucoma
- Shock (from hypovolemia)
- Hypotension (from hypovolemia)
- Alcohol or drug intoxication
- Allergies to cherries
-
Midazolam
side effects
- Cardiovascular: bradycardia, rebound tachycardia, hypotension
- Neurological: amnesia, drowsiness, agitation, ALOC
- Respiratory: respiratory depression or arrestG
- astrointestinal: nausea/vomiting
-
Midazolam
precautions
- Elderly patients with impaired respiratory function
- Patients with renal failure, liver failure or COPD
-
Midazolam
interactions
Other CNS depressants or benzodiazepines
-
Midazolam
routes
IV, IO, IM, IN
-
Midazolam
onset and duration
Onset in 1-5 minutes (IV/IO/IN) or 5-15 (IM) and may last 2-6 hours
-
Midazolam
dosages
- Adult:
- Pre-cardioversion or transcutaneous pacing: – 2.5 mg slow IV/IO
- Seizure: 0.1 mg/kg slow IV/IO/IN or 0.2 mg/kg IM to a maximum of 5.0 mg
Pediatric: Seizure: 0.1 mg/kg slow IV/IO/IN or 0.2 mg/kg IM to a maximum of 5.0 mg
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-
Naloxone
trade name
Narcan
-
Naloxone
class
Narcotic (Opiate) Antagonist
-
Naloxone
mechanism of action
Reverses the respiratory depression and CNS sedation of narcotics by competing for opiate receptor sites in the brain
-
Naloxone
indications
Known or suspected narcotic overdoses with inadequate respiratory function
-
Naloxone
contraindications
none
-
Naloxone
side effects
- Cardiovascular: tachycardia, hypertension, dysrhythmias
- Neurological: tremors/seizures, aggressive/combative
- Gastrointestinal: nausea/vomiting
-
Naloxone
precautions
- Give drug prior to intubation
- Prepare to protect patient and EMS personnel due to aggressive/combative personality following rapid reversal of a narcotic overdose
- Does not reverse narcotic-induced hypotension
- Use with caution in narcotic addicts or chronic pain patients, as Narcan will rapidly reverse the CNS depressant effects of opiods.
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Naloxone
interactions
none
-
Naloxone
routes
IV, IO, IM, IN, ET
-
Naloxone
onset and durations
Immediate onset when administered IV/IO/IN/ET and 5-10 minutes if administered IM. Either may last 20-30 minutes
-
Naloxone
dosages
Adult: 1.0 – 2.0 mg IV/IM or 2.0 – 4.0 mg ET. Titrate IV dose toadequate respiratory rate and tidal volume. May repeat dose every 5 minutes as needed
Pediatric: 0.1 mg/kg IV/IM or 0.2 mg/kg ET. Titrate IV dose toadequate respiratory rate and tidal volume. May repeat dose every 5 minutes as needed
-
Naloxone
notes
Darvon and other synthetic narcotics may require larger dosages to reverse the effects
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-
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Glucagon
mechanism of action
- Elevates blood glucose level by converting stored liver glycogen into glucose
- Increases heart rate and myocardial contractility and improves AV conduction in a manner similar to that produced by catecholamines
-
Glucagon
indications
- ALOC with hypoglycemia when no IV can be established
- Beta-Blocker OD
-
Glucagon
contraindications
Not significant
-
Glucagon
side effects
- Cardiovascular: tachycardia, hypertension
- CNS: dizziness, headache
-
Glucagon
precautions
- Only effective if liver glycogen is available, may be ineffective in chronic hypoglycemia or starvation patients
- Use with caution in patients with cardiovascular disease or renal insufficiency/disease
-
Glucagon
interactions
none
-
Glucagon
routes
IM, IVP, IO
-
Glucagon
onset and duration
Onset in 5-20 minutes and may last 15-30 minutes
-
Glucagon
dosages
- Adult:
- Hypoglycemia: 1 mg IM; May repeat in 20 minutes
- Beta Blocker OD: 1 mg IV
Pediatric: 0.03 – 0.1 mg/kg IM; Max dose 1 mg (must have documented hypoglycemia)
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Glucagon
notes
Place patient into recovery position to prevent aspiration should vomiting occur prior to patient becoming fully conscious
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Dextrose 50% in water (D50W)
trade name
25 gm of Dextrose in a 50 ml solution
-
Dextrose 50% in water (D50W)
class
carbohydrate
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Dextrose 50% in water (D50W)
mechanism of action
Provides immediate source of glucose for cellular metabolism
-
Dextrose 50% in water (D50W)
indications
ALOC due to documented or suspected hypoglycemia
-
Dextrose 50% in water (D50W)
contraindications
- There are no absolute contraindications to the IV administration of dextrose in the emergency setting
- Relative contraindication: Use with caution in patients with increasing Intracranial pressure as the added glucose may worsen the cerebral edema.
-
Dextrose 50% in water (D50W)
side effects
- Patients may complain of warmth, pain or burning at the injection site.
- Dextrose can cause severe neurologic symptoms (Wernicke’s encephalopathy or Korsakoff’s psychosis) if patient is thiamine deficient.
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Dextrose 50% in water (D50W)
precautions
- Aspirate prior to administration and after every 10-15 ml to ensure IV patency (medication will cause necrosis)
- Cannulate largest vein possible and run IV wide open prior to and after administration
- Relative contraindication: Use with caution in patients with increasing intracranial pressure as the added glucose may worsen the cerebral edema or potentiate cellular necrosis in hemorrhagic stroke
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Dextrose 50% in water (D50W)
interactions
none
-
Dextrose 50% in water (D50W)
routes
IVP, IO
-
Dextrose 50% in water (D50W)
onset and duration
Onset will be 30-60 seconds but duration depends upon degree and cause of hypoglycemia
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Dextrose 50% in water (D50W)
dosages
Adult: 25 gm (50 ml solution preload) IVP/IOMay repeat once in 5 minutes
Pediatric: Birth – 1 month: 0.5g-1gm/kg (5-10 ml/kg) slow IVP of a 10% solution. May repeat once in 10 minutes.
1 month+-2 years: 0.5g-1gm/kg (2-4 ml/kg) slow IVP/IO of a 25% solutionMay repeat once in 5 minutes
Over 2 years: 0.5g-1gm/kg (1-2 ml/kg) slow IVP/IO of a 50% solution (same solution as for the adult)May repeat once in 5 minutes
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Dextrose 50% in water (D50W)
notes
Do not exceed a 12.5% concentration in neonates.
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Thiamine
class
water soluble vitamin
-
Thiamine
mechanism of action
Coenzyme necessary for carbohydrate metabolism of glucose
-
Thiamine
indications
- Coma associated with delirium tremens (DTs) or alcohol withdrawal prior to Dextrose
- Alcoholism or malnutrition
- Coma of unknown origin
-
Thiamine
contraindications
none
-
Thiamine
side effects
- Cardiovascular: mild hypotension
- Respiratory: pulmonary edema
- Gastrointestinal: nausea/vomiting
-
Thiamine
precautions
none
-
Thiamine
interactions
none
-
Thiamine
routes
IV, IO, IM
-
Thiamine
onset and duration
Onset is immediate with an unknown duration
-
Thiamine
dosages
- Adult: 10-100 mg
- Pediatric: 10-25 mg
-
Thiamine
notes
Medication should be administered prior to Dextrose 50%
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