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Oxygen
Functional Class
Oxidizer
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Oxygen
Route
BLS and/or ALS airway adjuncts as appropriate
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Diazepam (Valium)
Functional Class
Benzodiazepine
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Diazepam (Valium)
Indications
Seizures (Status Epilepticus), To induce Sedation prior to painful procedures, Acute anxiety
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Diazepam (valium)
Contraindications
Known hypersensitivity, Shock, Coma, Acute alcohol intoxication
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Diazepam (Valium)
Side effects
Hypotension, Drowsiness, Tachycardia, Ataxia, Amnesia, Slurred speach, Edema, Headache, Dizziness, N/V, Blurred vision, And respiratory depression.
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Diazepam (valium)
Adult Dose and Route
5 mg IVP, may repeat at 2.5 mg q 5 min prn, max 10 mg
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Diazepam (Valium)
Pediatric Dose and Route
- 0.1-0.25 mg/kg IV/IO, max single dose 5mg
- may repeat once after 5 min
- OR
- 0.5 mg/kg PR, max single dose 10mg
- may repeat once after 5 min
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Diazepam (Valium)
Pharmacokinetics
- Onset= 1-5 min IV
- Half-life= 20-50 hrs
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Diazepam (Valium)
What is an antagonist to Diazepam
Flumazenil
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Lorazepam (Ativan)
Functional Class
Benzodiazepine
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Lorazepam (Ativan)
Indications
Seizures (status epilepticus), To induce sedation prior to painful procedures, anxiety
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Lorazepam (Ativan)
Contraindications
Hypersensitivity to benzodiazepines, Acute narrow-angle glaucoma, coma, shock, and acute alcohol intoxication
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Lorazepam (Ativan)
Side effects
Anterograde amnesia, sedation, hypertension or hypotension, Blurred vision, N/V, and confusion
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Lorazepam (Ativan)
Adult Dose and Route
1-2 mg slow IVP or IM q 5 min, max 8 mg
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Lorazepam (Ativan)
Pediatric Dose and Route
- 0.1 mg/kg slow IVP or IM max single dose 2 mg
- may repeat once after 5 min
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Lorazepam (Ativan)
Pharmacokinetics
- Onset= 1-5 min IV, 5-10 min IM
- Half-life= 10-20 hrs
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Midazolam (Versed)
Functional Class
Bezodiazepine (short acting)
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Midazolam (Versed)
Indications
Seizures (Status epilepticus), To induce sedation prior to painful procedures
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Midazolam (Versed)
Contraindications
Hypersensitivity to benzodiazepines, Acute narrow-angle glaucoma, coma, shock, acute alcohol intoxication.
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Midazolam (Versed)
Side effects
N/V, Blurred vision, Retrograde amnesia, Excessive amnesia, Apnea, Hypotension, PVC's.
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Midazolam (Versed)
Adult Dose and Route
1.0-2.5 mg slow IVP or IM q 5 min until seizure is abolished
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Midazolam (Versed)
Pediatric Dose and Route
- 0.1 mg/kg slow IVP or IM max single dose 6 mg
- may repeat once after 5 min
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Midazolam (Versed)
Pharmacokinetics
- Onset= 3-5 min IV
- Duration= Less than 2 hrs
- Half-life= 1-4 hrs
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Atropine Sulfate
Functional Class
Parasympatholytic
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Atropine Sulfate
Indications
Symptomatic Bradycardia, Asystole (Brady asystolic arrest), Organophosphate/Nerve agent poisoning, Bradycardic PEA
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Atropine Sulfate
Contraindications
None in the emergency setting
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Atropine Sulfate
Side effects
Blurred vision, Dialated pupils, Dry mouth, Tachycadia, Drowsiness, Convusions, Hypertension or Hypotension, Palpitations, Paradoxical bradycardia ( if given to slowly), AV dissociation, urinary retention
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Atropine Sulfate
Adult Dose and Route
Asystole / Bradycardic PEA
- 1 mg IVP q 3-5 min max total 0.04 mg/kg
- 2-2.5 mg ET q 3-5 min
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Atropine Sulfate
Pediatric Dose and Route
Asystole / Bradycardic PEA
0.02 mg/kg IVP/IO (minimum single dose 0.1 mg and maximum single dose is 1 mg) q 5 min max total 0.04 mg/kg.
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Atropine Sulfate
Adult Dose and Route
Symptomatic Bradycardia
0.5 mg IVP q 3-5 min max total 0.04 mg/kg
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Atropine Sulfate
Pediatric Dose and Route
Symptomatic Bradycardia
0.02 mg/kg IVP or IO (minimum single dose is 0.1 mg and maximum single dose is 1 mg) q 5 min max total 0.04 mg/kg
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Atropine Sulfate
Adult Dose and Route
Organophosphate Poisoning
2 mg IVP q 5 min prn
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Atropine Sulfate
Pediatric Dose and Route
Organophosphate poisoning
0.05-0.1 mg/kg IV/IM (minimum single dose is 0.1 mg and maximum single dose is 5 mg) repeat q 2-5 min prn
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Atrpine sulfate
Pharmacokinetics
- Absorption= 2-4 min IV
- Half-life= 2-3 hrs
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Epinephrine (adrenalin)
Functional Class
Sympathomimetic
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Epinephrine (Adrenalin)
How it is supplied
- 1:1,000 (1 mg of epinephrine in 1 ml or 1 mg/ml)
- 1:10,000 (1 mg of epinephrine in 10 ml or 0.1 mg/ml)
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Epinephrine (Adrenalin)
Indications
Cardiac arrest, asystole, VF, Pulsless VT, PEA, Systematic bradycardia, anaphylaxis, severe reactive airway disease
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Epinephrine (Adrenalin)
Contraindications
Hypersensitivity to sympathomimetic amines
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Epinephrine (Adrenalin)
Side effects
Increases myocardial oxygen demand, can cause palpitations, anxiety, headache, CVA, Syncope, HTN, Tachydysrhythmias, Tissue necrosis with Repeated injectionsor extravasation of IV.
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Epinephrine (Adrenalin)
Adult Dose and Route
Cardiac Arrest
- 1.0 mg of 1:10,000 IVP q 3-5 min or
- 2.0-2.5 mg ET q 3-5 min of 1:1,000 (Diluted to 10 ml)
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Epinephrine (Adrenalin)
Pediatric Dose and Route
Cardiac Arrest
- 0.01 mg/kg of 1:10,000 IV/IO or
- 0.1 mg/kg of 1:1000 ET q 3-5 min (Diluted to 3-5 ml)
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Epinephrine (Adrenalin)
Adult Dose and Route
Severe Anaphylaxis/Asthma
- 0.3-0.5 mg SQ of 1:1,000 q 5-15 min if ineffective give
- 0.1-0.5 mg of 1:10,000 IVP q 5-15 min
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Epinephrine (Adrenalin)
Pediatric Dose and route
Severe anaphylaxis/Asthma
- 0.01 mg/kg of 1;1,000 SQ if ineffective give
- 0.01 mg/kg of 1:10,000 IVP q 5-15 min
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Epinephrine (Adrenalin)
Symptomatic Bradycardia Infusion
Preparation, Adult and Pediatric
rates
- Preparation-1 mg of 1:1,000 in 250 ml of NS
- Adult: 2-10 mcg/min
- Pediatric: 0.1-1 mcg/kg/min
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Vasopressin (Pitressin)
Fuctional Class
Hormone (ADH) Vasopressor
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Vasopressin (Pitressin)
Indications
Cardiac Arrest
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Vasopressin (Pitressin)
Contrindications
Chronic nephritis, Ischemic heart disease, PVC's, First stage of labor
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Vasopressin (Pitressin)
Side effects
N/V, Abdominal cramps, HTN, Bradycardia, PAC's, MI
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Vasopressin (Pitressin)
Drug interactions
Epinephrine, Heparin, Alcohol, Phentoin, Neostigmine,Thiazide diuretics, carbamazepine
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Vasopressin (Pitressin)
Dosage and route
40 units IVP/IO (Single dose only)
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Vasopressin (Pitressin)
is used when
May replace first or second dose of epinephrine in cardiac arrest
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Lidocaine (Xylocaine)
Functional class
Class 1B antidysrhythmic (sodium channel blocker)
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Lidocaine (Xylocaine)
Indications
VF, Pulseless VT, VT with a pulse, Malignant PVC's= more than 6 unifocal PVC's a minute, multifocal PVC's, couplets, R on T phenomena.
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Lidocaine (Xylocaine)
Contraindications
Hypersensitivity, supraventricular dysrhythmias, untreated sinus bradycardia, 2nd degree morbitz II AV block, 3rd degree AV block, stokes adams syndrome
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Lidocaine (Xylocaine)
Side effects
Altered mental status including confusion, bradycardias, hypotension, seizures
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Lidocaine (Xylocaine)
Adult Dose and route
Cardiac Arrest
- 1-1.5 mg/kg IVP repeat at 1/2 the initial dose
- (0.5-0.75 mg/kg IVP) q 5 min up to a max of 3 mg/kg
- Note: A single dose of 1.5 mg/kg is acceptable if
- moving on to amiodarone
- ET 2-4 mg/kg q 3-5 min
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Lidocaine (Xylocaine)
Pediatric Dose and route
Cardiac arrest
1 mg/kg IVP/IO/ET
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Lidocaine (Xylocaine)
Adult Dose and Route
With a pulse
- 1-1.5 mg/kg IVP repeat at 1/2 the initial dose
- (0.5-0.75 mg/kg IVP) q 5 min up to a max of 3 mg/kg
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Lidocaine (Xylocaine)
Adult IV infusion
1-4 mg/min
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Lidocaine (Xylocaine)
Pharmacokinetics
- Absorption= 3 minutes
- Duration= 10-20 minutes
- Half-life= 1.5-2 hours
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Amiodarone (Cordarone)
Functional class
Class III antidysrhythmic (potassium channel blocker)
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Amiodarone (Cordarone)
Indications
Life threatening ventricular and supraventricular Dysrhythmias (VF, VT, A-fib, A-flutter, SVT, WPW.
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Amiodarone (Cordarone)
Contraindications
Hypersensitivity, cardiogenic shock, Severe sinus bradycardia, AV block
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Amiodarone (Cordarone)
Side effects
CHF, Angioedema, hypotension, AV block, Hepatoxicity, Cardiogenic shock, fatigue, Bradycardia, Sinus arrest, permenant blindness, N/V, Prolongs the Q-T interval.
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Amiodarone (Cordarone)
Adult Dose and Route
Pulse
- 150 mg (in 50-100 ml of NS) IV infusion over 10 minutes
- may repeat dose once after 10 minutes
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Amiodarone (Cordarone)
Adult Dose and Route
Pulseless
300 mg IVP repeat in 3-5 min at 150 mg IVP
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Amiodarone (Cordarone)
Adult Maintenance Infusion
1 mg/min over the next 6 hours
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Amiodarone (Cordarone)
Pediatric Dose and Route
5 mg/kg IV/IO
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Adenosine (Adenocard)
Functional Class
Antidysrhythmic
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Adenosine (Adenocard)
Indications
SVT refractory to vagal maneuvers including (WPW)
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Adenosine (Adenocard)
Contraindications
2nd and 3rd degree AV heart blocks, symptomatic bradycardia, sick sinus syndrome, Hypersensitivity.
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Adenosine (Adenocard)
Side efffects
Sycope, Dizziness, dyspnea, N/V, Headaches, Palpitations, chest pain, Hypotension, Dysrhythmias, Side effects are self limiting due to a short half-life
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Adenosine (Adenocard)
Interactions which two drugs antagonize adenosine
Caffiene or xanthines(aminophylline or theophylline)
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Adenosine (Adenocard)
Interactions Which two drugs potentiate adenosine
Dipyridamole(persantine) and Carbamazepine (tegretol)
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Adenosine (Adenocard)
Adult Dose and Route
- 6 mg rapid IVP followed by a 10-20 ml NS flush
- If no conversion after 1-2 minutes administer
- 12 mg rapid IVP followed by a 10-20 ml NS flush
- If no conversion after1-2 minutes administer
- repeat 12 mg rapid IVP followed by a 10-20 ml NS flush
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Adenosine (Adenocard)
Pediatric Dose and Route
- 0.1 mg/kg IVP/IO (maximum single dose is 6 mg)
- may repeat only once in 1-2 min at 0.2 mg/kg
- (maximum 2nd dose is 12 mg)
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Adenosine (Adenocard)
Pharmacokinetics
- Onset=rapid
- Half-Life= Approximately 10 seconds
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Diltiazem (Cardizem)
Functional Class
Class IV antidysrhythmic (calcium channel blocker)
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Diltiazem (Cardizem)
Indications
SVT refractory to adenosine, rapid a-fib or a-flutter
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Diltiazem (Cardizem)
Contraindications
Hypersensitivity, sick sinus syndrome, 2nd and 3rd degree AV block, Hypotension, WPW, wide complex tachycardia
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Diltiazem (cardizem)
Side effects
Chest pain, Bradycardia, Hypotension, Syncope, CHF, N/V, Dysrhythmias, Headache, Sweating, Dizziness, Dyspnea, 2nd and 3rd degree AV block, Palpitations
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Diltiazem (cardizem)
Dosage and Route
Bolus
- 0.25 mg/kg slow IVP may repeat in 5 minutes at
- 0.35 mg/kg slow IVP
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Diltiazem (Cardizem)
Dose and Route
IV Infusion
5-15 mg/hr, titrate to heart rate
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