Pharmacology Manual: Indications/ Contraindications

• 1. Moderate to severe pain, especially in burn patients or extremity fractures
• 2. Chest pain of suspected myocardial origin
• 3. Pulmonary edema

• 1. Head injury- increasing intracranial pressure
• 2. Respiratory depression, <12 respirations
• 3. Hypotension, Hypovolemia

• 1. Suppression of seizure activity
• 2. Sedation prior to cardioversion or TC Pacing
• 3. Agitated Delirium
• 4. Facilitated Intubation
• 5. Inhibit possible seizure activity due to organophosphate poisoning

• 1. Infants under 6 months
• 2. Glaucoma
• 3. Shock, Hypotension
• 4. Patients taking calcium channel blockers, anti-fungal meds, or AIDS medications
• Relative Contraindications:
• 1. Head injury
• 2. Alcohol intoxication or narcotic ingestion

• 1. Sedation prior to cardioversion
• 2. Suppression of seizure activity

• 1. Acute narrow angle glaucoma
• 2. Alcohol intoxication
• 3. Shock, hypotension
• Relative Contraindications:
• 1. Head injury with depressed CNS function

Suspected narcotic overdose with respiratory rate of <12 or with decreased tidal volume

1. None significant due to INDICATIONS

• 1. Perfusing PSVT unresponsive to Valsalva manuever (i.e. blow on a 50 ml syringe, blow on thumb, or cough)
• 2. Poorly perfusing PSVT in a conscious patient
• 3. Regular and monomorphic wide-complex tachycardia

• 1. Hx of Sick Sinus Syndrome
• 2. 2nd or 3rd degree heart block
• 3. Poison or drug induced tachycardia (i.e. Persantine (dipyridamole), Tegretol (carbamepine))

• 1. Bronchospasm: toxic gas inhalation, pulmonary edema, drug overdose, near drowning, COPD/ Bronchitis, Acute Asthma
• 2. Crush Syndrome: suspected hyperkalemia, crush/ entrapment more than 4 hours

None significant

• 1. V-Fib
• 2. PVT unresponsive to CPR (LAC Protocol)

None significant for patients in cardiac arrest

Cyanide poisoning

None significant

Inhibit platelet aggregation in suspected myocardial ischemia

• 1. Active gastrointestinal bleeding or ulcer disease
• 2. Hemorrhagic stroke

• 1. Symptomatic bradydysrhytmias
• 2. Insecticide poisoning (organophosphates) (if HR<60, respiratory depression, and/or extreme salivation

None significant

• 1. Cardiac arrest associated with: hyperkalemia, overdose of calcium channel blockers
• 2. Crush syndrome: suspected hyperkalemia, crush/ entrapment more than 4 hours

None significant

Suspected overdose or accidental ingestion of drugs or chemicals

• 1. Patients with an altered (decreased) LOC or who are at risk for decreased LOC in the field
• 2. Absent gag reflex
• 3. < 2 yr old

Conscious diabetic patient with s/s of hypoglycemia

• 1. Patients with ALOC
• 2. Patients complaining of nausea
• 3. Patients taking Precose (Acarbose)

• 1. IV access for medication
• 2. Diluting solution for IVPB meds

Volume replacement

• 1. ALOC due to suspected hypoglycemia
• 2. Cardiac arrest due to hypoglycemia
• 3. Seizures due to hypoglycemia

Patients without documented hypoglycemia

• 1. Allergic reactions
• 2. Adjunct to epinephrine during anaphylaxis
• 3. Muscle spasms due to dystonic reactions

• 1. Acute asthma
• 2. Glaucoma

• 1. Cardiogenic shock
• 2. Distributive shock after fluids

• 1. Hypovolemia
• 2. Tachydysrhythmias

• 1. Cardiopulmonary arrest: V-Fib, Asystole, PEA, PVT
• 2. Asthma/ Severe allergic reaction
• 3. Anaphylaxis with shock
• 4. Pediatric bradycardia
• 5. Severe respiratory distress with stridor and croup

• 1. Hypovolemia
• 2. Hypertension

• 1. Pulmonary edema (not in LAC)
• 2. Increased ICP

• 1. Hypovolemia
• 2. Pregnancy (only used in life-threatening situations
• 3. Hypokalemia

• 1. ALOC when hypoglycemia is suspected and an IV cannot be established
• 2. Adjuvant tx of toxic effects of CCB or Beta blocker overdose

None significant

• 1. Cardiac arrest: as an alternative to Amiodarone in V-Fib or PVT
• 2. Ventricular dysrhythmias: Stable monomorphic VT, Stable wide-complex tachycardia

• 1. Stokes-Adams Syndrome
• 2. Wolff-Parkison-White Syndrome
• 3. Severe degrees of SA, AV or intraventricular blocks
• 4. Wide complex ventricular escape beats associated with bradycardia

• 1. Chest pain of suspected myocardial origin or myocardial ischemia
• 2. CHF/ Cardiogenic pulmonary edema

• 1. S/S of cerebral hemorrhage or increased ICP
• 2. Systolic BP <90 mmHg (<100 mmHg in LAC)
• 3. Bradycardia <50 bpm or Tachycardia >100 bpm
• 4. Right ventricular MI
• 5. Viagra, Levitra in last 24 hours, Cialis in last 48 hours

N/V

None significant

In any situation where O2 demand increases: hypoxemia, chest pain of myocardial origin, respiratory insufficiency, cardiopulmonary arrest

None significant

Potassium deficiency

None significant

S/S of organophosphate type nerve agent: respiratory distress/ respiratory arrest, muscle twitching, generalized weakness/ paralysis, seizure

None significant

• 1. Initial fluid replacement in hypovolemia and/ or dehydration or burns
• 2. Intravenous access for drug administration

None significant

• 1. Crush Syndrome: suspected hyperkalemia, crush force/ entrapment more than 4 hours
• 2. Cardiopulmonary arrest: suspected hyperkalemia (dialysis patient), down time more than 20 minutes
• 3. Known pre-existing bicarbonate responsive acidosis: tricyclic OD, aspirin OD, diphenhydramine OD, cocaine OD, DKA

None significant

• 1. Initial fluid replacement in hypovolemia, dehydration and Crush Syndrome
• 2. IV access for drug administration
• 3. Maintains patency of saline locks and PVAD

None significant