Midterm Paramedic Meds.txt

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• Amyl Nitrate (cyanide antidote kit) dosage:
• -Amyl Nitrate: breathe 30 sec out of every minute
• -Sodium Thiosulfate & Sodium Nitrate: IV per antidote kit directions

• IV Drip= 20 units in 1,000ml NS run w/o
• IM= 10 units

2-100mcg SLOW IVP, IM, use local protocols to find appropriate dose

• -Ventricular ectopy: 1mg/kg SLOW IVP/IO, MR 0.5 mg/kg q 5-10 min to Max 3mg/kg
• - V-tach: 1mg/kg SLOW IVP/IO, MR 0.5 mg/kg q 5-10 min to Max 3mg/kg
• -V-fib: 1-1.5mg/kg IVP/IO, MR 1-1.5 mg/kg q 5-10 min to Max 3mg/kg
• IV infusion: 2gm in 250cc D5W run @ 2-4 mg/min. 2gm/min=15 gtts, 4gm/min=30 gtts

• -Chest Pain= 3-5mg slow IVP, MR q 5 min to Max 10mg
• -Pulmonary Edema= 3-5mg slow IVP, MR q 5 min to Max 10mg
• -Ortho trauma/burns= 3-5mg slow IVP, MR q 5 min to Max 10mg (base contact required for >10mg)

0.4mg SL spray or tablet MR q 3-5 min to Max 3 doses

• IV= 0.1 mg/kg SLOW IVP (Max 5mg)
• IM= 0.2 mg/kg IM (Max 10mg)

• 5-20 mcg/kg/min IV infusion, dosage ranges:
• -5-10 mcg/kg/min= beta stimulation
• -over 10 mcg/kg/min= alpha stimulation

• -Asthma: 0.3mg-0.5mg 1:1,000 IM, MR q 5 min to Max 2 doses
• -Anaphylaxis: 0.3mg-0.5mg 1:1,000 IM, MR q 5-15 min as needed
• -Cardiac Arrest: 1.0mg 1:10,000 IVP, IO, MR q 3-5 min
• -Drip: mix 1mg in 250cc NS or D5W & start at 30 gtts/min. (equivalent to 2mcg/min), titrate to effect

Stimulates contraction of uterine muscles (constricts muscles and blood vessels, reducing hemorrhage)

Post-partum hemorrhage

• -Before delivery of infant and placenta.
• -Allergy to oxytocin

• CV= hypotension, arrhythmias
• GI= N/V

• -Monitor VS & Blood loss q 5 mins.
• -Use other hemorrhage control methods such as: fluid replacement, uterine massage, baby to breast, shock position.
• -Pts. w/ Hx of C-section or uterine surgery are high risk for hemorrhage

• -Binds to opiate receptors in sympathetic NS
• -Alters the perception of pain (shorter lasting than Morphine)
• -CNS depressant
• -Analgesia
• -Anxiety relief

• -Anginal CP
• -Pulmonary edema
• -Severe pain in isolated extremity trauma and burns

• -Hypersensitivity to opiates
• -Hypotension, hypovolemia, shock
• -Severe respiratory depression
• -Pain, unknown etiology
• -Head trauma
• -Diminished LOC
• -Multi system trauma
• -Acute abdominal pain

• Euphoria, sedation, confusion, ataxia
• CV= Hypotension, bradycardia
• RESP= Respiratory depression
• Gi=N/V

• -Have Narcan and airway equipment ready to use.
• -Monitor EKG & VS at regular intervals.
• -Potentiates effects of ETOH/CNS depressants.
• -For pain, obtain Pt's pain level prior to each dose
• -Use w/ caution in very old and very young patients
• -Has an adverse interaction w/ amiodarone, use caution

• -Have Narcan and airway equipment ready to use.
• -Monitor EKG & VS at regular intervals.
• -Potentiates effects of ETOH/CNS depressants.
• -For pain, obtain Pt's pain level prior to each dose
• -Use w/ caution in very old and very young patients

• Euphoria, sedation, confusion, ataxia
• CV= Hypotension, bradycardia
• RESP= Respiratory depression
• Gi=N/V

• -Hypersensitivity to opiates
• -Hypotension, hypovolemia, shock
• -Severe respiratory depression
• -Pain, unknown etiology
• -Head trauma
• -Diminished LOC
• -Multi system trauma
• -Acute abdominal pain

• -Anginal CP
• -Pulmonary edema
• -Severe pain in isolated extremity trauma and burns

• -Binds to opiate receptors in sympathetic NS
• -Alters the perception of pain
• -Systemic vasodilation (reduces afterload and preload)
• -CNS depressant
• -Analgesia
• -Anxiety relief

• -Amyl Nitrate: affinity for cyanide ions, reacts with hemoglobin to form methemoglobin (low toxicity)
• -Sodium Nitrate: same as Amyl Nitrate
• -Sodium Thiosulfate: Produces thiocyanate, which is then excreted

-Cyanide or Hydrocyanic acid poisoning

None

Excessive dose of Amyl Nitrate & Sodium Nitrate can produce severe, life threatening methomoglobinemia. Use only recommended doses.

Cyanide poisoning must be recognized quickly & treated quickly: if pulse persists, even in the presence of apnea, prognosis is good with treatment. The antidote kit must be used in conjunction with administration of oxygen.

• -Increases fibrillatory threshold
• -Decreases ventricular irritability
• -Suppresses ventricular ectopy

V-fib, V-tach, malignant PVC's

• -PVC's w/ bradycardia
• -2nd or 3rd degree AV block
• -Idioventricular rhythm
• -Allergy to amide type local anesthetics

• -Early s/s: restlessness, anxiety, disorientation, combativeness, twitching, numbness, euphoria
• -Late s/s: convulsions, coma, hypotension, widening QRS complex, prolonged PRI interval, cardiac arrest.

• -Monitor VS & EKG, ectopy, CNS toxicity.
• -Use supplemental O2
• -Stop infusion @ first sign of toxicity
• -Use cautiously and 1/2 dose if patient is >65yo or has Hx of CHF or liver disease.

• -Stimulates dopaminergic, alpha and beta receptors of sympathetic NS
• -Low dose stimulates dopaminergic receptors (=renal & mesenteric)
• -Mid dose stimulates beta receptors (= +inotrope)
• -High dose stimulates alpha receptors (= peripheral renal & mesenteric vasoconstriction)

• -DOC for cardiogenic shock.
• -Bradycardia w/ hypotension.
• -Other shock states after fluid resuscitation

• -Hypovolemic shock.
• -Tachydysrhythmias

• CNS: h/a
• CV: Ventricular irritability, dysrhythmias, HTN (high dose), hypotension
• GI: n/v

• -Monitor VS & EKG continuously!
• -Use supplemental O2
• -If unwanted rise in diastolic pressure is seen, STOP infusion
• -Tissue necrosis occurs on extravasion
• -Incompatible w/ Bicarb

• Stimulates adrenergic receptors:
• -Alpha = peripheral vasoconstriction
• -Beta 1= +inotrope & +chronotrope
• -Beta 2= bronchodilation

• W/o pulse = asystole, V-fib, V-tach, PEA, Idioventricular rhythm
• W/ pulse: Anaphylaxis, bronchospasms (from respiratory distress)

• -None in cardiac arrest.
• -Underlying cardiovascular disease.
• -Hypersensitivity to sympathomimetics
• -Tachyarrhythmias, HTN
• -Hemorrhagic or cardiogenic shock

• -CNS=h/a, anxiety (skeletal muscle tremors)
• -CV=HTN, SVT, ventricular irritability, palpitations, MI

• -Monitor VS & EKG
• -Use supplemental O2
• -Potentiation may occur w/ sympathomimetics

• -Reduces myocardial O2 demands
• -Systemic vasodilation (reduces afterload and preload)
• -Increases blood flow in collateral coronary vessels

• -Angina pectoris
• -Pulmonary edema
• -Hypertensive crisis

• -Hypersensitivity to nitrates
• -Hypotension (BP<90 systolic)
• -S/S of ICP
• -Pt. use of viagra (or other sexual performance drugs) within 24 hrs

• -CNS: h/a, dizziness
• -CV: orthostatic hypotension, tachycardia, flushing, palpitations
• -GI= n/v

• -Monitor VS(BP!) & EKG.
• -Use supplemental O2.
• -Anticipate "throbbing" headache (indicative of Max response).
• -Store tablets in a dark, cool, dry place. -Do not shake spray

• -Anticonvulsant/CNS depressant
• -Sedative (w/ amnesic effect)
• -Skeletal muscle relaxant

• -Seizures
• -Adjunct to intubation
• -Sedation prior to cardioversion
• -Chemical restraint

• -Hypersensitivity to Versed.
• -Hypovolemia, hypotension, shock, coma.
• -Acute narrow-angle glaucoma.
• -Acute ETOH intoxication.
• -Depressed vital signs.
• -Pregnancy.

• -CNS: sedation, ataxia, coma, drowsiness
• -CV: Hypotension
• -RESP: Respiratory depression, apnea

• -Keep airway equipment ready (airway management)
• -Monitor VS & assess reputations continuously
• -IM injections: give in large muscle mass (no deltoid)
• - Possible respiratory depression w/ rapid IVP
• -Potentiates effects of ETOH & CNS depressants