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Calcium Chloride
- Electrolyte
- Des: increases myocardial contractile force and increases ventricular automaticity.
- Ind: Hyperkalemia, hypocalcemia, hypermagnesemia, ad calcium channel blocker toxicity
- CI: Ventricular fibrillation, hypercalcemia, and possible digitalis toxicity
- PC: may precipitate toxicity in pts taking digoxin, ensure the IV line is in a large vein and is flushed before and after using calcium
- Dose: 2 to 4mg/kg IV (10% solution)/ 10min as needed
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Methylprednisolone
- (Solu-Medrol) Corticosteroid, Antiinflammatory
- Des: Effective as an antiinflammatory and used in the management of allergic reactions and in some cases shock. Can sometimes be used in the treatment of spinal cord injury.
- Ind: Spinal cord injury, asthma, severe anaphylaxsis, COPD
- PC: Only use a single dose prehospitally
- Dose: 125 to 250mg IV/IM (Asthma/ COPD/ Anaphylaxis); 30 mg/kg IV over 15 min, after 45 min an indusion of 5.4 mg/kg/hr (Spinal Cord Injury)
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Magnesium Sulfate
- (Magnesium) Electrolyte
- Des: Acts as a calcium channel blocker, acting as a CNS depressant and anticonvulsant. Depresses the function of smooth, skeletal, and cardiac muscles.
- Ind: Refractory ventricular fibrillation and pulseless ventricular tachycardia (especially torsade de pointes), AMI, eclamptic seizures
- CI: Heart block, myocardial damage, shock, persistent hypertension, and hypocalcemia
- PC: Other CNS depressants or neuromuscular blocking agents
- Dose: 1 to 2g IV over 2 min (VFib or VTach); 1 to 2g IV over 5 to 30 min (AMI); 2 to 4g IV/IM (eclampsia)
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Phenytoin
- (Dilantin) Anticonvulsant
- Des: Reduces the spread of electrical discharges in the motor cortex and inhibits seizures. Also has antidysrythmic properties that counteract the effects of digitalis.
- Ind: Seizures, status epilepticus, cardiac dysrythmias secondary to digitalis.
- CI: Sinus bradycardia, heart block, Adams-Stokes syndrome
- Dose: 10 to 15mg/kg slow IV (Seizures); 100mg slow IV (over 5 min) to a maximum of 1000mg (Dysrythmias)
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Sodium Bicarbonate
- (NaHCO3) Alkalizing Agent
- Des: Provides vascular bicarbonate to assist the buffer system in reducing the effects of metabolic acidosis and in the treatment of some overdoses
- Ind: Tricyclic antidepressant and barbituate overdose, refractory acidosis, or hyperkalemia
- PC: May precipitate calcium chloride
- Dose: 1mEq/kg IV, then 0.5 mEq/kg/10 min
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Thiamine
- Vitamin
- Des: Vitamin B1, which is required to covert glucose into energy, it is not manufactured in the body and must be constantly provided from diet
- Ind: Coma of unknown origin, chronic alcoholism with associated coma, and delirium tremens
- Dose: 50 to 100mg IV/IM
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Diphenhydramine
- (Benadryl) Antihistamine
- Des: blocks histamine release, thereby reducing bronchoconstriction, vasodilation, and edema
- Ind: Anaphylaxis, allergic reactions, and dystonic reactions
- CI: Asthma and other lower respiratory diseases
- Dose: 25 to 50mg IV/IM
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Lorazepam
- (Ativan) Sedative
- Des: the most potent benzodiazepine available. It has strong antianxiety, sedative, hypnotic, and skeletal muscle relaxant properties, and a relatively short half-life
- Ind: Sedation for cardioversion and status epilepticus
- PC: Narrow-angle glaucoma, depression or psychosis, coma, shock, acute alcohol intoxication, renal or hepatic impairment, organic brain syndrome, myasthenia gravis, GI disorders, elderly, debilitated, limited pulmonary reserve
- Dose: 2 to 4mg IM, 0.5 to 2 mg IV (sedation); 2mg slow IV/PR (2 mg/min) (status epilepticus)
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Metoclopramide
- (Reglan) Antiemitic
- Des: a dopamine antagonist similar to procainamide but with few antidysrhythmic or anesthetic properties. Its antiemetic properties stem from rapid gastric emptying and desensitization of the vomiting reflex
- Ind: Nausea and vomiting
- CI: allergy to sulfite agents, seizure disorders, pheochromocytoma, mechanical GI obstruction or perforation, and breast cancer
- PC: CHF, hypokalemia, renal impairment, GI hemorrhage, intermittent porphyria
- Dose: 10 to 20mg IM; 10mg slow IV (over 1 to 2 min)
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Zofran
- Antiemetic
- Des: selective blocking agent of the serotonin receptor type
- Ind: Nausea and intractible vomiting
- PC: may mask a progressive ileus and/or gastric distension
- Dose: single 24mg tablet ODT; 4mg IV undiluted over at least 30 seconds, preferably
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Chlordiazepoxide
- (Librium) Sedative/ Hyponotic
- Des: a benzodiazepine derivative that produces mild sedation and anticonvulsant, skeletal muscle relaxant, and prolonged hypnotic effects
- Ind: Severe anxiety and tension, acute alcohol withdrawal symptoms (DTs)
- CI: pregnant and nursing mothers, children under 6
- PC: Primary depressive disorders or psychoses, acute alcohol intoxication
- Dose: 50 to 100mg IV/IM
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Pancuronium
- (Pavulon) Nondepolarizing Neuromuscular Blocker
- Des: causes paralysis without bronchospasm or hypotension
- Ind: to facilitate endotracheal intubation
- CI: Tachycardia
- Dose: 0.04 to 0.1mg/kg IV
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Vercuronium
- (Norcuron) Nondepolarizing Skeletal Muscle Relaxant
- Ind: Facilitated endotracheal intubation
- PC: Severe obesity, myasthenia gravis, or maliginant hypothermia
- Dose: 0.08 to 0.1mg/kg IV
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Butorphanol
- (Stadol) Narcotic Analgesic
- Des: a centrally acting synthetic narcotic analgesic about 5 times more potent than morphine. A schedule IV narcotic
- Ind: Moderate to severe pain
- CI: Head injury, or undiagnosed abdominal pain
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Meperidine
- (Demerol) Narcotic Analgesic
- Des: a synthetic narcotic with sedative and analgesic properties comparable to morphine but without hemodynamic side effects
- Ind: Moderate to sever pain
- CI: Seizure disorders, undiagnosed abdominal injury or pain
- PC: ICP, asthma or other respiratory conditions, SVTs, prostatic hypertrophy, utheral structure, glaucoma, elderly or debilitated, renal or hepatic impairment, hypothyroidism, Addison's disease
- Dose: 25 to 50mg IV, 50 to 100mg IM
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Nalbuphrine
- (Nubain) Narcotic Analgesic
- Des: a synthetic narcotic analgesic equivalent to morphine, though its respiratory depression does not increase with higher doses
- Ind: Moderate to severe pain
- CI: Undiagnosed head or abdominal injury
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Aminophylline
- (Aminophylline, Somophyllin) Methylxanthine Bronchodilator
- Des: Prolongs bronchodilation and decreases mucus production and has mild CNS and cardiac simulating effects.
- Ind: CHF; Bronchospasm and COPD refractory to sympathomimetics and other bronchodilators
- CI: Uncontrolled cardiac dysrhythmias
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Chlorpromazine
- (Thorazine) Tranquilizer, Antipsychotic
- Des: Phenothiazine derivatice used to managae psychotic episodesby providing stong sedation and moderate extrapyramidal symptoms
- Ind: Acute psychotic episode, intractable hiccups, nausea/vomiting
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Promethazine
- (Phenergan) Antiemetic
- Des: An anticholinergic agent that enhances the effects of analgesics and is a potent antiemetic
- Ind: Nausea/vomiting, motion sickness, to enhance the effects of analgesics, and to induce sedation
- Dose: 12.5 to 25mg IV/IM/PR
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Terbutaline
- (Brethine, Bricanyl) Sympathetic Agonist
- Des: Causes bronchodilation with less cardiac effect than epinephrine
- Ind: Bronchial asthma and bronchospasm in COPD
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Heparin
- Anticoagulant
- Des: Rapid-onset anticoagulant, enhancing the effects of antithrombin III and blocking the conversion of prothombrin to thombrin and fribrogen to fibrin
- Ind: to prevent thrombus formation in acute MI
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Norepinephine
- (Levophed) Ampathomimetic Agent
- Des: Causes vasodilation, cardiac stimulation, and increased blood pressure, myocardial oxygen demand, and coronary
- Ind: refractory hypotension and neurogenic shock
- CI: hypotension due to uncorrected hypovolemia
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Timpotic
- Beta blocker
- Des: Non-selective beta-adrenergic receptor blocking agent
- Ind: HTN, AMI, elevated ocular pressure
- CI: Asthma, severe COPD, sinus bradycardia, 2nd or 3rd degree AV block, cardiogenic shock
- PC: readily absorbed
- Dose: Opthalmic, one drop per eye BID
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Alteplase Recombinant
- (tPA, Activase) Thrombolytic
- Des: Recombinant DNA- derived form of human tPA promotes thrombolysis by forming plasmin. Plasmin, in turn, degrades fibrin and fibrogen, and ultimately the clot
- Ind: To thrombolyse in AMI, acute ischemic stroke, and pulmonary embolism
- CI: active internal bleeding, suspected aortic dissection, traumatic CPR, recent hemmoragic stroke (6 months), intracranial or intraspinal surgery or tauma (2 months), pregnancy, uncontrolled hypertension.
- PC: recent major surgery, cerebral vascular disease, recent GI or GU bleeding, recent trauma, hypertension, pt >75 years old, current oral anticoagulants, or hemmorhagic opthalmic conditions
- Dose: 15mg IV, then 0.75mg/kg (up to 50mg) over 30 min, then 0.5mg/kg (up to 35mg) over 60 min (AMI and stroke)
- 100mg IV infusion over 2 hours (pulmonary edema)
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Dexamethasone
- (Decadron) Steroid
- Des: a long-acting synthetic adrenocorticoid with intense antiinflammatory activity
- Ind: Anaphylaxis, COPD, Asthma, and Spinal Cord Edema
- CI: None in emergency setting
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Ketorolac
- (Toradol) NSAID
- Des: an injectable NSAID that exhibits analgesic, antiinflammatory, and antipyretic properties without sedative effects
- Ind: Mild or moderate pain
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Mannitol
- (Osmitrol) Osmotic diuretic
- Des: an osmotic diuretic that draws water into the intravascular space through its hypertonic effects, then causes diuresis
- Ind: cerebral edema
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Glucagon
- (GlucaGen) Hormone, Antihypoclycemic
- Des: a protein secreted by pancreatic cells that causes a breakdown of stored glycogen
- Ind: Hypoglycemia without IV access and to reverse beta-blocker overdose
- PC: Effective only if there are sufficient stores of glycogen in the
- liver
- Dose: 1mg IM/SQ repeat/5 to 20 min (Hypoglycemia)
- 50 to 150mcg/kg IV over 1 min (Beta-blocker overdose)
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Oxytocin
- (Pitocin) Hormone
- Des: a naturally occurring hormone that causes the uterus to contract, thereby inducing labor, encouraging delivery of the placenta, and controlling postpartum hemorrhage
- Ind: Severe postpartum hemorrhage
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Prochlorperazine
- (Compazine) Antiemetic
- Des: Has potent antiemetic properties and fewer sedative, hypotensive, and anticholinergic effects
- Ind: Severe nausea and vomiting, or acute psychosis
- CI: Coma or depression
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Racemic Epinephrine
- Sympathomimetic Agonist
- Des: a variation of epinephrine used only for inhalation to induce bronchodilation and to reduce laryngeal edema and mucus secretion
- Ind: Croup
- CI: Hypertension or epiglottitis
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