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Epinephrine
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- Trade Name: Adrenalin, Epinephrine
- Class: Sympathominmetic
- Action: Directly stimulates Alpha & Beta adrenegic receptors in sympathic NS
- Bronchodialtion=> relaxes smooth muscle (Beta2)
- inhibits histomine release
- positive chronotropic & inotrophic (Beta1)
- increase cardiac output + myocardial 02 consumption
- Indications: Anaphylaxis
- Contraindications: none in emergent anaphylaxis
- Adverse Effects: Palpitations, anxiousness, headache, tremors
- Onset: 5-10 min IM
- Duration: 5-10 min IM
- Adult Dosage: 0.3mg (1:1000) IM Repeat q 5-10 minutes prn
- Ped Dosage: 0.01 mg/kg IM/SQ (do not exceed 0.3 mg)
- Route: IM - Massaging the site after an IM injection may hasten absorption
- Interactions/Precautions: hypotension in circulatory callapse
- hypotension by pheothiazines
- antagonized by Alpha and Beta receptors
- additive toxicities with other sympathominmetics
- pH dependent
- deactivated when given with high alkaline solutions
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Glucagon
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- Class: hormone (aantihypoglycemic agent)
- Actions: cause break down of glycogen to glucose
- inhibits glycogen synthesis
- elevates blood glucose level
- positive chronotropic & inotropic
- Indications: Hypoglycemia
- Contraindications: hypersensitivity
- Adverse effects: dizziness, headache, hypotension, N/V hyperglycemia, hypokalemia
- Onset:: 5-20 min, peak @ 30 min
- Duration: 1- 1.5hrs
- Adult Dosage: 1 mg IM, q 15-20 minutes (prn)
- Ped Dosage:
- (<5 years) 0.5 mg IM
- (>5 years) 1.0 mg IM
- Route: IM
- Interactions/Precautions: After patient regains LOC – supplemental carbohydrates should be provided as soon as possible
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Nitroglycerin Spray
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- Trade names: Nitrostat, Nitro-Bid, Tridil
- Class: nitrate, anti-anginal, vasodilator
- Actions: Antianginal=> relaxes vascular smooth muscle of both venous and arterial beds, resulting in a net decrease in the myocardial oxygen consumption. It also dilates coronary vessels, leading to redistribution of blood flow to ischemic tissue and improves collateral circulation Vasodilating=> dilates peripheral vessels, decreasing venous return to the heart (preload) useful in treating pulmonary edema and heart failure. Arterial vasodilation decreases afterload, thereby decreasing left ventricular work and aiding the failing heart
- Indications: Acute coronary syndromes (pain & ischemia with Acute Myocardiac Infarction without hypotension), Suspected ischemic cardiac pain
- Contraindications:
- Hypersensitivity to nitrates
- Unable to initiate IV
- Increased intracranial pressure
- Hypotension (Systolic pressure under 100mmHg)
- Uncorrected hypovolemia
- Suspected cardiac tamponade or pericarditis
- Sildenafil (Viagra) or similar generic drug use within 24 hours
- Avoid use in extreme bradycardia (<50 bpm) or severe tachycardia (> 180 bpm)
- Important! Right ventricular infarction: use with Extreme Caution- if at all!
- Adverse effects: Hypotension
- Palpitations
- Tachycardia
- Syncope
- Dry mouth
- N/V
- Headache
- Dizziness
- Skin rash
- Onset: 1-3 minutes
- Duration: may last 30-60 minutes
- Adult Dosage: SL 0.3 mg tab
- SL 0.4 mg spray q 5 minute intervals (prn) as long as BP remains > 100 mmHg
- Route: sublingual spray or tablet
- Interactions/Precautions:Do not shake canister if administered as a spray as it will altered the metered dose in a single spray
- Do not have patient inhale drug on administration as it will alter absorption rate
- Establish IV prior to or immediately following administration to combat hypotension if necessary
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ASA
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- Trade Name: Asprine, Alka Seltzer, Aspergum, Bayer, Cosprin....
- Class: Anit-infammatory
- analgesic
- antipyretic
- platelet inhibitor
- Action:Anticoagulant: at low doses, appears to impede clotting by blocking prostaglandin synthesis, which prevents formation of platelet-aggregating substance thromboxane A2
- Analgesia/anti-inflammatory: inhibits the synthesis of prostaglandin, preventing or reducing pain (this is irreversible and can prolong bleeding time)
- Antipyretic: acts on the hypothalamus to produce peripheral vasodilation causing sweating which leads to heat loss and cooling by evaporation
- Inications: Acute coronary syndroms suggestive of an acute myocardial infraction
- Contraindications: Hypersensitivity
- GI bleeds
- ulcers
- asthma (May produce bronchoconstriction in asthmatics)
- unconsciousness
- Adverse Effects: Heartburn, N/V, wheezing
- Onset: 5-30 min
- Duration: 1-4 hours, halflife 15-20min, peak effects 15min -2hrs
- Adult Dose: 160mg - 325mg chewed as soon as possible
- Route: PO
- Interactions/Precautions: Anticoagulants increase risk of bleeding
- Impaired renal and hepatic function
- The effects of a single dose of aspirin persist for the life of the platelet (about 8 days)
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Dextrose D50W/D25W
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- Class: carbohydrate, antihypoglycemic
- Actions: Rapidly metabolized calories given parenterally, which promotes glycogen stores and prevents ketosis in patients with inadequate oral intake
- Indications: Hypoglycemia
- Coma of unknown origin (if unable to obtain blood glucose reading)
- Contraindications: Hyperglycemia
- Patients with increased ICP or intracranial
- hemorrhage
- Adverse effects:Hyperglycemia
- Thrombophlebitis is phlebitis (vein inflammation) related to a thrombus (blood clot)
- Onset: 30-60 seconds
- Duration: depends upon degree and cause of hypoglycemia
- Adult Dosage :0.5 – 1.0 g/kg of D50W slow IVP Second dose may be given if first dose ineffective
- Suspected head injury 12.5 g D50W slow IVP
- Re-check chemstrip in opposite limb and assess patient
- Pediatric Dosage: 0.5-1.0 g/kg of D25W (2-4 mls/kg) slow IVP
- Route: IV
- Interactions/Precautions:
- Dextrose greater (>) than 5% is considered a hypertonic solution. It can be very irritating to the vein and could cause cerebral bleeding if not given slowly
- Patients with increased intracranial pressure (give a half dose and reassess – Never withhold, if the patient’s metabolic needs are deficient)
- Ensure patency of IV – can cause tissue sloughing if interstitial Localized venous irritation and tissue necrosis may result
- IV cathalon should be 18g minimum as solution is very viscous
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Nitrous Oxide
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- Trade Name: Entonox
- Class: gaseous analgesic/anesthetic
- Action: Potent analgesic, weak anesthetic at these percentages
- CNS depressant with analgesic properties
- Indications: Pain of musculoskeletal origin, particularly fractures
- Burns
- Suspected ischemic chest pain (BLS)
- Pregnancy (only in active labor)
- ContraIndications:Unable to follow commands – due to interpretive problem, drugs, alcohol
- Altered LOC
- Significant COPD
- Any traumatic chest injury
- Any suspicion of pneumothorax, obstructed bowel (abd pain with distension)
- Decompression sickness (diving in last 48 hours)
- Pregnancy – except in active labor
- Adverse Effects:
- Dizziness
- ALOC
- Hallucinations
- N/V
- Onset: ~50sec
- Duration: effects last only 2-5 minuets after administration ceases
- Dosage: (Adult and Pedi)Self administrated inhalation until pain is relieved or patient drops the mask.
- Route: Inhalation by demand valve and mask
- Interactions/Precautions:
- Use in well ventilated area
- Ensure to invert tank three times prior to use
- Do not use outside if ambient temperature is below minus six degrees Celsius (-6°C).
- Do not use if frost on the tank
- Prolonged use can cause hypoxemia- provide supplemental Oxygen
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Medical Oxygen
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- Class: medicinal gas
- Action: Colorless, odorless, tasteless gas essential to respiration
- At sea level, oxygen makes up approximately 10% - 16% of venous blood and 17% - 21% of arterial blood
- Transported from the lungs to the body’s tissues attached to hemoglobin in the red blood cells
- Inhalation/administration will increase arterial oxygen tension (PaO2) and hemoglobin saturation
- Indications: Hypoxia from any cause
- Chest pain due to cardiac ischemia
- Altered level of consciousness
- Contraindications: None for emergency use.
- Adverse effects: none
- Dosage: Nasal Cannula: @ 1-6 L/min (24% - 40% O2 concentration)
- Simple & Pocket Mask: @ 6 – 10 L/min (40% - 60% O2 concentration)
- Partial/ Non-Rebreather (NRB): @ 10 – 15 L/min (up to 98% O2 concentration)
- Bag-Valve Mask (BVM): @ 10 – 15 L/min (up to 100% O2 concentration)
- Venturi Masks: @ 4 L/min (24% - 28% O2 concentration) @ 8 L/min (35% - 40% O2 concentration) Note: liter flow is dependent on the Venturi mask used.
- Route: Inhalation
- Interactions/Precautions: In some cases of COPD, oxygen administration may reduce the patient’s respiratory drive This is not a reason to withhold oxygen, but be prepared to assist ventilations.
- Oxygen that is not humidified may dry out or irritate mucous membranes
- Monitor long-term high flow in neonates as retrolental fibroplasia may develop
- Open flames
- 1 L/minute increase from 25% = 4% increase in dose
- Example:
- 1 L/minute = 25%
- 2 L/minute = 29%
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Dimenhydrinate
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- Trade name: Gravol, Dramamine
- Class: antihistamine, anticholinergic, antiemetic, antivertigo
- Action: antiemetic,
- antivertigo: inhibits nausea and vomiting by centrally depressing sensitivity to the labyrinth apparatus that relays stimuli to the chemoreceptor trigger zone and stimulates the vomiting center of the brain
- Indications: Nausea, vomiting
- Contraindications: Hypersensitivity (contains benzyl alcohol)
- Seizures
- Any condition which may be worsened by anti-cholinergic effects
- Adverse Effect: Can cause sedation
- dry mouth
- blurred vision
- urinary retention
- Onset: Immediate
- Duration: 4-7 hours Peak :1-4 hours
- Adult Dosage: 25 – 50 mg slow IVP 50 – 10 mg IM Note: IV dose must be diluted with NS to 10 ml Pediatric Doseage: 1 mg/kg IM or slow IVP (diluted)
- 2 – 5 years do not exceed 25 mg
- 6 – 12 years do not exceed 50 mg
- Route: IV, IM
- Interactions/Precautions: Seizure disorders
- Asthma
- Patients with increased intraocular pressure or angle-closure glaucoma.
- Undiluted solution is irritating to the veins and may produce sclerosis
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Glucose (oral)
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- Trade Name: Insta-glucose, Monogel, Glutose
- Class: glucose
- Action: A monosaccharide that is given orally and is readily absorbed in the intestine
- Indications: Hypoglycemia in patients who are alert, are able to follow commands & can swallow
- Contraindications: Any patient who is not alert
- Any patient unable to follow commands
- Any patient who lacks a gag reflex
- Hyperglycemia
- Adverse Effects: Nausea and vomiting
- Onset: 1 minute
- Duration: Depends on the degree of hypoglycemia
- Dosage: 25 g orally (may repeat in 10 minutes if necessary) (Administer the entire contents of tube (25 g) slowly and intermittently while patient swallows)
- Route: Oral
- Interactions-Precautions:
- May cause nausea or the patient may gag when administered
- Oral glucose is not absorbed sublingually or buccally
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Salbutamol (Canada), albuterol sulfate
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- Trade Name: Ventolin
- Class: bronchodilator, beta2-selective adrenergic agonist (sympathomimetic)
- Actions: Selectively stimulates beta-adrenergic receptors of the lungs, uterus, and vascular smooth muscle
- Brochodilation results from relaxation of the vascular smooth muscles, which relieves bronchospasm and reduces airway resistance
- Higher doses will drive serum potassium (K+) into the cells.
- Indications: Bronchospasm due to bronchial asthma
- chronic bronchitis and other chronic bronchopulmonary disorders
- Respiratory distress with bronchospasm
- Contraindications: Hypersensitivity
- Adverse effects: Often dose-related and include
- restlessness, tremors dizziness,
- palpitations, tachycardia, nervousness, peripheral vasodilation, nausea,
- vomiting, hyperglycemia, increased blood pressure, and paradoxical bronchospasm.
- Onset: 5-15 minutes
- Duration: 3-4 hours Peak effect: in 30 minutes to 2 hours
- Adult Dosage: 2.5 – 5.0 mg nebule – repeat q 10 minutes prn
- MDI minimum 6 puffs max 20
- Pediatric Dosage: 0.15 mg/kg diluted to 2.5 ml saline via nebulizer
- < 10 kg give 1.25 mg with NS to 2.5 ml
- 10-20 kg give 2.5 mg
- > 20 kg give 2.5 – 5.0 mg
- MDI pediatrics minimum 2 puff max 10
- Route: Nebulizer or metered dose inhaler
- Interactions-Precautions: Should not be used with patients presenting with acute heart failure Cardiovascular disease – cardiac dysrhythmias, hypertension
- Diabetes mellitus – risk of drug induced hyperglycemia
- Hypokalemia – risk further reducing serum potassium levels and possible adverse cardiovascular events
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Ipratropium bromide
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- Trade Name: Atrovent
- Class: anti-cholinergic, bronchodilator
- Actions: Inhibits cholinergic receptors in the bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophosphate (cyclic GMP). Decreased levels of cyclic GMP produce local, not systemic, bronchodilation
- Indications: bronchospasm in asthma, chronic bronchitis and emphysema
- Contraindications: Hypersensitivity to drug or atropine or its derivatives
- Adverse Effects:Palpitations
- Dizziness
- Anxiety
- Headache
- Nervousness
- Onset: 1-3 min
- Duration: 4-6 hrs, Peak 1-2hrs
- Adult Dosage: 250 –500 mcg via nebulizer with Salbutamol (mixed) repeat up to two times if necessary
- Normally only 1-2 doses in other conditions (eg. emphysema, chronic bronchitis)
- Combivent: 2.5 – 5.0 ml nebule – repeat q 10 minutes prn (not to exceed max dose for Atrovent )
- MDI: minimum 1- 4 puffs prn; max 10 (give after salbutamol; ipratropium has a much slower onset of action) Pediatric Dosage: (ages 5-11) – 25-250 mcg via nebulizer with salbutamol (mixed) repeat up to times two if necessary
- MDI: minimum 2 puff prn; max 4 (give after salbutamol; ipratropium has a much slower onset of action)
- safety and efficacy in children under 12 years of age haven’t been established.
- Route: Nebulizer or metered dose inhaler
- Interactions - Precautions: Hypersensitivity to soy lecithin or related food products (soybeans, peanuts)
- Patients with narrow angle glaucoma
- Be careful to avoid accidental release into the eyes (use mouth piece neb if possible)
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