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ACTIVATED CHARCOAL (ACTIDOSE)
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Protocol: Overdose / Toxic Ingestion
- Indications: Toxic Ingestion
- Class: Antidote, Adsorbent
- MOA: Inhibits absorption by binding to certain chemicals
- Contraindications: Ingestion of acids, alkalis, ethanol, methanol, cyanide, ferrous sulfate or other iron salts, lithium; coma; GI obstruction
- SE: N/V/D. If aspirated into the lungs, charcoal can induce a potentially fatal form of pneumonitis
- Route: PO
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Protocol: Narrow / Wide Complex Tachycardia
- Indications: SVT
- Class: Anti-Arrhythmic
- MOA: Slows the conduction of electrical impulses at the AV node.
- Contraindications: A-Fib or flutter, 2nd or 3rd degree AV block or SSS, and VT.
- SE: Facial flushing, dyspnea, HA, N/V, chest pressure, dizziness, diaphoresis, hypotension, palpations, and chest, jaw or neck pain. Route: IV/IO
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Protocol: Respiratory Distress
- Indications: Asthma, bronchitis with bronchospasm, and COPD
- Class: Bronchodilator
- MOA: Stimulates beta2-adrenergic receptors in lungs, resulting in relaxation of bronchial smooth muscle. Reduces bronchospasm and reduces airway resistance
- Contraindications: Hx of hypersensitivity to sympathomimetics, caution with HTN, CVD, hyperthyroidism and diabetes.
- SE: HA, N/V, restlessness, nervousness, tremors, dizziness, throat dryness and irritation. May increase risk of arrhythmias with Digoxin
- Route: NEB
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Protocol: Narrow / Wide Complex Tachycardia, V-Fib / Pulseless V-Tach
- Indications: VF/ pulseless VT, VT with a pulse.
- Class: Anti-Arrhythmic
- MOA: Acts directly on the myocardium to delay re-polarization and increase the duration of the action potential (Rate Control).
- Contraindications: Bradycardia induced syncope, 2nd and 3rd degree AV block, severe hepatic disease, severe sinus node dysfunction, and hypersensitivity to iodine.
- SE: Hypotension, Bradycardia, HA, N/V, and muscular incoordination.
- Route: IV/IO, Infusion (DRIP)
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Protocol: Chest pain
- Indications: Angina, AMI
- Class: Anti-Platelet
- MOA: Prevents the formation of a chemical which causes platelets to clump together, or aggregate, and form plugs that cause obstruction or constriction of small coronary arteries
- Contraindications: Bleeding disorders, GI bleeding or ulceration, hepatic impairment, and Hx of hypersensitivity to ASA and NSAID’s
- SE: GI distress, cramping, heartburn, mild nausea and allergic reaction
- Route: PO
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ATROPINE SULFATE (ATROPINE)
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Protocol: Bradycardia, Organophosphate Poisoning
- Indications: Symptomatic bradycardia, AV block, and antidote for organophosphate pesticides
- Class: Anti-Cholinergic
- MOA: Competes with acetylcholine for common binding sites on muscarinic receptors located on exocrine glands, cardiac, smooth muscle ganglia, and intramural neurons (blocks vagal tone)
- Contraindications: Use with caution in presence of MI and hypoxia. (Increases myocardial O2 demand) Avoid in hypothermic Bradycardia
- SE: Dry mouth, nose, throat, decreased diaphoresis, constipation and blurred vision; tachycardia
- Route: IV/IO
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Protocol: Asystole / PEA, Bradycardia, V-Fib / Pulseless V-Tach
- Indications: OD of CaCB’s and BB’s, acute hypocalcemia, cardiac arrest and hyperkalemia
- Class: Electrolyte
- MOA: Increase in myocardial contractility and ventricular automaticity; positive inotropic effect
- Contraindications: Digoxin toxicity, Hypercalcemia and VF
- SE: Rash, flushing, feeling of warmth, N/V, diaphoresis and hypotension
- Route: IV/IO
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Protocol: Altered Mental Status, Hypoglycemia
- Indications: Hypoglycemia
- Class: Anti-Hypoglycemic
- MOA: Increases blood glucose concentrations
- Contraindications: CVA, DTs
- SE: Hyperglycemia, warmth, burning, pain and thrombosis of the peripheral veins
- Route: IV/IO
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Protocol: Pain Control, Seizures, Behavioral
- Indications: Anxiety, skeletal muscle relaxation, ETOH withdrawal, seizures; prior to cardioversion
- Class: Benzodiazepine
- MOA: Depressing CNS with anticonvulsive and sedative properties
- Contraindications: Coma, CNS depression, respiratory depression, head injury
- SE: Drowsiness, fatigue, ataxia, orthostatic hypotension, HA and N/V
- Route: IV/IO, Rectal
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Protocol: Narrow / Wide Complex Tachycardia
- Indications: A-Fib/A flutter
- Class: Calcium Channel Blocker
- MOA: Inhibits Ca movement across cardiac, slows conduction in AV node (rate control). Cause dilation of coronary arteries, peripheral arteries and arterioles.
- Contraindications: Acute MI, 2nd or 3rd degree AV block, severe hypotension and SSS
- SE: Hypotension, peripheral edema, dizziness, light headedness, HA, BradycardiaRoute: IV/IO, Infusion (DRIP)
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DIPHENHYDRAMINE (BENADRYL)
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Protocol: Allergic Reactions, Behavioral
- Indications: Allergic reactions, motion sickness
- Class: Antihistamine
- MOA: Binds and blocks H1 histamine receptors
- Contraindications: Hypersensitivity
- SE: Hypotension, HA, drowsiness, use caution with acute asthma patients – may thicken secretions, may have a paradoxical effect on children causing an excitable state
- Route: IV/IO/IM
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Protocol: Bradycardia, Hypotension, Induced Hypothermia
- Indications: 2nd-line drug for symptomatic bradycardia and hypotension (non-trauma shock and post-resuscitation), non-trauma pediatric hypotension
- Class: Adrenergic agonist
- MOA: Stimulates alpha and beta adrenergic receptors, at moderate doses (2-10 mcg/kg/min) stimulates beta1 receptors resulting in increased inotropic and increased cardiac output
- Contraindications: Hypovolemic shock, HTN
- SE: Tachycardia, angina, N/V, arrhythmias, skin and soft tissue necrosis, correct hypovolemia with fluid replacement before initiating dopamine, use caution in cardiogenic shock with CHF
- Route: IV/IO, Infusion (DRIP)
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Protocol: Allergic Reaction, Respiratory Distress
- Indications: Anaphylaxis and allergic reactions with respiratory compromise
- Class: Adrenergic agonist
- MOA: Binds with alpha and beta receptors, producing increased BP, increased HR, and bronchodilation
- Contraindications: Extreme tachycardia
- SE: Anxiety, HA, HTN, tremors, N/V, use caution in patients with previous cardiac Hx and tachycardia
- Route: IM
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Protocol: Allergic Reaction, Aystsole / PEA, Bradycardia, V-Fib Pulseless V-Tach
- Indications: Cardiac arrest, anaphylaxis
- Class: Adrenergic agonist
- MOA: Binds with alpha and beta receptors, producing increased BP, increased HR, and bronchodilation
- Contraindications: Extreme tachycardia
- SE: Anxiety, HA, HTN, tremors, N/V, use caution in patients with previous cardiac Hx and tachycardia
- Route: IV/IO
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EPINEPHRINE RACEMIC (RACEPINEPHRINE)
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Protocol: Respiratory Distress
- Indications: Respiratory Distress
- Class: Adrenergic agonist
- MOA: Alpha and beta receptor stimulator- vasoconstriction, reduction in mucous
- Contraindications: Cardiac disease, HTN and sulfate sensitivity
- SE: Anxiety, dizziness, HA, tachycardia, tremors, N/V
- Route: Neb
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Protocol: Adult Airway RSI
- Indications: RSI induction, induction of anesthesia
- Class: Hypnotic, anesthesia induction agent
- MOA: GABA like effects, exact mechanism unknown
- Contraindications: DO NOT use during labor or lactating mothers, only use in pregnancy if benefit out weights risk
- SE: Hypotension, Respiratory depression, N/V, arrhythmias, laryngospasm
- Route: IV/IO
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Protocol: Allergic reactions, Nausea / Vomiting
- Indications: Allergic reactions, N/V
- Class: Antihistamine
- MOA: Competitively inhibits action of histamine at the H2 receptor sites decreasing gastric acid secretion
- Contraindications: Hypersensitivity
- SE: Palpitations, flushing, tinnitus, dizziness, constipation, anorexia, dry mouth
- Route: IV/IO
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Protocol: Pain Control
- Indications: Pain
- Class: Narcotic analgesic
- MOA: Binds to opiate receptors
- Contraindications: Use in caution in TBI, Respiratory depression
- SE: Respiratory depression, hypotension, N/V, dizziness, bradycardia, palpitations
- Route: IV/IO/IM/IN
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Protocol: Pulmonary Edema
- Indications: Pulmonary Edema, CHF
- Class: Loop diuretic
- MOA: Inhibits the absorption of Na and chloride ions and water in the loop of Henle
- Contraindications: Known sensitivity to sulfonamides or Furosemide
- SE: Hypotension, vertigo, dizziness, hypokalemia
- Route: IV/IO
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Protocol: Asystole / PEA, Altered Mental Status, Bradycardia
- Indications: Hypoglycemia, BB overdose
- Class: Hormone
- MOA: Converts glycogen to glucose and stimulating glucose synthesis
- Contraindications: Pheochromocytoma, insulinoma
- SE: N/V, HTN, tachycardia
- Route: IV/IO/IM
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Protocol: Altered Mental Status
- Indications: Hypoglycemia
- Class: Carbohydrate, hypertonic solution
- MOA: Distributed into tissues & provides a prompt increase in circulating blood sugar
- Contraindications: Must be mentally alert and able to swallow
- Route: PO
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HALOPERIDOL LACTATE (HALDOL)
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Protocol: Behavioral / Agitated Delirium
- Indications: Behavioral/agitated delirium
- Class: Antipsychotic
- MOA: Selectively blocks postsynaptic dopamine receptors.
- Contraindications: CNS depression, coma, Parkinson’s disease, use caution with elderly
- SE: Hypotension, tachycardia, HTN, drowsiness, respiratory depression
- Route: IM
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Protocol: Respiratory Distress
- Indications: Asthma, bronchospasm associated with COPD
- Class: Anticholinergic, bronchodilator
- MOA: Antagonizes the acetylcholine receptor on bronchial smooth muscle, producing bronchodilation
- Contraindications: Peanut allergy
- SE: Paradoxical bronchospasm, cough, headache, dizziness, dry mouth, palpitationsRoute: Neb
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KETOROLAC TROMETHAMINE (TORADOL)
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Protocol: Pain Control
- Indications: Mild to moderate pain
- Class: NSAID
- MOA: Inhibits the production of prostaglandins in inflamed tissue which decreases the responsiveness of pain receptors
- Contraindications: History of peptic ulcer disease or GI bleed, patients with renal insufficiency, hypovolemia, pregnancy (third trimester) nursing mothers, allergy to NSAID's, CVA, head trauma, immediate surgery
- SE: Pain at injection site, drowsiness, dizziness, N/V, abdominal pain, headacheRoute: IV/IO/IM
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Protocol: Respiratory Distress
- Indications: Acute bronchospasm in asthma or COPD
- Class: Selective Beta2 agonist
- MOA: Relaxing muscles in the airways to improve breathing
- Contraindications: Known sensitivity
- SE: Hyperglycemia, hypokalemia, palpitations, sinus tachycardia, anxiety, tremor, N/V, hypertension, HA
- Route: Neb
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Protocol: Adult Airway RSI, IV, Head Trauma, Narrow / Wide Complex Tachycardia, V-Fib Pulseless V-Tach
- Indications: RSI with head trauma, IO insertion
- Class: Anti-Arrhythmic, Sodium channel blocker
- MOA: Blocks sodium channels increasing recovery period after repolarization
- Contraindications: AV block
- SE: Cardiac arrhythmias, hypotension, bradycardia, seizures
- Route: IV/IO, Infusion (DRIP)
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Protocol: Wide Complex Tachycardia, V-Fib / Pulseless V-Tach, Obstetrical Emergency
- Indications: Eclamptic seizures, polymorphic VT (torsades de pointes), Respiratory distress
- Class: Electrolyte
- MOA: Reduces striated muscle contractions and blocks peripheral neuromuscular transmission
- Contraindications: AV block
- SE: Diaphoresis, hypotension, muscle paralysis, weakness, hypothermia
- Route: IV/IO, Infusion (DRIP)
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METHYLPREDNISOLONE (SOLU-MEDROL)
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Protocol: Allergic Reaction, Respiratory Distress
- Indications: Anaphylaxis, asthma, COPD, Acute spinal cord injury
- Class: Corticosteroid
- MOA: synthetic steroid that suppresses acute and chronic inflammation. In addition, it potentiates vascular smooth muscle relaxation by beta adrenergic agonists
- Contraindications: Cushing’s syndrome, measles, GI bleed, known sensitivity
- SE: Depression, headache, restlessness, hypertension, bradycardia, N/V/D, swelling
- Route: IV/IO
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Protocol: Chest Pain
- Indications: To reduce myocardial ischemia and damage in patient with acute MI
- Class: Beta-blocker Agent
- MOA: Beta-adrenergic blocking agent, Beta1 blocking action on the heart decreasing heart rate, conduction velocity, myocardial contractility, and cardiac output.
- Contraindications: Heart Failure, 2 and 3-degree heart blocks, hypotension, bradycardia
- SE: Bradycardia, atrioventricular conduction delays, hypotensionRoute: IV/IO
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MIDAZOLAM HYDROCHLORIDE (VERSED)
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Protocol: Behavioral / Agitated Delirium, Cardioversion, Induced Hypothermia, Seizure
- Indications: Sedation, anxiety, skeletal muscle relaxation
- Class: Benzodiazepine
- MOA: Enhances the inhibitory effects of GABA receptors on chloride channels in central nervous system, hyperpolarizing membrane. Induces sleep, decreases anxiety, and impairs memory retention.
- Contraindications: Acute-angle glaucoma, pregnant women, Hypersensitivity, Depressed vital signs, use with barbiturates, alcohol, narcotics, or other CNS depressants
- SE: Respiratory depression, respiratory arrest, hypotension, nausea/vomiting, headache, hiccups, cardiac arrest
- Route: IV/IO/IM/IN
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MORPHINE SULFATE (ASTROMORPH)
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Protocol: Chest Pain, Pain Control,
- Indications: Moderate to severe pain
- Class: Opiate agonist
- MOA: Narcotic analgesic
- Contraindications: Respiratory depression, shock, use with caution in hypotension, acute bronchial asthma
- SE: Hypotension, Tachycardia or bradycardia, Palpitations, Syncope, Facial flushing, Respiratory depression, Euphoria, Bronchospasm, Allergic reaction
- Route: IV/IO/IM
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Protocol: Altered Mental Status, Asystole / PEA, Hypothermia, Overdose / Toxic Ingestion
- Indications: Narcotic OD/Misuse
- Class: Narcotic Antagonist
- MOA: Competitive inhibition at narcotic receptor sites, reverse respiratory depression secondary to opiate drugs, completely inhibits the effect of Morphine
- Contraindications: Use with caution in narcotic dependent patients. Use with caution in neonates of narcotic-addicted mothers
- SE: Possible projectile vomiting with rapid admin
- Route: IV/IO/IM/IN
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NITROGLYCERIN (NITRO SPRAY)
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Protocol: Chest Pain, Hypertension, Pulmonary Edema,
- Indications: Acute angina pectoris, Ischemic chest pain, HTN, CHF, pulmonary edema
- Class: Vasodilator
- MOA: Smooth muscle relaxant acting on vascular, bronchial, uterine, and intestinal smooth muscle; dilation of arterioles and veins in the periphery; reduces preload and afterload; decreases the heart work load, thereby, myocardial oxygen demand
- Contraindications: Hypotension, hypovolemia; intracranial bleeding or head injury; administration of Viagra, Revatio, Levitra, Cialis, or similar agents in last 24 hours
- SE: Headache, hypotension, syncope, reflex tachycardia, flushing, nausea/vomiting, diaphoresis, muscle twitching
- Route: SL, Infusion (DRIP)
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Protocol: Adult Airway
- Indications: Facilitation of nasotracheal intubation
- Class: Topical vasoconstrictor
- MOA: Stimulates alpha receptors in the blood vessels of the nasal mucosa which causes their constriction and thereby decreases the risk of nasal bleeding
- Contraindications: Known allergy to medication
- SE: Rare with single dose, rarely absorbed systemically from nasal inhalation, CV: Hypertension, palpitations, CNS: Tremors
- Route: IN
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Protocol: Chest Pain, Abdominal Pain, Nausea / Vomiting
- Indications: For prevention and control of nausea and vomiting.
- Class: 5-HT3 receptor antagonist
- MOA: Blocks action of Serotonin, which is a natural substance that causes N/V.
- Contraindications: Known allergy to this medicine or other 5-HT3 receptor antagonists.
- SE: Chest pain, wheezing, hives/skin rash, nausea, vomitingRoute: IV/IO
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Protocol: Asystole / PEA, Overdose / Toxic Ingestion
- Indications: Mild to moderate metabolic acidosis due to shock, severe dehydration, anoxia, metabolic acidosis, cardiac arrest, and to treat overdose of Tricyclic antidepressants
- Class: Alkalizing agent, electrolyte and antacid
- MOA: Neutralizes hydrochloric acid. Systemic and urinary alkalinizer
- Contraindications: Metabolic and respiratory alkalosis, hypertension, convulsions, CHF, and other situations where sodium can be dangerous
- SE: Gastric distention, hypercalcemia, metabolic acidosis, tissue sloughing at the siteRoute: IV/IO
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SUCCINYLCHOLINE (ANECTINE)
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Protocol: Adult Airway RSI
- Indications: Facilitate intubation, terminate laryngospasm, promote muscle relaxation, and facilitate electroconvulsive shock therapy
- Class: Neuromuscular Blocker; Paralyzing Agent
- MOA: Bind to the receptors for Acetylcholine
- Contraindications: Acute narrow-angle glaucoma, penetrating eye injuries, inability to control airway or support ventilations with oxygen and positive pressure
- SE: Apnea, malignant hyperthermia, arrhythmias, bradycardia, hypertension, hypotension, cardiac arrest, hyperkalemia, increased intraocular pressure, fasciculation, and exacerbation of hyperkalemia in trauma patientsRoute: IV/IO
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Protocol: Altered Mental Status, Seizure, Stroke, Syncope
- Indications: Coma of unknown origin, Delirium Tremens, Beriberi, Wernicke's encephalopathy
- Class: Vitamin B-1
- MOA: Combines with ATP to form thiamine pyrophosphate coenzyme, a necessary component for carbohydrate metabolism. The brain is extremely sensitive to thiamine deficiency
- Contraindications: None
- SE: Hypotension from too rapid of an injection or too high a dose, anxiety, diaphoresis, nausea/vomiting, allergy (rare)
- Route: IV/IO
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Protocol: Asystole / PEA, V-Fib / Pulseless V-Tach
- Indications: Alternate vasopressor to the 1st or 2nd dose of Epinephrine in cardiac arrest. May be useful in cases of vasodilatory shock (septic shock)
- Class: Antidiuretic Hormone
- MOA: Stimulation of V1 smooth muscle receptors. Potent vasoconstrictor when given in high doses
- Contraindications: Hypersensitivity to Vasopressin, responsive patients with coronary artery disease
- SE: Bronchial constriction, ischemic chest pain, nausea/vomiting, abdominal pain
- Route: IV/IO
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