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ALS Meds

Statewide Protocols

TermDefinition
Adenosine (Adenocard) Indications: Specifically for tx or diagnosis of supraventricular tachycardia Consider for regular or wide complex tachycardia
Adenosine (Adenocard) Dosing Tachycardia: 6 mg rapid IV/IO push over 1-3 seconds May repeat 12 mg after 1-2 mins x 2, if no conversion
Albuterol - Beta Agonist Indications: Nebulized treatment for use in respiratory distress with bronchospasm
Albuterol - Beta Agonist Dosing Allx Rx/Anaphylaxis: 2.5mg via nebulizer - May repeat 2.5mg Asthma/COPD/RAD: 2 puffs per dose of MDI - May repeat every 5 mins Albuterol is 2nd line drug, initial tx should be 2.5mg albuterol and 0.5mg ipratropium (Duoneb)- may repeat every 5 mins
Amiodarone (Cordarone) Indications/Contraindications -Antiarrhythmic used mainly in wide complex tachycardia and ventricular fibrillation -Avoid in patients with heart block or profound bradycardia -Contra: in pts with iodine hypersensitivity
Amiodarone (Cordarone) Dosing Cardiac Arrest - V-Fib/Pulseless V-Tach 300 mg IV push - repeat dose of 150 mg IV/IO push for recurrent episodes PostArrest: 150mg in 10mL normal saline slow IV/IO over 8-10 mins. If successful maintenance infusion of 1 mg/min Tachy:Wide complex Tachy-150 mg in 50-100mL normal saline infused over 10 mins. if successful, consider maintenance infusion of 1mg/min
Aspirin Indications/Contra: -An antiplatelet drug for use in cardiac chest pain -Hx of anaphylaxis to aspirin or NSAIDs -Not used in presence of active GI bleeding
Aspirin Dosing Acute Coronary Syndrome -324 mg chewed PO
Atropine Indications: -Anticholinergic drug used in bradycardia and organophosphate poisonings
Atropine Dosing Bradycardia: 0.5 - 1mg IV/IO every 3-5 mins up to max of 3mg Organophosphate Poisoning and Nerve Agent 2-6mg IM/IV/IO every 5 mins as needed
Atropine and Pralidoxime Auto-Injector (DuoDote) Nerve Agent Kit Indications: Antidote for nerve agents or organophosphate overdose
Atropine and Pralidoxime Auto-Injector (DuoDote) Nerve Agent Kit Dosing Nerve agents: -Pts experiencing: apnea, convulsions, unconsciousness, flaccid paralysis administer 3 DuoDote and 1 Atropine (10mg) auto injectors -Pts experiencing: dyspnea, twitching, nausea, vomiting, sweating, anxiety, confusion, constricted pupils, restlessness, weakness administer 1 DuoDote
Calcium Chloride 10% solution Indications: For calcium channel blockers overdose
Calcium Chloride 10% solution Dosing Bradycardia: -2-4mg/kg slow IV over 5 mins, max 1g -Avoid use if pt is taking digoxin
Cyanide Antidote Kit (Amyl Nitrite, Sodium Nitrite and Sodium Thiosulfate) Indications: Antidote for Cyanide Poisoning
Cyanide Antidote Kit (Amyl Nitrite, Sodium Nitrite and Sodium Thiosulfate) Dosing Poisoning: -Amyl Nitrite 2 Inhalants -Sodium Nitrite: 3%, 10mL slow IV/IO over 2-4 mins -Sodium Thiosulfate: 25% 50mL IV/IO bolus
Cyanokit (Hydroxocobalamin) Indications: Antidote for Cyanide Poisoning
Cyanokit (Hydroxocobalamin) Dosing Poisoning: 5gm IV/IO over 15 mins
Dextrose (Glucose solutions) Indications: Symptomatic hypoglycemia
Dextrose (Glucose solutions) Dosing Diabetic Emergencies: - 12.5g to 25g IV/IO Name Concentration Volume (25g) D50 0.5g/mL. 25g/50mL D25. 0.25g/mL. 25g/100mL D10. 0.1g/mL. 25g/250mL
Diazepam (Valium) Benzodiazepine Indications: -Seizure control -Sedation -Anti-anxiety (anxiolytic)
Diazepam (Valium) Benzodiazepine Dosing Sedation for Electrical Therapy - 2.5-5mg IV/IO/IM/IN/PR Nerve Agent -10mg IV/IN/IO/IM/PR. OR - 10mg IM via auto-injector Seizure/Poisoning/Substance abuse/OD -5-10mg IV/IO/IM/PR Induced Therapeutic Hypothermia - 5-10mg IV/IO/IM/PR (for shivering)
Diltiazem (Cardizem) Indications/Contraindications: -Calcium channel blocker used to treat narrow complex SVT -Contra: in pts with heart block, ventricular tachycardia, WPW and/or acute MI
Diltiazem (Cardizem) Dosing Tachycardia- Narrow Complex Tachycardia: 0.25 mg/kg slow IV/IO push; may repeat dose in 15 mins at 0.35mg/kg if necessary
Diphenhydramine (Benadryl) Indications: Antihistamine used as an adjective treatment in allergic reactions
Diphenhydramine (Benadryl) Dosing Allergic Reaction/Anaphylaxis: 25-50 mg IV/IO/IM
Dopamine Indications: -A vasopressor used in shock or hypotension -Used when infusion pump/norepinephrine not available
Dopamine Dosing Bradycardia, Post-Resuscitation and Shock - Infusion 2-20 mcg/kg/min IV/IO
Epinephrine 1:1,000 (Auto-Injector ONLY) Indications: Bronchodilation in asthma and COPD exacerbation. primary tx for anaphylaxis
Epinephrine 1:1,000 (Auto-Injector ONLY) Dosing Allergic Rx/Anaphylaxis - 0.3mg IM, repeat every 5 mins to a total of 3 doses Asthma/COPD/RAD - 0.3mg IM (no repeat) If authorized by service, Advanced EMTs and Medics may administer Epinephrine 1:1,000 IM if using a kit that has following criteria: - Supplies in separate container from all other meds - Medication provided as 1mg/mL in glass vial - Kit case and med vial labeled with "NOT FOR IV USE"/ adult/pedi dose - Kit has 2 sterile 1 cc graduated syringes and 21 to 25 gauge attached
Epinephrine 1:1,000 (by Infusion ONLY) Indications: Vasopressor Post-Resuscitation, Bradycardia, allergic reaction
Epinephrine 1:1,000 (by Infusion ONLY) Dosing Allx Rx 2-10 mcg/min IV/IO infusion (maintenance) Bradycardia 2-10 mpg/min IV/IO Infusion Post-Resuscitation 2-10mcg/min IV/IO infusion Shock-Adult 2-10 mcg/min IV/IO infusion-by pump
Epinephrine 1:10,000 Indications: Vasopressor used in cardiac arrest
Epinephrine 1:10,000 Dosing Cardiac Arrest 1 mg IV/IO, repeat every 3-5 mins per AHA guidelines
Epinephrine (Racemic, for inhalation) Indications: Croup
Epinephrine (Racemic, for inhalation) Dosing Croup: 11.25 mg in 2.5mL solution
Fentanyl (Sublimaze) Indications: Opioid analgesic
Fentanyl (Sublimaze) Dosing Pain 1mcg/kg up to 150 mpg slow IV/IO/IM/IN Therapeutic Hypothermia, Shivering 50 mpg every 5 mins, max 200mcg IV/IO/IM/IN
Furosemide (Lasix) Indications: CHF, Pulmonary Edema, Hypertensive Emergencies, Toxicology
Furosemide (Lasix) Dosing CHF, Pulmonary Edema 20-40mg IV/IO Hypertensive Emergencies 0.5-1mg/kg IV/IO Toxicology 40mg IV/IO
Glucagon Indications: -Hypoglycemia -Beta Blocker or Calcium channel blocker overdose
Examples of Calcium Channel Blockers Amlodipine (Norvasc) Diltiazem (Cardizem, Tiazac,) Felodipine. Isradipine. Nicardipine. Nifedipine (Adalat CC, Afeditab CR, Procardia) Nisoldipine (Sular) Verapamil (Calan, Verelan)
Examples of Beta Blockers acebutolol (Sectral) atenolol (Tenormin) betaxolol (Kerlone) betaxolol (Betoptic S) bisoprolol fumarate (Zebeta) carvedilol (Coreg) esmolol (Brevibloc) labetalol (Trandate [Normodyne - discontinued]) metoprolol (Lopressor, Toprol XL) nadolol (Corgard) nebivolol (Bystolic) penbutolol (Levatol) propranolol (Hemangeol, Inderal LA, Inderal XL, InnoPran XL) sotalol (Betapace, Sorine) timolol timolol ophthalmic solution (Timoptic, Betimol, Istalol)
Glucagon Dosing Diabetic Emergencies 1mg IV/IO/IM/IN/SC Beta Blocker/Calcium Channel Blocker Overdose 1-5mg IV/IO/IM/IN/SC Bradycardia 1-5mg IV/IO/IM/IN/SC
Glucose Oral Indications: Use in conscious hypoglycemic patients
Glucose Oral Dosing Diabetic Emergencies Administer 1-2 tubes of commercially prepared glucose gel or equivalent
Haloperidol (Haldol) Phenothiazine Preparation Indications/Contra Medication to assist with sedation of agitated patients
Haloperidol (Haldol) Phenothiazine Preparation Dosing Behavioral Emergencies 5 mg IM
Hydrocortisone (Solu-Cortef) Indications/Contra -Adrenal Insufficiency/Crisis -Other inflammatory processes (COPD/Asthma)
Hydrocortisone (Solu-Cortef) Dosing Adrenal Insufficiency/Crisis 100mg IV/IO/IM Respiratory Distress (COPD/Asthma) 100mg IV/IO/IM
Ipratropium Bromide (Atrovent) Indications/Contra -Anticholinergic bronchodilator. Blocks the muscarinic receptors of acetylcholine -Relief of bronchospasm in patients with reversible obstructive airway disease and bronchospasm
Ipratropium Bromide (Atrovent) Dosing Asthma/COPD/RAD -2-3 puffs per dose of MDI combo of albuterol/ipratropium bromide. may repeat as necessary every 5 mins OR -0.5mg ipratropium and 2.5mg albuterol (DuoNeb) May repeat as necessary every 5 mins 0.5mg ipratropium nebulizer may repeat as necessary every 5 mins
Ketamine Indications: Agitated patient
Ketamine Dosing Behavioral: 4mg/kg IM only, to a max dose of 400mg IM only as a single dose
Lidocaine -Antiarrhythmic used for control of ventricular dysrhythmias -Used prior to intubation of pts c suspected increased intracranial pressure (ex. TBI, ICH) to reduce increases in intracranial pressure -Anesthetic for nasotracheal intubation and intraosseous procedures
Lidocaine Dosing Cardiac Arrest: 1-1.5mg/kg IV/IO; repeat dose 0.75mg/kg up to max 3mg/kg follow by 2-4mg/min maint. infusion V. Tachycardia c pulses: 1-1.5mg.kg IV/IO (consider 2nd therapy to amiodarone) repeat dose of 0.5-0.75mg/kg every 3-5 mins - total of 3 mg/kg follow by 2-4 mg/min maint. infusion Post-Resus.: 1-1.5mg/kg IV/IO follow by 2-4mg/min maint infus Nasotracheal intub.: 2% lidocaine jelly Intraosseous: 40mg 2% lidocaine slow bolus over 2 mins follow 10mL normal saline flush, then use IO access for meds
Lorazepam (Ativan) Benzodiazepine Indications: Seizure control Sedation Anti-anxiety (anxiolytic)
What does anxiolytic mean? Used to reduce anxiety
Lorazepam (Ativan) Benzodiazepine Dosing Behavioral: 2-4mg IV/IO/IM Nerve Agent/Seizures 2-4mg slow IV/IO/IM
Magnesium Sulfate Indications: -Elemental electrolyte used to treat eclampsia during the third trimester of pregnancy -A smooth muscle relaxer used in refractory respiratory distress resistant to beta-agonists -Torsades de Pointes
Magnesium Sulfate Dosing Asthma/RAD 2 grams in 100mL NS given IV over 10 mins Seizures 4 grams IV over 10 mins in the presence of a sz in 3rd trimester of pregnancy or post party Cardiac Arrest/Tachycardia-Torsades de Pointes 1-2 grams IV over 5 mins
Methylprednisolone (Solu-Medrol) Indications: Steroid used in respiratory distress to reverse inflammatory and allergic reactions
Methylprednisolone (Solu-Medrol) Dosing Asthma/COPD/RAD 125mg IV/IO/IM
Metoprolol (Lopressor) Rate control for adult patients who are already prescribed a beta blocker NOTE: do not use IV Beta Blockers with IV Calcium channel blockers
Metoprolol (Lopressor) Dosing Tachycardia 2.5mg to 5 mg slow IV over 2-5 mins May repeat every 5 mins to a max of 15mg
MIdalozam (Versed) Benzodiazepine Seizure control sedation anxiolytic
MIdalozam (Versed) Benzodiazepine Dosing Behavioral/Sz/Induced Therapeutic Hypothermia 2-6mg IV/IO/IM/IN Nerve Agent/Organophosphate Poisonin 2mg IV/IO/IN every 5 mins or 6mg IM every 10 mins as needed Sedation for Electrical Therapy 0.5mg -2mg IV/IO/IM/IN Difficult Airway 2mg slow IV/IO/IM/IN, repeat if needed up to total dose of 6mg
Morphine Sulfate Opioid analgesic Avoid use if BP < 100mmHg
Morphine Sulfate Dosing Pain 0.1mg/kg every 5 mins IV/IO/IM/SC up to 10mg max
Naloxone (Narcan) Opioid Antagonist Opioid overdose
Naloxone (Narcan) Opioid Antagonist Dosing Pain: Antidote: for hypoventilation from opioid admin by EMS, admin naloxone 0.4mg - 4.0mg IV/IM/IN as needed Poisoning/Substance Abuse/Opioid OD 0.4mg - 4mg IV/IM/IN if no response, may be repeated as needed First responders and EMTs may administer by auto-injector or nasal atomizer
Nitroglycerin Indications/Contra Vasodilator used in the tx of cp secondary to acute coronary syndrome and CHF Hypertensive emergencies Contra: not used in the presence of hypotension or recent use of phosphodiesterase-type-5 inhibitor within last 48 hours
Nitroglycerin Dosing Cardiac conditions/Hypertensive emergencies -0.4mg SL tabs or 1 spray every 3-5 mins while symptoms persist and if systolic BP remains > 120mmHg -1 inch paste to chest wall, transdermal
Norepinephrine (Levophed) Alpha and Beta 1 receptor adrenergic receptor agonist vasopressor Infusion pump REQUIRED
Norepinephrine (Levophed) Dosing Hypotension 0.1mcg/kg/min IV/IO titrate to goal SBP of 90mmHg - generally to a max dose of 30 mcg/min - 4 mg mixed in 250mL of D5 diluent packaged with medication; max dose: generally to a max dose
How many epinephrine and norepinephrine are there? 4 epis and 1 nor
Ondansetron (Zofran) Anti-emetic used to control nausea and/or vomiting
Ondansetron (Zofran) Anti-emetic Dosing Nausea/Vomiting 4mg IV/IO/IM/ODT
Oxygen -Any condition with increased cardiac work load, respiratory distress, or illness/injury resulting in altered ventilation and/or perfusion. Goal oxygen sat > or = 94% -Used for pre-oxygenation whenever possible prior to endotracheal intubation. Goal oxygen sat 100%
Oxygen Dosing -1-6 liters/min via nasal cannula -10-15 liters/min via NRB mask -15 liters/min via BVM
Pralidoxime (2-PAM) -Antidote for nerve agents or organophosphate overdose -administered as part of Mark I kit
Pradidoxime (2-PAM) Dosing Nerve Agent/Organophosphate Poisoning 600mg via Auto-Injector IM per kit, 1-3 kits
Sodium Bicarbonate A buffer used in acidosis to increase the pH in cardiac arrest, hyperkalemia, or tricyclic overdose
Sodium Bicarbonate Dosing Poisoning/Substance Abuse/OD/Toxicology 0.5 - 1 mEq/kg IV/IO Cardiac Arrest/Known Hyperkalemia/Acidosis/TCA Overdose 1 mEq/kg IV/IO
What is an organophosphate overdose? Organophosphate are used as insecticides, medications, and nerve agents. Symptoms include increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle tremors, and confusion. Carbamate poisoning can present similarly.
What is a tricyclic overdose? Antidepressant overdose Examples: Amitriptyline Amoxapine Doxepin Nortriptyline (Pamelor) Protriptyline (Vivactil) Trimipramine (Surmontil)
What is hyperkalemia and some symptoms> Potassium level in your blood that's higher than normal. Potassium is a nutrient that is critical to the function of nerve and muscle cells, including those in your heart. Your blood potassium level is normally 3.6 to 5.2 millimoles per liter (mmol/L). Symptoms: asymptomatic, nausea,fatigue,muscle weakness, tingling sensations, slow heartbeat or weak pulse
Tetracaine 0.5% Topical anesthetic for eye injuries
Tetracaine 0.5% Dosing Eye injuries 1-2 drops to affected eye; repeat every 5 mins as needed
Vasopressin Used in Cardiac Arrest
Vasopressin Dosing Cardiac Arrest; Asystole, Pulseless Electrical Activity, Ventricular Fibrillation, Ventricular Tachycardia (without pulses) 40 units IV/IO in place of first or second dose of epinephrine
Created by: Jess2008