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ALS Drugs Profile

ALS Drugs Profile Maryland Medical Protocols for EMS Providers July1, 2010

QuestionAnswer
1. ACETAMINOPHEN Indications Patients ages 3 years and above judged to be in mild to moderate discomfort (e.g. 2-5 on FACES scale)
1. ACETAMINOPHEN Contraindications Head Injury; Low BP; Taken of acetaminophen or medications containing acetaminophen within the previous four hours; Can't swallow; Respiratory distress; Persistent vomiting; Liver disease; Current alcohol ingestion; Allergy to acetaminophen
1. ACETAMINOPHEN Adverse effects Not clinically significant
1. ACETAMINOPHEN Precautions Administration of acetaminophen for mild to moderate pain does not eliminate the need for transport of the patient to the hospital to receive a comprehensive evaluation of the cause of the pain and appropriate definitive treatment.
1. ACETAMINOPHEN Dosage < 3 years of age: Not indicated; 3-5 yo: Unit dose 160 mg/5 mL; 6-9 yo: Unit dose 325 mg/10.15 mL; > 9 yo: Give TWO Unit doses of 325 mg/10.15 mL each for total of 650 mg/20.3 mL; Consult for patients who are significantly underweight or overweight.
2. ACTIVATED CHARCOAL (WITHOUT SORBITOL) Indications Poisoning by mouth
2. ACTIVATED CHARCOAL (WITHOUT SORBITOL) Contraindications Altered mental status; Patients who have received an emetic
2. ACTIVATED CHARCOAL (WITHOUT SORBITOL) Adverse Effects May indirectly induce vomiting and cause nausea.
2. ACTIVATED CHARCOAL (WITHOUT SORBITOL) Precautions Does not absorb all drugs and toxic substances.
2. ACTIVATED CHARCOAL Dosage Must consult. Adult: 1 gram/kg; Ped: 1 gram/kg
3. ADENOSINE (ADENOCARD) Indications To slow the rate of narrow complex tachycardia; Is only effective on SVT/PSVT.; No effect on VT, atrial fibrillation, or flutter; In stable, wide complex tachycardia (possible VT) for pediatric with medical consultation and caution.
3. ADENOSINE (ADENOCARD) Contraindications Known hypersensitivity
3. ADENOSINE (ADENOCARD) Adverse Effects Chest pressure; dizziness; dyspnea; flushing; headache; hypotension and nausea
3. ADENOSINE (ADENOCARD) Precautions Effects antagonized by theophylline; Effects enhanced by dipridimole (persantine), digitalis, calcium channel blockers, and benzodiazepines such that the dose of adenosine must be reduced for patients on these medications; Up to 40 seconds of asystole
3. ADENOSINE (ADENOCARD) Dose - Adult EMT-P w/o consult. 6 mg rapid IVP bolus followed by a rapid flush. Give 12 mg if no response within 2 minutes. Give 12 mg more if no response within another 1 to 2 minutes
3. ADENOSINE (ADENOCARD) Dose - Peds EMT-P w/o consult. 0.1 mg/kg rapid IVP/IO, maximum initial dose 6 mg. Second and third doses: 0.2 mg/kg rapid IVP/IO maximum single additional dose 12 mg.
4. ALBUTEROL SULFATE (PROVENTIL, VENTOLIN) Indications To reverse bronchospasm (wheezing); Hyperkalemia (NEW ’10)
4. ALBUTEROL SULFATE (PROVENTIL, VENTOLIN) Contraindications Known hypersensitivity
4. ALBUTEROL SULFATE (PROVENTIL, VENTOLIN) Adverse Effects Headache; nausea; nervousness; palpitations; peripheral vasodilation; PVCs; sore throat; tachycardia; tremors and vomiting
4. ALBUTEROL SULFATE (PROVENTIL, VENTOLIN) Precautions Coronary artery disease; May potentiate MAO inhibitors or tricyclic antidepressants; Medical direction required before administering to pregnant patient or patient having a cardiac history
4. Albuterol Doses - Adult (Bronchospasm) 2.5 mg by nebulized aerosol connected to 6-8 lpm of oxygen; may repeat one time.
4. Albuterol Doses - Peds (Bronchospasm) Age two or older: 2.5 mg by nebulized aerosol. Ages less than two years: 1.25 mg by nebulized aerosol.
4. Albuterol Doses - Adult (Hyperkalmia) Must consult. 20 mg (if available) by nebulized aerosol connected to 6-8 lpm of oxygen.
4. Albuterol Doses - Peds (Hyperkalmia) Age two or older: 2.5 mg by nebulized aerosol. Ages less than two years: 1.25 mg by nebulized aerosol.
5. ASPIRIN Indications Chest pain when acute myocardial infarction is suspected
5. ASPIRIN Contraindications Known hypersensitivity
5. ASPIRIN Adverse Effects Heartburn; Nausea; Vomiting; Wheezing
5. ASPIRIN Precautions GI bleeding and upset
5. ASPIRIN Dosage Adult: 324 mg or 325 mg chewed; Pediatric: Not Indicated
6. ATROPINE SULFATE Indications Asystole; idioventricular rhythm; Nerve agents; Organophosphate poisoning and Symptomatic bradycardia
6. ATROPINE SULFATE Contraindications Known hypersensitivity; Dysrhythmias in which enhancement of conduction may accelerate the ventricular rate and cause decreased cardiac output (e.g. atrial fibrillation, atrial flutter, or PAT with block)
6. ATROPINE SULFATE Adverse Effects Excessive doses of atropine can cause ataxia, blurred vision, coma, delirium, disorientation, dry mucous membranes, flushed skin, hot skin, restlessness, tachycardia.; VF and tachycardia have occurred following IV administration of atropine.
6. ATROPINE SULFATE Precautions Not clinically significant
6. ATROPINE SULFATE Dose - Adult Asystole: 1 mg IVP repeated every 3-5 minutes to a total of 0.04 mg/kg; max. 3 mg. Bradycardia: 0.5-1 mg IVP repeated every 3-5 minutes. Max. 0.04 mg/kg.
6. ATROPINE SULFATE Dose - Peds Bradycardia: Administer 0.02 mg/kg IV/IO; minimum dose 0.1 mg; maximum single dose Child (10 kg-25 kg), 0.5 mg; Adolescent (25-40 kg), 1 mg; ET 0.03 mg/kg, dilute 5 mL; repeat once
6. ATROPINE SULFATE Dose (Organophosphate poisoning) Adult and Peds Must consult. Adult: Administer 2-4 mg IVP or IM every 5-10 minutes; Peds: Administer 0.02 mg/kg IVP/IO or IM every 5-10 minutes.
7. ATROVENT (Ipratropium) Indications Allergic reactions/ anaphylaxis; Bronchial asthma; Reversible bronchospasms associated with chronic bronchitis and emphysema
7. ATROVENT (Ipratropium) Contraindications Hypersensitivity to the drug; Hypersensitivity to atropine; Less than one year of age
7. ATROVENT (Ipratropium) Adverse Effects More common: cough, dry mouth, or unpleasant taste; Less common: chest tightness, dizziness, eye burning or pain, facial sweating, headache, hives, nervousness, palpitations, rash, sweating, trembling or vision changes
7. ATROVENT (Ipratropium) Precautions Use with caution in patients with CHF, elderly patients, glaucoma, heart disease and hypertension; May worsen glaucoma if it gets into the eyes. Having the patient close eyes during nebulization may prevent this.; Must be used with a beta-angonist.
7. ATROVENT Dose (Ipratropium) - Adult Single administration ONLY, 500 mcg (2.5 mL) by nebulized aerosol connected to 6-8 lpm of oxygen in combination with albuterol 2.5 mg.
7. ATROVENT Dose (Ipratropium) - Peds ONE TIME ONLY. Use with albuterol, nebulized aerosol is connected to 6 - 8 lpm of oxygen. < 1 year of age: contraindicated; Ages 1 year but less than 2 years: 250 mcg (1.25 mL) by nebulized aerosol; Age 2 and older: 500 mcg (2.5 mL) by nebulized aerosol.
8. CALCIUM CHLORIDE (10% Solution) Indications Hyperkalemia; Hypocalcemia; To treat adverse effects caused by calcium channel blocker overdose; Hypotension secondary to diltiazem administration
8. CALCIUM CHLORIDE (10% Solution) Contraindications Not indicated in cardiac arrest except when hyperkalemia, hypocalcemia, or calcium channel toxicity is highly suspected; Patient currently taking Digoxin with suspected calcium channel blocker overdose
8. CALCIUM CHLORIDE (10% Solution) Adverse Effects Arrhythmia; bradycardia (with rapid injection); cardiac arrest and syncope
8. CALCIUM CHLORIDE (10% Solution) Precautions Use cautiously on patients taking digitalis, as calcium may increase ventricular irritability and precipitate digitalis toxicity.; If given with sodium bicarbonate, calcium will precipitate.; Calcium salts may produce coronary and cerebral artery spasm.
8. CALCIUM CHLORIDE (10% Solution) Doses - Adult Must consult. 0.5-1 gram SIVP over 3-5 min. Max 1 gram. Administer 250 mg SIVP for hypotension following diltiazem administration.
8. CALCIUM CHLORIDE (10% Solution) Doses - Peds Must consult. 20 mg/kg (0.2 mL/kg) SIVP/IO (50 mg/min). Max 1 gram or 10 mL.
9. CAPTOPRIL (Capoten) Indications Respiratory distress from Congestive Heart Failure or Pulmonary Edema
9. CAPTOPRIL (Capoten) Contraindications Known hypersensitivity; Known history of angioedema
9. CAPTOPRIL (Capoten) Adverse Effects Angioedema; cough; hyperkalemia; rash and renal impairment
9. CAPTOPRIL (Capoten) Precautions Not for use with pregnant females
9. CAPTOPRIL (Capoten) Dosage Adult: 25 mg SL for moderate and severe symptoms so long as SBP = or > 110 after nitroglycerin administration; Peds: Not indicated.
10. DEXTROSE 50% Indications Correction of altered mental status due to cardiac arrest, low blood sugar (hypoglycemia) and seizures
10. DEXTROSE 50% Contraindications Known hyperglycemia
10. DEXTROSE 50% Adverse Effects May worsen hyperglycemia (high blood sugar)
10. DEXTROSE 50% Precautions May worsen pre-existing hyperglycemia; Tissue necrosis if extravasation occurs
10. DEXTROSE 50% Dose - Adult 25 grams in 50 mL IV (1 ampule of 50% solution)
10. DEXTROSE 50% Dose - Peds < 2 mo, 5–10 mL/kg D10W IV/IO (D10W - mix one part of D50W with four parts LR).; > 2 mo and < 2 yo, 2-4 mL/kg of 25% dextrose IV/IO (D25W - mix D50W with an equal volume of Lactated Ringer’s). >2 yo D50W 1–2 mL/kg IV/IO. Max. 25 grams.
11. DIAZEPAM (VALIUM) (for Chempack or Mark I Optional Protocol) Indications Sustained and/or recurrent seizures due only to nerve agent or organophosphate exposure
11. DIAZEPAM (VALIUM) (for Chempack or Mark I Optional Protocol) Contraindications Known head injury; hypersensitivity; Should be used with caution in patients with altered mental status, acute narrow angle glaucoma or hypotension
11. DIAZEPAM (VALIUM) (for Chempack or Mark I Optional Protocol) Adverse Effects Additive effect with ethanol; amnesia; ataxia; confusion; impairment of mental and psychomotor function; Lightheadedness; motor impairment; slurred speech; Irritability and excitation may be seen paradoxically.
11. DIAZEPAM (VALIUM) (for Chempack or Mark I Optional Protocol) Precautions Respiratory depression may occur with IV administration, especially if given too rapidly.; Respiratory support may be required.; Use with caution in persons ingesting alcohol, persons ingesting sedatives or pregnant patients
11. DIAZEPAM (VALIUM) (for Chempack or Mark I Optional Protocol) Dose - Adult EMT-P w/o consult for sustained and/or recurrent seizures due only to nerve agent or organophosphate exposure. 10 mg IM.
11. DIAZEPAM (VALIUM) (for Chempack or Mark I Optional Protocol) Dose - Peds EMT-P w/o consult for sustained and/or recurrent seizures due only to nerve agent ororganophosphate exposure. Greater than 30 kg/66 lbs: Administer 10 mg or 0.1 mg/kg IM,maximum of 10 mg.
12. DILTIAZEM (Cardizem) Indications Symptomatic atrial fibrillation and atrial flutter
12. DILTIAZEM (Cardizem) Contraindications Hypersensitivity to the drug; hypotension below 90 mm Hg; Second or third degree heart block; Patients less than 12 years of age
12. DILTIAZEM (Cardizem) Adverse Effects Bradycardia; Headache; Hypotension; Nausea; Vomiting;
12. DILTIAZEM (Cardizem) Precautions Use cautiously in patients with congestive heart failure or renal failure.
12. DILTIAZEM (Cardizem) Dose Must consult. 0.25 mg/kg (max 20 mg) by IV bolus SIV over 2 min; if response is not adequate, repeat in 15 min 0.35 mg/kg (max 25 mg) over 2 min; > 50 yo or borderline BP, consider initial bolus 5-10 mg IV over 2 min. Peds:Contraindicated for <12 yo.
13. DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) Indications Allergic reaction; Anaphylaxis; Dystonic reactions
13. DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) Contraindications Known allergy to diphenhydramine
13. DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) Adverse Effects blurred vision; drowsiness; headache; hypotension; loss of coordination; palpitations; tachycardia; thickening of bronchial secretions leading to chest tightness and wheezing
13. DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) Precautions Alcohol intoxication; Severe vomiting; Medical consultation required for asthma and nursing mothers
13. DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) Dose - Adult Consult required for Asthma, nursing mothers, mild allergic reactions or doses > 25 mg. Administer 25 - 50 mg SIVP or IM.
13. DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) Dose - Peds Consult required for Asthma, mild allergic reactions or doses > 25 mg. 1 mg/kg slow IV/IO or IM. Maximum single dose 25 mg.
14. DOPAMINE HYDROCHLORIDE (INTROPIN) Indications Cardiogenic shock; Anaphylactic shock; Septic shock; Hypovolemic shock (after sufficient volume replacement)
14. DOPAMINE HYDROCHLORIDE (INTROPIN) Contraindications Pheochromocytoma (adrenal tumor which causes excessive release of epinephrine and norepinephrine); Pre-existing tachydysrhythmias; Uncorrected hypovolemia
14. DOPAMINE HYDROCHLORIDE (INTROPIN) Adverse Effects Anginal pain; Hypertension; Nausea; Tachydysrhythmias; Undesirable degree of vasoconstriction and vomiting
14. DOPAMINE HYDROCHLORIDE (INTROPIN) Precautions Extravasation should be told to ER on arrival.;Patients taking MAOI are very sensitive to dopamine and should get a much lower dosage than usual.;Patients with pheochromocytoma are very sensitive to dopamine and may develop very high BP with minimal dose.
14. DOPAMINE HYDROCHLORIDE (INTROPIN) Dose - Adult Must Consult. Administer 2-20 mcg/kg/min IV drip titrated to BP of 100 systolic or medical consultation selected BP; initial infusion rate 2-5 mcg/kg/min.
14. DOPAMINE HYDROCHLORIDE (INTROPIN) Dose - Peds Must Consult. Administer 2-20 mcg/kg/min IV drip titrated age specific BP or medical consultation selected BP; initial infusion rate is 2 mcg/kg/min.
15. EPINEPHRINE 1:10,000/1:1,000 Indications Allergic reaction/anaphylaxis, moderate to severe; Bronchial asthma; Cardiac arrest; Respiratory Stridor (Suspected Croup); IV epinephrine should be reserved for cardiac arrest patients and for impending cardiac arrest due to anaphylactic shock.
15. EPINEPHRINE 1:10,000/1:1,000 Contraindications Hypertension; Pre-existing tachydysrhythmias with a pulse (ventricular and supraventricular); Use with pregnant women should be avoided whenever possible.
15. EPINEPHRINE 1:10,000/1:1,000 Adverse Effects Decreased level of consciousness;Headache;Hypertension;May induce early labor in pregnant women;Nervousness;Rebound edema may occur 20-30 minutes after administration to croup patients;Tachydysrhythmias (supraventricular and ventricular)
15. EPINEPHRINE 1:10,000/1:1,000 Precautions Do not mix with sodium bicarbonate.; Epinephrine causes a dramatic increase in myocardial O2 use.; Its use in the setting of an AMI should be restricted to cardiac arrest.; IVP epinephrine (1:1,000) should not be administered to any patient with a pulse.
15. EPINEPHRINE 1:10,000/1:1,000 Dose - Adult Cardiac Arrest 1 mg (1:10,000) IVP every 3-5 minutes.
15. EPINEPHRINE 1:10,000/1:1,000 Dose - Adult Allergic Reaction/Anaphylactic Shock/Asthma Must consult for anaphylactic. 0.01 mg/kg of 1:1,000 IM.
15. EPINEPHRINE 1:10,000/1:1,000 Dose - Peds Cardiac Arrest Administer 0.01 mg/kg (0.1 mL/kg) of 1:10,000 IVP/IO; repeat every 3-5 minutes.ET: 0.1 mg/kg of 1:1,000, diluted with 5 mL of Lactated Ringer’s; repeat every 3-5 minutes.
15. EPINEPHRINE 1:10,000/1:1,000 Dose - Neonate Cardiac Arrest 0.01 mg/kg (0.1 mL/kg) of 1:10,000 IVP/IO;repeat every 5 minutes. ET: 0.03 mg/kg of 1:10,000, diluted with 1 mL of Lactated Ringer’s.
15. EPINEPHRINE 1:10,000/1:1,000 Dose - Peds Bradycardia 0.01 mg/kg (0.1 mL/kg) of the 1:10,000 IVP/IO; repeat every 3-5 minutes. ET: 0.1 mg/kg of 1:1,000, diluted with 5 mL of Lactated Ringer’s solution; repeat every 3-5 minutes.
15. EPINEPHRINE 1:10,000/1:1,000 Dose - Neonates Bradycardia 0.01 mg/kg (0.1 mL/kg) of 1:10,000 IVP/IO;repeat every 3-5 minutes. ET: 0.03 mg/kg of 1:10,000, diluted with 1 mL of Lactated Ringer’s.
15. EPINEPHRINE 1:10,000/1:1,000 Dose - Peds Allergic Reaction/Anaphylactic Shock/Asthma Must consult for anaphylactic. 0.01 mg/kg of 1:1,000 IM; maximum single dose: 0.5 mg.
15. EPINEPHRINE 1:10,000/1:1,000 Dose - Peds Croup Must consult. 2.5 mL of 1:1,000 via nebulizer. If patient does not improve, administer a second dose of 2.5 mL of 1:1,000 via nebulizer.
16. FUROSEMIDE (LASIX) Indications Acute pulmonary edema; CHF; edema related to kidney or liver disease
16. FUROSEMIDE (LASIX) Contraindications Dehydrated patients; Known allergy to sulfonamides; Known hypersensitivity; Patients exhibiting signs and symptoms of electrolyte imbalance (primarily hypokalemia); Pregnancy
16. FUROSEMIDE (LASIX) Adverse Effects Decreased cardiac output; Decreased circulatory blood volume; Dehydration; Loss of electrolytes, specifically magnesium and potassium; Transient hypotension due to decreased cardiac output; Transient vasoconstriction in patients with chronic heart failure
16. FUROSEMIDE (LASIX) Precautions May cause or aggravate the following conditions: Dehydration, Hyperosmolality, Hypokalemia, Hypotension, Hypovolemia
16. FUROSEMIDE (LASIX) Dose - Adult 0.5-1mg/kg slow IVP.
16. FUROSEMIDE (LASIX) Dose - Peds 1 mg/kg slow IVP/IO; maximum dose of 50mg.
17. GLUCAGON Indications Unconscious patients who are highly suspected of being hypoglycemic where IV access is unobtainable; Unconscious combative patients where IV access is unobtainable due to venous collapse or altered mental status
17. GLUCAGON Contraindications Known hypersensitivity
17. GLUCAGON Adverse Effects Nausea and vomiting
17. GLUCAGON Precautions Glucagon only works if liver has significant glycogen stores.
17. GLUCAGON Dose - Adult For suspected hypoglycemia without IV access 1 mg IM.
17. GLUCAGON Dose - Peds For suspected hypoglycemia without IV access 1 mg IM (25-40 kg); maximum total dose 3 mg. 0.5 mg IM (less than 25 kg); maximum total dose 3 mg
17. GLUCAGON Dose - Adult For suspected beta blocker overdose Must consult. 1 mg IVP every 5 minutes.
17. GLUCAGON Dose - Peds For suspected beta blocker overdose Must consult. 1 mg IVP (25-40 kg); maximum total dose 3 mg. Administer every 5 minutes.; 0.5 mg IVP (less than 25 kg); maximum total dose 3 mg. Administer every 5 minutes.
18. HALOPERIDOL (HALDOL) (EMT-P Only) Indications When needed for restraint of dangerous, violent, agitated, and aggressive patients. Consult required.
18. HALOPERIDOL (HALDOL) (EMT-P Only) Contraindications Acute CNS injury; Children under 6 years of age; CNS depression; Parkinson’s disease.
18. HALOPERIDOL (HALDOL) (EMT-P Only) Adverse Effects Extrapyramidal symptoms (dystonic reaction) - most common side effects - generally not with short-term use.; Low BP and tachycardia are common (20-25%) but usually selflimiting.; Torsades de pointes; VT; Put medicated patients on cardiac monitor.
18. HALOPERIDOL (HALDOL) (EMT-P Only) Precautions Violent patients should be physically restrained while the medication is administered.; May mask subsequent evaluation.
18. HALOPERIDOL (HALDOL) (EMT-P Only) Dose - Patient 15-69 years of age 5 mg IM or IV
18. HALOPERIDOL (HALDOL) (EMT-P Only) Dose - Patient greater than 69 years of age 2.5 mg IM or IV
18. HALOPERIDOL (HALDOL) (EMT-P Only) Dose - Child 6-11 years of age 0.05 mg/kg IM or IV, max of 2.5 mg
18. HALOPERIDOL (HALDOL) (EMT-P Only) Dose - Patient 12-14 years of age 2.5 - 5 mg IM or IV
19. LACTATED RINGER’S Indications Fluid boluses; Hypovolemia; Keep vein open
19. LACTATED RINGER’S Contraindications Fluid overload states
19. LACTATED RINGER’S Adverse Effects Rare in therapeutic doses
19. LACTATED RINGER’S Precautions Patients receiving lactated Ringer’s should be monitored to prevent circulatory overload.; Lactated Ringer’s should be used with caution in patients with congestive heart failure or renal failure.
19. LACTATED RINGER’S Dose - Adult 2,000ml max w/o medical consult. 20 mL/kg to a SBP 100 mm Hg.
19. LACTATED RINGER’S Dose - Peds 2,000ml max w/o medical consult. 20 mL/kg.; Neonates and volume sensitive children are 10 mL/kg. If patient's condition does not improve, administer the second fluid bolus. Medical consult required for third and subsequent fluid boluses.
20. LIDOCAINE (XYLOCAINE) Indications Decrease intracranial pressure with Rapid Sequence Intubation; Nasal tracheal intubation; Prevent recurrence of VF/VT after defibrillation and conversion to supraventricular rhythm; Reduce or eradicate ventricular ectopy; VF; VT
20. LIDOCAINE (XYLOCAINE) Contraindications Accelerated idioventricular rhythm; AV blocks; Hypotension; Idioventricular escape rhythms; Sensitivity to lidocaine; Shock; Sinus bradycardia or arrest or block; Ventricular conduction defects
20. LIDOCAINE (XYLOCAINE) Adverse Effects Early: AMS, anxiety, less hearing, Lower HR, musscle twitching, nausea, numbness, paresthesia, slurred speech, TB or swallowing, visual disturbances; Late: coma, convulsions, hallucinations, hearing loss, longer P-R, Low BP, widening QRS
20. LIDOCAINE (XYLOCAINE) Precautions Reduce the dosage in patients with decreased cardiac output, liver dysfunction, and the elderly (age over 70); Bolus doses should be administered over a 1-minute period, except in VF/VT, when they are administered IVP.
20. LIDOCAINE (XYLOCAINE) Dose - Adult Cardiac Pulse: 1 -1.5 mg/kg IVP/IO bolus followed by 0.5-0.75 mg/kg every 8-10 minutes as needed, up to max of 3 mg/kg.; Without pulse: 1.5 mg/kg IVP/IO bolus initially followed by additional 1.5 mg/kg IVP bolus in 3-5 minutes to max of 3 mg/kg.
20. LIDOCAINE (XYLOCAINE) Dose - Peds Cardiac Pulse: 1 mg/kg initial and 0.5 mg/kgIVP/IO every 8-10 min, as needed, to max of 3 mg/kg. ET: 2-2.5X the above dose.; No pulse: 1 mg/kg initial IVP/IO then by 1 mg/kg IVP boluses in 3-5 min to a max of 3 mg/kg. ET: 2-2.5X the above dose.
20. LIDOCAINE (XYLOCAINE) Dose - IO infusion pain control Adults: (40 kilograms or greater), administer 20-40mg (1-2 mL) of 2% (preservative free) lidocaine IO. Peds: (39 kilograms or less), consult a pediatric base station.
21. MIDAZOLAM (VERSED) Indications Awake patient requiring TCP; Bucking ET Intubated patient (for RSI jurisdictions); Chemical Restraint; ICD Malfunction; Nerve/ organophosphate exposure; NT Intubation; Precardioversion and Sustained and/or recurrent seizures
21. MIDAZOLAM (VERSED) Contraindications Hypotension; Known hypersensitivity to midazolam
21. MIDAZOLAM (VERSED) Adverse Effects Hypotension; Respiratory depression or apnea
21. MIDAZOLAM (VERSED) Precautions The effects of midazolam can be accentuated and significantly potentiated by CNS depressants, such as narcotics or alcohol; Midazolam is five times as potent per milligram as diazepam and there is an increased risk of respiratory depression
21. Midazolam (Versed) Doses (Not Chemical Restraint or Bucking Endotracheal Intubated patients) EMT-P w/o consult for active seizures. 0.1 mg/kg SIVP/IM (Peds IM 0.2mg/kg.) in 2 mg increments; Max 5 mg. Patients > 68yo Max 2.5 mg. All consult for more doses to Max of 10 mg. Patient in status consider IO. Suspected nerve agent give 5mg w/o consult.
21. Midazolam (Versed) Doses - Chemical Restraint Must consult. < 15 yo not indicated. 15-69 yo: 5 mg IM/IV; > 69 years: 2.5 mg
21. Midazolam (Versed) Doses - Adult Bucking Endotracheal Intubated patient Must consult. Adult: 0.05 mg/kg (2-5 mg) slow IVP over 1-2 minutes, while keeping SBP systolic > 80 mmHg. STOP ONCE BUCKING HAS RESOLVED AND VENTILATION IS RELAXED.
21. Midazolam (Versed) Doses - Peds Bucking Endotracheal Intubated patient Must consult. 0.05 mg/kg slow IVP over 1-2 minutes, while keeping SBP > 60 in patients < 28 days old, < 70 in patients < 1 yo, < [70 + (2 x years) = SBP] for patients > 1 yo
22. MORPHINE SULPHATE Indications Acute myocardial infarction; Burns; Isolated injuries requiring pain relief; Sedative for transcutaneous pacing
22. MORPHINE SULPHATE Contraindications COPD with compromised respiratory effort; Head injury; Hypotension; Multiple trauma; Sensitivity to codeine, morphine or percodan
22. MORPHINE SULPHATE Adverse Effects AMS; Constricted pupils (pin-point); Increased cerebral blood flow; Nausea; Respiratory depression/arrest; Slowed HR and vomiting
22. MORPHINE SULPHATE Precautions Administration masks pain, making hospital diagnosis difficult.; Hypotension is a greater possibility in volume-depleted patients.; Narcan reverses all effects.; Should be administered slowly and titrated to effect.; Vital signs should be monitored often.
22. Morphine Doses - Adult (AMI) Must consult. Administer 2-5 mg slow IVP, followed by 1 mg every 5 minutes to a maximum of 10 mg or until pain is relieved.
22. Morphine Doses - Adult (Isolated injuries including burns, frostbites and eye trauma) Administer 2-10 mg slow IVP at 1-2 mg/min increments to 10 mg or until pain is relieved (Paramedic may perform without consult.) Doses above 10 mg require medical consultation.
22. Morphine Doses - Adult (Pacing) Administer 1-2 mg/min IVP. (Paramedic may perform without consult.)
22. Morphine Doses - Peds Must consult. 0.1 mg/kg slow IVP/IO/IM (1-2 mg/min) Maximum dose 5 mg.
23. NALOXONE (NARCAN) Indications To reverse respiratory and central nervous system depression induced by opiates
23. NALOXONE (NARCAN) Contraindications Not clinically significant
23. NALOXONE (NARCAN) Adverse Effects Not clinically significant
23. NALOXONE (NARCAN) Precautions Certain drugs may require much higher doses of naloxone for reversal.; May induce opiate withdrawal in patients who are physically dependent.; Should be given and titrated so respiratory efforts return but not intended to restore full LOC.
23. Naloxone (Narcan) Doses - Adult 0.4-2mg IVP/IO/IM/Intranasal. Consult for > 2 mg IV.
23. Naloxone (Narcan) Doses - Peds 0.1 mg/kg IVP/IO/IM/Intranasal. Max 2mg; may repeat as needed to keep resp activity. Consult for > 2 mg IV.
24. NITROGLYCERIN Indications For treatment of acute pulmonary edema, angina and congestive heart failure
24. NITROGLYCERIN Contraindications Any patient having taken medication for erectile dysfunction (eg, Viagra™, Levitra™, or Cialis™) within the past 48 hours (Override with Medical consult); Asymptomatic hypertension; HR < 60; Known hypersensitivity; Patient < 12yo; SBP < 90
24. NITROGLYCERIN Adverse Effects Decreased level of consciousness; dizziness; headache; hypotension; nausea and vomiting
24. NITROGLYCERIN Precautions May cause hypotension
24. NITROGLYCERIN Doses Not indicated for peds. 0.4 mg SL. May repeat 2 times at 3-5 min intervals if symptoms persist. Max 1.2 mg. w/o Medical consult.
25. NITROGLYCERIN PASTE (Nitro-Bid Ointment) Indications Patients in respiratory distress with moderate or severe symptoms and elevated systolic blood pressure
25. NITROGLYCERIN PASTE (Nitro-Bid Ointment) Contraindications Any patient having taken medication for erectile dysfunction (eg, Viagra™, Levitra™, or Cialis™) within the past 48 hours (Override with Medical consult); Asymptomatic hypertension; HR < 60; Known hypersensitivity; Patient < 12yo; SBP < 90
25. NITROGLYCERIN PASTE (Nitro-Bid Ointment) Adverse Effects Dizziness; dry mouth; headache; hypotension; nausea; orthostasis; skin rash; tachycardia; vomiting and weakness
25. NITROGLYCERIN PASTE (Nitro-Bid Ointment) Precautions Patients taking the drug routinely may develop a tolerance and require an increased dose. Postural syncope sometimes occurs so keep supine when possible and monitor BP constantly.
25. NITROGLYCERIN PASTE (Nitro-Bid Ointment) Dose Generally 1/2 to 1 inch (1.25 to 2.50 centimeters) of the Nitro-Bid Ointment is applied. Measuring applicators are supplied. Peds: Not indicated.
25A. Ondansetron (Zofran) Indications Control of nausea and vomiting
25A. Ondansetron (Zofran) Contraindications Known hypersensitivity to Ondansetron
25A. Ondansetron (Zofran) Adverse Effects Extrapyramidal reactions; Hypotension; QT interval prolongation; Seizures and Tachycardia
25A. Ondansetron (Zofran) Precautions Have emesis basin and suction ready.; Monitor ECG, pulse oxymetry, and blood pressure.
25A. Ondansetron (Zofran) Dose - Adult Adult: 4 mg slow IV over 2-5 minutes or 4 mg IM; May repeat once with medical consultation.
25A. Ondansetron (Zofran) Dose - Peds Must consult.; < 41 kg : 0.1 mg/kg SIV over 2-5 minutes; > 40 kg: 4 mg slow IV over 2-5min OR if no IV: 0.1 mg/kg IM (with max single dose of 4 mg); May repeat once with medical consultation.
26. OXYGEN Indications Acute chest pain; Cardiopulmonary arrest; Dyspnea; Suspected hypoxemia of any etiology; Trauma
26. OXYGEN Contraindications Not clinically significant
26. OXYGEN Adverse Effects High concentrations of oxygen will reduce the respiratory drive in some COPD patients. These patients should be carefully monitored.
26. OXYGEN Precautions Never withhold oxygen from those who need it.; NRB face masks min 12 lpm.; Simple or partial rebreather face masks min 6 lpm.; Use caution with COPD patients.
26. OXYGEN Dose - Adults and Peds Administer 12-15 lpm via NRB mask or 2-6 lpm via nasal cannula, unless otherwise directed.
27. SALINE NEBULIZED Indications Suspected croup
27. SALINE NEBULIZED Contraindications History of airway hyperresponsiveness
27. SALINE NEBULIZED Adverse Effects Patient discomfort; Wheezing or bronchospasm
27. SALINE NEBULIZED Precautions The extent of patient monitoring should be determined on the basis of the stability and severity of the patient’s condition.; Monitor the patient for: Accessory muscle use, Dyspnea, Respiratory pattern, Respiratory rate and Restlessness.
27. SALINE NEBULIZED Dose Adult: Not indicated; Peds: 3 mL of saline by nebulizer. May be repeated with medical direction.
28. SODIUM BICARBONATE Indications Used in cardiac arrest only after more definitive treatments; Hyperkalemia; Tricyclic and phenobarbital overdose
28. SODIUM BICARBONATE Contraindications Pre-existing alkalosis
28. SODIUM BICARBONATE Adverse Effects Acute hypokalemia; Exacerbation of central venous acidosis; Hyperosmolality; May precipitate CHF; Metabolic alkalosis; Shifting the oxyhemoglobin dissociation curve, inhibiting the release of oxygen; Worsened intracellular acidosis due to CO2 formation
28. SODIUM BICARBONATE Precautions Inactivates simultaneously administered catecholamines; Priorities before use: Antiarrhythmics, Defibrillation, Epinephrine, Hyperventilation, Intubation
28. Sodium Bicarbonate Doses - Adult (not hyperkalemia, crush syndrome or renal) Must consult. 1 mEq/kg IVP initially; 0.5 mEq/kg at 10 min intervals.
28. Sodium Bicarbonate Doses - Peds (not hyperkalemia, crush syndrome or renal) Must consult. 1 mEq/kg IVP/IO. For patients < 1 yo, must dilute (1:1) with LR.
28. Sodium Bicarbonate Doses - Adult (hyperkalemia, crush syndrome and renal) Must consult. Consider/ Administer sodium bicarbonate 50 mEq SLOW over 5 minutes and then initiate drip of sodium bicarbonate 100 mEq in 1000 mL LR to run over 30-60 minutes
28. Sodium Bicarbonate Doses - Peds (hyperkalemia, crush syndrome and renal) Must consult. Consider / administer sodium bicarbonate 1 mEg/kg IV over five minutes. For patients less than 1 year of age, must be diluted 1:1 with LR
29. TERBUTALINE SULFATE Indications Bronchial asthma; Reversible airway obstruction associated with bronchitis or emphysema
29. TERBUTALINE SULFATE Contraindications Hypertension; Pediatric under 12 years of age; Tachycardia due to digitalis intoxication
29. TERBUTALINE SULFATE Adverse Effects Dizziness; Nausea; Nervousness; Palpitations; Tachycardia; Tremors and Vomiting
29. TERBUTALINE SULFATE Precautions Administer cautiously to patients with history of cardiac history, diabetes or seizures; Monitor ECG
29. TERBUTALINE SULFATE Dose Adult: 0.25 mg IM; Peds: Not indicated
Created by: David645