ALS Drugs Profile Maryland Medical Protocols for EMS Providers July1, 2010
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| 1. ACETAMINOPHEN Indications | Patients ages 3 years and above judged to be in mild to moderate discomfort (e.g. 2-5 on FACES scale)
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| 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
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| 1. ACETAMINOPHEN Adverse effects | Not clinically significant
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| 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.
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| 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.
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| 2. ACTIVATED CHARCOAL (WITHOUT SORBITOL) Indications | Poisoning by mouth
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| 2. ACTIVATED CHARCOAL (WITHOUT SORBITOL) Contraindications | Altered mental status; Patients who have received an emetic
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| 2. ACTIVATED CHARCOAL (WITHOUT SORBITOL) Adverse Effects | May indirectly induce vomiting and cause nausea.
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| 2. ACTIVATED CHARCOAL (WITHOUT SORBITOL) Precautions | Does not absorb all drugs and toxic substances.
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| 2. ACTIVATED CHARCOAL Dosage | Must consult. Adult: 1 gram/kg; Ped: 1 gram/kg
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| 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.
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| 3. ADENOSINE (ADENOCARD) Contraindications | Known hypersensitivity
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| 3. ADENOSINE (ADENOCARD) Adverse Effects | Chest pressure; dizziness; dyspnea; flushing; headache; hypotension and nausea
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| 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
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| 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
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| 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.
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| 4. ALBUTEROL SULFATE (PROVENTIL, VENTOLIN) Indications | To reverse bronchospasm (wheezing); Hyperkalemia (NEW ’10)
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| 4. ALBUTEROL SULFATE (PROVENTIL, VENTOLIN) Contraindications | Known hypersensitivity
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| 4. ALBUTEROL SULFATE (PROVENTIL, VENTOLIN) Adverse Effects | Headache; nausea; nervousness; palpitations; peripheral vasodilation; PVCs; sore throat; tachycardia; tremors and vomiting
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| 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
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| 4. Albuterol Doses - Adult (Bronchospasm) | 2.5 mg by nebulized aerosol connected to 6-8 lpm of oxygen; may repeat one time.
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| 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.
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| 4. Albuterol Doses - Adult (Hyperkalmia) | Must consult. 20 mg (if available) by nebulized aerosol connected to 6-8 lpm of oxygen.
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| 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.
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| 5. ASPIRIN Indications | Chest pain when acute myocardial infarction is suspected
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| 5. ASPIRIN Contraindications | Known hypersensitivity
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| 5. ASPIRIN Adverse Effects | Heartburn; Nausea; Vomiting; Wheezing
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| 5. ASPIRIN Precautions | GI bleeding and upset
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| 5. ASPIRIN Dosage | Adult: 324 mg or 325 mg chewed; Pediatric: Not Indicated
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| 6. ATROPINE SULFATE Indications | Asystole; idioventricular rhythm; Nerve agents; Organophosphate poisoning and Symptomatic bradycardia
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| 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)
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| 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.
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| 6. ATROPINE SULFATE Precautions | Not clinically significant
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| 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.
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| 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
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| 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.
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| 7. ATROVENT (Ipratropium) Indications | Allergic reactions/ anaphylaxis; Bronchial asthma; Reversible bronchospasms associated with chronic bronchitis and emphysema
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| 7. ATROVENT (Ipratropium) Contraindications | Hypersensitivity to the drug; Hypersensitivity to atropine; Less than one year of age
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| 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
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| 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.
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| 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.
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| 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.
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| 8. CALCIUM CHLORIDE (10% Solution) Indications | Hyperkalemia; Hypocalcemia; To treat adverse effects caused by calcium channel blocker overdose; Hypotension secondary to diltiazem administration
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| 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
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| 8. CALCIUM CHLORIDE (10% Solution) Adverse Effects | Arrhythmia; bradycardia (with rapid injection); cardiac arrest and syncope
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| 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.
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| 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.
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| 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.
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| 9. CAPTOPRIL (Capoten) Indications | Respiratory distress from Congestive Heart Failure or Pulmonary Edema
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| 9. CAPTOPRIL (Capoten) Contraindications | Known hypersensitivity; Known history of angioedema
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| 9. CAPTOPRIL (Capoten) Adverse Effects | Angioedema; cough; hyperkalemia; rash and renal impairment
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| 9. CAPTOPRIL (Capoten) Precautions | Not for use with pregnant females
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| 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.
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| 10. DEXTROSE 50% Indications | Correction of altered mental status due to cardiac arrest, low blood sugar (hypoglycemia) and seizures
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| 10. DEXTROSE 50% Contraindications | Known hyperglycemia
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| 10. DEXTROSE 50% Adverse Effects | May worsen hyperglycemia (high blood sugar)
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| 10. DEXTROSE 50% Precautions | May worsen pre-existing hyperglycemia; Tissue necrosis if extravasation occurs
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| 10. DEXTROSE 50% Dose - Adult | 25 grams in 50 mL IV (1 ampule of 50% solution)
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| 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.
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| 11. DIAZEPAM (VALIUM) (for Chempack or Mark I Optional Protocol) Indications | Sustained and/or recurrent seizures due only to nerve agent or organophosphate exposure
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| 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
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| 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.
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| 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
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| 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.
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| 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.
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| 12. DILTIAZEM (Cardizem) Indications | Symptomatic atrial fibrillation and atrial flutter
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| 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
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| 12. DILTIAZEM (Cardizem) Adverse Effects | Bradycardia; Headache; Hypotension; Nausea; Vomiting;
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| 12. DILTIAZEM (Cardizem) Precautions | Use cautiously in patients with congestive heart failure or renal failure.
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| 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.
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| 13. DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) Indications | Allergic reaction; Anaphylaxis; Dystonic reactions
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| 13. DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) Contraindications | Known allergy to diphenhydramine
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| 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
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| 13. DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) Precautions | Alcohol intoxication; Severe vomiting; Medical consultation required for asthma and nursing mothers
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| 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.
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| 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.
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| 14. DOPAMINE HYDROCHLORIDE (INTROPIN) Indications | Cardiogenic shock; Anaphylactic shock; Septic shock; Hypovolemic shock (after sufficient volume replacement)
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| 14. DOPAMINE HYDROCHLORIDE (INTROPIN) Contraindications | Pheochromocytoma (adrenal tumor which causes excessive release of epinephrine and norepinephrine); Pre-existing tachydysrhythmias; Uncorrected hypovolemia
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| 14. DOPAMINE HYDROCHLORIDE (INTROPIN) Adverse Effects | Anginal pain; Hypertension; Nausea; Tachydysrhythmias; Undesirable degree of vasoconstriction and vomiting
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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)
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| 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.
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| 15. EPINEPHRINE 1:10,000/1:1,000 Dose - Adult Cardiac Arrest | 1 mg (1:10,000) IVP every 3-5 minutes.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 16. FUROSEMIDE (LASIX) Indications | Acute pulmonary edema; CHF; edema related to kidney or liver disease
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| 16. FUROSEMIDE (LASIX) Contraindications | Dehydrated patients; Known allergy to sulfonamides; Known hypersensitivity; Patients exhibiting signs and symptoms of electrolyte imbalance (primarily hypokalemia); Pregnancy
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| 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
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| 16. FUROSEMIDE (LASIX) Precautions | May cause or aggravate the following conditions: Dehydration, Hyperosmolality, Hypokalemia, Hypotension, Hypovolemia
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| 16. FUROSEMIDE (LASIX) Dose - Adult | 0.5-1mg/kg slow IVP.
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| 16. FUROSEMIDE (LASIX) Dose - Peds | 1 mg/kg slow IVP/IO; maximum dose of 50mg.
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| 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
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| 17. GLUCAGON Contraindications | Known hypersensitivity
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| 17. GLUCAGON Adverse Effects | Nausea and vomiting
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| 17. GLUCAGON Precautions | Glucagon only works if liver has significant glycogen stores.
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| 17. GLUCAGON Dose - Adult For suspected hypoglycemia without IV access | 1 mg IM.
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| 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
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| 17. GLUCAGON Dose - Adult For suspected beta blocker overdose | Must consult. 1 mg IVP every 5 minutes.
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| 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.
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| 18. HALOPERIDOL (HALDOL) (EMT-P Only) Indications | When needed for restraint of dangerous, violent, agitated, and aggressive patients. Consult required.
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| 18. HALOPERIDOL (HALDOL) (EMT-P Only) Contraindications | Acute CNS injury; Children under 6 years of age; CNS depression; Parkinson’s disease.
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| 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.
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| 18. HALOPERIDOL (HALDOL) (EMT-P Only) Precautions | Violent patients should be physically restrained while the medication is administered.; May mask subsequent evaluation.
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| 18. HALOPERIDOL (HALDOL) (EMT-P Only) Dose - Patient 15-69 years of age | 5 mg IM or IV
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| 18. HALOPERIDOL (HALDOL) (EMT-P Only) Dose - Patient greater than 69 years of age | 2.5 mg IM or IV
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| 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
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| 18. HALOPERIDOL (HALDOL) (EMT-P Only) Dose - Patient 12-14 years of age | 2.5 - 5 mg IM or IV
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| 19. LACTATED RINGER’S Indications | Fluid boluses; Hypovolemia; Keep vein open
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| 19. LACTATED RINGER’S Contraindications | Fluid overload states
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| 19. LACTATED RINGER’S Adverse Effects | Rare in therapeutic doses
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| 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.
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| 19. LACTATED RINGER’S Dose - Adult | 2,000ml max w/o medical consult. 20 mL/kg to a SBP 100 mm Hg.
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| 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.
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| 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
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| 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
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| 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
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| 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.
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| 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.
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| 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.
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| 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.
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| 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
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| 21. MIDAZOLAM (VERSED) Contraindications | Hypotension; Known hypersensitivity to midazolam
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| 21. MIDAZOLAM (VERSED) Adverse Effects | Hypotension; Respiratory depression or apnea
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| 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
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| 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.
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| 21. Midazolam (Versed) Doses - Chemical Restraint | Must consult. < 15 yo not indicated. 15-69 yo: 5 mg IM/IV; > 69 years: 2.5 mg
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| 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.
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| 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
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| 22. MORPHINE SULPHATE Indications | Acute myocardial infarction; Burns; Isolated injuries requiring pain relief; Sedative for transcutaneous pacing
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| 22. MORPHINE SULPHATE Contraindications | COPD with compromised respiratory effort; Head injury; Hypotension; Multiple trauma; Sensitivity to codeine, morphine or percodan
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| 22. MORPHINE SULPHATE Adverse Effects | AMS; Constricted pupils (pin-point); Increased cerebral blood flow; Nausea; Respiratory depression/arrest; Slowed HR and vomiting
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| 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.
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| 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.
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| 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.
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| 22. Morphine Doses - Adult (Pacing) | Administer 1-2 mg/min IVP. (Paramedic may perform without consult.)
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| 22. Morphine Doses - Peds | Must consult. 0.1 mg/kg slow IVP/IO/IM (1-2 mg/min) Maximum dose 5 mg.
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| 23. NALOXONE (NARCAN) Indications | To reverse respiratory and central nervous system depression induced by opiates
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| 23. NALOXONE (NARCAN) Contraindications | Not clinically significant
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| 23. NALOXONE (NARCAN) Adverse Effects | Not clinically significant
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| 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.
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| 23. Naloxone (Narcan) Doses - Adult | 0.4-2mg IVP/IO/IM/Intranasal. Consult for > 2 mg IV.
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| 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.
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| 24. NITROGLYCERIN Indications | For treatment of acute pulmonary edema, angina and congestive heart failure
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| 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
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| 24. NITROGLYCERIN Adverse Effects | Decreased level of consciousness; dizziness; headache; hypotension; nausea and vomiting
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| 24. NITROGLYCERIN Precautions | May cause hypotension
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| 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.
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| 25. NITROGLYCERIN PASTE (Nitro-Bid Ointment) Indications | Patients in respiratory distress with moderate or severe symptoms and elevated systolic blood pressure
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| 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
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| 25. NITROGLYCERIN PASTE (Nitro-Bid Ointment) Adverse Effects | Dizziness; dry mouth; headache; hypotension; nausea; orthostasis; skin rash; tachycardia; vomiting and weakness
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| 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.
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| 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.
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| 25A. Ondansetron (Zofran) Indications | Control of nausea and vomiting
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| 25A. Ondansetron (Zofran) Contraindications | Known hypersensitivity to Ondansetron
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| 25A. Ondansetron (Zofran) Adverse Effects | Extrapyramidal reactions; Hypotension; QT interval prolongation; Seizures and Tachycardia
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| 25A. Ondansetron (Zofran) Precautions | Have emesis basin and suction ready.; Monitor ECG, pulse oxymetry, and blood pressure.
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| 25A. Ondansetron (Zofran) Dose - Adult | Adult: 4 mg slow IV over 2-5 minutes or 4 mg IM; May repeat once with medical consultation.
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| 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.
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| 26. OXYGEN Indications | Acute chest pain; Cardiopulmonary arrest; Dyspnea; Suspected hypoxemia of any etiology; Trauma
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| 26. OXYGEN Contraindications | Not clinically significant
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| 26. OXYGEN Adverse Effects | High concentrations of oxygen will reduce the respiratory drive in some COPD patients. These patients should be carefully monitored.
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| 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.
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| 26. OXYGEN Dose - Adults and Peds | Administer 12-15 lpm via NRB mask or 2-6 lpm via nasal cannula, unless otherwise directed.
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| 27. SALINE NEBULIZED Indications | Suspected croup
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| 27. SALINE NEBULIZED Contraindications | History of airway hyperresponsiveness
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| 27. SALINE NEBULIZED Adverse Effects | Patient discomfort; Wheezing or bronchospasm
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| 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.
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| 27. SALINE NEBULIZED Dose | Adult: Not indicated; Peds: 3 mL of saline by nebulizer. May be repeated with medical direction.
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| 28. SODIUM BICARBONATE Indications | Used in cardiac arrest only after more definitive treatments; Hyperkalemia; Tricyclic and phenobarbital overdose
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| 28. SODIUM BICARBONATE Contraindications | Pre-existing alkalosis
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| 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
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| 28. SODIUM BICARBONATE Precautions | Inactivates simultaneously administered catecholamines; Priorities before use: Antiarrhythmics, Defibrillation, Epinephrine, Hyperventilation, Intubation
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| 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.
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| 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.
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| 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
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| 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
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| 29. TERBUTALINE SULFATE Indications | Bronchial asthma; Reversible airway obstruction associated with bronchitis or emphysema
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| 29. TERBUTALINE SULFATE Contraindications | Hypertension; Pediatric under 12 years of age; Tachycardia due to digitalis intoxication
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| 29. TERBUTALINE SULFATE Adverse Effects | Dizziness; Nausea; Nervousness; Palpitations; Tachycardia; Tremors and Vomiting
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| 29. TERBUTALINE SULFATE Precautions | Administer cautiously to patients with history of cardiac history, diabetes or seizures; Monitor ECG
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| 29. TERBUTALINE SULFATE Dose | Adult: 0.25 mg IM; Peds: Not indicated
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|
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