EMT-I Drug Cards Flash Cards

 
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Oxygen adjusted dose CLASS - oxygen

ACTION
Increase O2 saturation

INDICATIONS
Any patient other than COPD

CONTRAINDICATIONS
COPD – decrease hypoxic drive

PRECAUTIONS
May decrease hypoxic drive

SIDE EFFECTS
May decrease hypoxic drive

ROUTE
Nasal cannula
Non-rebreather
King airway
Combitube
Endotracheal tube

DOSAGE
Nasal cannula – 2-4 lpm (28-36% O2)
Non-rebreather – 12-15 lpm (90-100% O2)

PEDIATRIC DOSAGE - same
Use pediatric mask
Blowby
1 TJEMSGROUPA Wed, 27 Jan 2010 21:52:11 GMT view revision history
100% O2 CLASS - Gas

ACTION - Increase O2 Saturation, cellular metabolism

INDICATIONS
Difficulty breathing, COPD, Hypoxia

CONTRAINDICATIONS
pulmonary fibrosis, lung damage resulting from Bleomycin treatment

PRECAUTIONS
Depression of Hypoxic Drive, caution in COPD patients, humidify in low flow rates

SIDE EFFECTS
Vasoconstriction, drying of mucus secretions

DOSAGE
Critical patients 100%
COPD 35%

ROUTE
inhaled

PEDIATRIC DOSAGE
Same as adult
3 TJEMSGROUPA Thu, 28 Jan 2010 03:24:53 GMT view revision history
NTG pt assisted CLASS: Antianginal

ACTION: Smooth-muscle relaxant, decreases cardiac work, dilates coronary arteries, dilates systemic arteries.

INDICATIONS: Chest Pain of suspected cardiac origin; pulmonary edema

CONTRAINDICATIONS: BP < 100MMHg, Hypotension, ICH, Prior use of sexual enhancement drugs

PRECAUTIONS: Constantly monitor blood pressure, syncope, drug must be protected from light, expires quickly once bottle is opened.

SIDE EFFECTS: Dizziness, hypotension, and headache

DOSE: 0.4 mg tablet

ROUTE: 1 tablet SL

PEDS DOSE: N/A

1 TJEMSGROUPA Thu, 28 Jan 2010 04:12:51 GMT view revision history
Oral glucose CLASS Monosaccharide
DOSE 15-45 G
ROUTE PO
ACTION After absorption from GI tract, glucose is distributed in the tissues and
provides a prompt increase in circulating blood sugar.
CONTRAINDICATIONS None
SIDE EFFECTS Nausea
PEDS DOSE 5-45G
2 TJEMSGROUPA Sat, 16 Jan 2010 20:35:09 GMT view revision history
Epinepherine pt assisted epi pen CLASS: Sympathomimetic

ACTION: Bronchodilation, Vasoconstriction, increases BP and Heart Rate

INIDICATIONS: Anaphylactic Shock

CONTRAINDICATIONS: None in Anaphylaxis. Otherwise do not give if >50 years with cardiac history, pulse >140 in adult or >180 in child, if hypertensive

PRECAUTIONS: Should be protected from light. Blood pressure, pulse, and EKG must be constantly monitored

SIDE EFFECTS: Palpitations, Hypotension, and dysrhythmias

DOSE: .3 mg

ROUTE: Sub-Q

PEDS DOSE: .15 mg

1 TJEMSGROUPA Thu, 28 Jan 2010 04:25:19 GMT view revision history
Beta agonist assisted MDI CLASS – beta agonist
Process:
1) Activate the beta-2 receptor on the muscles in the airway
2) Receptors relax the muscles around airway

ACTION
Bronchodilator

INDICATIONS
Bronchospasm related to asthma
Chronic bronchitis
Emphysema
Albuterol (Proventil) - allergy / COPD

CONTRAINDICATIONS
Tachydysrythmias

PRECAUTIONS
Duration – about 4 hours

SIDE EFFECTS
Tachycardia
Albuterol (Proventil) - anxiety, N / V
Atrovent (Ipratropium) - myocardial ischemia

ROUTE - nebulizer

DOSAGE
Albuterol (Proventil) – 2.5 mg / 3 mL
Atrovent (Ipratropium) – 0.5 mg / 3 mL

PEDIATRIC DOSAGE - same
1 TJEMSGROUPA Wed, 27 Jan 2010 21:40:34 GMT view revision history
Maintain IV fluid additives (potassium, bicarb, multivitamin) ??? Not completely sure what is being asked for here 1 TJEMSGROUPA Thu, 28 Jan 2010 03:33:36 GMT view revision history
Ipatropium (Atrovent) CLASS: Anticholinergic.
ACTIONS: Causes bronchodilation, dries respiratory tract secretions.
INDICATIONS: Bronchial asthma, reversible bronchospasm associated with chronic bronchitis and emphysema.
CONTRAINDICATIONS: Patients with history of hypersensitivity to the drug, should not be used as primary agent in acute treatment of bronchospasm.
PRECAUTIONS: Blood pressure, pulse, and EKG must be constantly monitored.
SIDE EFFECTS: Palpitations, dizziness, anxiety, tremors, headache, nervousness, dry mouth.
DOSAGE: Small-volume nebulizer: 500 µg should be placed in small volume nebulizer (typically administered with a ß agonist).
ROUTES: Inhalation only.
PEDIATRIC DOSAGE: Safety in children has not been established.
2 TJEMSGROUPA Wed, 27 Jan 2010 15:20:51 GMT view revision history
Albuterol CLASS Beta2 Agonist
DOSE MDI—1-2 inhalations
• Nebulizer—2.5 mg via nebulizer

ROUTE inhalation MDI NEB
ACTION B2 agonist Bhroncodilation Acts selectively on Beta2 receptor sites in the lungs, relaxing bronchial
smooth muscle, decreasing airway resistance, & relief of bronchospasm.
Although Albuterol is beta selective, it will cause some CNS stimulation,
cardiac stimulation, increased diuresis, & gastric acid secretion.
CONTRAINDICATIONS Known hypersensitivity
• Tachydysrhythmias

SIDE EFFECTS• Palpitations, Tachycardia
• Anxiety, Nervousness
• Dizziness
• HA
• Tremor
• N/V
Less frequent, but more concerning:
• HTN
• Dysrhythmias
• Chest pain

PEDS DOSE
2 TJEMSGROUPA Sat, 16 Jan 2010 21:18:11 GMT view revision history
Nitrous oxide CLASS: Anesthetic

ACTION: : The key effect of nitrous oxide is its noncompetitive antagonism of NMDA receptor complexes

INDICATIONS: Acute pain due to any one of the following conditions:
• orthopedic trauma (e.g. soft tissue injury, suspected fracture)
• renal colic
• burns
• abdominal pain (not due to suspected bowel obstruction).

CONTRAINDICATIONS:
1. Head injury with altered level of consciousness
2. Recent ingestion of alcohol or illicit drugs
3. Major facial injuries or trauma
4. Thoracic trauma
5. Known or suspected bowel obstruction
6. Known or suspected cardiac ischemic chest pain
7. Patient developing cyanosis or respiratory distress with use of nitrous oxide –
oxygen
8. Inability to comply with instructions regarding use of nitrous oxide – oxygen
9. Pulse oximeter reading indicating oxygen saturation is less than 90% prior to nitrous oxide-oxygen mixture use

PRECAUTIONS: Use in well ventilated areas only.

SIDE EFFECTS: Nausea/Vomiting

DOSE: 50% Premixed, Self Administered Only

ROUTE: Inhalation

PEDS DOSE: N/A
1 TJEMSGROUPA Thu, 28 Jan 2010 05:11:53 GMT view revision history
Vecuronium CLASS - nondepolarizing neuromuscular blocking agent

ACTION
Nondepolarizing neuromuscular blocking agent
Competes for cholinergic receptors
Paralytic

INDICATIONS
Patient needs advanced airway

CONTRAINDICATIONS
Known inability to intubate patient
Renal failure
Severely obese patients
Neuromuscular disease

PRECAUTIONS
Drug interactions
Used with succinylcholine - enhances the neuromuscular blocking effect / increases duration of action
Recovery - 25% of control – 25-40 minutes,
95% of control – 45-65 minutes
Effects may be easily reversed by anticholinesterase agents in conjunction with anticholinesterase agent
Half life – 4 minutes
Pts with slower circulation time (C/V disease)
Old age
Pregnancy – Category C

SIDE EFFECTS
Extended time of drug’s effect
Skeletal muscle weakness
Decreased respiratory reserve
Low tidal volume
Apnea

ROUTE - IV

DOSAGE
0.08 – 0.1 mg / kg
After 1 minute – depresses twitch
2.5-3 minutes – good to excellent intubation conditions
3-5 minutes – max neuromuscular blockade
If used with succinylcholine (given 1st):
0.04 – 0.06 mg / kg
DO NOT use Vecuronium until pt starts recovering from succinylcholine induced blockage
Repeat doses - 0.01-0.015 mg / kg
Usually needed within 25-40 minutes

PEDIATRIC DOSAGE - same
1 TJEMSGROUPA Wed, 27 Jan 2010 21:05:08 GMT view revision history
Succinylcholine CLASS - Neuromuscular blocking agent (depolarizing)

ACTION - General anesthesia to facilitate intubation.

INDICATIONS
general anesthesia to facilitate intubation

CONTRAINDICATIONS
Hypersensitivity to drug, know history of malignant hyperthermia, skeletal muscle myopathies

PRECAUTIONS
Respiratory depression, must be ready to intubate

SIDE EFFECTS
Prolonged paralysis, hypotension, bradycardia

DOSAGE
1.5 mg/kg

ROUTE
IV

PEDIATRIC DOSAGE
2mg/kg in infants and small children
1mg/kg in adolescents
3 TJEMSGROUPA Thu, 28 Jan 2010 03:27:37 GMT view revision history
Etomidate CLASS: Anesthetic

ACTION: : a short-acting hypnotic, which appears to have gamma-aminobutyric acid (GABA)–like effects.

INDICATIONS: General Anesthesia, Conscious Sedation of Patients prior to short-term invasive procedures (intubation, cardioversion)

CONTRAINDICATIONS:
1. Known Hypersensitivity to Etomidate
2. Known Adrenocortical steroid secretion suppression (eg. Addison’s disease)
3. Cardiac or Trauma arrest

PRECAUTIONS: May induce seizures in Pts with known seizure disorder unless pt is pretreated with benzodiazapenes.

SIDE EFFECTS: Nausea/Vomiting, hypo/hypertension, laryngospasm, brady/tachycardia, adrenocortical steroid suppression

DOSE: 0.3 mg/kg slow IV push over 10 - 20 seconds

ROUTE: IV

PEDS DOSE: same
1 TJEMSGROUPA Thu, 28 Jan 2010 06:40:40 GMT view revision history
Ondansetron, Zofran CLASS: Anti emetic
DOSE: [4 mg IV/IM ] : 8mg PO
ROUTE: IV, IM, PO, SL ,
ACTION: selectively antagonizes serotonin 5-HT3 receptors
CONTRAINDICATIONS: hypersens. to drug/class
caution if hepatic impairment
caution if abdominal surgery
SIDE EFFECTS: * hypersensitivity rxn, severe
* anaphylaxis
* bronchospasm
* extrapyramidal symptoms
* oculogyric crisis
* blindness, transient
* QT prolongation

PEDS DOSE: [1 mo-12 yo and <40 kg]
Dose: 0.1 mg/kg IV x1; Max: 4 mg
[>12 yo or >40 kg]
Dose: 4 mg IV x1
4 TJEMSGROUPA Sun, 17 Jan 2010 20:27:22 GMT view revision history
Methylprednisolone, Solumedrol CLASS: Steroid

ACTION: : Anti-inflammatory, suppresses immune response (especially in allergic reactions).

INIDICATIONS: Anaphylaxis, severe allergic reaction, asthma, COPD.

CONTRAINDICATIONS: None in Anaphylaxis, premature infants, pregnancy

PRECAUTIONS: Dosage should not exceed 300 mg/hr. Monitor for CNS toxicity. Dosage should be reduced by 50% in patients older than 70 years of age or who have liver disease in cardiac arrest, use only bolus therapy.

SIDE EFFECTS: CHF, Hypertension, Nausea/Vomiting

DOSE: 125 mg.

ROUTE: IV over 1 minute

PEDS DOSE: 1 mg/kg
1 TJEMSGROUPA Thu, 28 Jan 2010 04:46:33 GMT view revision history
Phenergan CLASS - anticholinergic

ACTION
Anti-emetic
Antihistamine - H1 receptor blocking agent
Sedation

INDICATIONS
Nausea / Vomiting (may be used postoperatively)
Seasonal allergy rhinitis
Allergic conjunctivitis
Anaphylactic reactions
Sedation – preoperative, postoperative, obstetric

CONTRAINDICATIONS
Lower respiratory tract symptoms (includes acute asthma attack)
Pediatric patient < 2 years
Potential for fatal respiratory depression
If must be given give smallest dose possible
Comatose states

PRECAUTIONS
May lead to potentially fatal respiratory depression
Use with caution in patients with history of seizures (lowers seizure threshold)
Bone marrow depression
Drug interactions:
• May increase / prolong / intensify sedative action of other CNS depressants (alcohol / narcotics)
• Epinephrine – reverse’s epi’s vasopressor effect
• DO NOT USE epi to treat hypotension due to phenergan
• Anticholinergics – use with caution
• MAO inhibitors
May lead to a false positive or a false negative in pregnancy tests
Pregnancy – Category C (not known if in breast milk)

SIDE EFFECTS
Hypotension
Wheezing
Drowsiness
Nasal stuffiness
Blurred vision
Neuroleptic malignant syndrome
• Symptoms: hyperpyrexia, muscle rigidity, AMS, evidence of autonomic instability, irregular pulse / BP , tachycardia / cardiac dysrhythmias

ROUTE - IM / IV

DOSAGE
IM - 25 mg
IV (must be diluted) - 12.5 – 25 mg

PEDIATRIC DOSAGE - 0.5 mg / kg **IM** (10 kg child = 0.2 mL)
1 TJEMSGROUPA Wed, 27 Jan 2010 20:13:40 GMT view revision history
Valium CLASS - Tranquilizer (Benzodiazepine).

ACTION - Anticonvulsant, skeletal muscle relaxant, sedative

INDICATIONS
Prolonged seizure, severe agitation

CONTRAINDICATIONS
hypersensitivity

PRECAUTIONS
Local venous irritation, Lower dose for PT with chronic respiratory insufficiency

SIDE EFFECTS
Hypotension, stupor, respiratory arrest

DOSAGE
2.5 - 5 mg

ROUTE
Slow IV push

PEDIATRIC DOSAGE
0.1 mg/kg
3 TJEMSGROUPA Thu, 28 Jan 2010 03:29:51 GMT view revision history
Naloxone, Narcan CLASS: opioid antagonist
DOSE : [0.4-2 mg IV ]
ROUTE : SC; IM; IV ET tube
ACTION :antagonizes various opioid receptors
CONTRAINDICATIONS: hypersens. to drug/class

SIDE EFFECTS : * ventricular fibrillation
* cardiac arrest
* seizures

PEDS DOSE: Narcotic overdose: 0.01 mg/Kg
5 TJEMSGROUPA Sun, 17 Jan 2010 20:27:44 GMT view revision history
Glucagon CLASS : hyperglycemic
DOSE : [0.5-1 mg IV/IM/SC ]
ROUTE : SC; IM; IV
ACTION: converts hepatic glycogen to glucose
CONTRAINDICATIONS :hypersens. to drug/class
SIDE EFFECTS: * hyperglycemia, severe
* allergic rxns

PEDS DOSE: [neonates]
Dose: 0.3 mg/kg IV/IM/SC
[children]
Dose: 0.025-0.1 mg/kg
3 TJEMSGROUPA Sun, 17 Jan 2010 01:30:45 GMT view revision history
Epi 1:1000 CLASS: Sympathomimetic

ACTION: Bronchodilation, Vasoconstriction, increases BP and Heart Rate

INIDICATIONS: Anaphylactic Shock

CONTRAINDICATIONS: None in Anaphylaxis. Otherwise do not give if >50 years with cardiac history, pulse >140 in adult or >180 in child, if hypertensive

PRECAUTIONS: Should be protected from light. Blood pressure, pulse, and EKG must be constantly monitored

SIDE EFFECTS: Palpitations, Hypotension, and dysrhythmias

DOSE: .0.3 MG , may repeat every 10-20 min

ROUTE: Sub-Q

PEDS DOSE: 0.01 mg/kg SQ
1 TJEMSGROUPA Thu, 28 Jan 2010 04:41:41 GMT view revision history
Diphenhydramine CLASS
Narcotic antitussive
Anticholinergic
Nonselective ethanolamine

ACTION
Blocks histamine effects
Competitively antagonizes histamine at H1 receptor sites
Antiemietic
Sedative
Reverses side effects of phenothiazines

INDICATIONS
Anaphylaxis
Allergic reactions
Dystonic reactions
Treatment of motion sickness (injection only)
Sleep aid
Parkinsonism management

CONTRAINDICATIONS
Hypersensitivity to antihistamines
Asthma
MAO inhibitor therapy
History of sleep apnea
Nursing mothers
Newborns / premature infants
Liver diseases
Sulfite allergy (sulfite preservatives are used)

PRECAUTIONS
Half life – 1-4 hours
Duration – 6-8 hours

SIDE EFFECTS
Hypotension (orthostatic)
Palpitations
Tachycardia
Headache
Sedation
Nausea / vomiting
Hemolytic anemia
Increased appetite / weight gain
Thickening of bronchial secretions
Chest tightness
Wheezing

ROUTE - IV / deep IM

DOSAGE
Concentration – 50 mg / mL
25-50 mg IV (administer slowly)

PEDIATRIC DOSAGE - MAX DOSE 50 mg
1 mg / kg slow IV push (over 2 minutes) (10 kg child = 0.2 mL)
1 TJEMSGROUPA Wed, 27 Jan 2010 20:09:43 GMT view revision history
Dextrose IV CLASS - Carbohydrate

ACTION - Elevates blood glucose level

INDICATIONS
Hypoglycemia

CONTRAINDICATIONS
None in emergency setting

PRECAUTIONS
Blood sample should be drawn

SIDE EFFECTS
local venous irritation

DOSAGE
25grams (50ml)

ROUTE
IV

PEDIATRIC DOSAGE
0.5 g/kg diluted to 25%
2 TJEMSGROUPA Thu, 28 Jan 2010 03:19:01 GMT view revision history
Dopamine CLASS: Sympathetic agonist
ACTIONS: Stimulates alpha and beta-1 receptors. Increases cardiac contractility, causes peripheral vasoconstriction. Positive chronotropic and inotropic effects
INDICATIONS: Hemodynamically significant hypotension (systolic BP of 70-100 mmhg) not resulting from hypovolemia, cardiogenic shock.
CONTRAINDICATIONS: Hypovolemic shock where complete fluid resuscitation has not occurred.
PRECAUTIONS: Should not be administered in the presence of severe tachyarrhythmias. Should not be administered in the presence of ventricular fibrillation, ventricular irritability. Beneficial effects lost when dose exceeds 20 µg/kg/min.
SIDE EFFECTS: Ventricular tachyarrhythmias, hypertension, palpitations.
DOSAGE:
Low-dose: 1-5 mcg/kg/minute, increased renal blood flow and urine output.
Intermediate-dose: 5-10 mcg/kg/minute, increased renal blood flow, heart rate, cardiac contractility, and cardiac output.
High-dose: 10-20 mcg/kg/minute, alpha-adrenergic effects begin to predominate, vasoconstriction, increased blood pressure
ROUTES: IV drip only.
PEDIATRIC DOSAGE: 2-20 µg/kg/minute.
1 TJEMSGROUPA Wed, 27 Jan 2010 15:18:39 GMT view revision history
Morphine CLASS : Opoid analgesic
DOSE :*angina, unstable [2-5 mg IV]
*MI, acute
[2-5 mg IV ]
ROUTE : PO, IV, SQ, IM
ACTION: binds to various opioid receptors, producing analgesia and sedation
CONTRAINDICATIONS:# hypersens. to drug/class/compon.
# respiratory depression
# asthma, acute or severe
# hypercarbia
# paralytic ileus
# <24h postop (opioid-naive, ER form)
# labor and delivery
# avoid abrupt withdrawal
SIDE EFFECTS : * respiratory depression
* apnea
* hypotension, severe
* cardiac arrest
* shock
* bradycardia
* paralytic ileus
* toxic megacolon
* seizures
* ICP incr.
* dependency, abuse
* withdrawal if abrupt D/C
* neonatal withdrawal (long-term maternal use)
* anaphylaxis

PEDS DOSE:
0.1-0.2 mg/Kg Max of 15MG
neonatal
[0.08-0.2 mg IV]
2 TJEMSGROUPA Sun, 17 Jan 2010 01:36:59 GMT view revision history
Lidocaine CLASS: Antiarrhythmic

ACTION: : Suppresses ventricular ectopic activity, increases ventricular fibrillation threshold, reduces velocity of electrical impulse through conductive system

INIDICATIONS: Malignant PVCs, ventricular tachycardia, ventricular fibrillation, prophylaxis of arrhythmias associated with acute myocardial infarction and thrombolytic therapy, premedication prior to rapid sequence induction.

CONTRAINDICATIONS: High-degree heart blocks, PVCs in conjunction with bradycardia.

PRECAUTIONS: Dosage should not exceed 300 mg/hr. Monitor for CNS toxicity. Dosage should be reduced by 50% in patients older than 70 years of age or who have liver disease in cardiac arrest, use only bolus therapy.

SIDE EFFECTS: Anxiety, drowsiness, dizziness, and confusion, nausea and vomiting, convulsions, widening of QRS

DOSE: Bolus: Initial bolus of 1.5 mg/kg; additional boluses of 0.5 - 0.75 mg/kg can be repeated at 8-10-minute intervals until the arrhythmia has been suppressed or until 3 mg/kg of the drug has been administered; reduce dosage by 50% in patients older than 70 years of age.
Drip: after the arrhythmia has been suppressed a 2-4 mg/minute infusion may be started to maintain adequate blood levels.

ROUTE: IV bolus, IV infusion

PEDS DOSE: 1 mg/kg
1 TJEMSGROUPA Thu, 28 Jan 2010 04:37:50 GMT view revision history
Furosemide CLASS - diuretic

ACTION
Blocks absorption of Na, Cl and H20 from filtered fluid in kidneys => increased urine
Vasodilation

INDICATIONS
CHF
Pulmonary edema
High blood pressure
Decreases blood calcium levels

CONTRAINDICATIONS
Hypotension
Hypokalemia
Pregnancy

PRECAUTIONS
Drug interactions
Aminoglycoside antibiotics – hearing damage
Aspirin – competes for elimination in the kidneys (can lead to aspirin toxicity)
Lithium – increases internal levels
Sucralfate – reduces effectiveness, binds Lasix to intestines, prevents absorption
Pregnancy – not known (secreted in breast milk)

SIDE EFFECTS
Dehydration - depletion of Na, Cl, H20 and other minerals
Decreases potassium
Hypotension
Jaundice
Sensitivity to light
Pancreatitis
Nausea
Abdominal pain

ROUTE - IV

DOSAGE
Concentration – 40 mg / 4 mL
Administration - 40 mg over 2-3 minutes
** Consider higher dose for patients on diuretics **
Onset – 5 minutes
Duration – 1-2 hours

PEDIATRIC DOSAGE
1-2 mg / kg (10 kg child = 1-2 mL)
1 TJEMSGROUPA Wed, 27 Jan 2010 20:05:45 GMT view revision history
NTG (SL and TD) CLASS - Antianginal

ACTION - Vasodilation, Smooth-muscle relaxant

INDICATIONS
Chest pain of suspected cardiac origin, pulmonary edema

CONTRAINDICATION
Hypotension (< 100), trauma, ICH, ED drugs in the last 24 hours

PRECAUTIONS
Hypotension, bradycardia

SIDE EFFECTS
Headache, hypotension, dizziness

DOSAGE
1 tablet (0.4mg) of 1inch (spread on applicator)

ROUTE
SL (under the tongue) or topically for paste

PEDIATRIC DOSAGE
none
3 TJEMSGROUPA Thu, 28 Jan 2010 03:31:15 GMT view revision history
Aspirin CLASS: Platelet inhibitor/anti-inflammatory.
ACTIONS: Blocks platelet aggregation.
INDICATIONS: New-onset chest pain suggestive of MI signs and symptoms suggestive or recent CVA.
CONTRAINDICATIONS: Patients with history of hypersensitivity to the drug.
PRECAUTIONS: GI bleeding and upset.
SIDE EFFECTS: Heartburn, nausea and vomiting
DOSAGE: 150-325 mg PO or chewed.
ROUTES: PO.
PEDIATRIC DOSAGE: not recommended.
1 TJEMSGROUPA Wed, 27 Jan 2010 15:13:27 GMT view revision history
Sodium bicarbonate CLASS: Alkalinizer
DOSE:[2-5 mEq/kg IV] 1 mEq = approx. 84 mg bicarbonate
ROUTE:IV, PO
ACTION:increases serum bicarbonate, raising pH; neutralizes gastric acidity
CONTRAINDICATIONS: # hypersens. to drug/class/compon.
# hypochoridemia
# hypocalcemia
# alkalosis

SIDE EFFECTS: * metabolic alkalosis
* cardiac arrest
* CHF exacerbation

PEDS DOSE: dose (mEq) = 0.3 x wt (kg) x base deficit (mEq/L); admin. 50% dose initially, then remaining dose over next 24h; subsequent doses based on response and acid-base status; 1 mEq = approx. 84 mg bicarbonate
3 TJEMSGROUPA Sun, 17 Jan 2010 01:41:06 GMT view revision history
Magnesium sulfate CLASS: Anticonvulsant/Antiarrhythmic

ACTION: : CNS depressant, anticonvulsant, antiarrhyhmic

INIDICATIONS: Refractory VT/VF; Eclampsia

CONTRAINDICATIONS: None

PRECAUTIONS: Caution should be used in patients receiving digitalis. Hypotension. Calcium Chloride should be readily available as an antidote if respiratory depression ensues. Use with caution in patients in renal failure.

SIDE EFFECTS: Flushing, Nausea, Respiratory depression, drowsiness

DOSE: Refractory VF – 1-2 grams of 50% solution diluted in 10ML NS, slow IV push
Eclampsia – 10% solution 2-4 grams IV push at no more than 1 gram per minute, until seizure stops or max dose of 4 grams is given.

ROUTE: IV

PEDS DOSE: N/A
1 TJEMSGROUPA Thu, 28 Jan 2010 04:33:25 GMT view revision history
Calcium chloride CLASS - Hypertonic

ACTION
Integrity of nervous / muscular system
Normal cardiac function
One of the factors in blood coagulation
Dissociates in H20 => Ca++ ions / Cl- ions

INDICATIONS
Hypocalcemia
Calcium channel blocker toxicity
Hypermagnesemia
Hyperkalemia

CONTRAINDICATIONS
During resuscitation - ventricular fibrillation, asystole, electromechanical dissociation
Digitalis toxicity
Hypercalcemia

PRECAUTIONS
Irritating to veins (administer slowly through a small needle in large vein)
DO NOT give IM / SC
Product contains aluminum
May be toxic => impaired kidney function
Pregnancy side effects – not known
Geriatrics - use with caution due to presence of decreased hepatic / renal / cardiac function

SIDE EFFECTS
Peripheral vasodilation
Hypotension
Dysrhythmias
CNS changes
Burning sensation
Overdose - decreased BP, cardiac syncope

ROUTE - IV

DOSAGE - administer SLOWLY
Concentration - 1 gm / 10 mL
IV - 20 mg / kg

PEDIATRIC DOSAGE (IV or IO)- 10 mg / kg (10 kg child = 1 mL)
1 TJEMSGROUPA Wed, 27 Jan 2010 19:58:55 GMT view revision history
Atropine CLASS - Belladonna alkaloid, Cycloplegic mydriatic

ACTION - Antiarrhythmic, anticholinergic-antimuscarinic; blocks action of acetycholine in parasympathetic nervous system

INDICATIONS
Bradycardia with hypotension, asystole, organophosphate poisoning

CONTRAINDICATIONS
Glaucoma

PRECAUTIONS
Caution when used in PT over 40
Pregnancy Class C


SIDE EFFECTS
Blurred vision, headache, dilated pupils, thirst, flushed skin, dysuria

DOSAGE
bradycarida - 1mg IV up to 3mg total
Asytole - 1mg IV up to 3 mg total
Organophosphate poisoning - 2mg IV every 5-10min

ROUTE
IV

PEDIATRIC DOSAGE
0.02mg/kg (min dose 0.1mg, max dose 0.5mg)
1 TJEMSGROUPA Thu, 28 Jan 2010 03:07:05 GMT view revision history
Dilitazem (Cardizem) CLASS: Calcium channel blocker.
ACTIONS: Slows conduction through the AV node, causes vasodilation, decreases rate of ventricular response, decreases myocardial oxygen demand.
INDICATIONS: To control rapid ventricular response associated with atrial fibrillation and flutter.
CONTRAINDICATIONS: Hypotension, wide complex tachycardia, conduction system disturbances.
PRECAUTIONS: Should not be used in patients receiving intravenous ß blockers. Hypotension. Must be kept refrigerated or discarded one month after removal from refrigeration.
SIDE EFFECTS: Nausea, vomiting, hypotension, and dizziness.
DOSAGE: 0.25 mg/kg bolus (typically 20 mg) IV over 2 minutes. This should be followed by a maintenance infusion of 5-15 mg/hour.
ROUTES: IV, IV drip.
PEDIATRIC DOSAGE: Rarely used.
1 TJEMSGROUPA Wed, 27 Jan 2010 15:11:35 GMT view revision history
Vasopressin CLASS
DOSAGE [40 units IV/IO x1]
ROUTE SC; IM; IV IO
ACTION directly stimulates smooth muscle V1 receptors, resulting in vasoconstriction
CONTRAINDICATIONS * hypersens. to drug/class/compon.
* caution if hepatic dz, severe
* caution if seizure disorder
* caution if CHF
* caution if CAD
* caution if renal impairment
* caution if asthma
* caution if migraine
* caution in elderly pts

SIDE EFFECTS
Serious Reactions
* MI
* water intoxication
* bradycardia
* angina
* arrhythmias
* HTN
* anaphylaxis
* bronchospasm
* angioedema
* venous thrombosis

Common Reactions

* abdominal cramps
* nausea
* sweating
* perioral pallor
* tremor
* headache
* flatulence
* vertigo
* vomiting
* diarrhea
* uterine cramps
* rash
* fever
* urticaria

PEDS DOSAGE
3 TJEMSGROUPA Sat, 16 Jan 2010 04:50:14 GMT view revision history
Metoprolol CLASS: BETA-1 Blocker

ACTION: Reduces heart rate (chronotropic effect) and contractility (inoptropic effect)

CONTRAINDICATIONS:
Shock
2nd or 3rd Degree AV Heart Block
Sinus Bradycardia
CHF
Bronchial Asthma

PRECAUTIONS: May create dizziness, generally should not be used with patients who have bronchospasm related diseases.

SIDE EFFECTS:
Hypotension
dysrhythmias
CHF
Nausea/Vomiting
CNS Changes

DOSE:[5mg IV over 2 minutes] May Repeat every 10 minutes to a max of 15 mg to achieve ventricular rate of 120 or less

ROUTE:IV

PEDS DOSE: N/A
1 TJEMSGROUPA Mon, 18 Jan 2010 17:26:43 GMT view revision history
Amiodarone CLASS - antiarrythmic

ACTION - antidysrhythmic of the ventricles, beta-blockade

INDICATIONS:
Ventricular tachycardia
Ventricular fibrillation
Supra-ventricular arrhythmia
Wide QRS complex and tachycardia
PSVT (re-entry SVT)

CONTRAINDICATIONS - NONE in cardiac arrest
History of bradycardia
Hypotension
Severe heart conditions (especially AV block)
Pregnancy side effects – DO NOT USE
Allergic to iodine
Pacemaker

PRECAUTIONS
May take months for the medication to clear from the body
Asthma or another lung disorder
Vision problems
Liver disease
Thyroid disorder
Electrolyte imbalance (low potassium / magnesium)
High / low BP
Grapefruit / grapefruit juice

SIDE EFFECTS
Bradycardia
Hypotension
Increased heart block
New / worsening irregular heartbeat pattern
Blurred / loss of vision
Weight changes – loss / gain
Increased sweating
Irregular menstrual periods
Numbness / burning / tingling in hands
Nausea
Jaundice

ROUTE - Oral / IV

DOSAGE -
Concentration - 150 mg / 3 mL vials
Cardiac arrest - 300 mg IV push
Unstable arrhythmias - 150 mg IV mixed in 100 mL D5W (given over 10 minutes, repeat x1)

PEDIATRIC DOSAGE - ONLY after Medical Control
5 mg / kg (10 kg child = 1 mL)
2 TJEMSGROUPA Wed, 27 Jan 2010 19:53:28 GMT view revision history
Epi 1:10,000 CLASS - Sympathomimetic

ACTION - Increases heart rate, force, and automaticity

INDICATIONS
Asystole, ventricular fibrillation, ventricular tachycardia with no pulse, PEA

CONTRAINDICATIONS
None

PRECAUTIONS

SIDE EFFECTS
Tachyarrhythmias

DOSAGE
Cardiac Arrest - 1mg every 3-5 minutes

ROUTE
IV

PEDIATRIC DOSAGE
0.01 mg/kg repeat every 3-5 minutes
1 TJEMSGROUPA Thu, 28 Jan 2010 03:11:26 GMT view revision history
Midazolam (Versed) CLASS: Benzodiazepine sedative.
ACTIONS: Hypnotic, sedative.
INDICATIONS: Premedication prior to cardioversion/RSI, acute anxiety states.
CONTRAINDICATIONS: Patients with known hypersensitivity to the drug, narrow-angle glaucoma, shock.
PRECAUTIONS: Emergency resuscitation equipment should be available. Dilute with normal saline or D5W prior to intravenous administration. Respiratory depression more common with Midazolam than with other Benzodiazepines.
SIDE EFFECTS: Drowsiness, Hypotension, Amnesia, Respiratory depression, Apnea
DOSAGE: 1.0 - 5.0 mg IV.
ROUTES: IV, PO, Intranasal, IM
PEDIATRIC DOSAGE: 0.03 mg/kg.
2 TJEMSGROUPA Wed, 27 Jan 2010 15:10:43 GMT view revision history
Adenosine Class Antiarrhythmic
dosage 6MG
route IV
Action slows AV node conduction time; interrupts AV node re-entry pathways
indications PSVT conversion, ACLS, narrow complex tachycardia, ACLS, wide complex tachycardia
contra indications hypersens. to drug/class
AV block w/o pacemaker, 2nd or 3rd degree
sick sinus syndrome w/o pacemaker
bronchospasm, acute
side effects * bradycardia, severe
* ventricular fibrillation
* ventricular tachycardia
* atrial fibrillation
* asystole
* complete heart block
* bronchospasm
* flushing
* dyspnea
* chest pressure
* nausea
* lightheadedness
* headache

peds dosage SVT [0.1 mg/kg IV x1]
3 TJEMSGROUPA Wed, 27 Jan 2010 15:22:47 GMT view revision history

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