Drug: OXYGEN
Class of medication: Oxidizing agent (gas)
Generic
ACTION: Reverses Hypoxia, Increases arterial oxygen, Increases hemoglobin saturation, Increases tissue oxygenation Indications: Hypoxia or anticipated hypoxia, or in any medical
Contraindications: There are no contraindications to oxygen
or trauma patient to improve respiratory efficiency.
therapy.
Dose:
Common side effects:
Route: Oral
DOSAGE: Adult: 1-6 LPM via NC; 10-15 LPM via NRB; 15 LPM via BVM Pediatric: 1-6 LPM via NC; 10-15 LPM via NRB; 15 LPM via BVM
Dry or bloody nose, skin irritation from the nasal cannula or face mask
Precautions/major interactions: Chronic obstructive pulmonary disease (COPD) and very prolonged istration of high concentrations in the newborn.
Drug: Oral Glucose
Class of medication: Monosaccharide Carbohydrate
Generic Glutose, Insta-Glucose
ACTION: After absorption from GI tract, glucose is distributed in the tissues and provides a prompt increase in circulating blood sugar
Onset: 10 min Indications: Patients with altered mental status and known
Contraindications:
history of diabetes mellitus
Unconsciousness; known diabetic who has not taken insulin for days; patient who is unable to swallow
Dose:
Route: Oral Common side effects:
DOSAGE/ROUTE:Adult: One tube or packet; repeat based on BGL Pediatric: One tube or packet; repeat based on BGL – minimum age 3 yrs
Nausea, may be aspirated by the patient without a gag reflex
Precautions/major interactions Assure patient has control of swallowing and airway.
Drug: Glucagon
Class of medication: Hormone, antihypoglycemic
Generic: GlucaGen
ACTION: Glucagon is a protein secreted by pancreatic cells that causes a breakdown of stored glycogen into glucose and inhibits the synthesis of glycogen from glucose.
Indications:
Contraindications:
Hypoglycemia without IV access.
Hypersensitivity to glucagon or protein compounds.
Dose:
Common side effects:
Route: Intramuscular Adult:1-2mg IM, repeat in 15 minutes if BGL <60. Ped:0.1 mg/kg IM, repeat in 15 minutes if BGL <60;age > 3 years
Nausea, vomiting
Precautions/major interactions Cardiovascular or renal impairment. Effective only if there are sufficient stores of glycogen in the liver.
Drug: 50% Dextrose in water (D50)
Class of medication: Monosaccharide, Carbohydrate
Generic
ACTION: Dextrose is a simple sugar that the body can rapidly metabolize to create energy. Indications: Hypoglycemia confirmed by glucometer.
Contraindications:
(Coma or seizure of unknown etiology)
None in hypoglycemia.
Dose:
Route: IV
Adult:1 amp or 25g D50WIV bolus, repeat based on BGL.
Common side effects: Tissue necrosis and phlebitis at injection site.
Precautions/major interactions: Increased I. Determine blood glucose level before istration. Ensure good venous access.
Drug: Lactated Ringer's
Class of medication: Isotonic crystalloid solution
Generic LR
ACTION: Assist in fluid replacement for dehydration or blood loss
Indications:
Contraindications:
Manage hypovolemia (uses lactate as a buffer and contains electrolytes)
CHF or renal failure
Dose:
Common side effects:
Route: IV
Adult Dose: 200-500cc Pediatric Dose:20cc/kg for fluid replacement Max:60cc/kg or 2-3 liters of fluid
Rare
Drug: 0.9% NaCl
Class of medication: Isotonic crystalloid solution
Precautions/major interactions CVA, Diabetics, Mixing with blood sets.
Generic Normal Saline
ACTION: - Electrolyte solution which equivalent osmotically to blood. - Increases the circulating volume in the vascular system. (2/3 of infused volume leaves vascular space within 1 hour.)
Indications:
Contraindications: CHF and circulatory overload, Rales for
Replaces water and electrolytes; useful in heat exhaustion, freshwater dorwning, hypovolemia, DKA
fluid bolus
Dose:
Common side effects:
Route: IV
Hypolemia 1. 1 L blood lost = 3 L of NS to infuse 2. Attempt to achieve SBP of 100 mmHg
Rare
Drug: albuterol sulfate (nebulized)
Class of medication: Sympathomimetic Bronchodilator
Generic: Proventil, Ventolin
(sympathomimetic = mimics effects of sympathetic nervous system)
Precautions/major interactions Be conservative in use of fluids with a suspected head injury patient to minimize the risk of developing cerebral edema. Judicious fluid use may be needed for hypotension associated with head injury to maintain cerebral perfusion. Check BP and lung sounds to determine if fluid overload may be developing.
ACTION: Albuterol is a synthetic sympathomimetic that causes bronchodilatation with less cardiac effect than epinephrine and reduces mucus secretion, pulmonary capillary leaking, and edema in the lungs during allergic reactions.
Indications: Bronchospasm and asthma in COPD.
Contraindications: Hypersensitivity to the drug, history of cardiac disease, heart rate >150 in adults, heart rate >200 in pediatrics
Dose: Adult: 2.5-5.0 mg (3cc)via nebulizer continuously, x3
Common side effects: Increased pulse rate (tachycardia)
doses,if no history of cardiac disease and heart rate ≤150. Ped:2.5mg (3cc) via nebulizer continuously, x3 doses, if no history of cardiac disease and heart rate ≤200
,anxiety, nausea, cough, wheezing, tremors, and/or dizziness
Precautions/major interactions The patient may experience tachycardia, anxiety, nausea, cough, wheezing, and/or dizziness. Vital signs and breath sounds must be monitored; use caution with elderly, cardiac, or hypertensive patients.
Drug: ipatromium bromide
Class of medication:
Anticholinergic
Trade: Atrovent, Apovent, Ipraxa, Aerovent and Rinatec
ACTION: Ipratropium bromide is an anticholinergic agent. It blocks muscarinic cholinergic receptors, without specificity for subtypes, resulting in a decrease in the formation of cyclic guanosine monophosphate
Indications: Bronchospasm associated with COPD
Contraindications: Hypersensitivity to ipratropium or
Can be used alone or combined with albuterol
atropine. Use caution in patients with narrow angle glaucoma
Dose:
Common side effects Resp: coughing, sputum increased
500 mcg in 2.5 mL unit dose via SVN or in-line with ventilator device. Repeat per Medical Direction. May mix one unit of ipratropium with one unit of albuterol
CNS: dizziness, insomnia, tremor, nervousness GI: nausea GU: Urinary retention.
Precautions/major interactions •Ipratropium bromide inhalation solution is not a fast-acting medication and cannot replace fast-acting rescue inhalers. Treatment of acute episodes of bronchospasm where rescue therapy is required for rapid response
Drug: Nitroglycerine
Class of medication:
Nitrate
Trade: (Nitrostat)
ACTION: Relaxes blood vessels, decreases workload of heart Indications: Chest pain associated with angina and acute
Contraindications: Hypersensitivity, tolerance to nitrates, severe
myocardial infarction.
anemia, head trauma, hypotension, increased I, patients taking sildenafil (Viagra), glaucoma, and shock.
Dose:
Route: Oral Common side effects: Hypotension (lowers blood pressure),
Adult: 1 tablet or spray (0.4 mg) SL every 5 minutes until pain- free or 3 doses. If SBP <100, medical control. Ped:Not indicated.
headache, pulse rate changes.
Drug: epinephrine (for anaphylaxis only)
Class of medication: Sympathomimetic
Precautions/major interactions May induce headache that is sometimes severe. Nitroglycerin is light sensitive and will lose potency when exposed to the air
Generic: Adrenalin
ACTION: Epinephrine is a naturally occurring catecholamine that increases heart rate, cardiac contractile force myocardial electrical activity, systemic vascular resistance, and systolic blood pressure and decreases overall airway resistance and automaticity. It also, through bronchial artery constriction, may reduce pulmonary congestion and increase tidal volume and vital capacity
Indications: severe allergic reactions.
Contraindications:
Dose: Allergic reactions
Common side effects:
Adult:0.3 mg of 1:1000 IM (if age <50) 0.15 mg of 1:1000 IM (if age >50) Ped:0.01 mg/kg of 1:1000 IM (use Broselow); max dose 0.3 mg
Precautions/major interactions
Hypersensitivity to sympathomimetic amines, narrow angle glaucoma, hemorrhagic, organic brain or or during labor Increased heart rate, pallor, dizziness, chest pain, headache,nausea, vomiting, excitability, anxiety. Elderly, debilitated patients, hypertension, diabetes,hyperthyroidism, Parkinson’s disease, tuberculosis, asthma,emphysema, and in children < 6 year
Drug: nitrous oxide (50/50 mix)
Class of medication:
Gaseous Analgesic/Anasthetic
Generic: Nitronox
ACTION: CNS depressant Indications:
Patients that are alert and complaining of pain caused by the following: Musculoskeletal injuries/fractures, kidney stones, suspected AMI (if NTG or morphine are ineffective or contraindicated), active labor during an uncomplicated delivery, thermal burns
Contraindications:Any altered level of consciousness or head
Dose:
Common side effects Hypotension/Dizziness
Route: Self-istered via mask
injury. Chronic Obstructive pulmonary disease. Chest trauma or actual/suspected pneumothorax. Abdominal distention major facial trauma acutely psychotic patients Decompression sickness Patients who cannot self-ister
Self-ister and self-regulated by the patient, who must hold the mask to face to create an airtight seal until the pain is significantly relieved or the patient drops the mask.
Precautions/major interactions
Drug: naloxone
Class of medication: Narcotic antagonist
Must be self-istered Check machine gauges daily for proper concentrations. Monitor blood pressure and pulse oximetry values
Generic: NARCAN
ACTION: Naloxone is a pure narcotic antagonist that blocks the effects of both natural and synthetic narcotics and may reverse respiratory depression.
Indications: Narcotic and synthetic narcotic overdose, coma
Contraindications:
of unknown origin
Hypersensitivity to the drug, non-narcotic induced respiratory depression.
Dose: Adult: 0.5-2 mg IV bolus titrated to patient’s respiratory
Common side effects:
response; may be given IM if unable to establish IV. Ped:0.1 mg/kg IV (max 2 mg), repeated in 5 minutes if no effect.
Abrupt reversal of narcotic depression may result in nausea, vomiting, sweating, tachycardia, increased blood pressure, tremulousness, seizures and cardiacarrest
Precautions/major interactions Possible dependency. Short also half-life than that of mostnarcotics; hence the patient may return to the overdose state.
Drug:
activated charcoal
Class of medication:
Adsorbent (binding agent)
Generic:
ACTION: Activated charcoal is a specially prepared charcoal that will adsorb and bind toxins from the gastrointestinal tract; combined with Sorbitol to promote GI motility
Indications: Acute ingested poisoning Dose: Adult: 50 gms PO Ped:1g/kg PO, max 25 gms
Contraindications:
An airway that cannot be controlled; ingestion of cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol.
Route: Oral
Common side effects Constipation, diarrhea, temporary darkening of the stool, vomiting.
Precautions/major interactions ister only after emesis or in those cases where emesis is contraindicate
Drug: acetaminophen
Class of medication:
Non-narcotic Analgesic, Antipyretic
Trade: Tylenol, Anacin-3
ACTION: Antipyretic Activity, Analgesic Activity - Inhibition of central & peripheral prostaglandin synthesis Indications: For pain and fever control
Contraindications:
Dose:
Common side effects: When used appropriately, side effects
Adult: 1000mg PO Pediatric: 10mg/kg PO
with acetaminophen are rare. The most serious side effect is liver damage due to large doses
Hypersensitivity, children under 3 years
Precautions/major interactions Extreme caution must be used when considering the use on a suspected liver dysfunction.
Drug: ibuprofen
Class of medication:
Trade: Advil, Motrin
NSAID
Analgesic, Antipyretic, Anti-inflammatory,
ACTION: Reduces the inflammatory response through the chemotaxis. Reduces the fever by blocking the prostaglandin synthesis Indications: Fever, Pain, Inflammation Reducer
Contraindications:
Hypersensitivity
Contraindication:
Dose: Adult Dose: 200-800mg p.o. every 6-8 hours
Common side effects:
Pediatric Dose:10mg/kg p.o. max of 40mg/kg per day (liquid form)
Precautions/major interactions
Drug:
Class of medication:
Aspirin (Acetylsalicylic Acid)
G.I. intolerance, many others possible
You may want to alternate with Acetaminophen
Platelet inhibitor/Anti-inflammatory
Trade: Alka-Seltzer, Bayer, Emperin, St Joseph Children’s
ACTION: Blocks platelet aggregation Indications: Chest pain suggestive of an MI
Contraindications: Hypersensitivity to salicylates, active ulcer disease, asthma
Dose: Adult: chewable baby aspirin (81mg each) PO
Common side effects: Nausea, vomiting, heartburn, bleeding.
Pediatric: Not indicated
Wheezing is possible with an allergic reaction.
Precautions/major interactions: GI bleeding and upset Drug: Atropine (Auto Injector)
Class of medication: Parasympatholytic
Generic:
(increases heart rate)
ACTION: Atropine blocks the parasympathetic nervous system, specifically the vagal effects on the heart rate. It does not increase contractility but may increase myocardial oxygen demand. Atropine decreases airway secretions
Dose:
Adult: 2 mg IM via autoinjector Pediatric: Per medical control
Contraindications: None in an emergency setting
only
Common side effects:: Dry mouth, blurred vision, urinary retention, tachycardia, constipation, decreased sweating
Precautions/major interactions: AMI, glaucoma.
Drug: Pralidoxime (2-PAM)
Class of medication:
Cholinesterase reactivator
Generic:
ACTION: Pralidoxime reactivates cholinesterase and reinstitutes the degrading of acetylcholine and restores normal neuromuscular transmission. It is used to reverse severe organophosphate poisoning. Indications: Organophosphate poisoning
Contraindications:
Dose:
Common side effects:
Adult: 600 mg IM via (Auto Injector) Ped: Per medical control only
Carbamate insecticides (Sevin), inorganic phosphates, and organophosphates having no anticholinesterase activity, asthma, peptic ulcer disease, severe cardiac disease, or patients receiving aminophylline, theophylline, morphine, succinylcholine, reserpine, or phenothiazines blurred or double vision, difficulty in focusing eyes, difficulty in speaking, difficult or rapid breathing, dizziness, fast heartbeat, muscle stiffness or weakness, pain at the place of injection.
Precautions/major interactions Rapid istration may result in tachycardia, laryngospasm, and muscle rigidity. Excited or manic behavior may be noted after regaining consciousness