Activated Charcoal-Class: * AbsorbentActions: * Absorbs poisons in the stomach, prevents absorption by the body and enhances their elimination from the BodyIndications: * Utilized for patients who have ingested poisons or overdosed medications by mouthContraindications:

* Altered mental status* Patients that have ingested acids of alkalis.* Patients unable to swallow.

Precautions: * Do not give the patient milk, ice cream or sherbet as they decrease the effectiveness of the charcoal.Adverse Reactions:

* Blackening of the stools.* Vomiting

Adult dose: Administer 1-2 g/kg (25-50)Pediatric dose:

Administer 1-2 g/kg (12.5-25 grams)

Adenosine/Adenocard- Class: antidysrhythmic.Action: *natural nucleoside that slows conduction through the AV node without negative inotropic effects. *Decreases chronotroic effect from direct activity of sinus pacemaker cells and vagal nerve terminals.Indication: *Superventricular tachycardia, except for atrial fibrillation and flutter.Contraindications: * Adenosine hypersensitivity

*Bradycardia * Second-or third –degree block *Sick sinus syndrome

Side effects/Precaution: *Transient dysrhythmias including second or third degree AV Blocks, asystole, sinus Bradycardia, premature atrial contractions, or premature ventricular contractions.

*facial flushing*Headache*Shortness of breath*Dizziness*Nausea*Chest Discomfort*Bronchoconstriction*Methylxanthines may decrease effectiveness, may require larger

dose.*Dipyridamole may potentiate effect, may need to reduce dose.

Dosage: 6mg rapid IV push followed by a 20 ml saline flush, repeated in 1 to 2 minutes at 12 mg to a total cumulative dose of 30 mg.

Albuterol (Proventil, Ventolin, Salbutaol)-

Class: * beta 2 specific sympathomimetic.Action: * Primarily a beta 2 agonist that dilates bronchial smooth muscle

* Relaxes vascular smooth muscle.Indications:

* Reverse Bronchoconstriction associated with asthma, emphysema, chronic bronchitis, and other conditions that cause bronchospasm.Contraindications:

* Hypersensitivity to drug* Symptomatic tachycardia* Hypertension* Tachycardia greater than 150 BPM* Acute myocardial infarction

Side Effects/Precautions:*Tachycardia* Hypertension*Chest pain*Anxiety* Headache

Side Effects/Precautions:* Dizziness* Sweating * Nausea and Vomiting*Tremors* Dysrhythmias* Antidepressants may potentiate vasodilation

Dosage:* 2.5 mg to 5.0 mg in 2.5 to 3 ml of normal saline via nebulizer over 5 to 10 minutes* Repeat if severe bronchospasm persists.

Amyl Nitrate- Class: * Antidote for cyanide PoisoningActions: Forms methemoglobin, which combines with the cyanide forming a nontoxic compound (cyanmethemoglobin) which is excreted when sodium thiosulfate is administered.

Indications: Used initially in the management of cyanide poisoning.

Contraindications: Non when used for cyanide poisoning.

Precautions: * stop administration once sodium nitrate infusion is started * Do not administer to patients improving on their own * Oxygenation is critical in these patients

Adverse Reactions: * Headache

* Hypotension * Tachycardia

* Nausea/VomitingAdult dose: Vapor inhaled every 10-20 minutes until sodium nitrate iv solution is available. Crush capsule inside oxygen mask and patient inhales vapor.

Pediatric dose: Same as adult.

Aspirin-

Class: * Platelet aggregation inhibitor* Anti-inflammatory agent

Action: * Inhibits platelet aggregation and reduces clot formation

Indications: * Acute Myocardial infarction * Acute ischemic stroke

Contraindications: *Hypersensitivity* Hemorrhagic stroke* Bleeding disorder* GI Bleed

Side Effects/ Precautions:* GI Bleeding* Nausea and vomiting* May cause wheezing* Heartburn

Dosage: * 160 or 325 mg tablet chewed or swallowed.

Atropine Sulfate-

Class: * Parasympatholytic (Anticholinergic, Vagolytic)Action: * Anticholinergic agent that blocks acetylcholine receptors blocking the parasympathetic nervous system influence on the heart, smooth muscle, and glands.

Indications: * Hemodynamically significant Bradycardia * Asystole * Organophosphate poisoning or nerve gas exposure * PEA with slow complex rate

Contraindications: * Asymptomatic Bradycardia * Tachycardia * Hypersensitivity * Thyrotoxicosis

Side Effects/Precautions:* Tachycardia* Palpitations* Seizures* Hypertension* Respiratory Distress* Dizziness*Anxiety

Side Effects/ Precautions:* Dry mouth* Pupillary Dilation* Blurred Vision* Urinary Retention

Dosage: * Symptomatic Bradycardia: 0.5 to 1.0 mg IV repeated in 3 to 5 minutes at dose of 0.5 to 1.0 mg to a total maximum cumulative dose of 0.04 mg/kg.

Calcium Chloride-

Class: Calcium Salt (electrolyte)Action: * Increases calcium levels (calcium is necessary for normal function of nerves, muscles, skeletal system, and for cell membrane and capillary permeability.

* Has a role in the release of neurotransmitters and hormones* Increases cardiac contractile state* May increase ventricular automaticity

Indications: * Acute hypocalcemia * Acute hyperkalemia * Calcium channel blocker overdose * Hypermagnesemia

Contraindications: * Hypercalcemia * Digitalis toxicity * Renal or cardiac disease

Side Effects/Precautions:* Extravasation may cause tissue damage and necrosis* Will precipitate of mixed with sodium bicarbonate* Rapid injection may cause vasodilation, Hypotension, Bradycardia, cardiac

dysrhythmias, syncope, and cardiac arrest.Dosage: * 2-4 mg/kg of a 10% solution repeated at 10 minute intervals

Dextrose 50 %-

Class: * Carbohydrate

Action: * Increases blood glucose level

Indications: * Hypoglycemia

Contraindications: * Do not use for altered mental status due to stroke, head injury, or other intracranial pathology unless hypoglycemia is documented.

Side Effects/Precautions:* Local venous irritation* Infiltration may cause tissue necrosis* Collect a blood sample before administration* Consider thiamine administration in suspected thiamine-deficient patients

Dosage: 25 g (50 ml) intravenous injection

Diazepam (Valium)-

Class: * BenzodiazepineAction: * CNS depressant * Anticonvulsant * Anxiolytic

* Sedative* Skeletal Muscle relaxant

Indications: * Status epilepticus or actively seizing patient * Skeletal muscle relaxant * Sedation prior to cardioversion * Reduction of extreme anxiety

Contraindications: *HypersensitivitySide Effects/Precautions:

* Local venous irritation and burning at the intravenous injection site* CNS depression* Respiratory depression* Hypotension when injected too rapidly* Use with caution in patients with narrow angle glaucoma and those with

increased intraocular pressure.Dosage: * Seizures: 5-10 mg over a three minute period repeat every 5 minutes to a total of 20 mg.

* Acute anxiety: 2-5 mg IV or IM * Premedication prior to cardioversion: 5-15 mg

Diphenhydramine (Benadryl)-

Class: * Antihistamines (H1 histamine blocker)

Action: * Blocks histamine 1 receptor sites* Anticholinergic effects* Reduces vasodilation, Hypotension, Tachycardia associated with histamine release in

anaphylaxis.

Indications: * Severe allergic reaction * Anaphylaxis * Dystonic (extrapyramidal) reaction as a result of phenothiazines and

antipsychotic drug.

Contraindications: * Hypersensitivity * Asthma * Narrow-angle glaucoma

Side Effects/Precautions:* Hypotension* Drowsiness * Wheezing* Nausea and vomiting * Thickened bronchial secretions* Disturbed coordination* Epigastric distress* Dry mouth * Dry nose

* Tachycardia* Urinary retention

Dosage: * 25-50 mg IV or Deep IM

Dobutamine (Dobutrex)

Class: * Synthetic catecholamine (sympathomimetic) with primary beta adrenergic reception stimulation.

Action: * Positive inotrope (increases myocardial contractility)* Increases stroke volume and cardiac output* Minimal chronotrope (increased heart rate)

Indications: * Cardiogenic shock from left ventricular dysfunction * Acute congestive heart failure

Contraindications: *Atrial fibrillation, atrial flutter * Bradycardia-induced hypotension

Side effects/Precautions: * May increase myocardial infarction size* May cause ventricular* May be deactivated by alkaline solutions* Headache* Hypertension

Side Effects/Precautions- cont.* Palpitations

Dosage: 2-20 ug/kg/minute intravenous infusion

Dopamine (Intropin)-

Class: * sympathomimetic

Action: * Precursor to noreinehrine* Dose-dependent action may include increased renal and mesentery blood flow, beta

adrenergic effects including increased heart rate in myocardial contractility, and increased systemic vascular resistance from vasoconstriction

* Acts on alpha, beta and dopaminergic adrenergic receptors

Indications: * Cardiogenic shock with hemodynamically significant hypotension (systolic BP of 70 to 100 mmHg)

Contraindications: * Hypotension due to hypovolemia prior to fluid resuscitation efforts * Pheochromocytoma (tumor of adrenal gland)

Side Effect/Precautions:* Tachydysrhythmias* Hypertension* Palpitations* Nausea and vomiting* Chest pain* Nervousness* Headache* Dyspnea

Side Effects/Precaustions cont:

* May be deactivated by alkaline solution* Reduce the dose of patient is taking MAO inhibitor (antidepressant)* May cause hypotension if administered concomitantly with phenytoin

(dilantin)

Dosage: * 2 to 5 ug/kg/minute will increase renal and mesentery blood flow * 2 to 10 ug/kg/minute for predominant beta adrenergic effects for increasing heart rate

and myocardial contractility * 10 to 20 ug/kg/minute for predominant alpha adrenergic effects for vasoconstriction and an increase in systemic vascular resistance

Epinephrine (Adrenalin)-

Class: * Sympathomimetic

Action: *Alpha and beta agonist* Alpha effects are vasoconstriction and an increase in peripheral vascular resistance

(PVR)* Beta 1 is a positive inotrope that increases myocardial contractility and a positive

chronotrope that increases heart rate* Beta 2 dilates bronchial smooth muscle and skeletal vasculature* Increases myocardial automaticity* Increases myocardial electrical activity* Vasoconstriction of arterioles in the skin, muscle, and splanchic (visceral) areas

Indications: * Cardiac arrest * Anaphylaxis * Status asthmaticus * Reactive airway disease

Contraindications:* None in cardiac arrest* Hypertension* Pregnant Patient* Cardiovascular or hyperthyroid disease

Side Effects/Precautions:* Protect drug from light* Tachycardia* Palpitations* Hypertension* Dysrhythmia due to myocardial irritability* Increased myocardial oxygen demand* Headache* Tremors* Anxiety* Nausea and vomiting* Use with caution in males > 40 years of age or females> 50 years of age

Dosage:* Cardiac arrest: 1 mg of 1:10,000 IV every 3 to 5 minutes* Anaphylaxis: 0.3 to 0.5 mg 1:1,000 SQ or 0.3 to 0.5 mg IV (1:10,000) if hypotension

and poor perfusion* Asthma with severe bronchochonstriction: 0.3 to 0.5 mg 1:1,000 SQ* Infusion: 1 mg in 500 ml D5W --- infuse at 1 to 2 ug/min and titrate to desired

response to 10 ug/min* Endotracheal dose: 2.0 to 2.5 mg

Flumazenil (Romazicon)

Class: * Benzodiazepine Antagonist

Action: * Reverses the effects of benzodiazepines

Indications: * Reversal of respiratory depression associated with administration of BenzodiazepinesContraindications:

* Hypersensitivity to drug* Cocaine or other stimulant intoxication* Should not be used to rule out benzodiazepine overdose in the same manner

as naloxone

Side Effect/Precautions:* Headache* Nervousness and agitation* Dizziness* Fatigue* Cutaneous vasodilation

*Careful administration in patients with known benzodiazepine dependencyDosage:

* 0.2 mg IV over 30 seconds with additional doses of 0.3 to 0.5 mg to a maximum dose of 3.0 mg

Furosemide (Lasix)-

Class: * Loop diuretic

Action: * Inhibits reabsorption of sodium and chloride in loop of Henle, promoting diuresis* Vasodilation increases venous capacitance and decreases preload

Indications: * Congestive heart failure * Pulmonary edema associated with left ventricular failure

Contraindications:* Anuria* Hypovolemia* Dehydration* Pregnancy* Hypersensitivity

Side Effects/Precautions:* Protect drug from light* Dehydration* Hypokalemia

Side Effects/Precautions: cont.* Hyperglycemia* Hypercalcemia* Hyponatremia* Hypochloremia

Dosage:

* 40 mg (0.5 to 1.0 mg/kg) slow IV push over 1-2 minutes not exceed 20 mg/min.

Glucagon-

Class: * Antihypoglycemic counter-regulatory hormone * Beta blocker overdose antidote

Action: * Causes glycogenolysis ( conversion of glycogen to glucose* Increases blood glucose level (only if liver glycogen is available)* Positive inotrope (increased myocardial contractility) and positive chronotrope

(increased heart rate)* Increases AV Conduction* Inhibits glycogenesis (syntheses of glycogen from glucose)

Indication: * Hypoglycemia * Beta-blocker overdose

Contraindications: * Hypersensitivity* Hyperglycemia

Side Effects/Precaution:

* Nausea* Vomiting* Headache* Tachycardia* Hypotension* Use with caution in patients with cardiovascular or renal disease

Dosage:

* Hypoglycemia: 0.5 to 1 mg IM or IV* Beta-blocker overdose: 3 to 10 mg IV Bolus followed by a 2 to 5 mg/hr infusion

Glucose (Oral)-

Class: Carbohydrate

Action: Increases blood Glucose Level

Indications: Altered mental statues secondary to hypoglycemia

Contraindications: *Patients unable to protect their own airway,*Patients unable to swallow.

Precautions: Assure that the patient has a gage reflex.

Adverse reaction: AspirationNausea and vomiting

Adult dose: 25-50 gm PO or one single dose tube, and may repeat once

Pediatric dose:0.5 gm/kg PO if the child is < 8 years of age (ALS ONLY)

Haloperidol (Haldol)-

Class: Tranquilizer Anti-psychotic

Actions: Strong anti-emetic effect and impairs central thermoregulation. Produces weak central anticholinergic effects and transient orthostatic hypotension due to blockade of dopamine activity.

Indications: Management of the manifestations of the psychotic disorders and for treatment of agitated states in acute and chronic psychoses.

Contraindications: Patients wit known hypersensitivityComaParkinson’s diseaseAlcoholismCNS depressionCocaine Overdose

Precaution: *Severe cardiovascular disorders (may cause transient hypotension or precipitate angina pectoris). * Receiving anticonvulsant medication (may lower convulsive threshold.

Adverse Reactions: Extra-pyramidal syndrome (EPS) Headache

Lethargy Tachycardia Hypotension

Adult dose: 5 mg IM> Patients over the age of 655 y/o, 2.5 mg IM

Pediatric:5 mg IM (>12 yrs) and 2 mg IM (6-12yrs) MEDICAL DIRECTION REQUIRED.

HYDROXYCOBALAMIN (CYANOKIT)-

Class: AntidotePrecursor of vitamin B12

Actins: Binds with cyanide ions to form cyanocobalamin, which is excreted in the urine.

Indications: Treatment of cyanide poisoning with significant signs and symptoms of circulatory compromise.

Contraindications: Patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin.

Precautions: Administer slowly over 15 minutes Transient hypertension

Adverse reactions: Hypertension Headache Red-colored urine Nausea

Adult dose:Initial dose is 5 g administered over 15 minutes slow IV. (Each 2.5 g vial of hydroxocobalamin for injections is

to be reconstituted with 100 mL of N.S. and administered at 10-15 mL/Min) An additional 5 g dose may be administered with medical control order.

Pediatric dose:70 mg/kg (reconstitute concentration is 25 mg/mL) Each 2.5 g vial of hydroxocobalamin for injection is to be

reconstituted with 100 mL/Minute. Maximum single dose 5 grams.

Ipratropium Bromide (Atrovent)-

Class: Anticholinergic Bronchodilator

Actions: Bronchodilation Dries respirator tract secretions. Is most effective in combination with a beta-adrenergic bronchodilator.

Indications: Bronchospasm related to asthma, chronic bronchitis and emphysema.

Contraindications: Sensitivity to soybeans or peanuts Sensitivity to Atropine

Tachydysrhythmias

Precautions: Administer Cautiously to patients with narrow-angle glaucoma.

Adverse Reactions: Tachycardia Palpitations

Dizziness Headache Dry Mouth

Adult dose:2.5 mL (500 mcg) mixed with 2.5 mg albuterol via nebulizer

Pediatric dose:< 2 y/o 1.25 mL (250 mcg) mixed with 2.5 mg Albuterol via nebulizer> 2 y/o 2.5 ml (500 mcg) mixed with 2.5 mg Albuterol via nebulizer.

Lidocaine (Xylocine)-

Class: * Antidysrhythmic

Action: * Decreases automaticity by slowing rate of phase for depolarization* Reduces re-entry by converting unidirectional block to bidirectional block in ischemic

tissue* Increases the ventricular fibrillation threshold

Indications: * Prevents a rise in intracranial pressure associated with administration of succinylcholine and the intubation procedure

* Suppression of ventricular dysrhythmia

Contraindications: * Hypersensitivity * Second- or third-degree block

* PVC’s with a heart rate less than 60 bmp

Side Effects/Precautions:* Hypotension* Drowsiness* Confusion* Anxiety* Seizures at high doses* Muscle twitching* Agitation* Blurred vision* Lightheadedness* Reduced conduction velocity at large doses

Dosage:* 1 to 1.5 mg/kg IV repeat at 0.5 to 0.75 mg/kg every 3-5 minutes to a total cumulative

dose of 3 g/kg* 2 to 2.5 mg/kg ET* After suppression of ectopy or dysrhthmia, initiate an infusion at 2 to 4 mg/minute

Magnesium Sulfate-

Class: * Anticonvulsant* Electrolyte* Antidysrhythmic

Action:* Magnesium depresses central nervous system and blocks neuromuscular transmission

Indications: * Seizures associated with eclampsia * Hypomagnesemia * Tosades de pointes * Severe asthma * Refractory ventricular fibrillation * Refractory pulseless ventricular tachycardia

Side Effects/Precautions:* CNS depression* Flushing* Hypotension* Myocardial depression* Diaphoresis* Respiratory depression* Hypothermia* Decreased heart rate* Use with caution in patient with renal failure or taking digitalis

Adult Dosage:Torsades de pointes (Pulseless)

2 gm slow IV/IO. Mix 2 gm in 10 mL of N.S. and administer over 2 minutes.With Pulses-

2 gm slow infusion. Mix 2 gm in 100 mL of N.S. Utilize a 10 gtts set and run at 50 gtts/min.Eclampsia-

4 gm slow infusion. Mix 4 gm in 100 mL of N.S. Utilize a 10 gtts set and run at 50 gtts/minAsthma=

2 gm slow infusion. Mix 2 gm in 100 mL of N.S. Utilize a 10 gtts set and run at 50 gtts/min.

Pediatric dosage:Tosades de pointes (Pulseless)

25-50 mg/kg IV over 20 minutes, up to maximum single dose of 2 gm.Torsades de pointes with pulse:

25-50 mg/kg IV over 20 minutes up to a maximum single dose of 2 gmAsthma-

25-50 mg/kg IV over 20 minutes up to a maximum single dose of 2 gm

Methylprednisolone ( Solu-Medrol)-

Class: * Corticosteroid

Action: * Anti-inflammatory* Immunosuppression

Indications: * Anaphylaxis * Asthma * Chronic obstructive pulmonary disease * Spinal cord injury

Contraindications: * None in the emergency setting

Side Effects/Precautions:* Headache* Hypertension* Hyperglycemia* Hypocalcemia* Nausea and vomiting* Use with caution in patients with renal disease, CHF and diabetes mellitus

Adult Dosage:

* 125 mg IV/IM

Pediatric dose:

* 2 mg/kg IV/IM up to a maximum single dose of 125.

Midazolam HCL (Versed)-

Class: Benzodiazepine

Actions: A short acting central nervous system depressant that causes amnesia, sedation and muscle relaxation,

Indications: Active seizures/status epilepticus. A sedation prior to cardioversion or Transcutaneous pacing in conscious patients. Chest pain or tachycardia due to overdose on ingestion of cocaine, amphetamine, ecstasy, LSD, PCP, or ketamine.

Contraindications: Known Hypersensitivity Hypotension

Precautions: Monitor respirations Avoid mixing with other medications, flush IV line after administration Titrate in small doses.

Adverse reactions: respiratory depression Apnea Hypotension

Amnesia Nausea

Adult Dose:2-5 mg IN/IN, up to a maximum dose of 5 mg. For combative patients the dosages is 5 mg IN/IM.

2-5 mg IV/IN, up to a maximum dose of 10 mg for patients requiring drug-assisted intubation.

Pediatric dose:0,1 mg/kg IV/IN, up to a maximum single dose of 5 mg

Morphine Sulfate-

Class: Narcotic AnalgesicActions: Potent analgesic

Decreases peripheral vascular resistance-vasodilatation. Decreases cardiac workload and oxygen demand on the heart.

Indications: Chest pain not relived by nitroglycerin Pain management

Contraindications: Known hypersensitivity. Head injury Hypotension Respiratory depression.

Precautions: Monitor respirator status and blood pressure. Have naloxone readily available.

Adverse reactions: Hypotension Respiratory Depression Syncope Bronchospasm

Adult dose: Pain management:

2 mg IV until pain is relieved or maximum of 10 mg is reached.

CHF:2 mg IV, up to a maximum of 10 mg as long as the patients systolic BP is > 140 mmHg.

Cardiac Chest Pain:2 mg IV, up to a maximum of 6 mg.

Pediatric dose:Pain management:

0.1 mg/kg IV, until pain is relieved or a maximum of 5 mg is reached.CHF:

0.1 mg/kg IV up to a maximum of 5 mg.

Naloxone (Narcan)-

Class: * Narcotic antagonist

Action: * Competes for narcotic receptor sites

Indications: * Known or suspected narcotic overdose

Contraindications: * Hypersensitivity

Side Effects/Precautions:* Hypertension* Nausea and vomiting* Dysrhythmia* Use with caution in patients who are depending on narcotics since it may

cause withdrawal

Dosage: * 0.4 mg to 2.0 mg IV, IM, or SQ* Endotracheal dose: 2 to 2.5 times IV dose

Nitroglycerin (Nitostat)-

Class: * Vasodilator* Antianginal analgesic

Action: * Vascular smooth muscle dilation* Reduction in myocardial workload* Coronary artery dilation* Reduction of systemic vascular resistance

Indications: * Angina pectoris * Chest pain associated with myocardial infarction * Hypertensive emergency * Congestive heart failure * Cerebral hemorrhage

Contraindications: * Hypersensitivity * Hypotension * Increased intracranial pressure

Side Effects/Precaution:* Hypotension* Reflex tachycardia* Headache* Syncope* Burning sensation in mouth* Dizziness* Nausea and vomiting

Dosage:* 1/150 g (0.4 mg) sublingual repeated every 3-5 minutes up to 3 doses* 1 to 2 metered dose sprays (0.4 mg/spray) repeat every 3 to 5 minutes up to 3 doses* 10 to 100 ug/min for IV infusion

Ondansetron (Zofran)-

Class: Anti-emetic.

Action: Potent anti-emetic

Indications: Persistent vomiting due to gastrointestinal

Contraindications: History of allergic reaction Pregnancy – MEDICAL CONTROL OPTION ONLY

Precautions: Avoid intra-arterial or subcutaneous administration.

Adverse reactions: Allergic reaction.

Adult dose: 4 mg IV.

Pediatric dose:Rarely used. 2-4 mg IV MEDICAL DIRECTION REQUIRED.

OXYGEN

Class: Gas

Action: Odorless, colorless, tasteless gas that is essential for life.

Indications: Cardiopulmonary arrest Trauma Dyspnea Suspected hypoxemia Cardiac related chest pain.

Contraindications: None

Precautions: Utilize the prescribed dose of the COPD patient unless the patient is in severe respiratory distress then 100 % is required.

Adverse reactions: May induce respiratory drive in some COPD patients.

Adult dose:> 15 lpm via BVM, 12-15b lpm via NRB, or 2-6 lpm via nasal cannula.

Pediatric dose:>15 lpm via BVM, 12-15 lpm vial NRB mask or blow by, 2-6 lpm via nasal cannula

Pralidoxime Chloride / 2-Pam CL (WMD)

Class: Cholinesterase Reactivator

Actions: * Reactivates cholinesterase which has been deactivated by chemical nerve agents and organophosphate poisons.

* Relieves paralysis of the respiratory muscles following chemical nerve agent or organophosphate exposure.Indications: *Second drug given for the treatment of poisoning due to organophosphate pesticides and chemical nerve agents. (First drug of choice is atropine).

* Primary indication for Pralidoxime administration is muscle weakness or respiratory depression in these patients.

Contraindications: Known hypersensitivity

Precautions: not indicated for poisonings with carbonate pesticides. Effects during pregnancy are unknown. Safety and efficacy in children is unknown. Do not administer more than 3 Auto-injectors due to its hypertensive effects.

Adverse Reactions: Tachycardia, laryngospasm, muscle rigidity if IV and infused to quickly Mild to moderate pain at the injection site. Blurred or double vision, dizziness, loss of coordination, headache drowsiness, hypertension,

tachycardia.

Adult dose:600 mg IM, uup to 1800 mg or 3 auto-injectors.

Pediatric dose:Not indicated.

Sodium Bicarbonate-

Class: * Alkalinizing agent, electrolyte

Action: * Sodium bicarbonate combines with hydrogen ions to for water and carbon dioxide* buffers metabolic acidosis* Forces and intracellular shift of excess potassium in hyperkalemia* Increases pH

Indications: * Severe metabolic acidosis in cardiac arrest refractory to ventilation * Tricyclic antidepressant overdose

* Hyperkalemia * Alkalinization agent for specific toxins

Contraindications:* Metabolic or respiratory alkalosis* Hypocalcemia* Hypokalemia* Hypernatremia

Side Effect/Precautions:* Metabolic alkalosis may occur* Precipitates when mixed with calcium chloride* May increase intracellular acidosis* May cause electrolyte imbalance* May deactivate catecholamine* Large solute load may lead to fluid overload

Dosage:* 1 mEq/kg IV Repeated at 0.5 mEg/kg every 10 minutes

Sodium Thiosulfate-

Class: Antidote for cyanide poisoning.

Actions: converts cyanide to less toxic thiocyanate which is excreted in the urine

Indications: Acute cyanide toxicity.

Contraindications: None in acute cyanide toxicity

Precautions: Not useful in hydrogen sulfide toxicity. Should be used after administration of nitrates.

Adverse reactions: No significant side effects in the setting of acute cyanide toxicity following the administration of nitrates.

Adult dose:12.5 grams (50 mL of 25 % solution) Slow IV push over 10 minutes.

Pediatric dose:MEDICAL CONTROL!!!

TETRACAINE HCL-

Class: Local anesthetic for the eye

Actions: Blocks the initiation and conduction of nerve impulse.

Indications: Topically applied local anesthetic for eye examination.

Contraindications: Hypersensitivity to ester anesthetics. Not to be applied in large amounts or to infants less than 1 year of age.

Do not use in the presence of penetrating trauma

Precautions: Advise patient that the drops may burn for a few seconds.

Adverse reactions: Stinging in affected eye.

Adult dose:1-2 drops per eye

Pediatric dose: 1-2 drops per eye.

Thiamine (bendizine)

Class: * Vitamin B1

Action: * Combines with ATP to form a co-enzyme in glucose metabolism

Indications: * Known or suspected thiamine deficiency * Alcoholism * Coma of unknown origin * Wernicke’s encephalopathy * Korsakoff’s syndrome

Contraindications: * None in emergency settings

Side Effects/Precautions:* May cause allergic reaction* Hypotension in rapid push* Nausea and vomiting

Dosage:* 100 mg slow IV or IM* Ideally, 50 mg IV and 50 mg IM