Utah Valley University

Paramedic ALS Guide

Generic Name: Acetaminophen

Onset: Within 30 minutes

Duration: Half-life 2.8 hours (range 2-4 hours)

Trade Name: Tylenol

Classification: Non-narcotic Analgesic, Antipyretic

Action/Effects: Antipyretic Activity, Analgesic Activity – Inhibition of central

& peripheral prostaglandin synthesis

Indication: Fever, Pain

Contraindication: Hypersensitivity

Side Effects: Possible Sleepiness

Adult Dose: 325-1000mg PO or Rectal (every 4 hours)

Pediatric Dose: 15mg/kg PO in liquid form or PR *in bullet form

(caution on previous doses not to overdose)

Max: 4gms per day

Cautions: Extreme caution liver dysfunction.

Generic Name: Activated Charcoal

Onset: Immediate

Duration: Continual while in the GI tract

Trade Name: Actidose, Super Char, Charcodate, Liqui-Char, Aqua-Char

Classification: Antidote, Adsorbent

Action/Effects: A fine black powder with liquid that adsorbs poisonous

compounds to its surface, reducing the absorption.

Indication: Oral poisonings

Over dose of a non caustic or other burning poison

Contraindication: Do NOT use in caustic acids, alkalis, irons tablets & lithium. There is NO

value for the ETOH OD pt.

Side Effects: Constipation is possible, vomiting due to pt. intolerance

Adult & Pediatric

Dose:

1gm/kg PO or slow Nasogastric or Orogastric tubes

Cautions: Some people like to spit it out at YOU!

Generic Name: Adenosine (Adenocard)

Onset: Immediate

Duration: 10 sec

Trade Name: Adenocard

Classification: Antiarrhythmic

Action/Effects: Slows supraventricular tachycardia, decreasing the electrical activity by interrupting the reentry pathways through the AV node.

Indication: Symptomatic SVT, monomorphic wide complex v-tach

Contraindication: Hypersensitivity, 2nd or 3rd degree heart block, sick-sinus syndrome, A-Fib, A-Flutter

Side Effects: Syncope, Chest Pain, facial flushing, SOB, dizziness, hypotension

Adult Dose: Initial dose rapid bolus 6 mg. rapid IV/IO push 1-3 sec. quickly followed by a 20 cc saline flush. Elevate extremity Repeat 12 mg. in 1-2 min. if needed

Pediatric Dose: 0.1mg/kg rapid IV/IO push followed by 5cc bolus, repeat 0.2mg/kg x 1

Cautions: Half life is 10 seconds. Pediatric doses don’t exceed adult doses

Generic Name: Albuterol

Onset: 5-15 min after inhalation

Duration: 3-4 hr after inhalation

Trade Name: Proventil, Ventolin

Classification: Bronchodilator, Sympathomimetic (ß2 selective)

Action/Effects: A beta2-adrenergic agonist which helps relax the bronchial smooth muscles

Indication: Asthma reversible bronchospasm associated with COPD

Contraindications: Known hypersensitivity to the drug, symptomatic tachycardia, cardiac dysrhythmia, angina, HTN, diabetes

Side Effects: Palpitations, anxiety, headache, dizziness, sweating, tremors, tachycardia

Routes:

Inhalation

Adult Dose: 2.5mg/3ml of NS

Pediatric Dose: 2.5mg in 3cc NS > 1 year old, 1.5mg in 3cc NS < 1 year old

Cautions: Be aware of prior doses/ can interact with diuretics, digoxin, beta- blockers, & MAO inhibitors/ can have toxicity effects on vascular system if used with tricyclic antidepressants

Generic Name: Amiodarone HCL

Onset: Within minutes

Duration: Variable

Trade Name: Cordarone

Classification: Antidysrhythmic

Action/Effects: Prolongs phase 3 of the cardiac action potential. Amiodarone increases the refractory period of sodium and potassium channels. This intern slows the cardiac action potential.

Indication: Ventricular arrhythmias, cardiac arrest (V-Fib, pulseless V-Tac) refractory paroxysmal SVT with cardioversion

Drug Interactions: Potentiate bradycardia and hypotension with beta and calcium blockers, increased risk of AV block and hypotension with calcium blockers, Y-site incompatibilities with furosemide, heparin, and sodium bicarbonate

Contraindication: Hypersensitivity, Pulmonary congestion, cardiogenic shock, hypotension, bradycardia

Side Effects: Lung problems, Liver Problems, Epididymitis in long term use

Adult Dose: 150-300 mg rapid IV/IO push (Expected 300mg IV loading dose) Check your protocols. (Expected 150 mg 2nd dose if needed)

Pediatric Dose: 5mg/kg IV/IO (Check your protocols for additional doses)

Generic Name: Amyl Nitrate

Onset: 30 seconds inhaled

Duration: 3-20 minutes

Trade Name: Vaporole

Classification: Vasodilator, Cyanide Antidote

Action/Effects: Causes oxidation of hemoglobin to the compound of methemoglobin. Vasodilatation, including coronary artery dilation. Smooth muscle relaxant

Indication: Cyanide poisoning

Contraindication: None when given for cyanide poisoning

Side Effects: Hypotension with syncope, Headache, Nausea & Vomiting

Adult Dose: 0.3ml or an Amyl Nitrate glass pearl (similar to ammonia)

Break ampule & inhale for 30 seconds, then 100% O2 for 50- 100 seconds, monitor blood pressure

Generic Name: Aspirin

Onset: 15 min

Duration: 2 - 4 hours

Trade Name: ASA, Baby Aspirin, Bayer

Classification: Platelet inhibitor, anti-inflammatory, Antipyretic, NSAID

Action/Effects: Decreases platelet aggregation, prolongs clotting time. Antipyretic Activity

Indication: New-onset chest pain suggestive of MI

Contraindication: Hypersensitivity, Pt. already on anticoagulants, Bleeding Disorders

Side Effects: Heart Burn, Nausea, Wheezing, Tinnitus

Adult Dose: 160-325mg PO chewable (2-4 tablets 81mg per tablet)

Pediatric Dosage: Not recommended.

Expected Dose: 324 mg (total of 4 baby aspirin)

Cautions: Pediatrics, GI bleeds

Generic Name: Atropine Sulfate

Onset: Rapid

Duration: 2-6 hours

Trade Name: Atropine

Classification: Parasympatholytic, Anticholinergic agent

Action/Effects: Increases HR, Contractility, Automaticity, Conduction, & Dilation of the peripheral vessels. Works mainly on the Atrium

Indication: Symptomatic Bradycardia, Organophosphate Poisoning

Contraindication: Hypersensitivity, Tachycardia, Relative or not functional uses:2nd & 3rd degree AV heart block Side Effects: Increased Cardiac consumption, Dryness in mouth, Headache, Dizziness, Nausea & Vomiting

Adult Dose: Brady 0.5mg q 3-5 min IV/ET/IO 2-5mg for Organophosphate Poisoning (Vary w/Pt. symptoms) Pediatric Dose: 0.02mg/kg IV/IO/ET Minimum dose 0.1mg

Cautions: A-Fib, A-Flutter, Glaucoma, and COPD

Generic Name: Calcium Chloride

Trade Name: Calcium Chloride

Classification: Electrolyte

Action/Effects: Increases the force of myocardial contraction

Indication: hypocalcemia, hyperkalemia, calcium channel blocker toxicity, antidote for magnesium sulfate

Contraindication: Patients receiving digitalis

Side Effects: hypotension, asystole, bradycardia

Adult Dose: 2-4mg/kg of a 10% solution repeat every 10 min if necessary, IV

Cautions: Precipitate digitalis toxicity, precipitate sodium bicarbonate, tissue necrosis.

Generic Name: Diazepam

Onset: IV: Rapid, IM: 15-30 minutes, ET: Rapid

Duration: 15 min – 1 hour

Trade Name: Valium

Classification: Benzodiazepine, Anticonvulsant

Action/Effects: Antianxiety & anticonvulsant activity. Acts on the CNS to relax the

nervous system

Indication: Status Epilepticus, Severe Anxiety, Pacing

Contraindication: Hypersensitivity, Depressed Vital Signs, CNS depressions due to head

trauma

Side Effects: Respiratory Depression, Hypotension, Slurred Speech,

Confusion, Nausea, Ataxia

Adult Dose: 5-20mg IV/IO

Expected Dose: 5 mg IV increasing to desired effects, smaller doses for elderly patients

are needed (2-5mg)

Pediatric Dose: Pediatric 0.1mg/kg IV/ET/IO 0.5mg/kg PR

Cautions: EMT’s carry nothing to reverse a benzodiazepine over dose.

Generic Name: Diphenhydramine

Onset: max effects 1-3 hours

Duration: 6-12 hours

Trade Name: Benadryl

Classification: Antihistamine

Action/Effects: Blocks histamine receptors. This is at the H1 sites

High dose cause Anticholinergic activity.

Indication: Anaphylaxis, moderate to severe allergic reactions (secondary to

epinephrine)

acute extrapyramidal (dystonic) reactions Contraindication: Asthma, Hypersensitivity, Pregnancy, nursing mothers

Side Effects: Sedation, hypotension, dry mouth/throat, blurred vision, headache,

palpitations, tachycardia, bradycardia, paradoxical excitement in

children Adult Dose: 25-50mg IM/IV/IO, 15-30 min onset

Expected Dose: 25mg IM

Pediatric Dose: 1-2mg/kg IM/IV/IO

Note: Deliver IM injections into deep muscle mass & alternate sites

Generic Name: Dopamine

Onset: 2-4 min

Duration: 10-15 min

Trade Name: Intropin

Classification: Sympathomimetic, Inotrope and chronotropic effects

Action/Effects: Naturally occurring neurotransmitter. Stimulates dopaminergic, beta1/alpha1 adrenergic receptors in a dose dependant amount.

Indication: Cardiogenic shock & hypotension not resulting from hypovolemia

Contraindication: Hypersensitivity, V-Fib, tachydysrhythmias

Side Effects: Ventricular irritability, Hypertension, Headache, Infiltration causes necrosis, Nausea, Vomiting

Adult/Pediatric Dose:

800mg in a 500cc D5W or NS IV/IO

Expected Dose: 5-20mcg/kg/min titrating to increase systolic to 100

2-5 mcg/kg/min are renal effects for lowering BP

Cautions: If possible correct hypovolemia before Dopamine treatment with a fluid bolus. 500-1000cc DO NOT MIX with NaHCO3

Dopamine Conversion with 800 mg in 500cc mcg/kg/min w/60 ggts

Kg lbs 7

mcg 10 mcg

12 mcg

14 mcg

16 mcg

18 mcg

20 mcg

5 10 1 2 2 2 3 3 3 9 20 2 3 4 5 5 6 7

23 50 6 9 10 12 14 15 17 32 70 8 12 14 17 19 21 24 41 90 11 15 18 21 25 28 31 45 100 12 17 20 24 27 31 34 55 120 14 20 25 29 33 37 41 64 140 17 24 29 33 38 43 48 73 160 19 27 33 38 44 49 55 82 180 21 31 37 43 49 55 61 91 200 24 34 41 48 55 61 68 100 220 26 38 45 53 60 68 75 109 240 29 41 49 57 65 74 82 118 260 31 44 53 62 71 80 89 127 280 33 48 57 67 76 86 95 136 300 36 51 61 72 82 92 102 145 320 38 55 65 76 87 98 109 155 340 41 58 70 81 93 104 116 164 360 43 61 74 86 98 110 123 173 380 45 65 78 91 104 117 130 182 400 48 68 82 95 109 123 136

This formula is based on a 60gtts being used

60

Generic Name: D5W (Dextrose 5%)

Onset: N/A

Duration: Short term therapy

Trade Name: 5% dextrose in water

Classification: Hypotonic Solution

Action/Effects: D5W provides nutrients in the form of dextrose as well as free water.

Indication: Mixing medications (Lidocaine, Dopamine)

Contraindication: D5W should not be used as a fluid replacement for Hypovolemic states.

Side Effects: Rare in therapeutic dosages.

Adult Dose: Medication Dependent

Expected Dose: N/A

Pediatric Dose: N/A

Cautions: Use caution if used for main IV solution

Generic Name: Epinephrine 1-1,000 Onset: (SQ) 5-10 min (IV) 1-2 min

Duration: 5-10 min

Trade Name: Adrenalin 1-1,000

Classification: Bronchodilator, Cardiac Stimulant, Sympathomimetic

Action/Effects: SQ = Bronchodilator & relief of bronchial edema, Beta 1&2

IV = Increases HR, Vasoconstricts, Alpha 1 & Beta 1

Indication: Anaphylaxis, Acute Allergic Reactions, Asthma, Shock

Side Effects: Tremors, Dizziness, Anxiety, Palpitations, Tachycardia, Acute Hypertension

Adult Dose: Anaphylaxis: 0.3-0.5mg SQ./IM/IO

Upper Airway Stridor: 2mg of 1:1,000 in 3ml of NS

Shock treatment= Infusion: as inotrope/pressor.

2 mg in 500ml NS = 4 mcg/ml titrated to effect: Usual range 2 -

10 mcg/minute (0.01 - 0.1 mcg/kg/minute). (Raise BP S 70-100)

Pediatric Dose: 0.01mg/kg with a max dose of 0.3mg for anaphylaxis

*0.1mg/kg ET (1-1,000) q 3-5 min w/3-5cc flush for cardiac

Cautions: Use caution with pregnancy & preexisting heart disease

Note: Be sure you are using the correct Epinephrine. Both

Epinephrines’ can have the same uses depending route.

Epinephrine Drip The epi drip is similar to the lidocaine drip but with much less medication. With the epi drip, add only 1mg to a 250ml bag to achieve a concentration of 4mcg/ml. Epi drips are administered at a rate of 1-4mcg/min.

Generic Name: Epinephrine 1-10,000

Onset: (SQ) 5-10 min (IV) 1-2 min

Duration: 5-10 min

Trade Name: Adrenalin 1-10,000

Classification: Sympathomimetic, Cardiac Stimulant, Bronchodilator

Action/Effects: Increases cardiac resistance, BP, Electrical activity, O2 Needs,

contractility, & myocardial activity. Alpha 1 & Beta 1

Indication: Cardiac Arrest V-Fib, Pulseless V-Tach, Asystole, PEA, & profound

Bradycardia

Side Effects: Hypertension, Peripheral constriction

Adult Dose: 0.5-1mg IV/IO every 3-5 minutes

(ET is 2-2 ½ time the dose w/20cc flush)

Expected Dose: 1mg IV/IO

Max: None in a life threatening emergency

Pediatric Dose: 0.01mg/kg IV/IO with a max dose of 1mg IV/IO

0.1mg/kg ET (1-1,000) q 3-5 min w/3-5cc flush

Cautions: DO NOT mix with NaHCO3, Heat destroys this drug

Generic Name: Fentanyl

Onset: < 1 minute IV

Duration: 30 - 60 minutes IV

Trade Name: Sublimaze

Classification: Opioid Analgesic

Action/Effects: Combines with receptors sites in brain to produce potent analgesic effects.

Indication: Analgesia, sedation during RSI, 2nd drug choice for chest pain if morphine allergy. Possible sedation with approved protocol. (RSI)

Adverse Reactions:

Sedation, nausea, respiratory depression, miosis, hypotension rapid administration may result in chest wall rigidity that will not respond to neuromuscular blockade.

Contraindication: Respiratory Depression, Hypotension, Head injury, Dysrhythmias, MAO inhibitors,

myasthenia gravis (Muscles tires easy), Hypersensitivity.

Drug Interactions:

Alcohol and other CNS depressants potentiate effects.MAO inhibitors may precipitate hypertensive crisis.

Side Effects: Respiratory depression, Bradycardia, Hypotension or Hypertension, ICP, Nausea

Adult Dose: 25-50mcg IV/IO/ IM Max: 200mcg

Ped Dose:Over 2 y/o 1 mcg/kg IV (75 micrograms max) or 2 mcg/kg nasal (100 micrograms max)

Cautions: Pregnancy, Incompatible with pentobarbital and thiopental, Schedule II controlled substance.

Generic Name: Furosemide

Onset: Diuretic effects within 15-20 minutes, vasodilatory effects within 5 minutes when given IV.

Duration: 4-6 hours

Trade Name: Lasix

Classification: Loop Diuretic

Action/Effects: Inhibits the reabsorption of sodium & chloride in the kidney tubule & promotes increased urine formation & excretion

Indication: Pulmonary Edema, CHF

Contraindication: Pregnancy, Hypovolemic, & Hypokalemia

Side Effects: Dehydration, hypotension, Tinnitus/hearing impairment with long term affects

Adult Dose: 20-80mg IV/IO SLOW push to prevent tinnitus

Pediatric Dose: 1mg/kg IV/IO SLOW push to prevent tinnitus

Cautions: PUSH slowly & lower doses to avoid Tinnitus.

Generic Name: Glucagon

Onset: Within 1 minute

Duration: 9-17 minutes

Trade Name: GlucaGen

Classification: Pancreatic Hormone, Insulin Antagonist

Action/Effects: Raises glucose level by using the glycogen in the liver for glucose.

Stimulating glucose synthesis

Indication: Hypoglycemia with altered level of consciousness, Beta-blocker overdose.

Contraindication: Hypersensitivity

Side Effects: Hypotension, Nausea, Hypokalemia

Adult Dose: 1mg IM/IV/IO but usually given IM

Pediatric Dose: 0.02-0.03mg/kg IM/IV/IO with max of 1mg

Cautions: Pt. may have home emergency glucagon kit

May be used w/calcium channel blocker and beta-blocker toxicity

Generic Name: Glucose or Dextrose

Onset: N/A

Duration: Short term therapy

Trade Name: D 50, 50% Dextrose

Classification: Carbohydrate

Action/Effects: Raises BSL, using electrolytes

Indication: Hypoglycemia

Contraindication: Intracranial Hemorrhage, & possible CVA. Consider D25

Side Effects: Tissue necrosis if infiltration occurs with IV

Adult Dose: 25-50gms IV/IO only (lower doses may be given)

Expected Dose: 25gm/50ml given slowly

Pediatric Dose: 0.5-1gm/kg IV/IO with a max of 25gms (D25 for Under 1y/o) (D10 for Under 1 month old)

Cautions: Tissue necrosis if infiltration occurs with IV

Generic Name: Haloperidol

Onset: IV: 10-20 minutes, IM: 30-60 minutes

Duration: 12-24 hours

Trade Name: Haldol

Classification: Antipsychotic, Butyrophenone

Action/Effects: Blocks the stimulation of dopamine receptors in the brain, altering mood & behavior

Indication: Acute psychotic episodes

Contraindication: Pregnancy, Severe toxic CNS depression, Coma, Parkinson’s disease, Head injury, Hypersensitivity

Side Effects: Orthostatic Hypotension, Parkinson like symptoms, N & V, blurred vision, headache, drowsiness, diaphoresis

Adult Dose: 5-10mg IM / IV/IO

Expected Dose: 5mg IM

Cautions: Use cautions with patients that have cardiovascular disorders, Receiving Anticonvulsants, and anticoagulants.

Not recommended for pediatrics.

Generic Name: Hydroxocobalamin

Trade Name: Cyanokit

Classification: Cyanide Antidote

Action/Effects: Hydroxocobalamin combines with cyanide to form

cyanocobalamin which is excreted through the kidneys

Indication: Known or suspected cyanide exposure

Contraindication: None prehospital

Side Effects: Turns the patient bright red, transient hypertension.

Adult Dose: 5.0 g (in two vials of 2.5 g) each reconstituted with 100 mL of

NS infused over 15 minutes

Pediatric Dose: Contact medical control. 70 mg/kg up to 5 g.

Cautions: None prehospital. Suspect cyanide intoxication in victims of smoke

inhalation from closed space with altered mental status, unstable vital

signs, or cardiorespiratory arrest.

Generic Name: Ibuprofen

Onset: 30 min.

Duration: 4-6 hours

Trade Name: Advil, Motrin

Classification: Non-narcotic Analgesic, Antipyretic, NSAID

Action/Effects: Antipyretic Activity, Analgesic Activity – Inhibition of central

& peripheral prostaglandin synthesis. Reduces inflammatory response

through chemotaxis.

Indication: Fever, Pain, Inflammation Reducer

Contraindication: Hypersensitivity

Side Effects: G.I. intolerance, many others possible effects

Adult Dose: 200-800mg PO every 6-8 hours

(not a common treatment for adults in EMS)

Pediatric Dose: 10mg/kg PO max of 40mg/kg per day (liquid form)

Cautions: You may want to alternate with Acetaminophen

Generic Name: Lactated Ringers

Trade Name: LR

Classification: Isotonic fluid but is slightly more hypertonic than NS

Action/Effects: Assist in fluid replacement for dehydration or blood loss

Indication: IV fluid for IV maintenance or Electrolyte replacement

Precautions: CVA, Diabetics, Mixing with blood sets.

Adult Dose: 200-500cc

Pediatric Dose: 20cc/kg for fluid replacement

Max: 60cc/kg for pediatrics or 2-3 liters of fluid for adults

Generic Name: Lidocaine HCL

Onset: 30-90 seconds

Duration: 2-4 hours

Trade Name: Xylocaine, Xylocard

Classification: Antiarrhythmic Agent Action/Effects: Decreases the depolarization, automaticity, & excitability in the ventricles during the

diastolic phase by the direct action on the tissue, especially the Purkinje network.

Indication: V-fib/ V-Tach, Post V-fib/ V-Tach (after conversion), possible symptomatic PVC’s

Contraindication: Hypersensitivity to other amide type anesthetics, Stokes-Adams syndrome, Second or Third degree AV Block without an artificial pacemaker, Bradycardia

Side Effects: Seizures, Coma, Respiratory depression may occur if given rapidly or in high doses, Sinus Brady, Hypotension

Adult & Pediatric

Dose:

1mg-1.5mg/kg IV/ET/IO q 3-5 min followed by a drip of 1-4mg/minute depending on prior boluses. Pain related to IO use: Lidocaine 20-40 mg administered SLOWLY through attached pre-primed extension set prior to IO bolus or flush on alert patient.

Expected Dose: Initial dose: 1mg/kg IV/IO/ET or 2 ½ times the dose for ET 2nd doses: ½ initial dose for 2nd and subsequent dosing

Max:

3mg/kg

Cautions: ½ doses for over 70 years old, ½ dose for liver disease pt

Lidocaine Clock The lidocaine clock is based on a 4mg/ml concentration. Add 1gram into a 250ml bag and use a 60gtt/ml infusion set. If you want to give 1mg/min, run your drip at 1 drop every 4 seconds (15gtts/min). For 2mg/min, run 1 drop every 2 seconds (30gtts/min) and so on.

Generic Name: Magnesium Sulfate

Trade Name: Magnesium Sulfate

Classification: Electrolyte, antiarrhythmic and anticonvulsant

Action/Effects: CNS depressant

Indication: seizures of ecclampsia and pulseless ventricular tachycardia

Contraindication: myocardial damage, shock and tachydysrhythmias

Side Effects: hypotension, flushing, drowsiness, respiratory depression and circulatory collapse

Adult Dose: 1- 4 grams, IV ( intravenous ) and IM ( intramuscular )

Pediatric Dose:

Max: Cautions: hypotension , use caution when administering to patients who are

taking digitalis or have renal failure, administer slowly to reduce potential for side effects..

Generic Name: Meperidine HCL

Onset: IV (5 min), IM (10-15 min)

Duration: 2-4 hr

Trade Name: Demerol

Classification: Narcotic Analgesic, Opioid Analgesic

Action/Effects: Addictive narcotic that depresses the CNS & may relieve pain

Indication: Relief of moderate to severe pain

Contraindication:

Hypersensitivity, Non-localized injury (cranial, abdomen), hypotension,

bradycardia, patient taking MAO or selective serotonin reuptake inhibitors

Side Effects: Nausea, CNS depression, hallucination, seizures, headache, hypotension, coma

Adult Dose: 50-100mg IM/IV/IO

Expected Dose 50mg followed by an anti-emetic slow IVP

Pediatric Dose: 1-2mg/kg

Cautions: May mix with promethazine for increase and potentiate analgesics, protect

from light, May aggravate seizures especially in patients with renal insufficiency,

use with caution in patients with asthma and COPD

Generic Name: Midazolam

Onset: IV (1-3 min), IM (15-30 min)

Duration: 2-6 hr

Trade Name: Versed

Classification: Tranquilizer, Benzodiazepine, CNS depressant, Anti-seizure

Action/Effects: Anti-seizure, anti-convulsant, sedative, muscle relaxant

Indication: Seizures, Conscious sedation, Chemical restraint

Contraindication:

Hypersensitivity, depressed CNS, shock

Cautions:

Pregnancy, Should not be used in patients who have taken other CNS

depressants

Side Effects: Depressed CNS, N/V, blurred vision, headache, retrograde amnesia

Adult & Pediatric Dose:

IV /IO 0.1mg/kg up to 5mg [1-5min onset] IN 0.2mg/kg up to 10mg dose [3-7min onset] 1cc per nostril IM 0.1mg/kg up to 10mg dose[15-30min]

Expected Dose ADULT IV (not faster than 1 ml/min), IM, rectal [never bolus] IV 2-5mg, IN/IM 5-10mg 2nd doses may be given

Generic Name: Morphine Sulfate

Onset: 1-2 min

Duration: 2-7 hours Trade Name: (Morphine) MS

Classification: Narcotic analgesic, Opioid analgesic

Action/Effects: CNS depressant causes peripheral vasodilation, Vasodilator, reducing venous return and myocardial oxygen demand, decreases sensitivity to pain.

Indication: Moderate to severe pain with trauma. Chest pain associated with MI

Contraindication: Hypersensitivity, Head injury, CVA, Hypotension, and respiratory depression

Drug Interactions: CNS depressants potentate effects, phenothiazines potentiate analgesia, MAO inhibitors cause paradoxical excitation

Side Effects: Depressed CNS, constipation, dry mouth Adult Dose: IV/IO 2-4mg titrated to max of 15mg max. [immediate onset]

IM/SC 5-20mg [10-30min onset]

Pediatric Dose: IV/IO 0.1mg/kg. IM/IO/SC 0.1 – 0.2mg/kg

Expected Dose: IV/IO 2-4mg titrated to max of 15

Caution: Have Narcan ready in case of severe adverse reaction.

Generic Name: Naloxone

Onset: Within 2 minutes

Duration: 30-60 min

Trade Name: Narcan

Classification: Narcotic Antagonist, Opioid Antagonist

Action/Effects: Displace narcotics at the receptor sites in the CNS. Attaches to the receptors & inhibits the narcotics action

indication: Narcotic overdoses including the following: Codeine, Demerol, Dilaudid, fentanyl, Heroin,

Lortabs, Methadone, Morphine, Paregoric, Percodan, Tylox, Vicodin, synthetic analgesics,

Darvon, Nubain, Stadol, Talwin, alcoholic coma To rule out narcotics in coma of unknown

origin, Respiratory depression

Contraindication:

Hypersensitivity

Side Effects: N/V, Seizures, tachycardia, HTN, diaphoresis, blurred vision, withdrawal

Adult Dose: 2-4mg IV/IM/IN/ET/IO.

Possible Dose: 0.5-1mg IV/IO, 2mg IM/IN

Pediatric Dose: 0.1mg/kg IV/IO/IM with max of 2mg

Cautions: Administer with caution to narcotic dependent patients due to withdrawal effects. It can

cause seizure from withdrawal in chronic opiate users, Short-acting, should be augmented

every 5 minutes

Generic Name: Nitroglycerin

Onset: 1-3 minutes

Duration: 20-30 minutes

Trade Name: Nitrostat

Classification: Coronary Vasodilator

Action/Effects: Decreases cardiac work, increases circulation to the heart, dilates coronary & systemic arteries.

Indication: AMI, Pulmonary Edema, Hypertension emergencies, CHF

Contraindication: EMT-P Systolic <90, EMT-I Systolic <100, CVA, head injury, Hypersensitivity, Use of recent use of ED drugs (Cialis, Levitra,Viagra)within past 24 hours will cause hypotension

Side Effects: Severe Hypotension, Weakness, Headache, Syncope, dizziness, N/V

Adult Dose: 0.3-0.4mg Sublingual q 5min up to 3x (May come in spray or tablet) (Most doses are 0.4mg)

Cautions: If the pt. is wearing a nitroglycerin patch or paste, additional administration may not be effective.

Generic Name: 0.9% Sodium Chloride Injection USP

Trade Name: Normal Saline, NS

Classification: Isotonic Fluid IV

Action/Effects: Assists in the rehydration of fluid & electrolytes in the vascular system

Indication: IV maintenance, Fluid Bolus, Combination with blood sets on trauma PT’s, volume replacement, dehydration, hypotension

Contraindication: Hypersensitivity, pulmonary Edema

Side Effects: 3rd spacing of fluid is possible on bolus dosing, Pulmonary Edema

Dose: 200-500cc bolus or TKO, after listening to lung sounds

Pediatric Dose: 20cc/kg with a max of 60cc/kg, 10cc/kg pre-term to28days

Max: 3 L max for Trauma PT’s may be suggested. Heat Exhaustion or Dehydrated PT’s you may exceed the 3L max.

Cautions: Overloading pediatrics/geriatrics/ & Pulmonary Edema

Generic Name: Ondansetron

Onset: P.O. I.V. 15-30 min, I.M. 40 min

Duration: P.O., I.V. 4-8 hr

Trade Name: Zofran

Classification: Anti-emetic, Serotonin type 3 (5-HT3) antagonis

Action/Effects: Prevention & control of severe nausea. Calms vomiting reflex through vagal

afferent nerves.

Indication: Non-sedating anti-emetic is desirable for preventing nausea

Contraindication:

Hypersensitivity

Side Effects: Headache, Dizziness, Diarrhea

Adult Dose: 4mg IV/IO Slow push 2-5 minutes, 4mg IM Max: 8mg

Ped Dose: Over 2 y/o

0.1mg/kg IV/IO/ IM Max: 4mg

Caution: Give undiluted by direct I.V. if nausea and vomiting occur. Administer slowly,

over at least 30 seconds (preferably over 2 to 5 minutes). Use caution in

patients with impaired liver function.

Note: Zofran has no effect on motion sickness

Generic Name: Oxytocin

Onset: IV immediate, IM within 3-5 minutes

Duration: IV 20 minutes after the infusion stops, IM 30-60 minutes

Trade Name: Pitocin

Classification: Pituitary Hormone

Action/Effects: Stimulates uterine smooth muscle contraction, & helps expedite

constricting uterine blood vessels & controlling excessive hemorrhage.

Indication: Post-partum hemorrhage, AFTER infant and placenta delivery

Contraindication:

Hypertonic & hyperactive uterus, 2nd

fetus, maternal

bradycardia

Side Effects: Hypo/hypertension, N/V, seizures, anxiety, dysrhythmias, Fetal

Bradycardia. Stimulates lactation

Dose: 3-10 units IM/IO, AFTER infant and placenta

Expected Dose: 10 units IM

Generic Name: Promethazine

Onset: < 1 min IV

Duration: 4-6 hours

Trade Name: Phenergan

Classification: Antiemetic, CNS depressant, Antihistamine

Action/Effects: Produces an antihistamine and Antiemetic response,

It also potentiates narcotics and increases the effectiveness

Indication: Nausea & vomiting,

Potentiates sedative effects of analgesics (Meperidine)

Contraindication:

Hypersensitivity

Side Effects: Pronounced sedation, confusion, and Tissue irritation

Adult Dose Range:

25-50mg IV/IM/IO (Dilute with 10cc when given IV to lesson tissue

damage and reduces pt. discomfort.)

Expected Dose: 12.5-25mg with 10cc NS. Slow push

Pediatric Dose: 0.5mg/kg

Cautions: Tissue irritation is possible on IV infiltration or SQ area injection. Use

caution with pediatrics.

Generic Name: Sodium Bicarbonate

Onset: 2-10 minutes

Duration: 30-60 minutes

Trade Name: NaHCO3

Classification: Alkalinizing Agent

Action/Effects: Neutralizes acids, returning blood & body fluid to a more normal PH

instead of an acidosis state. (Increases pH)

Indication: Metabolic acidosis, Prolonged CPR or down time (more than

5-10 minutes), Tricyclic overdoses. (Tricyclic meds = Amitriptyline,

Desipramine, Endep, Janimine, Norpramin, Nortriptyline, Pamelor,

Surmontil, Tofranil, Triavil, Trimpramine)

Contraindication:

Hypersensitivity, Alkalosis patient.

Side Effects: Pushing a PH to an alkalosis state instead of neutralizing the ph.

Adult & Pediatric Dose:

1mEq/kg followed ½ the initial dose q 10 minutes. Use 4.2%

solution for pediatrics

Cautions: Avoid mixing with Epinephrine or Calcium.

Generic Name: Vasopressin

Onset: Immediate

Duration: Variable

Trade Name: Pitressin

Classification: Antidieretic Hormone

Action/Effects: directly stimulates smooth muscle V1 receptors, resulting in

vasoconstriction Indication: Alternate to Epi, Vasodilitory shock

Contraindication: Hypersensitivity, Responsive patients with coronary artery disease

Side Effects: MI,water intoxication, bradycardia, angina, arrhythmias, HTN anaphylaxis, bronchospasm, angioedema, venous thrombosis

Adult Dose: 40 units IV/IO push may replace Epi 1st or 2nd dose

Ped Dose: Cardiac 0.4-1 unit/kg IV/IO bolus

Caution: