Emergency Medications

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Adenosine (Adenocard)

• Class: Antidysrhythmic.
• MOA: Slows conduction through the AV node, dilates coronary and peripheral vessels. Half-life of 10-12 seconds.
• Indications: Narrow complex tachycardias, SVT.
• Contraindications: 2nd and 3rd degree AV blocks; caution with asthma history.
• Side effects: Transient asystole, chest pain, SOB, flushing.
• Adult dosage: 6mg rapid IV push with 20ml NS, repeat with 12mg if needed twice, base contact for pediatrics.

Albuterol (Proventil)

• Class: Sympathomimetic Bronchodilator.
• MOA: Beta II adrenergic stimulant, relaxes bronchial smooth muscle.
• Indications: Bronchospasm, asthma, emphysema, and bronchitis.
• Contraindications: Hypersensitivity, caution with CHF patients.
• Side effects: Anxiety, dizziness, tachycardia, palpitations, nausea.
• Dosage: 2.5mg in nebulizer over 5-15 minutes at 6-8 LPM, may repeat twice; same dose for pediatrics.

Aspirin (Bayer, A.S.A.)

• Class: Anti-platelet.
• MOA: Inhibits platelet aggregation via thromboxane formation.
• Indications: Chest pain of unknown etiology, MI, TIA.
• Contraindications: GI bleed history, intracranial hemorrhage, hypersensitivity, major surgery in past 1-2 weeks, previous thrombosis, AAA history.
• Side effects: Nausea, vomiting, and hemorrhage.
• Adult Dosage: 325mg PO (four 81mg tablets), not indicated for pediatrics.

Atropine Sulfate (Atropine)

• Class: Parasympatholytic Agent.
• MOA: Blocks acetylcholine receptors, increases heart rate in bradycardia originating above ventricles.
• Indications: Bradycardia, organophosphate poisonings.
• Contraindications: Documented MI, 2nd and 3rd degree AV blocks, children <8 in cardiac emergencies.
• Side effects: Increased heart rate and blood pressure.
• Adult dosage: 0.5mg IV, repeat every 5 minutes to max of 3mg for bradycardia. 2mg IV, repeat in 2mg increments for organophosphate poisoning; not indicated for pediatrics.

Atrovent (Ipratropium Bromide)

• Class: Parasympatholytic Bronchodilator.
• MOA: Blocks acetylcholine receptors, inhibiting parasympathetic stimulation, bronchodilates, and dries respiratory secretions.
• Indications: Acute bronchospasms.
• Contraindications: Hypersensitivity, peanut, and soy allergies.
• Side effects: Nausea, vomiting, epistaxis, nervousness, headache.
• Adult Dosage: 0.5mg nebulized over 5-15 minutes at 6-8 LPM, one dose only.
• Pediatric dosage: 0.25mg for 1 day to 12 months, 0.5mg for 1-14 years, one dose only.

Calcium Chloride (Calcium Chloride)

• Class: Electrolyte.
• MOA: Increases myocardial contractile force, enhances ventricular excitability.
• Indications: Calcium channel blocker overdose/poisoning.
• Contraindications: V-fib, hypercalcemia, and digitalis toxicity.
• Side effects: Bradycardia, arrhythmias, cardiac arrest, syncope.
• Dosage: Base hospital order only; 1gm IV for adults.

Dextrose (D10W)

• Class: Carbohydrate.
• MOA: Provides a rapid glucose source for cellular metabolism.
• Indications: Hypoglycemia.
• Contraindications: Hyperglycemia.
• Side effects: Hyperglycemia and tissue necrosis.
• Adult dosage: Dextrose 10%/250ml (D10W 25gm) IV/IO bolus.
• Pediatric dosage: (neonates (0-4 weeks) whose blood glucose <35 mg/dL or pediatric patients (greater than 4 weeks) whose blood glucose <60mg/dL) Dextrose 10%/250ml (D10W 25gm) 0.5gm/kg (5ml/kg) IV/IO.

Diphenhydramine (Benadryl)

• Class: Antihistamine.
• MOA: Blocks histamine release by competing for H1 receptor sites.
• Indications: Allergic reactions/anaphylaxis symptoms.
• Contraindications: Hypersensitivity to similar antihistamines.
• Side effects: Fatigue, headache, sedation, sleepiness, dizziness.
• Adult dosage: 50mg IM or 25mg IV/IO slowly.
• Pediatric dose: 2mg/kg IM or 1mg/kg IV/IO slowly, not to exceed adult dose.

Epinephrine (Epi, Adrenaline)

• Class: Sympathomimetic, Endogenous Catecholamine.
• MOA: Adrenergic receptor with alpha & beta actions, vasoconstricts, increases heart rate and contractility, may convert fine V-fib to coarse V-fib.
• Indications: PEA/Asystole, Anaphylaxis, Bronchospasms.
• Contraindications: None for Cardiac Arrest, caution with patients over 40 or history of CAD or Hypertension.
• Side effects: Increased heart rate, hypertension, weakness, dizziness, syncope.
• Adult dosages: Cardiac Arrest, Asystole, PEA-1mg IV/IO (1:10,000 Solution) repeat after 2 minutes cycle of CPR. Allergic Reaction: 0.1mg IVP/IO, may repeat every 5 minutes to max of 0.5mg (1:10,000 Solution). Allergic Reaction/Bronchospasm: 0.3mg IM (1:1,000 Solution), may repeat once after 15 minutes.
• Pediatric dosages: Cardiac Arrest-0.01mg/kg IV/IO (1:10,000) (do not exceed adult dose); 9-14 years: 1mg IV/IO. Anaphylactic Shock-0.01mg/kg SC (1:10,000) no more than 0.1mg per dose, may repeat to a maximum of 0.5mg. Severe Bronchospasm: 0.01mg/kg IM not to exceed adult dosage of 0.3mg

Fentanyl (Duragesic, Sublimaze)

• Class: Opioid analgesic, synthetic narcotic.
• MOA: Binds to opioid receptors, blocking pain signal transmission to the brain.
• Indications: Isolated extremity trauma, burns, chest pain, cardioversion, pacing.
• Contraindications: Fentanyl allergy, caution advised for pregnant patients.
• Side effects: Respiratory depression, bradycardia, dizziness, nausea, vomiting.
• Dosage for adults: for Trauma, burns: 50mcg IV/IO over 1 minute, repeat after 5 minutes up to 200mcg; 100mcg IN/IM, repeat at 50mcg after 10 minutes up to 200mcg. For Pacing, cardioversion: 50mcg IV/IO over 1 minute, repeat after 5 minutes up to 200mcg; 100mcg IN, may repeat at 50mcg after 10 minutes up to 200mcg.
• Dosage for pediatrics: 5mcg/kg slow IV/IO over 1 minute, repeat after 5 minutes not to exceed 100mcg; 1mcg/kg IM/IN every 10 minutes not to exceed 200mcg.

Glucagon (Glucagen)

• Class: Pancreatic Hormone.
• MOA: Elevates blood glucose by breaking down glycogen in the liver. Can act as a smooth muscle relaxant and stimulates the sympathetic nervous system.
• Indications: Hypoglycemia, beta-blocker OD.
• Contraindications: Hypersensitivity & hyperglycemia.
• Side effects: Hyperglycemia, dizziness & headache.
• Adult dosage: 1mg IM/SC/IN for hypoglycemia, once only. Beta blocker OD is 1mg IV/IO, base contact only.
• Pediatric dosage: 0.025mg/kg IM/IN, may repeat once after 20 minutes up to a max of 1mg.

Ketamine (Ketalar)

• Class: Sedative, analgesic dissociative anesthetic.
• MOA: Blocks pain receptors and minimizes spinal cord activity.
• Indications: Excited delirium, pain management, procedural sedation.
• Contraindications: Hypersensitivity, conditions where HTN would be hazardous.
• Side effects: HTN, dysrhythmia, bronchodilation, respiratory depression.
• Adult and Pediatric dosage: 1 to 2 mg/kg IVP over 5-10 minutes.
• Contraindicated in pregnant women. Administer ketamine dose of 0.3 mg/kg to a max of 30 mg in a 50-100 cc bag slow IV drip over five (5) minutes.

Lidocaine (Xylocaine)

• Class: Antidysrhythmic.
• MOA: Suppresses ectopic pacemakers, elevates the electrical stimulation threshold.
• Indications: V-Tach, V-fib, intubation w/head injury, prior to IO infusion.
• Contraindications: 2ND & 3RD Degree AV Blocks, do not give in conjunction w/ PVC's or Bradycardia, hypersensitivity.
• Side effects: Irritability, Confusion, Seizures, ALOC, Coma.
• Adult dosage: PULSELESS V-Tach/V-fib-1.5mg/kg IV/IO after 2 minute cycles of CPR, may repeat twice at 0.75mg/kg to a max of 3mg/kg IO INFUSION- Administer 0.5mg/kg slow IO push to a max of 40mg.
• Pediatric dosage: CARDIAC ARREST- V-fib/Pulseless V-Tach- 1.0mg/kg IV/IO, may repeat at 0.5mg/kg after 5 minutes up to a max dose of 3mg/kg

Magnesium Sulfate (Magnesium)

• Class: Electrolyte.
• MOA: Essential for neurotransmission & muscle excitability.
• Indications: Torsades de pointes & seizures related to eclampsia.
• Contraindications: Shock, hypocalcemia, hypertension, and heart blocks.
• Side effects: Drowsiness, respiratory depression, hypotension, and circulatory collapse.
• Adult dosage: SEIZURES/ECLAMPSIA-4gm diluted w/ 20ml of NS over 3 to 4 minutes, TORSADES DE POINTES- 2gm in 100ml of NS infused over 5 minutes.
• Pediatric: Not Indicated.

Midazolam (Versed)

• Class: Sedative/hypnotic.
• MOA: A benzodiazepine w/ amnesic properties, relaxes skeletal muscle during seizure activity, used for amnesic properties .
• Indications: Seizure activity, cardioversion & pacing.
• Contraindications: Allergies to cherries, signs of inadequate tissue perfusion, sensitivity & shock
• Side effects: Bronchospasm, dyspnea, respiratory depression & bradycardia
• Adult dosage: For seizures, give 5mg IM, repeat every 10 minutes; or 2.5mg IV/IO/IN, repeat every 5 minutes, max of 3 doses. Cardioversion/Pacing- 2mg IV/IO/IN
• Pediatric dosage: For seizures: 0.1mg/kg IV/IO up to a max of 2.5mg, or 0.2mg/kg IM/IN up to a max of 5mg. Max of 3 doses.

Naloxone (Narcan)

• Class: Narcotic Antagonist.
• MOA: Reverses narcotics effects by competing for opiate receptors.
• Indications: ALOC w/ suspicion of narcotic use, respiratory depression & constricted pupils.
• Contraindications: Hypersensitivity.
• Side effects: Nausea, vomiting, sweating & tachycardia.
• Dosage: 0.5mg IV/IO/IM/IN, repeat every 2-3 minutes if needed to a max of 10mg, for both adults and peds.

Nitroglycerine (Nitrostat)

• Class: Smooth Muscle Relaxant.
• MOA: Direct vasodilator, increases perfusion to ischemic tissue, reduces work/oxygen consumption.
• Indications: Chest Pain, Left sided MI, CHF, Pulmonary Edema.
• Contraindications: Inadequate tissue perfusion, right sided MI & Recent use of sexual enhancements within the past 48 hours.
• Side effects: Hypotension, headache & flushing.
• Adult dosage: 0.4mg metered dose, repeat as needed with signs of adequate tissue perfusion, not indicated for pediatrics.

Ondasetron (Zofran)

• Class: Antiemetic
• MOA: Blocks serotonin release, reduces vagus nerve activity.
• Indications: Nausea, vomiting
• Contraindications: Allergy to Ondansetron, Granisetron, Dolasetron or Palonosetron or other serotonin blockers
• Side effects: : Headache, lightheadedness, dizziness, drowsiness, QT prolongation
• DOSAGES: 4-8 years old-4mg ODT or 4mg IV, 4mg total prior to contact 9 and older-4mg ODT or 4mg IV, may repeat twice at 10 minute intervals for total of 12mg

Sodium Bicarbonate (Sodium Bicarbonate)

• Class: Electrolyte.
• MOA: Neutralizes hydrochloric acid, systemic urinary alkalizer.
• Indications: Extended downtime during cardiac arrest & tricyclic antidepressant overdose/poisoning
• Contraindications: No real contraindications, but too much given can cause metabolic alkalosis
• Side effects: Metabolic alkalosis
• Adult dosage: BASE HOSPITAL ORDER ONLY- TRICYCLIC OVERDOSE/POISONING- 1mEq/kg IV/IO pediatric dosages- BASE HOPITAL ORDER ONLY

Tranexamic Acid (TXA) (Cyklokapron, Lysteda)

• Class: Hemostatic agent, antifibrinolytic.
• MOA: Reduces plasminogen activation.
• Indications: Blunt or penetrating trauma less than 3 hours from onset with hemodynamic compromise, bleeding.
• Contraindications: Hypersensitivity, MOI greater than 3 hours; history of PE, DVT or other thrombolytic disorder
• Side effects: Fatigue, headache, abdominal pain, anemia, DVT, PE, other thrombolytic disorder. Rapid infusion may cause hypotension.
• DOSAGES: Administer TXA 1 gm in 50 - 100 ml of NS via IV/IO over ten (10) minutes. Do not administer IVP as this will cause hypotension.

Test your knowledge of emergency medications, including Albuterol, Calcium Chloride, Adenosine, Atrovent (Ipratropium Bromide), and Epinephrine. Questions cover mechanisms of action, contraindications, side effects, dosages, and indications for each medication in emergency medical scenarios.