San Bernadino County Drug Guide: Acetaminophen, Adenosine

• Drug book for San Bernadino County, revised 11/24, compiled by Robert Armani contains:

Acetaminophen (Tylenol)

• Class: Analgesic, antipyretic, (NSAID)
• MOA: Elevates pain threshold in the CNS and acts on hypothalamic thermoregulatory centers
• Indications: Mild to moderate pain scales of 1-5 or in moderate to severe pain where other medications are contraindicated or deferred
• Contraindications: Hypersensitivity, children younger then 2 years old
• Side Effects: Dizziness, lethargy, n/v, abdominal pain, diarrhea, diaphoresis, chills
• Dose (Adult): 1 gm IV/IO infusion over 15 minutes, single dose only
• Dose (Pediatrics 2 days-14 years): 15 mg/kg to max of 1 gm IV/IO infusion over 15 minutes, single dose only
• Packaging: 10mg/mL

Adenosine

• Class: Antidysrhythmic
• MOA: Depresses automaticity in SA node, slows conduction of SA and AV nodes, inhibits re-entry through AV node
• Indications: Stable Narrow Complex Tachycardia, SVT, unresponsive to valsalva maneuver
• Contraindications: Hypersensitivity, 2nd/3rd degree AV Block, History of Sick Sinus Syndrome, Patients on Tegretol or Persantine
• Side Effects: Chest Pain, Hypotension, Heart Blocks, Bradycardia, Asystole, PVCs, Dizziness, SOB, Flushing
• Dose (Adult): 6mg, 12mg, 12mg RIVP, Followed by 20m NS Bolus
• Packaging: (3mg/mL)

Albuterol

• Class: Sympathomimetic (relatively Beta-2 specific), bronchodilator
• MOA: Relaxes bronchial smooth muscle (stimulation of beta-2 receptors) causing bronchodilation & reduction of airway resistance.
• Indications: Asthma, bronchospasms, allergic reactions, COPD, bronchitis, toxic gas inhalation, near drowning, wheezing
• Contraindications: Hypersensitivity, symptomatic tachydysrhythmias
• Side Effects: Chest pain, tachycardia, palpitations, arrhythmias, hypertension, headache, dizziness, tremors, nervousness, anxiety, nausea, coughing, wheezing
• Dose (Adult/Pediatrics): 2.5 mg nebulized, may repeat two (2) times
• Dose (Adult/Pediatrics): MDI, (4) puffs every 10 min for continued SOB/ wheezing
• Packaging: 2.5mg/Bullet

Aspirin

• Class: Anticoagulant, (NSAID), Antipyretic, Analgesic
• MOA: Impedes clotting action and prolongs bleeding by blocking platelet aggregation by slowing prostaglandin synthesis action, which also impedes inflammation response
• Indications: AMI or myocardial ischemia
• Contraindications: Hypersensitivity, history of gastrointestinal bleeding/ ulcers or known bleeding disorders
• Side Effects: Prolonged bleeding, nausea, vomiting, heartburn, GI bleeding, epigastric pain
• Dose: 325 mg PO chewed or four (4) chewable 81 mg aspirin
• Packaging: 81mg/tablet

Atropine

• Class: Parasympatholytic (cholinergic blocking agent) Antidysrhythmic agent, bronchodilator, antidote
• MOA: Decreases action of the parasympathetic nervous system by blocking cholinergic receptors: Increases heart rate and increases conduction through atrioventricular (AV) junctional node (blocking vagal tone), Causes bronchodilation and reduces respiratory secretions, Decreases gastrointestinal secretions and motility
• Indications: Symptomatic bradycardia, Organophosphate (pesticide) or Nerve Agent poisoning
• Contraindications: Stable PT, 2* II HB, 3*HB, Documented MI
• Side Effects: Tachycardia, hypertension, palpitations, increases myocardial oxygen demand, seizures, dizziness, confusion, dilated pupils, blurred vision, difficulty swallowing, dry mouth, hot, dry skin, headache
• Dose (Bradycardia): 1 mg IV/IO, may repeat every five (5) minutes up to a maximum of 3 mg or 0.04 mg/kg
• Dose (Organophosphate poisoning): Atropine, 2 mg IV/IO, repeat at 2 mg increments every five (5) minutes if patient remains symptomatic
• Dose (Pediatric >14: Organophosphate poisoning): Atropine, 0.05 mg/kg IV/IO not to exceed adult dose of 2 mg, repeat at 0.1 mg/kg increments every five (5) minutes if patient remains symptomatic
• Packaging: 1mg/10mL (0.1mg/mL)

Calcium Chloride

• Class: Electrolyte, antidote
• MOA: Increases inotropy and automaticity (ventricular), Restores myocardial conduction in presence of hyperkalemia, Actively competes with potassium ions at cardiac and neuromuscular receptors
• Indications: Calcium Channel Blocker Poisonings, Cardiac arrest with suspected hypocalcemia, hyperkalemia, hypermagnesemia, (ESRD) patients on dialysis with suspected hyperkalemia and hemodynamic instability with documented sinus bradycardia, 3rd degree AV Block, 2nd degree Type II AV Block, slow junctional and ventricular escape rhythms, or slow atrial fibrillation.
• Contraindications: Hypercalcemia, digitalis toxicity, ventricular fibrillation, cardiac arrest of other etiologies
• Side Effects: Bradycardia, hypotension, syncope, headache, nausea, vomiting, dizziness, acidosis
• Dose (Cardiac Arrest/ CCB OD): 1 gm IV/IO, BASE ORDER ONLY for all indications
• Dose (Pediatric Calcium Channel Blocker Poisonings): 20 mg/kg IV/IO over five (5) minutes, BASE ORDER ONLY
• Packaging: 1gm/10mL (100mg/mL)

Dextrose (D10)

• Class: Carbohydrate, Hyperglycemic Agent
• MOA: Increases blood glucose levels to provide an immediate source of glucose that can be rapidly used for cellular metabolism
• Indications: Adult hypoglycemia: <80 mg/dl, Pediatric (4 weeks-15 y/o) hypoglycemia: <60 mg/dl, Neonate (0-4 weeks) hypoglycemia: <35 mg/dl
• Contraindications: None in emergency setting with presence of hypoglycemia
• Side Effects: Venous irritation, necrosis if infiltrated
• Dose (Adult): 25 gm/ 250ml Bolus
• Dose (Pediatric/Neonates): 0.5 gm/kg (5 ml/kg) IV/IO
• Packaging: 25g/250mL (100mg/mL)

Diphenhydramine (Benadryl)

• Class: Antihistamine
• MOA: Competes with histamines at receptor sites
• Indications: Anaphylaxis secondary to Epinephrine, Mild - Moderate allergic reactions
• Contraindications: Hypersensitivity, Neonates or Premature Infants, Nursing Mothers
• Side Effects: Hypotension, tachycardia, palpitations, drowsiness, nausea, vomiting
• Dose (Adult): 25 mg IV/IO or 50 mg IM
• Dose (Pediatric 2 years to 14 years): 1 mg/kg slow IV/IO or 2 mg/kg IM not to exceed adult dose
• Packaging: 50mg/mL

Epinephrine (1mg/mL)

• Class: Sympathomimetic
• MOA: Catecholamine which acts directly on both Alpha and Beta adrenergic receptors; increases heart rate, strength, contractility, dilated bronchiole and smooth muscle, increases BP, increases automaticity
• Indications: Severe Bronchospasm/Asthma Attack, Pending Respiratory Failure, Severe Allergic Reaction
• Contraindications: Hypertension, Tachydysrhythmias, CONSULT BASE if age over 40, HX of HTN, or CAD
• Side Effects: Palpitations, Anxiety, Headache, Nausea, Vomiting
• Dose (Adult): 0.3 mg IM, May repeat after 15 minutes one (1) time if symptoms do not improve
• Dose (Pediatric): 0.01 mg/kg IM not to exceed adult dosage of 0.3 mg, May repeat after 15 minutes one (1) time if symptoms do not improve
• Packaging: 1mg/mL Ampule

Epinephrine (0.1mg/mL)

• Class: Sympathomimetic
• MOA: Catecholamine which acts directly on both Alpha and Beta adrenergic receptors; increases heart rate, strength, contractility, dilated bronchiole and smooth muscle, increases BP, increases automaticity
• Indications: For persistent severe anaphylactic reaction, Cardiac arrest, asystole, PEA, Newborn care, persistent hypotension, newborn bradycardia
• Contraindications: None in cardiac arrest
• Side Effects: Increased Myocardial O2 Demand
• Dose (Adult persistent severe anaphylactic reaction): 0.1 mg slow IVP/IO. May repeat every five (5) minutes as needed to total dosage of 0.5 mg
• Dose (Adult Cardiac Arrest, Asystole, PEA): 1 mg IV/IO
• Dose (Pediatric Anaphylactic Reaction): 0.01 mg/kg IV/IO, no more than 0.1 mg per dose. May repeat to a maximum of 0.5 mg
• Dose (Pediatric Cardiac Arrest: (1 day to 8 years)): 0.01 mg/kg IV/IO (do not exceed adult dosage)
• Dose (Adult Auto injector): For severe asthma and/or anaphylaxis, 0.3 mg auto-injector, may repeat once after 15 minutes
• Dose (Pediatric Auto injector): For anaphylaxis only, 0.15 auto-injector
• Dose (Pediatric Cardiac Arrest (9 to 14 years)): 1 mg IV/IO
• Dose (Newborn Care (0-4 weeks)): 0.01 mg/kg IV/IO if heart rate is less than 60 after one (1) minute after evaluating airway for hypoxia and assessing body temperature for hypothermia
• 0.005 mg/kg IV/IO every 10 minutes for persistent hypotension as a BASE HOSPITAL ORDER or in radio communication failure
• Packaging: 1mg/10mL (0.1mg/mL) 

Epinephrine (0.01mg/mL)

• Class: Inotropic agent, Vasopressor
• MOA: Targets alpha and beta receptors increases BP by increasing heart rate, stroke volume and vasoconstriction
• Indications: Post resuscitation, persistent profound shock and hypotension, Persistent shock due to trauma where cardiac arrest is imminent
• Contraindications: NONE
• Side Effects: Tachycardia, increased Myocardial O2 Demand, anxiety, n/v, hypertension
• Dose (Adult): 1ml, Administer 1 ml every one (1) to five (5) minutes titrated to maintain SBP more than 90 mm Hg
• Dose (Pediatric): 0.1 ml/kg (do not exceed adult dosage), Every one (1) to five (5) minutes, Titrate to maintain a SBP more than 70 mm Hg
• To prepare, draw up 1mL of Epinephrine, and 9mLs of N.S agitate and label

Fentanyl

• Class: Narcotic analgesic, opiate agonist, CNS depressant
• MOA: Alters pain perception by binding to opiate receptors; increases pain threshold
• Indications: Chest Pain, Acute traumatic injuries, Burn injuries, Acute abdominal/flank pain, Cancer pain, Sickle Cell Crisis, Pacing, Synchronized cardioversion
• Contraindications: Hypersensitivity, myasthenia gravis, head injury
• Side Effects: Bradycardia, hypotension, blurred vision, respiratory depression, weakness, dizziness, n/v, ALOC
• Dose (Chest Pain (Presumed Ischemic Origin)): 50 mcg slow IV/IO over one (1) minute, may repeat every five (5) minutes titrated to pain, not to exceed 200 mcg, 100 mcg IM/IN, may repeat 50 mcg every 10 minutes titrated to pain, not to exceed 200 mcg
• Dose (Acute traumatic injuries, acute abdominal/flank pain, burn injuries, Cancer pain, Sickle Cell Crisis): 50 mcg slow IV/IO push over one (1) minute, may repeat every five (5) minutes titrated to pain, not to exceed 200 mcg IV/IO, or 100 mcg IM/IN, may repeat 50 mcg every 10 minutes titrated to pain, not to exceed 200 mcg
• Dose (Pacing/ Synchronized cardioversion): 50 mcg slow IV/IO over one (1) minute, may repeat in five (5) minutes titrated to pain, not to exceed 200 mcg, 100 mcg IN. May repeat 50 mcg every 10 minutes titrated to pain, not to exceed 200 mcg. Any combination of IV/IO/IM/IN may be administered, not to exceed 200 mcg.
• Dose (Pediatric Traumatic injuries and burns): 0.5 mcg/kg slow IV/IO over one (1) minute. May repeat in five (5) minutes titrated to pain, not to exceed 50 mcg for a single dose, 1 mcg/kg IM/IN, may repeat every 10 minutes titrated to pain not to exceed 100 mcg for a single dose, Any combination of IV/IO/IM/IN may be administered, not to exceed four (4) doses or cumulative maximum of 200 mcg
• Packaging: 100mcg/2mL (50mcg/mL)

Glucose

• Carbohydrate, hyperglycemic agent
• MOA: Increased blood glucose levels to serve as an immediate sources of glucose which is rapidly utilized for cellular metabolism.
• Indications: Patients with an intact gag reflex and hypoglycemia
• Contraindications: Unresponsive patients, patients who are unable to swallow or have a diminished gag reflex
• Side Effects: Aspiration, obstructed airway, vomiting/nausea
• Dose (Adults): <80 mg/dl ,Oral (1) tube
• Dose (Neonates): (0 - 4 weeks <,35 mg/dL Oral (1) tube
• Dose (Pediatric) (4 weeks- 15 y/o): <60 mg/dL Oral (1) tube
• Packaging: 24 grams/tube

Glucagon

• Class: Antihypoglycemic agent, Antidote
• MOA: A protein secreted by the alpha cells of the pancreas, which causes breakdown of stored glycogen to glucose, therefore increasing blood glucose levels, Also inhibits the synthesis of glycogen from glucose
• Indications: Hypoglycemia, Beta-blocker poisoning
• Contraindications: Adrenal insufficiency, hypersensitivity, malnutrition
• Side Effects: Tachycardia, n/v, hypertension
• Dose (Adult hypoglycemia): 1 mg IM/SC/IN, if unable to establish IV, may administer one (1) time only
• Dose (Adult Beta blocker Poisoning): 1 mg IV/IO, BASE ORDER ONLY
• Dose (Pediatric Hypoglycemia): 0.03 mg/kg IM/IN May be repeated one (1) time after 20 minutes for a combined maximum dose of 1 mg, if unable to establish IV
• Dose (Pediatric Beta blocker poisoning): 0.03 mg/kg IV/IO (BASE ORDER ONLY)
• Packaging: 1mg/mL

Ipratropium Bromide (Atrovent)

• Class: Bronchodilator, Parasympatholytic
• MOA: Anticholinergic agent, acts directly on smooth muscle of the bronchial tree by inhibiting ACH at receptor sites; blocks parasympathetic action it dilates the bronchial smooth muscle and decreases secretions
• Indications: Asthma, COPD, allergic reactions
• Contraindications: Hypersensitivity
• Side Effects: Headache, nausea, vomiting, weakness, dizziness, palpitations, tachycardia, hypertension, airway dryness
• Dose (Adult Ipratropium Bromide/ 1year-14 y/o)): 0.5 mg nebulized, Administer one (1) dose only.
• Dose (Ipratropium Bromide 1 day to 12 months): 0.25 mg nebulized, Administer one (1) dose only
• Packaging: 0.5mg/Bullet

Ketamine

• Class: Hypnotic, sedative, amnestic, CNS depressant
• MOA: Fast acting CNS agent used to induce anesthesia which does not cause muscle relaxation
• Indications: Acute traumatic injury/ Burn injuries, Acute abdominal/flank pain burn, Cancer related pain and sickle cell crisis
• Contraindications: Hypersensitivity to drug, head injury
• Side Effects: Hypertension, tachycardia, hypotension, respiratory depression, nausea, vomiting, drowsiness
• Dose: 0.3 mg/kg to a max of 30 mg in a 50 - 100 ml of NS via IV over five (5) minutes, May repeat one (1) time, after 15 minutes, if pain score remains at five (5) or higher, DO NOT administer IVP, IO, IM, or IN
• Packaging: 500mg/5mLs (100mg/mL)

Lidocaine

• Class: Antidysrhythmic (Class II – Sodium channel blocker), local anesthetic
• MOA: Suppresses ventricular ectopy and dysrhythmias, Increases ventricular fibrillation threshold, Decreases automaticity & speed of electrical impulse through the conduction system
• Indications: VT (pulseless)/VF, V-Tach, Wide Complex Tachycardia - with Pulses, Pain associated with IO infusion
• Contraindications: Hypersensitivity 2nd and 3rd degree Heart Blocks, Junctional rhythms, Idioventricular rhythms, Bradycardic rhythms
• Side Effects: Bradycardia, arrest, respiratory depression, respiratory arrest, seizures, n/v, anxiety, drowsiness, confusion, widening QRS complex, lightheadedness, hypotension, dyspnea, paraesthesias, restlessness, slurred speech
• Dose (VT (pulseless)/VF: Initial Dose): 1.5 mg/kg IV/IO
• For refractory VT (pulseless)/VF, may administer an additional 0.75 mg/kg IV/IO, repeat one (1) time in five (5) to 10 minutes; maximum total dose of 3 mg/kg
• Dose (V-Tach, Wide Complex Tachycardia - with Pulses): 1.5 mg/kg slow IV/IO May administer an additional 0.75 mg/kg slow IV/IO; maximum total dose of 3 mg/kg
• Dose (Cardiac Arrest(1 day to 14 y/o)): 1.0 mg/kg IV/IO May repeat Lidocaine at 0.5 mg/kg after five (5) minutes; maximum total dose of 3 mg/kg
• Dose (Pain associated with IO infusion): 0.5 mg/kg slow IO push over two (2) minutes, not to exceed 40 mg total
• Packaging: 100mg/5mL (20mg/mL)

Magnesium Sulfate

• Class: Electrolyte, Antidysrhythmic, Anticonvulsant, CNS depressant
• MOA: Essential for Na+ - K+ ATP pumps, Decreases Acetylcholine in motor nerve terminals, produces neuromuscular blockade in CNS, physiological calcium channel blocker
• Indications: Torsades, Eclampsia, Severe Asthma/Respiratory distress
• Contraindications: Heart blocks, hypersensitivity, hypermagnesemia
• Side Effects: Bradycardia, respiratory depression, flushing, sweating, drowsiness, hypotension, heart blocks
• Dose (Polymorphic Ventricular Tachycardia): 2 gm IV/IO bolus over five (5) minutes for polymorphic VT if prolonged QT is observed during sinus rhythm post-cardioversion
• Dose (Eclampsia): See polymorphoc ventricular tachycardia, Eclampsia (Seizure/Tonic/Clonic Activity)
• Dose (Severe Asthma/Respiratory Distress): 2 gm slow IV drip over 20 minutes, Do not repeat BASE ORDER ONLY
• Dose (Pediatric Severe Asthma/Respiratory Distress): 50 mg/kg slow IV drip over 20 minutes, Do not exceed the adult dosage of 2 gm total. Do not repeat, BASE ORDER ONLY
• 4 gm IV/IO slow IV push over three (3) to four (4) minutes
• 10 mg/min IV/IO drip to prevent continued seizures
• Packaging: 5gm/10mL (.5gm/mL)

Midazolam (Versed)

• Class: Benzodiazepine, anticonvulsant, CNS depressant, amnesic agent, sedative/hypnotic, antianxiety agent.
• MOA: Reduces anxiety, relaxes skeletal muscles, produces short term CNS depression and amnesia
• Indications: Behavioral Emergencies, Post ROSC agitation, CPAP anxiety, Seizures, Pacing/Synchronized cardioversion
• Contraindications: Hypersensitivity, Hypotension, Head Injury, ETOH
• Side Effects: Respiratory Depression, Dyspnea, Bradycardia, Hypotension, ALOC
• Dose (Behavioral Emergencies): 2.5 mg IV/IO may repeat in five (5) minutes or 5 mg IM/IN, may repeat in 10 minutes
• MAX (3) doses using any combination of IV/IO/IM/IN may be administered
• Contact base hospital for additional orders and to discuss further treatment options
• Dose (Behavioral Emergencies): Pediatric Seizures, 0.1 mg/kg IV/IO with a maximum dose 2.5 mg May repeat Midazolam in five (5) minutes, or 0.2 mg/kg IM/IN with a maximum dose of 5 mg May repeat Midazolam in 10 minutes for continued seizure
• Dose (Behavioral Emergencies): Pediatric Behavioral Emergencies If patient meets criteria for potentially fatal and dangerous agitation, 0.1 mg/kg IV/IO May repeat in five (5) minutes, or 0.2 mg/kg IM/IN May repeat in 10 minutes, Assess patient for medication related to reduced respiratory rate or hypotension BASE HOSPITAL CONTACT ONLY
• Maximum of three (3) doses using any combination of IV/IO/IM/IN may be administered, not to exceed adult dose
• Contact base hospital for additional orders and to discuss further treatment options
• Packaging: 10mg/2mL (5mg/mL)

Narcan

• Class: Narcotic antagonist, antidote
• MOA: Reverses effects of certain narcotic and synthetic narcotic analgesics by competing with analgesic at opiate receptor site
• Indications: Respiratory depression related to suspected opiate overdose.
• Contraindications: Hypersensitivity
• Side Effects: N/V, withdrawals, anger, tachycardia, hypertension, tremors, dysrhythmias
• Dose: Respiratory depression related to suspected opiate overdose, 0.5 mg IV/IO/IM/IN, may repeat every 2-3 minutes PRN
• Suspected Fentanyl overdose with respiratory depression Consider a loading dose of 4 mg IN; may repeat one (1) time, if no signs of respiratory improvement, consider 0.5 mg IV/IO/IM/IN; may repeat every 2-3 minutes PRN; do not exceed 10 mg of Naloxone total, regardless of route administered.
• Pediatric respiratory depression related to suspected opiate overdose, (1 day to 8 years) 0.1 mg/kg IV/IO/IM/IN (Do not exceed the adult dose of 0.5 mg per administration) (9 to 14 years)
• 0.5 mg IV/IO/IM/IN (May repeat every 2-3 minutes PRN); Do not exceed the adult dosage of 10mg total IV/IO/IM/IN
• Packaging: 2mg/2mL (1mg/mL)

Nitroglycerin

• Class: Vasodilator, nitrate.
• MOA: Relaxes smooth muscle causing venous dilation / pooling,Decreases myocardial oxygen demand, Decreases preload and afterload, Increases coronary artery perfusion by dilation of arteries relaxation of coronary vasospasms
• Indications: Chest pain of cardiac origin (angina, acute myocardial infarction), Acute pulmonary edema
• Contraindications: Inadequate tissue perfusion, Sexually Enhancing Drugs within 48 Hours, ICP
• Side Effects: Hypotension, bradycardia, rebound hypertension, reflex tachycardia, headache, n/v, dizziness, confusion, blurred vision, dry mouth, flushed skin, sublingual burning
• Dose: 0.4 mg sublingual/transmucosal, May repeat every 2-3 minutes PRN
• Packaging: 0.4mg/tablet 1 gram/1 inch, Requires BASE HOSPTIAL CONTACT if the patient is suspected to have a Right Ventricular Infarction

Ondansetron (Zofran)

• Class: Antiemetic
• MOA: Blocks the serotonin receptors in the CTZ, the stomach, and the small intestine
• Indications: Nausea/Vomiting
• Contraindications: Known sensitivity to 5-HT3 antagonists, Pediatrics younger than 4 years
• Side Effects: Headache, Fatigue, Dizziness, Flushing
• Dose (Adult): 4 mg slow IV/IO/ODT May repeat every 10 minutes x2, For a total of 12 mgs prior to base hospital contact
• Dose (Pediatric younger than 4-8 years): 4 mg slow IV/IO/ODT, May administer a total of 4 mgs of Ondansetron prior to base hospital contact
• Dose (Pediatric 9 and older): May repeat two (2) times, at 10 minute intervals, for a total of 12 mgs prior to base hospital contact
• Packaging: 4mg/2mL (2mg/mL) Vial (4mg/ODT)

Oxygen

• Class: Gas
• MOA: Enters body through the respiratory system and is transported to the cells by hemoglobin. Required for the efficient breakdown of glucose into usable energy forms
• Indications: Hypoxia
• Contraindications: Stable O2 Sat
• Side Effects: N/V, headache
• Dose (General Administration (Hypoxia)): Titrate Oxygen at lowest rate required to maintain SPO2 at 94%
• Dose (Chronic Obstructive Pulmonary Disease (COPD)): Titrate Oxygen at lowest rate required to maintain SPO2 at 90%
• Packaging: D Cylinder

Saline

• Class: Isotonic solution
• MOA: Sodium chloride (NaCl) is an essential compound your body uses to: absorb transport nutrients, maintain blood pressure, maintain the right balance of fluid
• Indications: Delivery system for intravenous administration, Hypotension, Bradycardia, Trauma
• Contraindications: Pulmonary edema, penetrating trauma
• Side Effects: Swelling, cramps, headaches
• Dose (Acute MI): 300 ml NS bolus, may repeat, Adult Medical
• Dose (Sepsis): 500 ml IV bolus, may repeat X1
• Dose (Adult Shock): 500 ml IV bolus, may repeat x1 to sustain a SBP of more than 90 mm Hg or until tissue perfusion improves If SBP>90/ Adequate tissue perfusion
• Dose (Adult Tachycardia): 300 ml IV bolus Tachy Narrow Complex Supraventricular Tachycardia (SVT)
• Dose (Adult Bradycardia): 300 ml IV bolus, may repeat; Maintain IV TKO
• Dose (Adult Cardiac Arrest): 300 ml IV bolus, may repeat
• Dose (Blunt Trauma): Unstable: IV NS, administer 250 ml bolus May repeat one (1) time to a maximum of 500 ml
• Dose: Stable: Saline lock only, do not administer IV fluids
• Dose (Penetrating Trauma): Saline lock only, do not administer IV fluids
• Dose (Isolated Closed Head Injury): Unstable: IV NS administer 250 ml bolus, May repeat (x1) time to a maximum of 500 ml Stable: Saline lock only, do not administer fluids
• Dose (Isolated Extremity Trauma): Unstable: IV NS, administer 250 ml bolus, May repeat (x1) time to a maximum of 500 ml Stable: Saline lock only, do not administer fluids
• Dose (Burns): Unstable: Inadequate tissue perfusion, start extra IV access; IV/IO NS 500 ml boluses; may repeat to a maximum of 1000 ml. Stable: BP >90, Adequate tissue perfusion IV/IO NS 500 ml per hour
• Dose (Pediatric Allergic Reaction): Symptomatic w/ poor perfusion,20 ml/kg of NS not to exceed 300 ml NS and repeat as indicated, Pediatric Medical
• Dose (Pediatric ALOC): Symptomatic w/ poor perfusion, 20 ml/kg of NS not to exceed 300 ml NS
• Dose (Pediatric Shock):  20 ml/kg IV bolus, may repeat x1 for tachycardia, change in central/peripheral pulses or altered level of consciousness, IV TKO SBP >70/ Adequate tissue perfusion
• Dose (Pediatric Cardiac Arrest):  20 ml/kg NS Bolus for all ages,
• Dose (Newborn): Contact base hospital if hypovolemia is suspected10 ml/kg IV NS over five (5) minutes, If unable to contact base hospital and or transport time is extended administer 10 ml/kg IV NS over five (5) minutes, may repeat
• Dose (Childbirth): Complicated Delivery; Obtain IV access and maintain IV PRN, excessive vaginal bleeding or post-partum hemorrhage 500 ml bolus Inadequate tissue perfusion repeat fluid bolus, Maintain IV rate at 150 ml p/hr, Pregnancy induced hypertension IV TKO, limit fluid intake
• Dose (Pediatric Trauma): Vital signs and or Inadequate tissue perfusion, start extra IV access, unstable 20 ml/kg NS bolus IV
• Stable: Saline lock only, Do Not administer IV fluids
• Dose (Pediatric Burns): Vital Signs, Unstable (Age Appropriate) Inadequate Tissue Perfusion, Start extra IV access 20 ml/kg NS bolus IV/IO; may repeat X1 stable <5 years of age, <NS 150 ml per hour;5-15 years of age , ,14250 ML per hour
• Packaging: 100mL/250mL/1000mL

Sodium Bicarbonate

• Class: Alkalizing agent, electrolyte, antidote.
• MOA: Neutralizes excess buildup of acid (binds with hydrogen ions to form carbonic acid) helps restore normal pH decreases precipitation of myoglobin in renal tubules
• Indications: Cardiac arrest with suspected metabolic acidosis hyperkalemia, Tricyclic poisoning
• Side Effects: Alkalosis, pulmonary edema, Seizures, cramps, ,Hypokalemia
• Dose: Adult; Pediatric Tricyclic Poisoning: (1 mEq/kg IV/IO) base order only
• Cardiac arrest with suspected metabolic acidosis, hyperkalemia, or tricyclic poisoning base order only
• (50 mEq IV/IO)
• Packaging: 1mEq/kg IV/IO

Tranexamic Acid (TXA)

• Class: Antifibrinolytic
• MOA: A synthetic reversible competitive inhibitor to the lysine receptor found on plasminogen; the binding of this receptor prevents plasmin (activated form of plasminogen) from binding to and ultimately stabilizing the fibin matrix
• Indications: Must be within three hours of injury must have: Signs and symptoms of hemorrhagic shock with SBP then 90mm Hg, significant hemorrhage with HR greater than or = to120, Bleeding not controlled by direct pressure, or tourniquet
• Contraindications: Hypersensitivity, ICP/ Head Trauma
• Side Effects: Seizures, ,Headaches, Backache, Abdominal Pain,n/v, Diarrhea, Fatigue, PE, DVT, Anaphylaxis
• Dose: 1 gm in 50mm, 100 millimeters of NS via IV/IO for over 10mm
• Packaging: 1000mg/10 millimeters (100 milligrams/ m)
• Signs of postpartum hemorrhagic shock base order only
• 1 gm in -100 millimeters of NS via IV/IO 10 minutes do not administer IVP as this will cause hypo tension