Paramedic Flash Drug Cards PDF

Cardiovascular Central Nervous Respiratory System System System Gastrointestinal Endocrine Urinary Musculoskeletal System System System System Acetaminophen (Tylenol®) Haloperidol (Hald...

Cardiovascular Central Nervous Respiratory System System System Gastrointestinal Endocrine Urinary Musculoskeletal System System System System Acetaminophen (Tylenol®) Haloperidol (Haldol®) Nitrous Oxide (Nitronox®) Activated Charcoal (Actidose®) Heparin Sodium (Hep-Lock®) Norepinephrine (Levophed®) Adenosine (Adenocard®) Hydralazine (Apresoline®) Normal Saline Albuterol (Proventil®) Hydromorphone (Dilaudid®) Ondansetron (Zofran®) Amiodarone (Cordarone®) Hydroxocobalamin (Cyanokit®) Oral Glucose (Insta-Glucose®) Aspirin (Acetylsalicylic Acid®) Hydroxyzine (Vistaril®)®) Oxygen Atropine Sulfate Ipratropium (Atrovent®) Oxytocin (Pitocin®) Bumetanide (Bumex®) Ketamine (Ketalar®) Potassium Chloride Calcium Chloride Ketorolac (Toradol®) Pralidoxime (2-PAM®) Dexamethasone (Decadron®) Labetalol (Trandate®) Procainamide (Pronestyl®) Dextrose (D5W/D10W/D25W/D50) Lactated Ringer‘s Promethazine (Phenergan®) Diazepam (Valium®) Levalbuterol (Xopenex®) Propofol (Diprivan®) Diltiazem (Cardizem®) Lidocaine (Xylocaine®) Propranolol (Inderal®) Diphenhydramine (Benadryl®) Lorazepam (Ativan®) Protamine Sulfate Dobutamine (Dobutrex®) Magnesium Sulfate Racemic Epinephrine (Micronefrin®) Dopamine (Intropin®) Mannitol (Osmitrol®) Rocuronium (Zemuron®) Droperidol (Inapsine®) Meperidine (Demerol®) Sodium Bicarbonate Epinephrine (Adrenaline®) Methylprednisolone (Solu-Medrol®) Succinylcholine (Anectine®) Etomidate (Amidate®) Metoprolol (Lopressor®) Terbutaline (Brethine®) Famotidine (Pepcid®) Midazolam (Versed®) Thiamine (Betaxin®) Fentanyl (Sublimaze®) Morphine Sulfate Tranexamic Acid (Lysteda®) Flumazenil (Romazicon®) Naloxone (Narcan®) Vasopressin (Pitressin®) Furosemide (Lasix®) Nicardipine (Cardine®) Vecuronium (Norcuron®) Glucagon (Glucagen®) Nitroglycerin (Nitrostat®) Verapamil (Veralin®)  Generic Name Acetaminophen uh·see·tuh·mi·nuh·fn Pronounciation Brand Name (Tylenol®) tai·luh·naal Targeted Body System Class Precautions A group of medications that have similar Specific situations or medical conditions where a chemical structures, mechanisms of action, particular medication should be used with caution. therapeutic effects, mode of action, and These may include factors such as the patient's age, therapeutic indications. pregnancy status, or other medications the patient is currently taking. Action The specific therapeutic effects or changes Dose & Route that a medication produces in the body. It is Dosage is the amount of a Route is the method by which the intended outcome of the medication that medication that should be a medication is administered aims to alleviate symptoms, treat a disease administered to a patient to a patient, including IV, IM, or prevent it from happening. based on the their weight, IN, IO, SC, PR, PO, SL, NEB, NC, age, and condition. NRB, ET, SGA, etc. Indications The specific medical conditions or symptoms for Adverse Effects which a medication is indicated, or approved by Any undesired effects that may occur as a result of regulatory authorities to be used as treatment. taking a medication. These can range from mild symptoms such as drowsiness or nausea to more Contraindications serious effects like allergic reactions or organ damage. Specific situations or medical conditions in which a particular medication should not be given. These Onset & Duration are factors such as allergies, other medications Onset is the amount of time Duration is the length of that would interact negatively, or situations in elapsed from administration time a medication continues which the medication would be ineffective or until the medication begins to be effective once it has potentially harmful. to take effect. been administered. Acetaminophen uh·see·tuh·mi·nuh·fn (Tylenol®) tai·luh·nawl Class Dose & Route Analgesic, Antipyretic Adults: 325-1000 mg (PO) may repeat after 4-6 hrs (max total 4 g). Action Peds: 10-15 mg/kg (PO/PR) may Blocks the activity of the enzyme cyclooxygenase-2, repeat after 4-6 hrs (max total 4 g). which inhibits the synthesis of prostaglandins in the central nervous system, thus reducing fever and Adverse Effects Onset & Duration blocking pain impulse generation. Headache Onset: 10-30 min. Dizziness Duration: 3-4 hrs. Indications Nausea & Vomiting Mild Pain Hepatotoxicity Fever Many OTC medications Allergic Reaction contain Acetaminophe n e Contraindications in them, which may mak patie nts pron e to a most Hypersensitivity possible overdose. Severe Liver Failure Pro Tip: Acetaminophen may be Precautions administered post febrile Exercise caution in patients with alcohol abuse as seizure, but the patient they are at higher risk of liver toxicity. Also, patients must be alert and able to with malnutrition or those who have a low intake of swallow the medication. dietary protein may be at an increased risk of Acetaminophen toxicity. Please Abide By Your local Protocol Activated Charcoal aak·tuh·vay·tuhd chaar·kowl (Actidose®) aak·tuh·dows Class Dose & Route Antidote Adult: 1 g/kg (PO) Peds: 1-2 g/kg (PO) Action Binds to ingested toxins and other harmful Adverse Effects Onset & Duration substances in the GI tract to prevent their Dehydration Onset: 5-10 min. absorption into the bloodstream. Nausea & Vomiting Duration: Until Excreted Indications Constipation Oral Toxic Ingestion (within 1 hour of EMS contact) Diarrhea Abdominal Pain Contraindications Aspiration Closely monitor your patient's respiratory Hypersensitivity status before, during, and Ingestion of: after the administration Pro Tip: of Activated Charcoal. Cyanide Iron Activated Charcoal Mineral Acids Ethanol should be administered Caustic Alkalis Methanol with sufficient water to Petroleum Distillates Corrosives prevent dehydration and constipation. Precautions Exercise caution in patients with abdominal pain of unknown origin, as well as a decreased LOC, as there is an increased risk of aspiration if the patient's airway is not adequately protected. Please Abide By Your local Protocol Adenosine uh·deh·nuh·seen (Adenocard®) uh·deh·nuh·kard Class Dose & Route Class 5 Antiarrhythmic (Miscellaneous) Adult: 6 mg (IV/IO) rapid bolus, followed by NS flush. May repeat after 1-2 min. at 12 mg. Action Peds: 0.1 mg/kg (IV/IO) (max 6 mg) rapid Binds to Adenosine receptors in the heart and blood bolus, followed by NS flush. May repeat vessels, which activates potassium channels and inhibits after 1-2 min. at 0.2 mg/kg (max 12 mg). calcium influx. This temporarily blocks the AV node's conduction of electrical impulses, giving it the ability to Adverse Effects Onset & Duration briefly stop the heart, which can be used diagnostically Dizziness Onset: Immediate to identify certain types of arrhythmias. Dyspnea Duration: 10 sec. Indications Hypotension Supraventricular Tachycardias (SVT & PSVT) Bronchospasm Consider using Palpitations a stopwatch to Contraindications Arrythmias precisely time your administration and Hypersensitivity A-Fib V-Tach Transient AV Block observe its effects. Sick Sinus Syndrome A-Flutter Bradycardia 2nd or 3rd Degree Blocks Drug Induced Tachycardia Pro Tip: Precautions Prior to administration, click print on the cardiac Exercise caution in patients with underlying monitor, then rapidly push respiratory conditions and heart disease, as Adenosine so that the ECG Adenosine can potentially trigger bronchospasm strip catches its effect. and cause transient cardiac effects. Please Abide By Your local Protocol Albuterol al·byoo·tur·awl (Proventil®) prow·ven·tl Class Dose & Route Bronchodilator, Sympathomimetic Adults: 2.5-5 mg (NEB) diluted in 2.5 mL of NS. May repeat after 20-30 min. (max total 3 doses/hr). Action Peds: 1.25-2.5 mg (NEB) diluted in 2.5 mL of NS. It is a selective Beta-2 agonist that stimulates May repeat after 20-30 min. (max total 3 doses/hr). the adrenergic receptors of the sympathomimetic nervous system. This leads to bronchodilation and Adverse Effects Onset & Duration improved airflow in patients suffering from respiratory Dizziness Onset: 5-15 min. conditions such as asthma or COPD. Anxiety Duration: 3-4 hrs. Indications Tremors Hypertension Asthma or COPD Exacerbation Ensure that the nebulizer Tachycardia rly Acute Bronchospasm machine and cup are prope as Palpitations cleaned and maintained, of Contraindications Arrythmias this can affect the delivery the medication to your Hypersensitivity patient. Hyperthyroidism Pro Tip: Precautions Administer supplemental oxygen Exercise caution in patients with underlying simultaneously to patients with cardiac conditions, as Albuterol can stimulate beta significant respiratory distress or receptors, increasing HR & BP, and potentially trigger life- hypoxia, as this can enhance the threatening arrythmias. Albuterol may also increase blood effectiveness of Albuterol. glucose levels, so closely monitor patients with diabetes during Albuterol treatment. Please Abide By Your local Protocol Amiodarone ah·mee·ow·duh·rown (Cordarone®) kor·duh·rown Class Dose & Route Class 3 Antiarrhythmic (Potassium Channel Blocker) Adults: Cardiac Arrest: 300 mg (IV/IO) bolus, Action followed by NS flush. May repeat after Blocks sodium, potassium, and calcium channels which 3-5 min. at 150 mg. prolongs the cardiac action potential and repolarization, V-Tach with Pulse: 150 mg (IV/IO) drip resulting in a decrease of AV conduction and SA node diluted in NS/D5W, titrated to patient function. This prolongation of the refractory period response (max total 2.2 g). decreases the likelihood of re-entrant arrhythmias. Peds: Indications Cardiac Arrest: 5 mg/kg (IV/IO) bolus, Cardiac Arrest followed by NS flush. May repeat after 3-5 min. (max total 15 mg/kg). V-Tach with Pulse V-Tach with Pulse: 5 mg/kg (IV/IO) drip Contraindications diluted in NS/D5W, titrated to patient response (max total 15 mg/kg). Hypersensitivity Sick Sinus Syndrome Cardiogenic Shock 2nd or 3rd Degree Blocks Adverse Effects Onset & Duration Precautions Dizziness Onset: 1-2 min. Bradycardia Duration: 30-40 days Monitor your patient for hypotension and increasing PR & QT intervals. Also exercise caution in patients with Hypotension underlying respiratory conditions, as Amiodarone can Pulmonary Toxicity cause pulmonary toxicity. Lactating women should not Prolonged QT Interval breastfeed following administration of Amiodarone. Please Abide By Your local Protocol  Aspirin as·pruhn (Acetylsalicylic Acid®) uh·see·tuhl·sa·li·si·luhk ah·suhd Class Dose & Route NSAID Adult: 162-324 mg (PO) may repeat after 4 hrs. Peds: Not Recommended in the EMS setting. Action Helps prevent blood clots by blocking the formation Adverse Effects Onset & Duration of a substance called thromboxane A2. Thromboxane Dizziness Onset: 10-20 min. A2 can make platelets stick together and block blood Nausea & Vomiting Duration: 3-6 hrs. vessels. Aspirin also reduces pain and inflammation by inhibiting the production of prostaglandins GI Bleeding through its action on cyclooxygenase. Stomach Irritation Bronchospasm Indications Reye Syndrome Ensure your Aspirin is Angina stored in a controlled Suspected MI environment that protects Pro Tip: it from excessive heat, moisture, and light. Contraindications When administering Aspirin, it's important Hypersensitivity Active Gastric Ulcers to inform your patient Bleeding Disorders Hemorrhagic Stroke to chew the tablet, not swallow it whole, and Precautions follow it with a full glass Exercise caution in patients with asthma or COPD, as it of water to reduce the can increase risk of bronchospasm. Aspirin is metabolized risk of irritation to the by the liver and excreted by the kidneys, so patients with stomach lining. liver or kidney disease should also be monitored closely. Please Abide By Your local Protocol Atropine Sulfate ah·truh·peen suhl·fayt Class Dose & Route Anticholinergic Adult: Bradycardia: 1-2 mg (IV/IO/ET/SGA) bolus, Action followed by NS flush if given IV/IO. May Acts as an antagonist to acetylcholine at muscarinic repeat after 3-5 min. (max total 3 mg). receptors in the AV node. By blocking these receptors, Poisoning: 2-5 mg (IV/IO/IM) bolus, followed Atropine inhibits the influence of the parasympathetic by NS flush if given IV/IO. May repeat after 5-10 nervous system, leading to an increased heart rate, min., until cessation of bronchial secretions. bronchodilation, and reduced secretions. Peds: Indications Bradycardia: 0.02-0.06 mg/kg (IV/IO/ET/SGA) Symptomatic Bradycardia (max 0.5 mg) bolus, followed by NS flush if given IV/IO. May repeat after 3-5 min. (max total 1 mg). Organophosphate or Nerve Gas Poisoning Poisoning: 0.05 mg/kg (IV/IO/IM) bolus, followed Contraindications by NS flush if given IV/IO. May repeat after 5-10 min., until cessation of bronchial secretions. Hypersensitivity Narrow-Angle Glaucoma Tachycardia 2nd or 3rd Degree Blocks Adverse Effects Onset & Duration Precautions Dizziness Onset: Immediate Nausea & Vomiting Duration: 4-6 hrs. Exercise caution in patients with underlying cardiac conditions and hypoxia, as Atropine may Urinary Retention increase HR and myocardial oxygen demand. Also Tachycardia be aware of potential drug interactions, as it may Paradoxical Bradycardia interact with other medications like antihistamines Arrythmias and antidepressants. Please Abide By Your local Protocol Bumetanide byoo·meh·tuh·nide (Bumex®) byoo·meks Class Dose & Route Loop Diuretic Adult: 0.5-1 mg (IV) slow bolus, followed by NS flush. Peds: Not Recommended in the EMS setting. Action Blocks the reabsorption of sodium, potassium, Adverse Effects Onset & Duration and chloride in the ascending loop of Henle in the Dizziness Onset: 3-8 min. kidneys. This causes an increase in urine output, Nausea & Vomiting Duration: 3-6 hrs. leading to decreased fluid volume and improved symptoms of edema and hypertension. Muscle Cramps Hypovolemia Indications Metabolic Alkalosis Bumetanide is Pulmonary Edema Hypotension approximately 40x more e, Congestive Heart Failure ECG Changes potent than Furosemid meaning lower doses are Contraindications required to achie ve similar diuretic effects. Hypersensitivity Hepatic Coma Hypovolemia Severe Electrolyte Imbalance Pro Tip: Precautions Be aware of other medications Exercise caution in pregnant women, as it can an lead the patient is taking, especially to fluid and electrolyte imbalances affecting placental diuretics, antihypertensives, or perfusion and fetal circulation. Bumetanide does not have medications that can affect the same vasodilatory effects as Furosemide, which may electrolyte levels. be crucial in some patients with congestive heart failure. Please Abide By Your local Protocol Calcium Chloride kal·see·um klow·ride Class Dose & Route Electrolyte, Hypertonic Solution Adult: 0.5-1 g (IV/IO) (5-10 mL of 10% solution) bolus, followed by NS flush. May repeat after 5-10 min. Action Peds: 20 mg/kg (IV/IO) (0.2 mL/kg of 10% solution) Increases amount of calcium ions in the body, (max 1 g) bolus, followed by NS flush. May repeat directly affecting intracellular calcium levels. after 5-10 min. This increases myocardial contractile force as well as ventricular automaticity. Adverse Effects Onset & Duration Nausea & Vomiting Onset: 1-3 min. Indications Hypercalcemia Duration: 20-30 min. Hypocalcemia Cardiac Arrest Bradycardia Hyperkalemia CCB & BB Overdose Hypotension Calcium and sodium Hypermagnesemia Tissue Necrosis preparations should be IV given through separate Contraindications Arrythmias lines, as they can form an uble preci pitat e and Hypersensitivity Digitalis Toxicity insol block the IV line. Hypercalcemia V-Fib During Resuscitation Pro Tip: Precautions Avoid extravasation by Calcium Chloride may increase myocardial using a smaller needle on contractility, so exercise caution in patients with visible peripheral veins. underlying cardiac conditions. It can also can have If extravasation occurs, potential drug interactions with medications like flush the area with NS Digoxin, increasing the risk of digitalis toxicity. and elevate the limb. Please Abide By Your local Protocol Dexamethasone dek·suh·meh·thuh·sown (Decadron®) deh·kuh·drawn Class Dose & Route Corticosteroid, Hormone Adult: 5-10 mg (IV/IM) bolus, followed by NS flush if given IV. Action Peds: 0.1-0.5 mg/kg (IV/IM) bolus, Binds to and activates the glucocorticoid receptors, followed by NS flush if given IV. leading to a reduction in the production of pro- inflammatory cytokines. This helps suppress the Adverse Effects Onset & Duration immune response and reduce inflammation. Nausea & Vomiting Onset: 15-30 min. Behavioral Changes Duration: 24-72 hrs. Indications GI Bleeding Cerebral Edema Croup Hyperglycemia Asthma Exacerbation Anaphylaxis Monitor your Hypertension patient's BGL closely Contraindications Fluid Overload and be prepared to Hypersensitivity Active Infection Electrolyte Imbalances manage elevated Immunosuppression levels, if they occur. GI Bleeding Systemic Fungal Infection Precautions Pro Tip: Dexamethasone can cause fluid retention and Prior to administration, review edema, which may be a concern in patients with your patient's medication list, and underlying heart or kidney failure. Dexamethasone look for any that may increase the may also increase BP and BGL, so ensure to exercise risk of adverse effects, such as caution in patients with hypertension and diabetes. NSAIDs or anticoagulants. Please Abide By Your local Protocol  Dextrose deks·trows (D5W/D10W/D25W/D50W) Class Dose & Route Carbohydrate, Isotonic/Hypertonic Solution Adult: 12.5-25 g (IV/IO) (25-50 mL of D50W or 125-250 mL of D10W) bolus or drip, titrated to Action patient response. Provides an immediate source of glucose that is rapidly Peds: 0.5-1 g/kg (IV/IO) (2-4 mL/kg of D25W absorbed into the bloodstream, thereby increasing blood or 5-10 mL of D10W) bolus or drip, titrated to sugar levels. This results in the pancreas responding by patient response. releasing insulin - the hormone responsible for regulating blood sugar. Insulin facilitates the uptake of glucose Adverse Effects Onset & Duration into cells, helping to stabilize blood sugar levels and Hyperglycemia Onset: 30-60 sec. restore normal cellular function. Fluid Overload Duration: 15-90 min. Indications Electrolyte Imbalance Hypoglycemia Tissue Necrosis To reduce the chances Cerebral Hemorrhage of missing or blowing the vein, search for a Contraindications Allergic Reaction visible and sizable vein, Hypersensitivity particularly in the hands. Intercranial Hemorrhage Pro Tip: Precautions Dextrose may cause Wernicke’s Patients with diabetes may experience hyperglycemia, so encephalopathy in Thiamine- ensure to avoid overshooting glucose levels. Patients with deficient patients. If suspected, heart or kidney failure may be sensitive to fluid overload, administer Thiamine 100 mg IV so also consider your volume of Dextrose solution. prior to Dextrose. Please Abide By Your local Protocol Diazepam dai·ah·zuh·pam (Valium®) vah·lee·oom Class Dose & Route Benzodiazepine, Anticonvulsant, Sedative Adults: 5-15 mg (IV/IM) slow bolus, followed by NS flush if given IV. May Action repeat after 5-10 min. (max total 30 mg). Binds to the GABA receptor in the central nervous system Peds: 0.2-1 mg/kg (IV/IM) slow bolus, and enhances its activity. This reduces the excitability followed by NS flush if given IV. May of neurons and induces relaxation, sedation, and repeat after 5-10 min. (max total 10 mg). anticonvulsant effects, thus raising the seizure threshold. Adverse Effects Onset & Duration Indications Drowsiness Onset: 2-15 min. Seizure Activity Nausea & Vomiting Duration: 30-60 min. Agitation & Anxiety Muscle Weakness Procedural Sedation Hypotension Diazepam has a relatively long half-life Behavioral Changes Contraindications compared to other CNS Depression benzodiazepines, which Hypersensitivity Narrow-Angle Glaucoma may be dangerous to Respiratory Depression Myasthenia gravis Respiratory Depression some patients. Precautions Pro Tip: Exercise caution in patients with hypotension and To minimize the risk of respiratory CNS depression as Diazepam may further depress depression, use the lowest effective the BP and CNS. Also avoid use in patients with dose and closely monitor your substance abuse, as it can exacerbate Diazepam's patient's respiratory status. sedative effects. Please Abide By Your local Protocol Diltiazem duhl·tai·uh·zem (Cardizem®) kaar·dih·zem Class Dose & Route Class 4 Antiarrhythmic (Calcium Channel Blocker) Adult: 0.25 mg/kg (IV) (max 20 mg) slow bolus, followed by NS flush. May repeat after 15 min. at Action 0.35 mg/kg (max 25 mg). Maintenance drip of 5-15 mg/hr. if needed, titrated to patient response. By inhibiting calcium channels, it slows the conduction of electrical impulses through the AV node, which acts Peds: Not recommended in the EMS setting. as a gatekeeper between the atria and ventricles. This can help in achieving a controlled ventricular response Adverse Effects Onset & Duration to the chaotic atrial activity in A-Fib and A-Flutter. Headache Onset: 2-5 min. Dizziness Duration: 1-3 hrs. Indications Dyspnea A-Fib with RVR Hypotension A-Flutter with RVR Diltiazem is the primary Bradycardia choice for A-Fib and A- Contraindications Peripheral Edema Flutter, but may also be Palpitations used in some cases for Hypersensitivity WPW & Sick Sinus Syndrome SVT/PSVT, refractory to Transient AV Block Adenosine. Hypotension 2nd or 3rd Degree Blocks V-Tach Cardiogenic Shock Pro Tip: Precautions Consider alternative therapies, Exercise caution in patients with heart failure, especially such as Calcium Chloride, in case those with reduced left ventricular function. Also be of a severe adverse reaction or aware of potential drug interactions, as Diltiazem may inadequate response to Diltiazem. interact with other antiarrhythmics and beta-blockers. Please Abide By Your local Protocol Diphenhydramine dai·fuhn·hai·druh·meen (Benadryl®) beh·nuh·dril Class Dose & Route Antihistamine Adult: 25-50 mg (IV/IM) bolus, followed by NS flush if given IV. May repeat after Action 4-6 hrs. (max total 400 mg). Blocks H1 histamine receptors, helping alleviate Peds: 1-2 mg/kg (IV/IM) bolus, followed symptoms of allergic reactions, such as itching, hives, by NS flush if given IV. May repeat after and runny nose. Additionally, it has mild anticholinergic 4-6 hrs. (max total 300 mg). effects, which can be useful for treating symptoms of anaphylaxis or dystonic reactions. Adverse Effects Onset & Duration Drowsiness Onset: 10-30 min. Indications Hallucinations Duration: 3-12 hrs. Allergic & Dystonic Reactions Nausea & Vomiting Contraindications Hypotension Remember, the first- CNS Depression line medication for Hypersensitivity Narrow-Angle Glaucoma Anaphylaxis in the Premature Infants Use of MAOIs Palpitations EMS setting is Seizures Epinephrine. Precautions Exercise caution in patients with CNS & respiratory Pro Tip: depression, as Diphenhydramine can potentiate Monitor closely for any signs sedative effects and worsen bronchospasm. Patients of paradoxical reactions like with underlying cardiac conditions, should also be hyperactivity, agitation, or treated with caution as Diphenhydramine may hallucinations. Discontinue cause tachycardia and palpitations. immediately if they occur. Please Abide By Your local Protocol Dobutamine dow·byoo·tuh·meen (Dobutrex®) dow·byoo·treks Class Dose & Route Inotropic Agent, Sympathomimetic Adults: 2-20 mcg/kg/min (IV/IO) drip diluted in NS/D5W, titrated to patient response. Action Peds: 2-20 mcg/kg/min (IV/IO) drip diluted Stimulates beta-1 adrenergic receptors in the heart, to in NS/D5W, titrated to patient response. increase contractility and cardiac output. Unlike other inotropic agents, it has minimal alpha-adrenergic Adverse Effects Onset & Duration activity, meaning it doesn't significantly cause Headache Onset: 1-2 min. peripheral vasoconstriction. Nausea/Vomiting Duration: 2-10 min. after Indications Dyspnea infusion is discontinued. Tachycardia Cardiogenic Shock Severe Hypotension Hyper/Hypotension Decompensated Heart Failure Consider titrating Palpitations your dose to maintain Contraindications Arrhythmias a HR increase no Hypersensitivity Drug-Induced Shock greater than 10% of baseline. Hypovolemic Shock Acute MI Pro Tip: Idiopathic Hypertrophic Subaortic Stenosis Evaluate your patient's fluid Precautions status prior to administering Dobutamine. Correcting any Use extreme caution in patients with myocardial ischemia, volume deficits can optimize its as Dobutamine can increase myocardial oxygen demand. effectiveness and minimize the It may also cause or exacerbate hypotension, especially at risk of complications. higher doses, so close monitoring of BP is essential. Please Abide By Your local Protocol Dopamine dow·puh·meen (Intropin®) in·truh·pin Class Dose & Route Vasopressor, Inotropic Agent, Sympathomimetic Adults: 2-20 mcg/kg/min (IV/IO) drip diluted in NS/D5W, titrated to patient response. Action Peds: 2-20 mcg/kg/min (IV/IO) drip diluted At moderate doses, it stimulates beta-1 adrenergic in NS/D5W, titrated to patient response. receptors, increasing cardiac contractility and output. At higher doses, it activates alpha-1 Adverse Effects Onset & Duration adrenergic receptors, causing vasoconstriction Anxiety Onset: 1-3 min. and a significant increase in blood pressure. Dyspnea Duration: 2-5 min after Indications Nausea & Vomiting infusion is discontinued. Severe Hypotension Hyper/Hypotension Cardiogenic & Distributive Shock Tissue Necrosis Dopamine may be Ischemia used for symptomatic Contraindications Palpitations bradycardia, if Hypersensitivity Hypovolemic Shock V-Fib Arrhythmias unresponsive to Atropine Sulfate. Tachyarrhythmias Pheochromocytoma Precautions Pro Tip: Dopamine is incompatible with alkaline solutions like Start with an appropriate or low Sodium Bicarbonate. Also use caution in patients taking initial dose, then re-evaluate your MAOIs as they may experience a potentiated hypertensive patient to slowly titrate the dose effect. Dopamine can also increase myocardial oxygen carefully based on their response. demand, so use with caution in patients with ischemic heart disease. Please Abide By Your local Protocol Droperidol drow·peh·ruh·daal (Inapsine®) ih·nap·sin Class Dose & Route Antipsychotic, Antiemetic Adults: 1.25-5 mg (IV/IM) bolus, followed by NS flush if given IV. May repeat after Action 15-30 min. (max total 10 mg). Blocks dopamine receptors in the central nervous Peds: Not Recommended in the EMS setting. system, which results in relaxation and sedation. By blocking dopamine receptors, Droperidol can Adverse Effects Onset & Duration also prevent or reduce nausea and vomiting. Drowsiness Onset: 3-10 min. Dystonia Duration: 2-4 hrs. Indications Hypotension Agitation & Anxiety QT Prolongation Nausea & Vomiting Consider obtaining CNS Depression an ECG strip prior to Contraindications Respiratory Depression administration, particularly in patients Hypersensitivity Parkinson's Disease with underlying CNS Depression Prolonged QT Interval cardiac conditions. Pro Tip: Precautions Extrapyramidal reactions are Exercise caution in patients with heart diseases, as a possible adverse effect that Droperidol may have effects on cardiac conduction may occur at higher doses. Be and can potentially cause arrhythmias. Droperidol prepared to treat this effect with can also lower the seizure threshold and potentially anticholinergic medications provoke seizures, particularly in individuals with a (such as Diphenhydramine). history of seizure disorders. Please Abide By Your local Protocol Epinephrine eh·puh·neh·fruhn (Adrenaline®) uh·dreh·nuh·lin Class Dose & Route Vasopressor, Inotropic Agent, Sympathomimetic Adults: Cardiac Arrest: 1-2.5 mg (IV/IO/ET/SGA) Action (1:10,000) bolus, followed by NS flush if Activates alpha-1 receptors, causing vasoconstriction, given IV/IO. May repeat after 3-5 min. which helps increase blood pressure and improve perfusion. Anaphylaxis/Asthma: 0.3-0.5 mg (IM) Simultaneously, Epinephrine stimulates beta-1 receptors, (1:1,000) may repeat after 5-15 min. leading to increased heart rate and contractility, which Severe Hypotension: 2-10 mcg/kg/min (IV/IO) enhances cardiac output and oxygen delivery. (1:10,000) drip diluted in NS, titrated to patient Indications response. Peds: Cardiac Arrest Severe Asthma Anaphylaxis Severe Hypotension Cardiac Arrest/Bradycardia: 0.01-0.1 mg/kg (IV/IO/ET/SGA) (1:10,000) bolus, followed by NS Contraindications flush if given IV/IO. May repeat after 3-5 min. Hypersensitivity Anaphylaxis/Asthma: 0.01 mg/kg (IM) (1:1,000) (max 0.3 mg) may repeat after 5-15 min. Hypovolemic Shock Adverse Effects Onset & Duration Precautions Dyspnea Onset: 1-5 min. Exercise caution in patients with myocardial ischemia, as Epinephrine can exacerbate ischemia and potentially Tremors Duration: 5-20 min. lead to a myocardial infarction. Epinephrine can also Restlessness significantly elevate BP, which could be problematic in Tachycardia patients with underlying hypertension. Hypertension Please Abide By Your local Protocol Etomidate uh·tah·muh·dayt (Amidate®) ah·muh·dayt Class Dose & Route Anesthetic, Sedative Adults: 0.2-0.6 mg/kg (IV/IO) slow bolus, followed by NS flush (max total 40 mg). Action Peds: 0.1-0.4 mg/kg (IV/IO) slow bolus, Enhances the activity of the GABA receptors in the followed by NS flush (max total 20 mg). central nervous system, facilitating the opening of chloride ion channels, and resulting in an increased Adverse Effects Onset & Duration influx of chloride ions into neurons. This process Apnea Onset: 30-60 sec. hyperpolarizes the cell membrane and reduces neuronal Myoclonus Duration: 5-10 min. excitability, leading to sedation and unconsciousness. Nausea & Vomiting Indications Hyper/Hypotension Procedural Sedation Hyper/Hypoventilation Consider administering Adrenal Suppression a low dose in older Contraindications patients and those with Respiratory Depression underlying cardiac Hypersensitivity Allergic Reaction conditions. Labor & Delivery Pro Tip: Precautions Pre-oxygenating your Exercise caution in patients with adrenal insufficiency, patient can help minimize as Etomidate may lead to a decrease in cortisol the risk of hypoxemia during production. Etomidate may also cause transient induction of anesthesia and hypotension, especially in patients with an unstable improve patient outcome. BP or underlying cardiac conditions. Please Abide By Your local Protocol Famotidine fuh·mow·tuh·deen (Pepcid®) pep·sid Class Dose & Route Antihistamine Adults: 20-40 mg/kg (IV) slow bolus, followed by NS flush. Action Peds: 0.25-0.5 mg/kg (IV) Blocks H2 receptors located on the parietal cells in slow bolus, followed by NS flush. the stomach lining, which prevents the secretion of gastric acid. This results in a reduction of gastric acid Adverse Effects Onset & Duration production, making it useful for treating conditions like Dizziness Onset: 10-30 min. gastroesophageal reflux disease and peptic ulcers. Nausea & Vomiting Duration: 8-10 hrs. Indications Constipation Peptic Ulcers Diarrhea Some protocols may Gastroesophageal Reflux Disease Fatigue recommend diluting Famotidine in a small Contraindications amount of NS, such as Hypersensitivity 50 mL, although this can vary. Precautions Pro Tip: Exercise caution in patients with porphyria, as Famotidine Double-check for potential drug may exacerbate the condition. Famotidine is primarily interactions before administering excreted by the kidneys, so also use caution in patients Famotidine, especially in patients with kidney disease. The drug’s efficiency in pediatric who are already on multiple patients has not been fully established, so use caution medications or have complex and consult pediatric dosing guidelines if considering medical histories. its use in this population. Please Abide By Your local Protocol Fentanyl fen·tuh·nuhl (Sublimize®) suh·bli·mice Class Dose & Route Opioid Analgesic Adults: 0.5-2 mcg/kg (IV/IO) (max 100 mcg) slow bolus, followed by NS flush. May repeat Action after 5-10 min. (max total 300 mcg). Binds to mu-opioid receptors in the central nervous Peds: 0.5-1 mcg/kg (IV/IO) (max 100 mcg) system, leading to an increased potassium efflux and slow bolus, followed by NS flush. May repeat decreased calcium influx. This prevents the release of after 5-10 min. (max total 3 mcg/kg). various neurotransmitters, like substance P, which are involved in the transmission of pain signals. As a result, Adverse Effects Onset & Duration Fentanyl produces potent analgesic and sedative effects. Drowsiness Onset: 1-2 min. Indications Delirium Duration: 30-60 min. Nausea & Vomiting Moderate to Severe Pain Hypotension Procedural Sedation A dose of 100 mcg of Bradycardia Fentanyl is generally Contraindications Respiratory Depression equivalent to 10 mg of Morphine or 75 mg of Hypersensitivity Myasthenia Gravis Chest Wall Rigidity Meperidine. Hypotention Arrythmias CNS & Respiratory Depression Overdose Precautions Pro Tip: Exercise caution in patients with severe head injuries as Use appropriate PPE to avoid Fentanyl can potentially increase intracranial pressure. exposure when handling It can also exacerbate existing opioid dependence, so use Fentanyl, as it is quite easy extreme caution in patients with an opioid dependance to overdose on it. or addiction. Please Abide By Your local Protocol Flumazenil fluh·ma·zuh·nil (Romazicon®) row·ma·zi·kawn Class Dose & Route Benzodiazepine Antagonist, Antidote Adults: 0.2- 0.3 mg (IV/IO) slow bolus, followed by NS flush. may repeat after Action 1-2 min. (max total 3 mg). Binds to benzodiazepine receptors in the central Peds: 0.01-0.02 mg/kg (IV/IO) (max 0.2 mg) nervous system, and effectively reverses the effects of bolus, followed by NS flush. may repeat benzodiazepines. It also blocks the activity of the GABA after 1-2 min. (max total 1 mg). receptor, increasing neuronal activity and arousal. Adverse Effects Onset & Duration Indications Dizziness Onset: 1-3 min Benzodiazepine Overdose Nausea & Vomiting Duration: 30-60 min. Rebound Sedation Contraindications Agitation Flumazenil is most Hypersensitivity effective when Hyper/Hypotension administered quickly Seizure-Prone Patients Seizures after benzodiazepine Tricyclic Antidepressant Overdose toxicity. Precautions Pro Tip: Exercise caution in patients with heavy dependance or The use of flumazenil in the pediatric withdrawal to benzodiazepines, as abrupt reversal can population within the EMS setting is precipitate seizures and severe anxiety. If the cause of generally limited and approached CNS depression is unknown, avoid flumazenil avoided with caution. It may be considered in as it may worsen the condition if benzodiazepines are certain cases of known or suspected not the cause. benzodiazepine overdose. Please Abide By Your local Protocol Furosemide fyr·ow·suh·mide (Lasix®) lay·suhks Class Dose & Route Loop Diuretic Adults: 0.5-1 mg/kg (IV/IO) slow bolus, followed by NS flush. May repeat after Action 15-30 min. (max total 80 mg). Primarily acts on the ascending limb of the loop Peds: 1 mg/kg (IV/IO) slow bolus, of Henle in the kidneys by inhibiting the sodium- followed by NS flush. May repeat after potassium-chloride (Na-K-Cl) cotransporter, leading 15-30 min. (max total 6 mg/kg). to increased excretion of sodium, chloride, and water. This results in decreased fluid volume and improved Adverse Effects Onset & Duration symptoms of edema and hypertension. Dizziness Onset: 5-10 min. Nausea & Vomiting Duration: 4-6 hrs. Indications Hypovolemia Pulmonary Edema Hyperglycemia Monitor your patient's Heart Failure BP closely before and Hypotension after administration. Contraindications Electrolyte Imbalances Do not administer if your patient's systolic Hypersensitivity Anuria Arrythmias BP is between 100-115. Hypovolemia Hepatic Coma Pro Tip: Precautions Although not a first-line Exercise caution in patients with underlying hypotension as treatment, furosemide may be Furosemide can decrease BP and cause further hypotension. used in cases of hypertensive Patients with severe electrolyte imbalances, should not emergencies to reduce BP receive Furosemide until those imbalances are corrected. and alleviate symptoms. Please Abide By Your local Protocol Glucagon gloo·kuh·gawn (GlucaGen®) gloo·kuh·jen Class Dose & Route Hormone Adults: Hypoglycemia: 1 mg (IM/IN) Action may repeat after 10-15 min. Stimulates glycogenolysis, therefore increasing CCB & BB Overdose: 3-10mg (IV) slow blood glucose levels rapidly. This provides a bolus, followed by NS flush. Maintenance source of energy to the body in emergency drip of 3-5 mg/hr. if needed, diluted in situations. Glucagon also relaxes smooth muscle NS/D5W and titrated to patient response. of the GI tract, primarily the esophagus, which Peds: makes it useful for esophageal obstruction. Hypoglycemia: 0.5-1 mg (IM/IN) may Indications repeat after 10-15 min. (max total 1 mg). Hypoglycemia Esophageal Obstruction CCB & BB Overdose: 0.05-0.15mg/kg (IV) Insulin Overdose CCB & BB Overdose slow bolus, followed by NS flush. Maintenance drip of 0.05-0.10 mg/hr. if needed, diluted in NS Contraindications and titrated to patient response. Hypersensitivity Adverse Effects Onset & Duration Hyperglycemia Dizziness Onset: 3-15 min. Precautions Nausea & Vomiting Duration: 1-2 hrs. Exercise caution in patients with an adrenal insufficiency, Hypertension as their response to Glucagon may be diminished. Glucagon Tachycardia also requires glycogen stores in the liver to increase blood Rebound Hyperglycemia glucose, so if your patient is malnourished Glucagon may not be effective. Please Abide By Your local Protocol Haloperidol ha·luh·peh·ruh·daal (Haldol®) hal·daal Class Dose & Route Antipsychotic Adults: 2-5 mg (IV/IM) slow bolus, followed by NS flush if given IV. May Action repeat after 45-60 min. (max total 15 mg). Blocks dopamine D2 receptors in the central Peds: Not Recommended in the EMS setting. nervous system, reducing symptoms of psychosis and improving overall mental function. It also has Adverse Effects Onset & Duration some effects on other neurotransmitters such as Drowsiness Onset: 15-20 min. serotonin and norepinephrine, which may Nausea & Vomiting Duration: 6-12 hrs. contribute to its therapeutic effects. Dystonia Indications Hypotension Tachycardia Always remember to begin Acute Psychosis with supportive care in Seizures any behavioral situation Contraindications QT Prolongation prior to administering any n. Hypersensitivity Prolonged QT Interval antipsychotic medicatio CNS Depression Parkinson's Disease Pro Tip: Precautions Treat hypotension secondary Exercise caution in patients with alcohol abuse, to Haloperidol with fluids, not as Haloperidol may potentiate CNS depression and Epinephrine. Haloperidol is known hypotension. Severe liver disease can affect the to prolong the QT interval, and metabolism of Haloperidol, increasing the risk of Epinephrine can exacerbate this, adverse effects. Haloperidol also has the potential increasing the risk of arrhythmias. to lower the seizure threshold. Please Abide By Your local Protocol Heparin Sodium heh·pruhn sow·dee·uhm Class Dose & Route Anticoagulant Adults: 70-80 units/kg (IV) (max 4,000 units) bolus, followed by a maintenance drip of Action 10-20 units/kg/hr. (max 1,000 units/hr.) diluted Binds to and enhances antithrombin III, which blocks in NS/D5W and titrated to patient response. the activity of clotting factors such as thrombin and Peds: Not Recommended in the EMS setting. Factor Xa. This prevents the formation of blood clots and is particularly important in emergency situations Adverse Effects Onset & Duration where rapid anticoagulation is required. Bruising Onset: Immediate. Indications Hypotension Duration: 4-8 hrs. Hyperkalemia Deep Vein Thrombosis Acute STEMI ACS GI Bleeding Pulmonary Embolism Ischemic Stroke Thrombocytopenia Heparin DOES NOT Contraindications Injection Site Pain break down existing clots, it only prevents Hypersensitivity Severe Thrombocytopenia future ones from Active Bleeding Severe Hypertension forming. Pro Tip: Precautions In case of a Heparin Heparin can have potential drug interactions with other overdose, administer 1 mg antiplatelet drugs, as it may increase the risk of bleeding. of Protamine Sulfate per Patients with recent head trauma may also be at an 100 units of Heparin given, increased risk of intracranial bleeding. Patients with liver or to reverse its effects. kidney failure may require dose adjustments due to altered metabolism and excretion. Please Abide By Your local Protocol Hydralazine hai·drah·luh·zeen (Apresoline®) ah·preh·sow·leen Class Dose & Route Vasodilator Adults: 10-20 mg (IV/IM) slow bolus, followed by NS flush of given IV. May Action repeat after 20-30 min. (max total 40 mg). Relaxes smooth muscles in the blood vessels, Peds: 0.1-0.2 mg/kg (IV/IM) slow bolus, causing them to dilate and leading to increased followed by NS flush. May repeat after blood flow and decreased blood pressure. 20-30 min. (max total 20 mg). Hydralazine works by acting on the arterioles and having a selective effect on the resistance vessels, Adverse Effects Onset & Duration which helps reduce the afterload on the heart. Dizziness Onset: 5-20 min. Flushing Duration: 2-6 hrs. Indications Nausea & Vomiting Severe Hypertension Hypotension Beta-blockers inhibit the Acute Heart Failure sympathetic nervous Palpitations system's response to Contraindications Reflex Tachycardia vasodilation, reducing the risk HR and mitigating the Hypersensitivity Acute MI of reflex tachycardia. Aortic Dissection Coronary Artery Disease Pro Tip: To counteract reflex Precautions tachycardia, especially in Exercise caution in patients with underlying tachycardia, patients with underlying as Hydralazine can trigger reflex tachycardia, potentially cardiac issues, consider worsening myocardial oxygen demand. Hydralazine can administering Hydralazine have potential drug interactions with MAOIs, NSAIDs and with a beta-blocker. other antihypertensives. Please Abide By Your local Protocol Hydromorphone hai·druh·mor·fown (Dilaudid®) dai·law·duhd Class Dose & Route Opioid Analgesic Adults: 0.5-2 mg (IV/IO/IM) slow bolus, followed by NS flush if given IV/IO. Action Peds: 0.2-1 mg/kg (IV/IO/IM) slow bolus, Binds to the mu-opioid receptors in the central followed by NS flush if given IV/IO. nervous system, producing pain relief, sedation, and euphoria. Dilauded has a higher affinity than Adverse Effects Onset & Duration other opioid analgesics, as it can produce a more Drowsiness Onset: 5-15 min. potent analgesic effect with a smaller dose. Nausea & Vomiting Duration: 2-3 hrs. Indications Apnea Constipation Moderate to Severe Pain Hypotension Contraindications Respiratory Depression Always begin with the lowest effective dose of Hypersensitivity GI Obstruction Use of MAOIs Chest Wall Rigidity Dilauded, especially if your patient has never Hypotension CNS & Respiratory Depression Overdose received opioids. Precautions Pro Tip: Exercise caution in patients with a recent head injury Always have reversal as Dilauded may lead to increased intracranial agents like Naloxone readily pressure. Hydromorphone may also exacerbate available, and be prepared for existing opioid dependence, so exercise caution in rapid intervention if signs of patients with addiction. It should also be used in respiratory depression occur. pregnant patients cautiously and only if the benefits outweigh the risks. Please Abide By Your local Protocol Hydroxocobalamin hai·drawk·sow·kow·bah·luh·muhn (Cyanokit®) sai·nuh·kit Class Dose & Route Antidote Adults: 5 g (IV) drip diluted in NS/D5W over 15 min., titrated to patient response. May Action repeat after 5-10 min. (max total 10 g). Binds to cyanide ions in the bloodstream, forming a Peds: 70 mg/kg (IV) drip diluted in NS/D5W nontoxic cyanocobalamin compound that can be over 15 min., titrated to patient response. excreted in the urine, thus preventing cyanide poisoning. May repeat after 5-10 min. (max total 5 g). It also increases the levels of methionine synthase, an enzyme involved in DNA synthesis and the formation of Adverse Effects Onset & Duration myelin that helps treat vitamin B12 deficiency. Dizziness Onset: 5-10 min. Indications Nausea & Vomiting Duration: 12-24 hrs. Skin Discoloration Cyanide Poisoning Dyspnea Ensure to reasses Vitamin B12 Deficiency your patient’s Hypertension airway, oxygenation, Contraindications Injection Site Pain and hydration during Hypersensitivity treatment. Pro Tip: Precautions The medication vial should be Hydroxocobalamin can cause a transient increase repeatedly inverted or rocked, in BP so closely monitor patients with underlying not shaken vigorously, for at least hypertension or other cardiac conditions. Patients 60 sec. prior to administration. with kidney disease may require dose adjustments Shaking can lead to foaming or due to altered metabolism and excretion. the introduction of air bubbles. Please Abide By Your local Protocol Hydroxyzine hai·drawk·suh·zeen (Vistaril®) vi·str·il Class Dose & Route Antiemetic, Antihistamine Adults: 25-50 mg (IM) may repeat after 4-6 hrs. (max total 3 g). Action Peds: 0.5-1 mg/kg (IM) may repeat Blocks the effects of histamine at H1 receptor sites, after 4-6 hrs. (max total 2 mg/kg). thereby reducing symptoms of allergic reactions such as itching and hives. Additionally, it has Adverse Effects Onset & Duration sedative properties that can help calm patients Drowsiness Onset: 15-30 min. experiencing anxiety or agitation. Nausea & Vomiting Duration: 4-6 hrs. Indications Constipation Mild Allergic Reactions Hypotension Be cautious in patients Urinary Retention with conditions like Anxiety & Agitation glaucoma or urinary Injection Site Pain retention, where Contraindications anticholinergic effects Hypersensitivity could be problematic. Early Pregnancy Pro Tip: Precautions Monitor your patient closely Exercise caution in patients with alcohol abuse or for signs of excessive sedation underlying CNS depression, as Hydroxyzine may potentiate or respiratory depression, this effect. Patients with respiratory conditions should also especially if they’ve taken other be carefully treated as Hydroxyzine has anticholinergic medications that may depress properties that can exacerbate conditions like asthma. the central nervous system. Please Abide By Your local Protocol Ipratropium ih·pruh·trow·pee·uhm (Atrovent®) ah·truh·vent Class Dose & Route Bronchodilator, Anticholinergic Adults: 0.25-0.5 mg (NEB) diluted in NS. May repeat after 15-20 min. (max total 3 doses). Action Peds: 0.25-0.5 mg (NEB) diluted in NS. May Blocks the action of acetylcholine at the muscarinic repeat after 15-20 min. (max total 3 doses). receptors in the airways, leading to bronchodialation. Ipratropium is most commonly used in conjunction with Adverse Effects Onset & Duration Albuterol (formally known as the treatment DuoNeB), as Dizziness Onset: 10-20 min. it is more effective than either medication used alone. Nausea & Vomiting Duration: 1-4 hrs. Indications Anxiety Blurred Vision Asthma or COPD Exacerbation Tremors The decision to use Acute Bronchospasm Ipratropium in children Tachycardia should be based on a Contraindications Arrythmias careful assessment of Hypersensitivity the potential risks and benefits. Peanut & Soy Allergy Precautions Pro Tip: Exercise caution in patients with underlying Ensure your patient is in a cardiovascular conditions, as Ipratropium can cause comfortable and Fowler’s tachycardia or arrhythmias. Ipratropium can also position to maximize lung increase intraocular pressure, which can be expansion during nebulization. dangerous in patients with narrow-angle glaucoma. Please Abide By Your local Protocol Ketamine keh·tuh·meen (Ketalar®) keh·tuh·laar Class Dose & Route Analgesic, Sedative Adults: 0.5-2 mg/kg (IV/IO) slow bolus, followed by NS flush. Action Peds: 0.5-2 mg/kg (IV/IO) Blocks N-methyl-D-aspartate (NMDA) receptors slow bolus, followed by NS flush. in the central nervous system, reducing the perception of pain in the body. It also releases a Adverse Effects Onset & Duration good amount of dopamine, which can contribute Hallucinations Onset: 30-60 sec. to its dissociative and hallucinogenic effects. Agitation Duration: 20-60 min. Indications Nausea & Vomiting Moderate to Severe Pain Tachycardia Hypertension Ensure a quiet and calm Procedural Sedation environment during Arrythmias administration, to Contraindications Respiratory Depression minimize the risk of hallucinations and Hypersensitivity Stroke agitation. Severe Hypertension Intercranial Pressure Pro Tip: Precautions Consider using a co-induction While ketamine generally preserves respiratory drive, agent, such as Midazolam in caution is advised in respiratory conditions like severe certain patient populations to asthma. Also exercise caution in patients with noticeable help minimize the risk of substance abuse as Ketamine might worsen their addiction. adverse reactions. Patients with liver disease may also require dose adjustments. Please Abide By Your local Protocol Ketorolac keh·tow·ruh·laak (Toradol®) tow·ruh·dawl Class Dose & Route NSAID, Analgesic Adults: 15-30 mg (IV/IM) slow bolus, followed by NS flush if given IV. Action Peds: Not Recommended in the EMS setting. Blocks the production of prostaglandins in the body that cause inflammation and pain by Adverse Effects Onset & Duration inhibiting COX-1 and COX-2 enzymes which in Drowsiness Onset: 10-30 min. turn reduces pain, fever, and inflammation. It Nausea & Vomiting Duration: 2-6 hrs. is known as a potent non-narcotic analgesic. Dyspnea Indications GI Bleeding Moderate to Severe Pain Fluid Overload Elderly patients may Hypertension be more susceptible to Contraindications Allergic Reaction the adverse effects of Ketorolac, particularly Hypersensitivity Severe Asthma or COPD GI bleeding and renal Bleeding Disorders Pregnancy 3rd Trimester damage. Precautions Pro Tip: Exercise caution in patients with underlying Toradol is a great option for hypertension as like other NSAIDs, Ketorolac can patients that have a history of increase the risk of cardiovascular events. The use drug abuse or narcotic addiction. of Ketorolac in patients with renal impairment can It is a very effective and potentially lead to kidney failure. Patients with nonaddictive pain medication. alcohol abuse may be at increased risk for GI bleeding when taking ketorolac. Please Abide By Your local Protocol Labetalol luh·bay·tuh·laal (Trandate®) traan·dayt Class Dose & Route Beta-Blocker Adults: 10-20 mg (IV) slow bolus, followed by NS flush. May repeat after 10-15 min. at Action 40-80 mg. Maintenance drip of 2-5 mg/min. Blocks the effects of adrenaline and noradrenaline in if needed, diluted in NS/D5W and titrated to the body, which are hormones that can increase BP patient response (max total 300 mg). and HR. It achieves this by blocking beta-adrenergic Peds: Not Recommended in the EMS setting. receptors in the heart and blood vessels, resulting in decreased cardiac output and blood pressure. Adverse Effects Onset & Duration Headache Onset: 2-5 min. Indications Drowsiness Duration: 3-6 hrs. Moderate to Severe Hypertension Dyspnea Contraindications Nausea & Vomiting Have IV fluids and Hyperglycemia vasopressors readily Hypersensitivity Severe Asthma or COPD Hypotension available to manage Hypotension Cardiogenic Shock potential hypotensive Bradycardia effects. Bradycardia 2nd or 3rd Degree Blocks Bronchospasm Precautions Exercise caution in patients with heart failure as it Pro Tip: can potentially worsen cardiac function. Labetalol Remember that 5-10 mg of Glucagon may also mask certain symptoms of hypoglycemia in can help reverse a beta-blocker patients with diabetes. Labetalol is metabolized in the overdose, in case you accidentally liver, so exercise caution in patients with liver failure. administer over your required dose. Please Abide By Your local Protocol Lactated Ringer’s lak·tay·tuhd ring·urz Class Dose & Route Isotonic Solution Adults: Fluid Resuscitation: 1-2 Liters (IV/IO) Action open infusion, titrated to patient response. It has a similar osmolarity to blood, making it suitable for Fluid Therapy: 100-150 mL/hr (IV/IO) treating hypovolemia caused by conditions like dehydration, drip, titrated to patient response. blood loss, or burns. LR increases intravascular volume, which is essential for maintaining adequate blood pressure Peds: and ensuring sufficient organ perfusion. The lactate in Fluid Resuscitation: 20 mL/kg (IV/IO) Lactated Ringer's is metabolized in the liver to bicarbonate, open infusion, titrated to patient response. which can also help buffer metabolic acidosis. Fluid Therapy: 40-70 mL/hr (IV/IO) drip, titrated to patient response. Indications Fluid Resuscitation & Therapy Adverse Effects Onset & Duration Fluid Overload Onset: Immediate Contraindications Electrolyte Imbalance Duration: Variable Hypersensitivity Lactate Metabolism Metabolic Alkalosis Precautions Exercise caution in patients with heart & kidney failure, Pro Tip: as excessive administration of LR may cause fluid overload. Patients with liver disease may not be able to effectively In suspected sepsis, LR is often preferred convert lactate to bicarbonate. If your patient has an over NS due to its more balanced electrolyte imbalance, the composition of LR might not electrolyte composition, which can be ideal, and a different fluid choice might be necessary. help mitigate acid-base imbalances. Please Abide By Your local Protocol Levalbuterol leh·vaal·byoo·tuh·rawl (Xopenex®) zow·puh·neks Class Dose & Route Bronchodilator, Sympathomimetic Adults: 0.63-2.5 mg (NEB) diluted in NS. May repeat after 15-20 min. (max total 3 doses). Action Peds: 0.31-1.25 mg (NEB) diluted in NS. May Levalbuterol is the R-enantiomer of Albuterol, it exhibits repeat after 15-20 min. (max total 3 doses). a higher affinity for the beta-2 adrenergic receptors compared to the S-enantiomer found in Albuterol. The R- Adverse Effects Onset & Duration enantiomer is responsible for the therapeutic effects of Headache Onset: 5-15 min. bronchodilation, while the S-enantiomer contributes more Anxiety Duration: 2-6 hrs. to potential side effects such as tremors and tachycardia. Tremors Indications Hypokalemia Levalbuterol is often Asthma or COPD Exacerbation Hypertension used in conjunction Acute Bronchospasm Tachycardia with other treatments Palpitations for bronchospasm, Contraindications such as oxygen therapy and corticosteroids. Hypersensitivity Pro Tip: Precautions Levalbuterol is often considered Exercise caution in patients with cardiac conditions, as the drug of choice over Albuterol Levalbuterol can increase HR and BP. Beta-agonists like in cases where there are serious Levalbuterol can also lower the seizure threshold, so use cardiac concerns because it has cautiously in patients with a history of seizures. Patients less of a serious impact on with diabetes should also be monitored closely as cardiac function. Levalbuterol can increase BGL. Please Abide By Your local Protocol Lidocaine lai·duh·kayn (Xylocaine®) zai·low·kayn Class Dose & Route Class 1b Antiarrhythmic (Sodium Channel Blocker) Adults: Cardiac Arrest: 1-3.75 mg/kg (IV/IO/ET/SGA) bolus, Action followed by NS flush if given IV/IO. May repeat after Blocks sodium channels, and acts primarily on the 3-5 min. at 0.5-1.5 mg/kg (max total 3 mg/kg). ventricles of the heart during phase 4 depolarization. V-Tach with Pulse: 1-1.5 mg/kg (IV/IO) bolus, This decreases automaticity, suppresses premature followed by NS flush. Maintenance drip of 1-4 ventricular complexes, and raises the V-Fib threshold. mg/min. if needed, diluted in NS/D5W and titrated to patient response. Indications Peds: Cardiac Arr