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NWC EMSS Drug Appendix Contraindications / Name Dose/Route Acti...

NWC EMSS Drug Appendix Contraindications / Name Dose/Route Action Indications for EMS Side Effects Precautions ≥13 & ≥ 50 kg (110 lbs): Non-salicylate antipyretic PO: Mild to mod pain: Severe hepatic Rare: Severe skin 625 to max 1000 mg and non-opioid analgesic HA, muscle aches, impairment or severe reaction l redness or rash ≤12 or 0.3 mcg/ sensitivity to epi → kg/min) (IVP/IO) or ≥0.5 dysrhythmias) Adult Anaphylaxis: 0.1 mg IVP/IO doses q. 1 min to mg: ß + alpha) - MOA inhibitors, TCAs, max total dose of 2 mg [all - Vasoconstrictor; ↑ SVR & levothyroxine sodium routes]. Reassess after BP; vascular permeability potentiate effects: each 0.1 mg increment. that leads to vascular (results in severe HTN) fluid volume loss and - Pregnancy hypotension- - Stabilizes mast cells and basophils NWC EMSS 2022 SOP 99 Rev. 3-11-24  Contraindications / Name Dose/Route Action Indications for EMS Side Effects Precautions Peds anaphylaxis: 0.01 - Makes CPR more effective Epinephrine cont. PUSH DOSE EPI IVP/IO (BACK) mg/kg slow IV/IO over 10 - ↑ coronary perf. pressure min. After 3 min may repeat Alternative inopressor for bradycardia, cardiogenic or septic shock w/severe - ↑ brain perfusion X1 to a Max total dose of 1 hypotension (MAP ≤45 mmHg) & pulse present - ↑ vigor & intensity of VF mg [all routes]. Reassess to ↑ success of defib. Adults: Mixing instructions: waste 9 mL of Epi 1 mg/10 mL (cardiac preload); draw after each increment. - Shortens repolarization up 9 mL NS (10 mcg/mL or 0.01 mg/mL). Label syringe. Give 0.5 to 1 mL (5-10 Severe croup/Epiglottitis/ mcg) IVP/IO boluses or “pushes” q. 2-5 min to desired BP (MAP). Onset 1 min; - May generate perfusing bronchiolitis/RSV: Neb 0.5 duration 5-10 min; reassess after each bolus. rhythm in asystole or mg (5 mL) w/ 6 L O2 bradydysrhythmias Peds: Mixing instructions: Draw up the standard code dose (Epi 1 mg/10 mL 0.01 Peds bradycardia/cardiac mg/kg - see chart in appendix) into a 10 mL syringe and then dilute with NS to arrest: 0.01 mg/kg up to 1 make a total of 10 mL of fluid in syringe. Each 1 mL now has 1 mcg/kg or 0.01 mg (max single dose) IV/IO mg/kg epinephrine for that pt. Label syringe. Push 0.5 to 1 mL q. 2-5 min IVP/IO to q. 6 min desired BP (MAP). Reassess after each bolus. ETOMIDATE 0.5 mg/kg IVP/IO Sedative-hypnotic without Alternate option to Contraindications MS: Myoclonus (Amidate) Bring unused portion to ED analgesic activity; effects ketamine for sedation in - Septic shock d/t adrenal Resp: Hyper/hypo ventilation; Dose guide are dose related – light children ≥10 and adults suppression apnea; laryngospasm 40 mg /20 mL or sleep to unconscious prior to ADV airway - Children 175 lbs: 40 mg reduce pain at inj. site function FENTANYL Citrate Bring unused portion to ED Class: Synthetic opioid Severe pain (7-10) CONTRAINDICATIONS Resp: hypoventilation; Adults & peds ≥ 2 years: Short acting opioid Pharmacologic and non– - Intolerance to opioids SpO2 < 90% on 15 L O2 100 mcg / 2 mL 1 mcg/kg (round to nearest pharmacologic options - AMS (GCS 65), debilitated, Duration 30-60 min practice, risks/benefits of - Pts on depressant drugs or SCI: 0.5 mcg/kg (max Uncommon Less histamine release each strategy. Provide PRECAUTIONS: Titrate amount 50 mcg) individualized pain mgt GI: N/V (give than morphine. Histamine - Avoid over sedation given based on pt Additional doses: OLMC. regardless of transport ondansetron) causes vasodilation, COPD (resp. depression) size, age, condition, May repeat 0.5 mcg/kg q. 5 interval. MS: Muscle rigidity, tachycardia, and itching. - Concurrent use of and response. myoclonic movements min to 3 mcg/kg (300 mcg) if Fentanyl better for STEMI. alcohol, benzos, SUD Document VS, ECG, Safety in children