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^ X P P P } P P P P P P P P P P P P P . : Medication FormularySEAS Medication Guidelines 7/2019
TOC \o "1-3" \h \z \u HYPERLINK \l "_Toc13215489" Activated Charcoal (Actidose) NOT STOCKED PAGEREF _Toc13215489 \h 2
HYPERLINK \l "_Toc13215490" Adenosine (Adenocard) PAGEREF _Toc13215490 \h 2
HYPERLINK \l "_Toc13215491" Albuterol Nebulizer PAGEREF _Toc13215491 \h 2
HYPERLINK \l "_Toc13215492" Amiodarone (Cordarone) IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215492 \h 2
HYPERLINK \l "_Toc13215493" Aspirin (ASA) PAGEREF _Toc13215493 \h 3
HYPERLINK \l "_Toc13215494" Atropine Sulfate (cardiac agent) PAGEREF _Toc13215494 \h 3
HYPERLINK \l "_Toc13215495" Atropine Sulfate (as an antidote for poisoning) PAGEREF _Toc13215495 \h 3
HYPERLINK \l "_Toc13215496" Atrovent Nebulizer PAGEREF _Toc13215496 \h 4
HYPERLINK \l "_Toc13215497" Benadryl (Diphenhydramine) PAGEREF _Toc13215497 \h 4
HYPERLINK \l "_Toc13215498" Calcium Chloride 10% PAGEREF _Toc13215498 \h 4
HYPERLINK \l "_Toc13215499" Diltiazem (Cardizem) IV Drip Administration - transport ONLY, not stocked PAGEREF _Toc13215499 \h 4
HYPERLINK \l "_Toc13215500" Dopamine HCL IV Drip Administration PAGEREF _Toc13215500 \h 5
HYPERLINK \l "_Toc13215501" Dobutamine IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215501 \h 5
HYPERLINK \l "_Toc13215502" Epinephrine PAGEREF _Toc13215502 \h 6
HYPERLINK \l "_Toc13215503" Epinephrine IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215503 \h 6
HYPERLINK \l "_Toc13215504" Fentanyl (Sublimaze) PAGEREF _Toc13215504 \h 6
HYPERLINK \l "_Toc13215505" Furosemide (Lasix) PAGEREF _Toc13215505 \h 7
HYPERLINK \l "_Toc13215506" Glucagon PAGEREF _Toc13215506 \h 7
HYPERLINK \l "_Toc13215507" Glucose Solution - D50 PAGEREF _Toc13215507 \h 8
HYPERLINK \l "_Toc13215508" Glucose Solution D10 Infusion PAGEREF _Toc13215508 \h 8
HYPERLINK \l "_Toc13215509" Heparin IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215509 \h 8
HYPERLINK \l "_Toc13215510" Ketamine PAGEREF _Toc13215510 \h 9
HYPERLINK \l "_Toc13215511" Levophed (norepinephrine) IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215511 \h 9
HYPERLINK \l "_Toc13215512" Lidocaine PAGEREF _Toc13215512 \h 9
HYPERLINK \l "_Toc13215513" Lidocaine Drip IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215513 \h 10
HYPERLINK \l "_Toc13215514" Magnesium Sulfate PAGEREF _Toc13215514 \h 10
HYPERLINK \l "_Toc13215515" Morphine Sulfate Currently NOT STOCKED PAGEREF _Toc13215515 \h 10
HYPERLINK \l "_Toc13215516" Naloxone (Narcan) PAGEREF _Toc13215516 \h 11
HYPERLINK \l "_Toc13215517" Nitroprusside (Nipride) IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215517 \h 11
HYPERLINK \l "_Toc13215518" Nitroglycerin PAGEREF _Toc13215518 \h 12
HYPERLINK \l "_Toc13215519" Nitroglycerin Drip IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215519 \h 12
HYPERLINK \l "_Toc13215520" Precedex (dexmedetomidine) IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215520 \h 12
HYPERLINK \l "_Toc13215521" Procainamide HCL IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215521 \h 14
HYPERLINK \l "_Toc13215522" Propofol (Diprivan) IV Drip Administration transport ONLY, not stocked PAGEREF _Toc13215522 \h 14
HYPERLINK \l "_Toc13215523" Sodium Bicarbonate PAGEREF _Toc13215523 \h 15
HYPERLINK \l "_Toc13215524" Thiamine PAGEREF _Toc13215524 \h 15
HYPERLINK \l "_Toc13215525" Valium (Diazepam) Currently NOT STOCKED PAGEREF _Toc13215525 \h 15
HYPERLINK \l "_Toc13215526" Versed (Midazolam HCL) PAGEREF _Toc13215526 \h 16
HYPERLINK \l "_Toc13215527" Vecuronium Bromide (Norcuron) Transfer ONLY PAGEREF _Toc13215527 \h 16
HYPERLINK \l "_Toc13215528" Xopenex Inhl (levalbuterol HCL) PAGEREF _Toc13215528 \h 16
HYPERLINK \l "_Toc13215529" Zofran (Ondansetron) PAGEREF _Toc13215529 \h 17
HYPERLINK \l "_Toc13215530" IV Drip Charts/Injections PAGEREF _Toc13215530 \h 18
HYPERLINK \l "_Toc13215531" Diltiazem PAGEREF _Toc13215531 \h 18
HYPERLINK \l "_Toc13215532" Dopamine Infusion Chart PAGEREF _Toc13215532 \h 18
HYPERLINK \l "_Toc13215533" Dobutamine Infusion Rate PAGEREF _Toc13215533 \h 18
HYPERLINK \l "_Toc13215534" Epinephrine Infusion Rate PAGEREF _Toc13215534 \h 18
HYPERLINK \l "_Toc13215535" Heprin Premix Infusion PAGEREF _Toc13215535 \h 19
HYPERLINK \l "_Toc13215536" Ketamine Injection PAGEREF _Toc13215536 \h 19
HYPERLINK \l "_Toc13215538" Nitroprusside Drip Chart ..19
HYPERLINK \l "_Toc13215539" Nitroglycerin Infusion PAGEREF _Toc13215539 \h 19
HYPERLINK \l "_Toc13215540" MEDICATION ADMINISTRATION - QUICK REFERENCE GUIDE PAGEREF _Toc13215540 \h 20
HYPERLINK \l "_Toc13215541" Intubation & Sedation - QUICK REFERENCE GUIDE PAGEREF _Toc13215541 \h 21
HYPERLINK \l "_Toc13215542" OTHER QUICK REFERENCE GUIDE PAGEREF _Toc13215542 \h 22
Activated Charcoal (Actidose) NOT STOCKED B / A / PIndications: Ingestion of certain oral poisons; overdose of both oral and IV medications. Poisoning following emesis or where emesis is contraindicated.
Contraindications: Caustic substances; corrosive substances; petroleum-based products.
Side Effects: Nausea; vomiting; constipation.
Precautions: Use during pregnancy; Activated charcoal and syrup of ipecac do not mix. Does not absorb all toxins; Must be stored in original container.
Adult Dosage: 1 - 2 g/kg
Pediatric Dosage: 0.5 - 1 g/kg (without Sorbital)
How Supplied: Oral ingestion; delivered through nasogastric tube or orally.Adenosine (Adenocard)PClass: Antidysrhythmic
Indications: Symptomatic PSVT. Slows tachycardia associated with AV node, decreases chronotropic & dromotropic activity of sinus pacemaker cells.
Contraindications: A-flutter, A-Fib, 2* & 3* AV Block, V-Tach
Adverse/Side Effects: CV: transient dysrhythmias, facial flushing, headache, sweating, palpitations, atrial fib. or flutter, chest pain, hypotension. RESP: dyspnea, chest pressure, hyperventilation, head pressure, bronchospasms. CNS: Lightheadedness, dizziness, tingling in arms, numbness, apprehension, blurred vision, burning sensation, heaviness in arms, neck & back pain. GI: nausea, metallic taste, tightness in throat, pressure in groin.
Adult Dose: 6 mg Rapid IV Push with 20 mL NS flush immediately after. 2nd dose: 12 mg Rapid IV push 1-2 minutes after if needed.
Pediatric Dose: 0.1 mg/kg Rapid IV push with 20 mL NS flush. May repeat with 0.2 mg/kg
Albuterol NebulizerA / PClass: Sympathomimetic bronchodilator
Indications: As a HYPERLINK "http://en.wikipedia.org/wiki/Bronchodilator" \o "Bronchodilator" bronchodilator, it is used to treat HYPERLINK "http://en.wikipedia.org/wiki/Asthma" \o "Asthma" asthma and HYPERLINK "http://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease" \o "Chronic obstructive pulmonary disease" COPD.
CONTRAINDICATIONS: Patients with a history of hypersensitivity to albuterol.
Side effects and special notes: Digestive System: dyspepsia, nausea. CNS: tremors, anxiety, dizziness, seizures, headache, insomnia. ENT: pharyngitis, nasal congestion. RESP: bronchospasm, cough, wheezing.
Adult dosage: 2.5 mg in 3 ml NS SVNeb, may repeat once. If no relief switch to Atrovent.
Pediatric dosage: 0.15 mcg/kg in 2.5 ml NS SVNeb.
How Supplied: 1.25 mg in 0.5 ml single dose container. Dilute with 3 ml NS in SVNebAmiodarone (Cordarone) IV Drip Administration transport ONLY, not stocked PClass: Antidysrhythmic
Indications: Pulseless ventricular tachycardia, ventricular fibrillation, refractory to any other therapy.
Studies have indicated amiodarone is an effective first line medication for Pulseless V-tach or V-fib.
Precautions: No contraindications in V-fib or pulseless V-tach. When administering amiodarone to a patient with unstable V-tach, monitor patient for hypotension and bradycardia.
Side effects and special notes: Amiodarone must be drawn up slowly to avoid bubbles in the syringe. There are no contra-Indications with use of amiodarone in patients with pulseless V-fib or V-tach.
Adult dose: 300 mg slow IV bolus given over 2 minutes. Aspirin (ASA)B / A / PIndications: Chest pain or unstable angina. Prevention of platelet aggregation in ischemia. Mild or moderate pain or fever.
Contraindications: Hypersensitivity to salicylates, GI bleeding, bleeding disorders, children <12yr with flu like symptoms, Peptic ulcer or recent surgery.
Side Effects: Thrombocytopenia, GI bleeding, nausea, vomiting, drowsiness, flushing, tinnitis.
Precautions: Anemia, hepatic disease, renal disease, Hodgkins disease.
Adult Dosage: 4 Chewable low dose tablets (324 mg P.O.)
How Supplied: Chewable tabs (81 mg) to be administered orally.Atropine Sulfate (cardiac agent)PIndications: For treatment of symptomatic bradycardia and atrial ventricular block. Organophosphate Poisoning (see following protocol).
Contraindications: Patients with known hypersensitivity, tachycardia secondary to thyrotoxicosis or heart failure, narrow angle glaucoma, myasthenia gravis, acute hemorrhagic states associated with cardiovascular instability and GI obstruction.
Side Effects: Delirium, headache, fever, confusion, psychotic behavior, tachypnea, respiratory paralysis, tachydysrrhythmia, hypertension, circulatory collapse, nausea and vomiting, urinary retention, photophobia, blurred vision, Dilated pupils and hypersensitivity responses including anaphylaxis.
Precautions: Potentiation of atropine affect occurs with many medications, including tricyclic antidepressants, benzodiazepines, antihistamines, nitrates and nitrites, haloperidol, corticosteroids, procainamide, quinidine. Antagonisms of atropine effects occur with histamine, thiazide, and metoclopramide. Atropine may delay or alter absorption of acetaminophen and levodopa.
Adult dosage: Bradycardia: 0.5-1 mg IV/IO/IN, may repeat every 3-5 min, up to 0.04 mg/kg.
Bradycardic PEA: 0.5-1 mg IV/IO push, may repeat in 3-5 minute intervals, up to 0.04 mg/kg.
Pediatric dosage: Symptomatic Bradycardia: 0.02 mg/kg, may repeat once if necessary.
0.1 mg minimum dose. Maximum single dose 0.5 mg in child; 1 mg in adolescent. Maximum total dose 1 mg in child; 2 mg in adolescent. Bradycardic PEA: NOT indicated in the pediatric patient in cardiac arrest.
How Supplied: Pre-filled syringe containing 1 mg/10 cc solution.Atropine Sulfate (as an antidote for poisoning)PIndications: Organophosphate Poisoning (e.g. parathion, malathion, sevin, diazinon and many common roach and ant sprays, and common fertilizer sprays). Nerve gas poisoning (Sarin gas, VX gas) with symptoms of excessive cholinergic stimulation.
POISONING SIGNS ARE: Salivation - Pinpoint pupils - Lacrimation - Defecation - Bradycardia - Abdominal cramping - Urination - Emesis - Excessive sweating
Contraindications: None when used in the management of organophosphate or nerve gas poisoning.
Side Effects: Signs of atropinization (flushing, pupil dilation, dry mouth, tachycardia) are the end results of treatment. Reduction of secretions is the most important goal.
WARNINGS: It is important that the patient be adequately oxygenated and ventilated prior to using Atropine, as Atropine may precipitate ventricular fibrillation in a poorly oxygenated patient.
Adult dosage: 2-5 mg IV/IO/IN, repeat with 2-5 mg Q 15 minutes until atropinization occurs.
Pediatric dosage: 0.05-0.1 mg/kg, repeat every 15 minutes if necessary.
How Supplied: Pre-filled syringes containing 1 mg in 10 ml.Atrovent NebulizerA / PIndications: It is administered by inhalation for the treatment of HYPERLINK "http://en.wikipedia.org/wiki/COPD" \o "COPD" obstructive lung diseases. Atrovent is also combined with albuterol (Proventil) (trade names HYPERLINK "http://en.wikipedia.org/wiki/Combivent" \o "Combivent" Combivent and HYPERLINK "http://en.wikipedia.org/wiki/Duoneb" \o "Duoneb" Duoneb) for the management of COPD and HYPERLINK "http://en.wikipedia.org/wiki/Asthma" \o "Asthma" asthma. Atrovent is effective for the management of asthma.
Contraindications: Patients allergic or hypersensitive to Atropine or its derivatives. Patients with significant or symptomatic tachycardia including heart rate > 150, chest pain, decreased level of consciousness, shock, or low blood pressure.
Side Effects: headache, dizziness; dry mouth, HYPERLINK "http://www.drugs.com/atrovent.html" \l "#" \t "_blank" cough, hoarseness; nausea, upset stomach; or blurred vision.
Precautions: None when used in the above listed bronchoconstrictive diseases.
Adult Dosage: 0.5 mg SVN. Should be used ONLY AFTER a beta-agonist. Administer full unit dose in adults and children over 12 y/o.
Pediatric Dosage: In children less than 12 y/o, administer half a unit dose.
Administration: By nebulizer with 6 8 L/min oxygenBenadryl (Diphenhydramine)A / PIndications: Allergic disorders, adjunct in anaphylaxis.
Contraindications: Neonates, premature infants, nursing mothers
Side Effects: Drowsiness, dizziness, anticholinergic effects, gastritis, paradoxical excitement, hypotension.
Precautions: Use with caution in patients with a history of asthma and lower respiratory disorders, glaucoma, hyperthyroidism, HTN, cardiovascular disease, GI or urinary obstruction, pregnancy.
Adult dosage: 25 - 50 mg IV/IM
Pediatric dosage: 1 mg/kg IV or IM (neonates - not recommended)
How Supplied: 1 ml vial, 50 mg/cc - IV or IM.Calcium Chloride 10%PIndications: Magnesium Sulfate overdose, Calcium channel blocker overdose; hyperkalemia; adjunctive therapy for insect bites; hypocalcemia.
Contraindications: VF during cardiac arrest patient suffering digitalis toxicity; hypercalcemia.
Adverse Reactions: Hypotension; bradycardia to include asystole; necrotic if IV infiltrates.
Drug Interactions: May antagonize calcium channel blockers; exacerbate dysrhythmias secondary to digitalis therapy.
Precautions: Use in pregnancy; must flush IV lines after administration; may cause cerebral and coronary vasospasm.
Adult dosage: 500-1,000 mg IV slow q 10 minutes watch EKG during administration
Pediatric dosage: 20 mg/kg IV slow q 10 minutes watch EKG during administration
How Supplied: 1.36 mEq/ml (100 mg/ml) pre-filled syringe.Diltiazem (Cardizem) IV Drip Administration - transport ONLY, not stockedPIndications: Rapid response Atrial Fib & flutter, PSVT unresponsive to vagal maneuvers & ADENOCARD.
Contraindications: Sick sinus syndrome, > 2 or 3 degree heart block, severe hypotension, V-Tach, cardiogenic shock, a-fib/flutter with WPW or short PR interval. Do Not give with Furosemide in same IV line (flush line first)
Side Effects: Just about any dysrhythmia, cardiac symptoms, nausea and vomiting, dizziness and headache, CHF. Increases serum digoxin levels.
Adult Dosage: 0.25mg/kg (approx. 20 mg. for most adults) over 2 min IV push. May repeat in 15 min. if response to first dose is inadequate. Usual second dose: 0.35mg/kg (approx. 25mg for most adults) over 2 min IV push.
Continuous Infusion: Add 25 cc of Diltiazem (5 mg/ml) to 100 ml of NS or D5W. Resulting concentration is 125 mg/125 ml or 1 mg/ml. Usual starting dose: 10 mg/hr (which is 10 ml/hr). Usual dose range: 5-15 mg/hr. Dosages above 15 mg/hr not recommended.
Precautions: Pregnancy, hypotension, PVCs may be present upon conversion. Do not mix in the same container as other medications. Avoid piggyback into other medication containing solutions if possible.
The following are known incompatibles: (medications that we may carry)DiazepamFurosemide InsulinHydrocortizoneSodium BicarbonateDopamine HCL IV Drip AdministrationPIndications: When augmentation of cardiac performance, blood pressure or renal blood flow are required for the treatment of early shock and hypoperfusion syndromes owing to such etiologies as septicemia, refractory cardiac failure, cardiac surgery, trauma, and acute myocardial infarction.
Contraindications: Dopamine is contraindicated in patients with pheochromocytoma, uncorrected tachyarrhythmias, ventricular fibrillation or known hypersensitivity. Patients who are hypotensive should have volume correction and optimization prior to the initiation of dopamine.
Side Effects: Tachydysrrhythmias, ischemia, widened QRS, vasoconstriction, azotemia, skin sloughing and necrosis and elevation of serum glucose.
Precautions: Dopamine effects may be potentiated by tricyclic antidepressants, diuretics, and cyclopropane. Beta-blockers antagonize the dopamine effect. Extravasation of dopamine infusions require discontinuation of the drug and immediate subcutaneous infiltration of 5 mg of phentolamine in 10 ml of saline. Administration of infusion should be by a control device and monitoring of blood pressure, ECG and pulse oximetry should be maintained as a minimum. Should not be mixed with alkaline solutions, bicarbonates or oxidizing drugs.
Dosage Guidelines: Infusion rate should be initiated at 1-5 mcg/kg/min over 1 minute and titrated for effect. Infusion rates > 10 mcg/kg/minute are rarely needed. Adjustment of the infusion rate should occur by 1-4 mcg/kg/minute every 10-30 minutes as required. Increments of 5-10 mcg/kg/minute may be necessary in severely ill patients such as septic shock.
How Supplied: Pre-mixed bag of 800 mg in 500 ml of D5W (concentration = 1600 g/ml). Administration should be by infusion via precision control device such an infusion pump. Dobutamine IV Drip Administration transport ONLY, not stockedPIndications: Short-term treatment of patients with cardiac decompensation due to depressed contractility resulting either from organic heart disease or cardiac surgical procedures.
Contraindications: None indicated.
Side effects: Increased heart rate, blood pressure, ventricular ectopy, phlebitis, nausea, headache, angina, palpations, shortness of breath.
Precautions: During the administration of dobutamine, as with any adrenergic agent, ECG and blood pressure should be continuously monitored. Dobutamine may cause a marked increase in heart rate or HYPERLINK "javascript:defwindow('blood')" blood pressure, especially systolic pressure.
Dosage: Initial starting dose is 2 - 5 mcg/kg/min.
How Supplied: Pre-mixed bag of 500 mg / 250 ml D5W (2000 mcg/ml) Administration should be by infusion via precision control device such as an infusion pump.EpinephrineA* / PIndications: Asystole, ventricular fibrillation unresponsive to defibrillation, PEA, anaphylaxis with hypotension. Blocks insulin release and elevates serum glucose and may increase serum potassium lactate levels and oxygen consumption.
Contraindications: Epinephrine is contraindicated when known hypersensitivity exists, narrow angle glaucoma, non-anaphylactic shock, or organic brain damage. Organic heart disease and cardiac dilatation as well as digoxin toxicity may also be relative contraindications.
Side Effects: Side effects may include cerebral hemorrhage, hemiplegia, respiratory distress and apnea, dysrhythmias, angina, aortic rupture, peripheral / visceral vasoconstriction, N / V, renal failure.
Precautions: Epinephrine is inactivated by alkaline solutions - never mix with sodium bicarbonate. Antidepressants potentiate the effect of epinephrine. Always assure correction of hypovolemia prior to initiating use. Use cautiously with the elderly, Parkinsons Disease, pre-existing cardiovascular renal disease, hypertension, diabetes, hyperthyroidism and psychoneurotic disorders.
Adult dosage: Cardiac Arrest: 1 mg of 1:10,000 every 3-5 min. as needed followed by a 20 mL NS flush
* Asthma/Anaphylaxis: 0.3 - 0.5 mg of 1:1,000 SQ/IM/IV/IO/IN. Repeat every 5-15 minutes as necessary.
PUSH DOSE PRESSOR: For added pressor effects when Dopamine & Levophed are not working
MIX; 1mL of Epi 1:10,000 in 9 mL NS (=1:100,000 mg) SIVP 1-2 mL and monitor for effect
Pediatric Dosage: Cardiac Arrest: 0.01 mg/kg, IV/IO of 1:10,000 every 3-5 minutes. 0.1 - 0.2 mg/kg of 1:1,000 after 1st dose Asthma/Anaphylaxis: 0.01 mg/kg of 1:1,000 SQ/IV/IO/IM/IN (up to 0.3 mg)
Unstable Bradycardia: 0.01 mg/kg, IV/IO of 1:10,000 solution every 3-5 minutes.
How Supplied: Epinephrine is supplied in a 1:1,000 dilution of 1 mg/ml consisting of 1 ml ampule/vial. 1:10,000 dilution or 0.1 mg/ml supplied as 10 ml syringes of 1mg.Epinephrine IV Drip Administration transport ONLY, not stockedPProcedure/Guidelines: Start IV of D5W TKO. If Central line is available utilize this access. Obtain infusion pump. Compute Epinephrine Dosage: Standard dilution and infusion 4 mg in 250cc NS (16mcg/ml)
Precautions: Epinephrine should not be mixed in the same infusion bag, bottle or tubing with alkaline solutions such as sodium bicarbonate. The infusion rate should be slowed gradually over several hours as clinically indicated. Abrupt withdrawal should be avoided.
Extravasation of Epinephrine infusions require discontinuation of the drug and immediate subcutaneous infiltration of 5 mg of phentolamine in 10 ml of saline.
See infusion table
Dosage: Unless specifically ordered: Initial infusion rate is 1 mcg/min. When maximal dose of 10mcg/min is reached without desired effect, notify MD. Titrate Epinephrine for systolic BP of 90-100 per Physician order.
Parameters: Check BP every 5 minutes while increasing dose. Observe for tachyarrhythmiasFentanyl (Sublimaze)PClass: synthetic opioid analgesic
Indications: Severe pain from burns and isolated extremity injuries/fractures. Chest pain from acute MI when patient is allergic to Morphine.
Contraindications: Patients with pain due to multi-system trauma or acute abdomen. Patients with volume depletion or hypotension. Patients with head, chest or abdominal trauma. Alcoholism or antidepressant ingestion. ANY respiratory difficulty. NOTE: Fentanyl is a potent respiratory depressant. Myasthenia Gravis and in those patients who have received MAO inhibitor therapy in the last 2-3 weeks as well as those who have a known hypersensitivity to the drug.
Side effects and special notes: CNS Euphoria, drowsiness, dizziness, pupillary constriction, respiratory depression and arrest. CV Bradycardia, hypotension. GI/GUNausea and vomiting. Urinary retention. RESP Apnea, Respiratory depression, broncho / laryngospasm, decreased cough/gag reflex.
WARNINGS: Rapid administration may cause chest wall rigidity, may inhibit or make ventilation impossible. Fentanyl should be used with great caution in patients who are concurrently using other narcotic analgesics, phenothiazines, benzodiazepines, sedative-hypnotics (barbiturates), tricyclic anti-depressants and other CNS depressants (including alcohol). May be reversed with Narcan.
Adult dosage: 12.5 - 100 mcg (1 mcg/kg) slow (over 1-2 min.) IV/IO. May repeat after 15 minutes to a maximum total dose of 150 mcg. If IV route is not available, may give IM/IN dose of up to 100 mcg. If severe pain persists; contact medical control for further orders.
Pediatric dosage: 1 mcg/kg IV/IO. IN dose of 1.5 mcg/kg may be used if IV/IO route is not accessible.
How supplied: 100 mcg / 2 ml (50 mcg/ml) vial.Furosemide (Lasix)PIndications: Furosemide may be used to treat edema from left ventricular dysfunction, cirrhosis, hypercalcemia, pulmonary edema and resulting hypoxemia, oliguria, cerebral edema and hypertension.
Contraindications: Patients with severe hypovolemia and/or hypoperfusion, patients with noted hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, coronary heart disease, and those receiving digitalis or other antiarrhythmic drugs, patients who have known allergies to sulfonamides.
Side Effects: Side effects may include: tinnitus, lightheadedness, blurred vision, angina, shortness of breath, hyperventilation, hypotension, Severe anaphylactic reactions can occur in patients who are allergic to sulfonamides.
Precautions: Diuretics such as furosemide must be used cautiously in AMI since small changes in volume may induce large changes in left ventricular pressure and resultant cardiac output and coronary perfusion. Combination therapy with morphine and nitrates should be used cautiously since diuretics are synergistic with those drugs on pre-load. Use with caution in patients with Diabetes mellitus.
Adult dosage: 0.5-1 mg/kg (20-40mg) IV slowly over 5-10 minutes. If the patient is on oral Lasix therapy, consider an initial IV dose that is twice the daily oral dose.
Pediatric dosage: 1 mg/kg IV slowly over 5-10 minutes.
How Supplied: Standard 40 mg/4 ml vials undiluted.GlucagonA / PIndications: Hypoglycemia states when an IV cannot be immediately started. Beta-blocker overdose.
Esophageal food blockage
Contraindications: Pregnancy or breastfeeding, DKA with or without consciousness. Since Glucagon is a protein, hypersensitivity is a possibility.
Side effects: Glucagon is known to cause nausea, vomiting, dizziness, hypotension, and headaches.
Precautions: Glucagon is only effective if there are sufficient stores of glycogen in the liver. Glucagon should be administered with caution to patients with a history of cardiovascular or renal disease. Because Glucagon is a protein, hypersensitivity may occur. Do not administer to patients with known hypersensitivity to the drug.
Adult dosage: 1 mg given IM/IN, may repeat if necessary in 7 to 10 min.
Pediatric dosage: Children under 20 kg should receive 0.5 mg given IM/IN. Children over 20 kg may use adult dose.
How Supplied: Glucagon must be reconstituted before administration. The rubber-stopper vials contain 1 unit of powder and 1 milliliter of diluting solution. Glucagon may be given IV, IM, IN or Sub-Q injection.Glucose Solution - D50A / PIndications: For the treatment of acute hypoglycemia with blood glucose level less than 60 mg/dL. May be used in conjunction with insulin for severe hyperkalemia.
Contraindications: Patients with severe hyperglycemia may have resultant or exacerbated ketoacidosis. Intracranial or intra-spinal hemorrhage. Delirium Tremens with dehydration. CVA, head injury, low perfusion state.
Side Effects: Patients who are alert/responsive may experience transient paresthesia & lightheadedness.
Precautions: Infiltration of D50 may cause severe resultant skin and subcutaneous tissue necrosis.
Adult dosage: 25-50 ml of a 50% solution (12.5-25 grams) IV push over 3-5 minutes.
How Supplied: Supplied in glass vials containing 25 grams of 50% Dextrose.
Glucose Solution D25
Pediatric dosage: 1 ml/kg of 50% solution IV over 3-5 minutes with IV fluids for dilution.
DO NOT give Dextrose solution to patients < 1 month old, use D10.Glucose Solution D10 InfusionA / PIndications: For the treatment of acute hypoglycemia with blood glucose level less than 60 mg/dL. May be used in conjunction with insulin for severe hyperkalemia.
*ASSESS patient for history and the presence of an insulin pump.
Contraindications: Patients with severe hyperglycemia may have resultant or exacerbated ketoacidosis. Intracranial or intra-spinal hemorrhage. Delirium Tremens with dehydration. CVA, head injury, low perfusion state.
Side Effects: Patients who are alert/responsive may experience transient paresthesia & lightheadedness.
Precautions: Infiltration of D 10 may cause severe resultant skin and subcutaneous tissue necrosis.
ALL AGES dosage: 75 - 125 mL of a D-10 solution (12.5-25 grams) IV DRIP over 5 - 10 minutes and reassess. Re-bolus if blood sugar levels are below 60 mg/dL 5 minutes after initial dose or mental status is still decreased.
How Supplied: Supplied in IV Bag with 25 grams of Dextrose in 250 mL water. Heparin IV Drip Administration transport ONLY, not stockedPDrug Interactions: May greatly increase risk of hemorrhage when administered with streptokinase, urokinase, or APSAC (Eminase). IV nitroglycerin may reduce the anticoagulant effects of heparin. Reduction in heparin dosage may be necessary if simultaneous IV nitroglycerin therapy is discontinued. Protamine sulfate neutralizes effects of heparin.
Precautions: Discontinue the heparin immediately if hemorrhage occurs. Nosebleed, hematuria, or tarry stools may be initial signs of bleeding. Petechiae or easy bruising (e.g., during blood pressure checks) may precede hemorrhage. Discontinue therapy if signs of arterial thrombosis (extremity pain, loss of distal pulses, loss of motor-sensory function) occur. Observe carefully for hypersensitivity reactions. Contact medical control if complications occur.
Administration and Dosage: For parenteral administration, heparin is available in concentrations of 1,000 to 40,000 USP units of heparin sodium per ml. For full-dose therapy, heparin is administered by continuous IV infusion, intermittent IV injection, or deep subcutaneous injection.
For full-dose continuous IV infusion therapy, the initial loading dose is usually 70--100 U/kg, followed by a maintenance infusion of 10--25 U/kg/hr, administered by infusion pump.
Follow written orders and instructions by the patients physician.Ketamine PClass: Anesthetic Agent
Indications: Induction, pain control, anesthetic sedation.
Adverse side effects: Tachycardia, hypertension
Contraindications: Patients with a significant hypertension, signs of CVA, and Head Injury. Patients with hypersensitivity to Ketamine. INCOMPATABLE with diazepam
Dosing:
Adult:
Induction: 1.5 - 2 mg/kg slow IV push loading dose. 1 mg/kg every 10 minutes PRN for maintenance.
Pain: 0.1 0.5 mg/kg (IV,IO,IN,IM)
Excited Delirium: 5 mg/kg IM OR 0.5 2 mg/kg slow IV push
Pediatric: 0.1 0.5 mg/kg slow IV push. MAX: 2 mg/kg
Precautions: MUST ADMINISTER SLOWLY TO AVOID LARYNGOSPASM
Onset: 45 60 seconds Duration: 10 20 minutes Half-life: 1 hour
Monitor/Document: HR, BP, RR and cardiac rhythmLevophed (norepinephrine) IV Drip Administration transport ONLY, not stockedPProcedure/Guidelines: RCRH and Spearfish Regional will pre-mix as follows: Levophed must be diluted prior to use. ONLY to be mixed with Dextrose 5%. Add 1 vial (4mg) to 250ml of D5W. Resulting concentration is 16 mcg/ml. Usual maintenance range is 2-4 mcg / minute (30 to 60 ml/hr). Higher doses may be required.LidocainePIndications: Lidocaine is a Class 1-B antiarrhythmic with local anesthetic properties. It is indicated for acute prophylaxis and treatment of ventricular dysrhythmias.
Contraindications: Patients with known hypersensitivity, Stokes-Adams syndrome. Severe sinoatrial node, AV node or intraventricular block without a functioning artificial pacemaker.
Side Effects: May produce respiratory depression, drowsiness, apprehension, and seizures. It has been known to be associated with dyspnea and respiratory depression and/or arrest. Lidocaine may cause hypotension, bradycardia heart block with cardiac arrest and has been associated with malignant hyperthermia. Potentiation of lidocaine effects occurs with cimetidine, phenytoin, procainamide, propranolol, quinidine.
Precautions: Reduce loading dose in patients with liver disease and do not administer more than 300 mg in any 1 hour period. Thrombophlebitis can occur at the infusion site.
Adult Cardiac Arrest: 1-1.5 mg/kg IV/IO/IN bolus. May repeat with initial dose q 5-10 min PRN. Not to exceed a total of 3 mg/kg.
Pediatric Cardiac Arrest: 1 mg/kg IV/IO/IN bolus. May repeat with initial dose q 5-10 min PRN. Max initial bolus is 100mg. Not to exceed a total of 3 mg/kg. Maintenance infusion range 1-4 mg/minute, maximum infusion rate 4 mg/minute.
PVCs: 1-1.5 mg/kg IV/IO/IN with initial dose q 5-10 min PRN. Not to exceed 3 mg/kg.
Head Trauma: 1 mg/kg IV/IO/IN
EZ-IO: Adult 20 - 40 mg (1-2 ml) for infusion site pain / Pediatric 0.5 mg/kg for infusion site pain.
How Supplied: 2% solution is 20 mg/ml in 5ml pre-filled syringe.Lidocaine Drip IV Drip Administration transport ONLY, not stockedPClass: Antiarrhythmic
Indications: Significant ventricular ectopy such as: Acute onset of 6 or more PVCs/minute, PVCs falling on the T-wave, multifocal PVCs. Ventricular tachycardia or ventricular fibrillation without a pulse.
Ventricular tachycardia with a pulse. Wide complex tachycardia of uncertain origin.Side effects and special notes: Contraindications to lidocaine include: Hypersensitivity to the drug, second/third degree heart block, Adams-Stokes syndrome. Whenever PVCs occur in conjunction with bradycardia, the bradycardia should be treated first with atropine then external pacing if atropine is unsuccessful, if PVCs are still present after increasing the rate, lidocaine should be administered. Use lidocaine with caution in patients with hepatic disease, heart failure, hypoxia, respiratory depression, hypovolemia or shock, heart block or bradycardia and atrial fibrillation.
Procedure and Guidelines: Preparation: Start an IV of NS and run TKO. Loading dose: Give a lidocaine bolus of 1 mg/kg, followed immediately by an infusion of 2 mg/min. Notify physician immediately.
Continuous infusion: Use lidocaine premix of 2 grams in 500ml of fluid, this gives a concentration of 4 mg/ml. Infuse lidocaine drip at 1-4 mg/minute. Notify physician if ectopy persists. If lidocaine toxicity is suspected, notify the physician.Magnesium SulfatePIndications: Magnesium is mainly used as an anticonvulsant for the prevention and control of seizures in severe preeclampsia or in eclampsia and to inhibit uterine contractions in preterm labor. Ventricular ectopy - Torsades de Pointes.
Side Effects: Basically caused by magnesium intoxication. These symptoms include flushing, sweating, hypotension, depression of reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and CNS depression.
Precautions: Disappearance of patellar reflex is a useful clinical sign to detect onset of magnesium toxication. In the event of overdose, artificial ventilation must be provided until a calcium chloride can be given IV. Magnesium should be administered with caution to patients with impaired renal function.
Pregnancy and Lactation: The neonate is usually not compromised by excess magnesium when given to the toxemic mother; however, if continuous IV infusion, the neonate may exhibit magnesium toxicity. IV magnesium should not be given 2 hours prior to delivery. Magnesium is present in breast milk for about 24 hours after parental administration and should be used cautiously is breast feeding mothers.
Adult Dosage: Eclampsia: 6 grams in 50cc NS slow IVP over 15-30 minutes
Ventricular Ectopy: 2 grams in 20cc NS SLOW IVP over 5 - 20 minutes. Usually given IM or IV. Not to be given faster than 150 mg/minute.
How Supplied: 1g / 2ml vialMorphine Sulfate Currently NOT STOCKEDPIndications: Chest pain of cardiac origin unresponsive to oxygen and nitroglycerin. Pain from injury excluding head, chest or abdomen. Severe burns. Cardiogenic pulmonary edema.
Contraindications: Morphine sulfates contraindicated in patients with known hypersensitivity, acute bronchospasm, upper airway obstruction, and diarrhea induced by poisoning.
Side Effects: Altered mental status, visual disturbances, agitation, syncope, bradycardia and tachycardia, hypertension, nausea, vomiting, constipation, toxic bowel dilation in ulcerative colitis, urinary retention, urethral spasm, antidiuresis, thrombocytopenia.
Precautions: Use with caution in patients with toxic psychosis, those with renal or hepatic dysfunction, COPD, depressed myocardial function, and those taking sympatholytics. Use with extreme caution and consider reducing the dose in patients with ulcerative colitis, Addisons disease, hypothyroidism, hypercapnia, cor pulmonale, myxedema, and delirium tremens. Potentiation of morphine effects can be seen with phenothiazines, antihistamines, barbiturates, tricyclic and other antidepressants, beta-adrenergic blockers and cimetidine.
Adult dosage: 2 - 4 mg in 2 mg increments, slow IV/IO/IN. May repeat to a total of 10 mg.
Pediatric dosage: 0.1 mg/kg slow IV/IO/IN.
How Supplied: 10 mg/ml syringe.Naloxone (Narcan)A / PIndications: Narcan is indicated for the complete or partial reversal of narcotic depression and respiratory depression secondary to narcotics or related drugs: Heroin. Lomotil. Hydromorphone (dilaudid). Meperidine (demerol). Methadone, Pentazocine (talwin). Propoxyphene (darvon or darvocet). Morphine. Codeine. Percodan. Narcan can also be used for suspected acute opiate overdose.
Contraindications: Contraindicated in patients known to be hypersensitive to it.
Side Effects and Adverse reactions:
CNS: Tremor, agitation, belligerence, pupillary dilation, seizures, increased tear production, sweating.
CV: Hypertension, hypotension, ventricular tachycardia, pulmonary edema, ventricular fibrillation.
GI: Nausea, vomiting.
Warnings: May need to repeat Narcan since duration of action of some narcotics may exceed that of Narcan. Narcan is not effective against a non-opioid drugs. Use caution during administration as patient may become violent as level of consciousness increases.
Adult dosage: An initial dose of 0.4 - 2 mg IV/IO/IM/IN. Repeat dosage may be required. Suspected overdose with synthetic narcotics (Talwin, Darvocet) may require larger dose.
Pediatric dosage: 0.1 mg/kg IV/IO/IM/IN - not to exceed 2 mg.
How Supplied: Narcan is available in 0.4 mg/ml vials.Nitroprusside (Nipride) IV Drip Administration transport ONLY, not stockedPClass: Antihypertensive/Vasodilator
Indications: Hypertensive crisis in which a prompt reduction in blood pressure is essential.
Contraindications: Aortic Stenosis, Caution in acute MI.
Side Effects: The usual dose rate is 0.5-10 mcg/kg/minute, but infusion at the maximum dose rate should never last more than 10 minutes. If blood pressure is not controlled after 10 minutes of infusion at the maximum rate, administration of nipride should be terminated immediately.
Procedure and Guidelines: Standard dilution, unless otherwise ordered, is 50 mg nipride in 250 cc D5W (200mcg/ml) Mix with D5W ONLY. Nipride is light sensitive and must be covered with opaque material, this is provided in the nipride package. The tubing need not be covered.
Dosage: Unless ordered by the physician: Start nipride infusion at 0.1 mcg/kg/min to 0.5 mcg/kg/min.
Increase dosage by 0.1 to 0.5 mcg/kg/minute every 5 to 10 minutes until: Therapeutic end-point is reached as specified by physician, or the patient is receiving an infusion rate of 2 mcg/kg/minute. If the nipride infusion rate of 2 mcg/kg/minute and the therapeutic end-point has not been reached, notify the physician. Dosage range 0.1-0.5 mcg/kg/min, but higher doses up to 10 mcg/kg/minute may be needed.
Parameters to monitor: Blood pressure every 5-10 minutes while increasing the infusion rate and no less than hourly when the therapeutic effect is reached. Watch for hypotension, if hypotension develops:
Decrease nipride infusion by 50%. Recheck blood pressure, if stable, keep nipride at present rate. If blood pressure continues low for 10 minutes, discontinue nipride and notify Medical Control. Monitor for decrease in urinary output, change in sensorium, and cold clammy skin.NitroglycerinBasst / A / PNitroglycerin: (Nitrostat, Nitro-bid, Nitro-Dur, Nitrol, NTG) antianginal, coronary and peripheral vasodilator.
Indications: Chest pain associated with angina pectoris and acute MI. Acute pulmonary edema.
Contraindications: Patients taking Viagra (sildenafil citrate), Cialis, Levitra. Allergy or known hypersensitivity to nitroglycerin. Head trauma. Hypovolemia, hypotension (BP<90mmHg systolic in adults), and shock.
Adverse reactions/Side Effects: Headache, dizziness, and weakness, Tachycardia, fainting, and hypotension. Monitor blood pressure between doses.
Adult dosage: 0.4 mg. SL tablet q 3-5 min. MAX of 3 doses in 15 min. Additional doses as needed with systolic BP >90mmHg. Each tablet contains 0.4 mg.
Nitro Paste (Transport ONLY) : 2% ointment starting at inch, increase in inch increments until desired results are achieved every 6-8 hrs.Nitroglycerin Drip IV Drip Administration transport ONLY, not stockedPIndications: Control of pain associated with unstable angina or AMI. Treatment of myocardial ischemia and congestive failure associated with AMI. Decreases pulmonary edema through venous pooling and reduced afterload. May reduce myocardial ischemia and decrease the extent of infarction. Control of hypertension, especially in patients with unstable angina, AMI or following cardiovascular procedures or surgery.
Contraindications: Hypotension, uncorrected hypovolemia, severe anemia. Increased intracranial pressure. Constrictive pericarditis, pericardial tamponade. Known hypersensitivity to nitrates.
Adverse Effects: Headache, usually transient, often severe and throbbing. Hypotension, often with weakness, dizziness, nausea/vomiting, pallor, diaphoresis, occasional postural syncope. Tachycardia, occasional paradoxical bradycardia.
Precautions: Closely monitor the ECG and vital signs. Reduce the infusion rate if systolic blood pressure falls below 90 mmHg. Severe hypotension may occur in patients who have consumed alcohol. Reduce or discontinue the infusion gradually. Abrupt withdrawal may precipitate angina or AMI.
Administration and Dosage: Administer by titrated infusion through a separate IV line, using an infusion pump. Use non-PVC administration supplies if available. Usual adult dosage is 5 -20 mcg/min. Precedex (dexmedetomidine) IV Drip Administration transport ONLY, not stockedPIndications/Criteria For Use:
For short-term sedation (72 hours) to aide in ventilator weaning in difficult to extubate patients.
Patients who are presenting with possible side effects related to use of benzodiazepines and narcotic sedation for mechanical ventilator support or in patients where anxiety/agitation cannot be controlled with propofol in a manner that allows for extubation.
Patients who have failed extubation using standard weaning protocols.
Patients undergoing severe alcohol withdrawal in the ICU especially those patients requiring escalating doses of benzodiazepines and not requiring intubation and mechanical ventilation for airway protection.
Adverse Reactions/Warnings and Precautions:
Hypotension, Bradycardia, and dry mouth
Most common adverse reactions (incidence >2%). May necessitate medical intervention.
Within an hour of commencing infusion a 10% drop in SPB and 19-15% drop in HR can be expected,
May be exaggerated in patients who receive a loading dose, or who are hypovolemic or receiving other vasodilators,
May be more pronounced in patients with hypovolemia, diabetes mellitus, or chronic hypertension, and in the elderly,
Use with caution in patients with advanced heart block or severe ventricular dysfunction,
Bradycardia and sinus arrest: Have occurred in young healthy volunteers with high vagal tone or with different routes of administration, e.g. rapid intravenous or bolus administration.
Transient Hypertension; Observed primarily during a loading dose. Consider reduction in loading infusion rate.
Arousability: Patients can become aroused with stimulation; this should not be considered as lack of efficacy.
Adverse reactions associated with infusions >24 hours in duration include:
ARDS, respiratory failure, and agitation.
May be associated with tolerance and thacyphylaxis and a dose-related increase in adverse events.
Enhanced or additive pharmacodynamics effects with:
Anesthetics, sedatives, hypnotics, opioids
Other vasodilators or Negative chronotropic agents
Dosing and Administration
Titration:
Titrate medication per physician order.
Titrate to the desired RASS score.
There is no need to wean the infusion slowly.
Adverse Effect Management suggestions; if medical intervention in required:
Hypotension management;
Initial management may be targeted at restoring intravascular volume with 10 mL/kg fluid bolus,
May include decreasing or stopping the infusion of dexmedetomidine,
Increasing rate of IV fluid administration,
Elevation of the lower extremities,
Use of vasopressor agents.
Bradycardia Management;
IV administration of anticholinergic agents (e.g. atropine) to modify vagal tone.
Dosage:
0.2 1.5 mcg/kg/hr Titrate per RASS
WARNING: Administrating dexmedetomidine with opioids, tranquilizers, hypnotics or sedatives may have a synergistic effect causing increased sedation, respiratory depression or hemodynamic compromise.
Parameters to Monitor
Levels of consciousness every 5-10 minutes with titration. The paramedic must document RASS score prior to titration and within 5 minutes after either an increase or decrease in the infusion rate.
RASS score evaluation and documentation every 15 minutes with stable continuous infusion.
Continuously:
EKG, SpO2, EtCO2, and respiratory monitoring
ALL Patients on dexmedetomidine must be on EtCO2 per ventilator or Zoll X-series
BP; every 5-10 minutes while titrating doses and every 15 minutes during transport.
Recommended parameters for notifying Physician:
HR < 50 bpm or > 30% change from initial HR prior to start of infusion,
MAP increase or decrease by > 30% from MAP prior to start of infusion,
EtCO2 trace absent or abnormal, signs of airway obstruction or ET tube displacement,
RR < 8 breaths/min.
Recommended parameters for discontinuing Infusion & notifying physician:
HR decreased by > 50% from HR prior to start of infusion,
MAP decreases / increases > 50% from MAP prior to start of infusion,
Unable to rouse patient.Procainamide HCL IV Drip Administration transport ONLY, not stockedPIndications: Suppresses PVCs and recurrent ventricular tachycardia when lidocaine is contraindicated or has not suppressed ventricular arrhythmias. Used to treat wide-complex tachycardias difficult to distinguish from VT (lidocaine is preferred)
Contraindications: Complete atrioventricular heart block, second or third degree AV block unless an electrical pacemaker is operative, preexisting QT prolongation, torsade de pointes, known sensitivity to procainamide. Procainamide is excreted by the kidneys. Caution use in patients with renal failure.
Side Effects: Hypotension with a blood pressure drop over 15 mm Hg, PR interval prolongation, QRS complex widening, QT interval prolongation, ventricular asystole, V-Fib, VT.
Precaution: Use extreme caution in first and second degree blocks, VT after an Myocardial infarction, digitalis intoxication, CHF, any structural heart disease and impaired liver or reduced kidney function.
Loading Dose: 100 mg every 5 minutes or 50 mg per minute IV Drip. May be given as an infusion until arrhythmia suppressed or 500 mg is administered. Wait 10 minutes to allow adequate distribution, then resume dosing until arrhythmia suppressed or maximum initial dose (1gm or 17 mg/kg) is reached, or side effects appear (hypotension, QRS widening by 50%)
Maintenance Dose: After arrhythmia is suppressed or max. Dose reached, follow initial dose with an infusion of 1 to 4 mg/min. Titrate to control arrhythmias.
decrease dose to 12 mg/kg for loading dose.
decrease dose by 1/3 for mild renal failure impairment.
decrease dose by 2/3 for severe renal impairment.
How Supplied: Add 1 gram of procainamide to 50, 250, or 500 ml of NS or LR, which yields 20 mg/ml, 4 mg/ml, or 2 mg/ml respectively. 20 mg/ml should be used as a loading dose. 2 and 4 mg/ml dilutions may be used for loading or maintenance based on fluid restrictions. Use an infusion pump or a microdrip (60 gtt/ml) for infusion to deliver a constant rate. Up to 50 mg may be given direct IV over 1 minute with extreme caution, follow with a maintenance infusion at 1 to 4 mg/min.Propofol (Diprivan) IV Drip Administration transport ONLY, not stockedPIndications: Propofol is a short-acting HYPERLINK "http://en.wikipedia.org/wiki/Intravenous" \o "Intravenous" intravenous non-barbiturate sedative agent used for the induction of general HYPERLINK "http://en.wikipedia.org/wiki/Anesthesia" \o "Anesthesia" anesthesia for adults and children, maintenance of general anesthesia, and HYPERLINK "http://en.wikipedia.org/wiki/Sedation" \o "Sedation" sedation in medical contexts, such as HYPERLINK "http://en.wikipedia.org/wiki/Intensive_care_unit" \o "Intensive care unit" intensive care unit (ICU) sedation for intubated, mechanically ventilated adults, and in procedures such as HYPERLINK "http://en.wikipedia.org/wiki/Colonoscopies" \o "Colonoscopies" colonoscopies and HYPERLINK "http://en.wikipedia.org/wiki/Endoscopies" \o "Endoscopies" endoscopies and HYPERLINK "http://en.wikipedia.org/wiki/Dental_surgery" \o "Dental surgery" dental surgery. Its effects are similar to that of HYPERLINK "http://en.wikipedia.org/wiki/Sodium_thiopental" \o "Sodium thiopental" Sodium Pentothal. It provides no HYPERLINK "http://en.wikipedia.org/wiki/Analgesia" \o "Analgesia" analgesia.
Side Effects: Hypotension (mainly through vasodilatation) and transient HYPERLINK "http://en.wikipedia.org/wiki/Apnea" \o "Apnea" apnea following induction doses, pain on injection, at times showing profound sedation with small doses, HYPERLINK "http://en.wikipedia.org/wiki/Dystonia" \o "Dystonia" dystonia. Mild HYPERLINK "http://en.wikipedia.org/wiki/Myoclonic" \o "Myoclonic" myoclonic movements are common, as with other intravenous hypnotic agents. Another recently described rare, but serious, side effect is HYPERLINK "http://en.wikipedia.org/w/index.php?title=Propofol_infusion_syndrome&action=edit&redlink=1" \o "Propofol infusion syndrome (page does not exist)" propofol infusion syndrome. This potentially lethal metabolic derangement in critically-ill patients after a prolonged infusion of high-dose propofol in combination with HYPERLINK "http://en.wikipedia.org/wiki/Catecholamine" \o "Catecholamine" catecholamines and/or HYPERLINK "http://en.wikipedia.org/wiki/Corticosteroid" \o "Corticosteroid" corticosteroids.
Precaution: Use with opiates or sedatives may intensify the reduction of systolic, diastolic, and mean arterial pressure, and cardiac output and may decrease induction dose requirements.
Adverse Reactions: CNS: movement, headache, dizziness, twitching, colonic/myoclonic movement
CV: hypotension, bradycardia, hypertension DERM: flushing GI: nausea, vomiting, ABD cramping RESP: apnea, cough / hiccups LOCAL: injection site burning/stinging, pain, tingling, numbness, coldness Other: fever
Contraindications: Allergy to eggs or soybeans/soy products.
Dosage: Drip is initiated at hospital starting at 20 mcg/kg/minute or greater.
Maintenance of Sedation Therapy: Increase drip by 5-15 mcg/kg/min every 5-10 minutes until desired affect is achieved. If patient requires a rate greater than 50 mcg/kg/min, contact physician. Reassess patients sedation level using the Richmond Agitation-Sedation Scale and monitoring criteria every 10-15 minutes until target level is achieved; then as clinically indicated or a minimum of every 4 hours if comfortable.
May make propofol changes every 5-10 minutes.
If patient is more sedated than the ordered Richmond Agitation-Sedation Scale, decrease the dose by one-half and reassess in 10-15 minutes or as ordered.
Monitor B/P every 15 minutes with initial titration and throughout transport.
Document Richmond Sedation Scale (RASS) with each set of vital signs or when adjusting the dose.Sodium BicarbonatePIndications: Metabolic acidosis due to: Cardiac arrest, Salicylate, Barbiturate/Tricyclic antidepressant OD.
Contraindications: Congestive heart failure; alkalotic states.
Side Effects: Sodium Bicarbonate administration increases CO2 which rapidly enters cells, causing paradoxical intracellular acidosis. Administration may cause metabolic alkalosis which is difficult to reverse in the field. Hypernatremia. Hyperosmolality of the blood can occur and cause CHF.
Warnings: Excessive bicarbonate therapy inhibits the release of oxygen. Will precipitate if mixed with calcium chloride. Administration should be guided by arterial blood gases and pH.
Cardiac arrest Dose:
Adults: 1 mEq/kg IV. Repeat with 0.5 mEq/kg q 10 min.
Pediatrics: 1 mEq/kg IV. Repeat with 0.5 mEq/kg q 10 min. MAX 10 mEq/min.
Neonatal: 0.5 mEq/kg IV, IO (diluted) slowly. May repeat in 10 min.
How Supplied: Pre-filled syringes containing 50 mEq/50 ml.ThiamineA / PClass: Vitamin (B1)
Indications: Coma of unknown origin, especially when alcohol may be involved. Suspected alcoholics and malnourished patients receiving dextrose-containing solutions. Delirium tremens. Wernickes Encephalopathy
Precautions: None significant in emergency use.
Side effects and special notes: Some side effects of thiamine are as follows: hypotension, dyspnea, respiratory failure, sweating, pain at injection site, pulmonary edema. Any comatose patient, especially patients suspected to be alcoholic or possibly under the influence of alcohol should receive thiamine by IV push along with 50% dextrose and narcan.
Adult dosage: 100 mg IV push or IM injection. Thiamine may be given IM or IV, the IV route is preferred. Administer Thiamine PRIOR to 50% Dextrose solution.Valium (Diazepam) Currently NOT STOCKEDPIndications: Seizures, acute alcohol withdrawal, amnesia effect for cardioversion, acute anxiety states.
Contraindications: Coma states, shock states, substance abuse, known hypersensitivity.
Adverse Reactions: Respiratory depression, psychomotor impairment and reflex tachycardia.
Drug Interactions: IV lines must be flushed between meds; may potentate other meds.
Precautions: Use in pregnancy, venous irritation, and short duration as anticonvulsant.
Adult dosage: Seizure - 5-10 mg IV/IO slow maybe repeated q 2-5 min max 30mg Sedation 5-15 mg over 2-3 min
Pediatric dosage: Seizure - 0.25 mg/kg IV/IO slow maybe repeated 2-5 min max 10mg
Rectal dose - 0.5 mg/kg with max of 10mg
How Supplied: 10 mg / 2 ml (5 mg/ml) syringe.Versed (Midazolam HCL)PIndications: Induction of sedation and amnesia. May be used for persistent seizure activity.
Contraindications: known hypersensitivity, narrow-angle glaucoma, untreated open-angle glaucoma.
Side Effects: Headache, ataxia, increased cough reflex, auditory disturbances, hyporeflexia, apnea, bronchospasm, hypotension, PVCs, junctional rhythm, bradycardia, phlebitis, chills, hiccups and acid taste.
Precautions: Do not give intra-arterial. Do not administer rapidly. Use with caution in patients that are older or debilitated, hypotensive, CHF, renal insufficiency, ETOH or other CNS depressants.
Adult dosage: Sedation: 1-2 mg IV/IO/IN q 30 minutes PRN. Seizures: 1-2 mg IN if IV route is not accessible.
Pediatric dosage: Sedation: 0.05 - 0.1 mg/kg, MAX 4 mg IV/IO/IN. Seizures: 0.2 mg/kg IN if IV route is not accessible.
How Supplied: Supplied as a 1mg/ml in 2 ml vial
Monitor B/P every 15 minutes with initial titration and throughout transport.
Refer to and document Richmond Sedation Scale (RASS) with each set of vital signs or when adjusting dose.Vecuronium Bromide (Norcuron) Transfer ONLYPIndications: Relax skeletal muscle and manage patients who are fighting mechanical ventilation.
Adverse Reactions: Neuromuscular blockers may cause apnea.
Contraindications & Cautions: Hypersensitivity to any of the drugs components. Use cautiously in; elderly patients, myasthenia gravis, and those with hepatic or renal disease, severe obesity.
Incompatibilities: Alkaline solutions, diazepam, furosemide, thiopental.
Maintenance of Sedation Therapy:
Adult: (age 10 and older) Initially, 0.08 0.1 mg/kg IV/IO bolus
Maintenance dose: 0.010.015 mg/kg every 20 -40 minutes after initial dose then every 12 15 minutes PRN
PEDS: (less than 10 y/o) may require higher initial dose
Administration Requirement: Patient must be chemically sedated prior to transport, Patient MUST be intubated prior to transport, Physician ordered for maintenance of sedation.
How Supplied: Reconstitute with 10 mL sterile water = (1 mg/ml)
Onset
Peak
Duration
1 minute
3-5 min.
25-40 min.
You MUST USE A SEDATIVE with Vecuronium; fentanyl and/or Versed
Fentanyl (Induction): 2-10 mcg/kg IV for analgesia in awake patient
Versed (sedative): 0.5-4 mg IV/IO/IN for sedation & anti-anxiety in awake patient
Monitor B/P every 15 minutes with initial titration and throughout transport.
Refer to and document Richmond Sedation Scale (RASS) with each set of vital signs or when adjusting dose.Xopenex Inhl (levalbuterol HCL)A / PClass: Sympathomimetic bronchodilator
Indications: As a HYPERLINK "http://en.wikipedia.org/wiki/Bronchodilator" \o "Bronchodilator" bronchodilator, it is used to treat HYPERLINK "http://en.wikipedia.org/wiki/Asthma" \o "Asthma" asthma and HYPERLINK "http://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease" \o "Chronic obstructive pulmonary disease" COPD. Some pediatricians also use levalbuterol for patients who experience hyperactivity or jitteriness from HYPERLINK "http://en.wikipedia.org/wiki/Racemic" \o "Racemic" racemic albuterol.
CONTRAINDICATIONS: With a history of hypersensitivity to levalbuterol HCl or racemic albuterol.
Side effects and special notes: Body as a whole: chills, pain, chest pain. Cardiovascular System: ECG abnormal, ECG change, hypertension, hypotension, syncope. Digestive System: diarrhea, dry mouth, dry throat, dyspepsia, gastroenteritis, nausea. Hemic/Lymphatic System: lymphadenopathy. Musculoskeletal System: leg cramps, myalgia. Nervous System: anxiety, hyperesthesia (increased sensitivity to stimulation) of the hand, insomnia, paresthesia, tremor. Special Senses: eye itch
Adult dosage: 1.25 mg in 2.5 ml NS SVNeb, may repeat once. If no relief switch to Atrovent.
Pediatric dosage: 0.75 - 1.25 mg in 2.5 ml NS SVNeb, in peds ! 1 2 y / o . I f n o r e l i e f s w i t c h t o A t r o v e n t .
H o w S u p p l i e d : 1 . 2 5 m g i n 0 . 5 m l s i n g l e d o s e c o n t a i n e r . D i l u t e w i t h 3 m l N S i n S V N e b Z o f r a n ( O n d a n s e t r o n ) A / P C l a s s : A n t i e m e t i c
I n d i c a t i o n s : O n d a n s e t r o n i s e f f e c t i v e i n c o n t r o l l i n g H Y P E R L I N K " h t t p : / / e n . w i k ipedia.org/wiki/Post-operative_nausea_and_vomiting" \o "Post-operative nausea and vomiting" post-operative nausea and vomiting (PONV) and post-radiation nausea and vomiting, and is a possible therapy for nausea and vomiting due to acute or chronic medical illness or acute HYPERLINK "http://en.wikipedia.org/wiki/Gastroenteritis" \o "Gastroenteritis" gastroenteritis.
Precautions: Constipation, dizziness and headache are the most commonly reported side effects associated with its use. There have been no significant drug interactions reported with this drug's use.
Side effects and special notes: Zofran is also used off-label to treat HYPERLINK "http://en.wikipedia.org/wiki/Hyperemesis_gravidarum" \o "Hyperemesis gravidarum" hyperemesis gravidarum in pregnant women, but there is no conclusive data available on its safety in HYPERLINK "http://en.wikipedia.org/wiki/Pregnancy" \o "Pregnancy" pregnancy, especially during the first HYPERLINK "http://en.wikipedia.org/wiki/Trimester" \o "Trimester" trimester. It is also often used to treat HYPERLINK "http://en.wikipedia.org/wiki/Cyclic_vomiting_syndrome" \o "Cyclic vomiting syndrome" cyclic vomiting syndrome.
Adult dosage: 4 mg IV push, may repeat X 1.
Pediatric dosage: 0.1 mg/kg, MAX 4 mg IV
How Supplied: 4 mg vial (2 mg/ml)Richmond Agitation-Sedation Scale (RASS)
ScoreTermDescription+4CombativeOverly combative, violent, Immediate danger to crew+3Very AgitatedPulls or removes tube(s) or catheter(s); aggressive+2AgitatedFrequent non-purposeful movement; fights ventilator+1RestlessAnxious but movements not aggressive or vigorous0Alert / Calm-1DrowsyNot fully alert, but has sustained awakening (eye opening/eye contact) to voice (greater than 10 sec)Verbal Stimulation-2Light SedationBriefly awakens with eye contact to voice (less than 10 sec)-3Moderate SedationMovement or eye opening to voice (but no eye contact)-4Deep SedationNo response to voice, but movement or eye opening to physical stimulationPhysical Stimulation-5UnarousableNo response to voice or physical stimulation
IV Drip Charts
DILTIAZEM (5 mg/cc)Patient weight in kgBolus Doses in ccs50607080901001st Dose: 0.25 mg/kg2.5 cc3 cc3.5 cc4 cc4.5 cc5 cc2nd Dose: 0.35 mg/kg3.5 cc4.2 cc4.9 cc5.6 cc6.3 cc7 cc[ for drip: mix 125 mg (25 cc) in 100 ml IV solution (1 mg/ml) & run at:]DILTIAZEM DRIPmg/hour5 mg10 mg15 mg( Drops/minute5 gtts10 gtts15 gtts
Dopamine Infusion Chart Pump setting ml/hrWt. in Kg4550556065707580909595100 5 mcg/kg/min891011121314151617181910 mcg/kg/min17192123242628303134363815 mcg/kg/min25283134373942454851535620 mcg/kg/min 34384145495356606468717525 mcg/kg/min42475256616670758084899430 mcg/kg/min51566268737884909610110711335 mcg/kg/min5966727985929810511211812513140 mcg/kg/min6875839098105113120128135143150Dobutamine Infusion Rate (ml/hr) for 2,000 mcg/mL concentrationDelivery Rate
(g/kg/min)Patient Body Weight (kg)51020304050607080901001100.50.070.10.30.40.60.70.911.21.31.51.61.00.10.30.60.91.21.51.82.12.42.733.32.50.40.71.52344.55677.585.00.71.534.567.5910.51213.51516.57.51.12.24.5791113.516182022.525101.5369121518212427303312.51.93.7711151922.526303437.541152.24.5913.51822.52731.53640.54549.517.52.65.210.515.72126.231.536.74247.252.557.7203612182430364248546066Epinephrine Infusion RateDose-
mcg/minInfusion rate-
ml/hrDose-
mcg/minInfusion rate-ml/hrDose-
mcg/minInfusion rate-
ml/hr148301556289341660311 10 Notify MD3817644151141186851912451971623134920757261453
Heparin Premix Infusion Drip Chart500 u/hr = 12.5 cc/hr1100 u/hr = 27.5 cc/hr1600 u/hr = 40 ml/hr600 u/hr = 15 cc/hr1200 u/hr = 30 cc/hr1700 u/hr = 42.5 ml/hr700 u/hr = 17.5 cc/hr1300 u/hr = 32.5 cc/hr1800 u/hr = 45 ml/hr800 u/hr = 20 cc/hr1400 u/hr = 35 cc/hr1900 u/hr = 47.5 ml/hr900 u/hr = 22.5 cc/hr1500 u/hr = 37.5 cc/hr2000 u/hr = 50 ml/hr1000 u/hr = 25 cc/hr20,000 units in 500cc D5W (40 units/ml)
Ketamine Injection 100 mg / 1 mL (calculations = mL SIVP) for pain management
MIX 100 mg (1 mL) of Ketamine in 9 mL NS = 10 mg/mL concentrationDrug
Delivery Rate
(mg/kg)Patient Body Weight (kg)51020304050607080901001100.10.050.10.20.30.40.50.60.70.80.91.01.10.20.10.20.40.60.81.01.21.41.61.82.02.20.30.150.30.60.91.21.51.82.12.42.73.03.30.40.20.40.81.21.62.02.42.83.23.64.04.50.50.250.51.01.52.02.53.03.54.04.55.05.5Nitroprusside Drip Chart [Mix 50 mg in 250 ml D5W (200 mcg/ml) & run at:] Microdrops/minute (or ml/hr)mcg/kg/
minutePatient weight in kg2.551020304050607080901000.1 mcg**0.30.60.91.21.51.822.42.830.5 mcg**1.534.567.59101214151 mcg*1.5369121518212427302 mcg1.5361218243036424854604 mcg3612243648607284961081208 mcg6122448729612014416819221624010 mcg7.515306090120150180210240270300
Nitroglycerin Infusion 50 mg / 250 ml= 200 mcg/ml (q by 10 mcg/min = of 3 cc/hr)
DosagePump settingDosagePump settingDosagePump settingDosagePump setting5 mcg/min1.5 cc/hr30 mcg/min9 cc/hr70 mcg/min21 cc/hr110 mcg/min33 cc/hr10 mcg/min3 cc/hr40 mcg/min12 cc/hr80 mcg/min24 cc/hr120 mcg/min36 cc/hr15 mcg/min4.5 cc/hr50 mcg/min15 cc/hr90 mcg/min27 cc/hr130 mcg/min39 cc/hr20 mcg/min6 cc/hr60 mcg/min18 cc/hr100 mcg/min30 cc/hr140 mcg/min42 cc/hr
MEDICATION ADMINISTRATION - QUICK REFERENCE GUIDE LevelMedication Adult DosePediatric DoseP Adenosine1st: 6 mg IV Push 2nd:12 mg IV Push1st: 0.1 mg/kg IV Push 2nd: 0.2 mg/kgAPAlbuterol inh2.5 mg in 3 mL NS SVN0.15 mcg/kg in 3 mL NS SVNBAP Aspirin324 mg (chewable)P Atropine (Cardiac)Brady: 0.5 - 1 mg IV/IOBrady: 0.02 mg/kg IV/IOP Atropine (poisoning)2 - 5 mg q 15 min IV/IO0.05 - 0.1 mg/kg q 15 min IV/IOAP Atrovent Nebulizer0.5 mg0.25 mgAP Benadryl25 - 50 mg IV/IO/IM1 mg/kg IV/IO/IMP Calcium Chl 10%500 - 1000 mg IV/IO slow20 mg/kg IV/IO slowP DiazepamSeizure: 5 - 10 mg IV/IO/IM slow
Sedation: 5 - 15 mg slowSeizure: 0.25 mg/kg IV/IO/IM (max 10mg)
Rectal: 0.5 mg/kg (max 10 mg)A Epinephrine 1:1=1:10001 : 1Asthma: 0.3-0.5 mg IV/IO/IM 1 : 1Asthma: 0.01mg/kg <0.3mg IV/IO/IM Allergy: 0.3-0.5 mg IV/IO/IMAllergy: 0.01mg/kg <0.3mg IV/IO/IMP Epinephrine 1:1=1:1000 1:10=1:10,0001: 10Arrest: 1mg q 3-51 : 1Asthma/Allergy:
0.3-0.5 mg1: 10Arrest/Brady:1 : 1Arrest: 0.1-0.2 mg/kg 0.01 mg/kgAsthma & Allergy: 0.01mg/kg <0.3mgPEpinephrine
Push Dose Pressor1mL of Epi 1:10,000 in 9 mL NS (=1:100,000 mg) SIVP 1-2 mL and monitor for effectP Fentanyl12.5 - 100 mcg IV/IO/IM/IN slow1 mcg/kg IV/IO/IM/IN slowP Furosemide0.5 1 mg/kg IV/IO slow1 mg/kg IV/IO slowAP Glucagon 1 mg IV/IO/SQ/IM/IN slow<20 kg 0.5 mg IV/IO/SQ/IM/IN slowAP Glucose (D-50)25 - 50 ml (25 g) IV slow1 ml/kg IV slow (dilute w/ IV fluids)APGlucose (D-10)75 125 mL over 5-10 min. May Repeat75 mL over 5-10 min. May RepeatPKetamine:Pain: 0.1-0.5 mg/kg SIVP
Induction: 1.5 - 2 mg/kg SIVP
Excited Delirium: 2 mg/kg SIVP OR 5 mg/kg IMPain: 0.1-0.5 mg/kg SIVP MAX: 2 mg/kgP Lidocaine1-1.5 mg/kg IV/IO1 mg/kg IV/IO/INP2nd 3rd dose = initial dose2nd 3rd dose = initial doseP Magnesium SulfateCardiac: 1-2 g IV slow (over 5-20 min)
Eclampsia: 1-5 g in 250cc NS over 15-30 minP Morphine2 - 4 mg IV/IO/IM/IN slow (up to 10 mg)0.1 mg/kg IV/IO/IM/IN slowAP Narcan0.4 2 mg IV/IM/IO/IN (may repeat)0.1 mg/kg IV/IO/IM/IN (MAX 2 mg)BAP Nitroglycerin0.4 mg SL q 5 min X 3 EMT may AssistP Sodium Bicarb.1 mEq/kg IV/IO repeat q 10 min1 mEq/kg IV/IO repeat q10 minAP Thiamine100 mg IV/IM/IO PRIOR to D 50P Versed1-2 mg IV/IO/IN q30 min PRN Consider MD Order Prior to use0.051 mg/kg IV/IO/IN (MAX 4 mg) Consider MD Order Prior to use PVecuronium0.08-0.1 mg/kg IV/IO Transfer ONLY<10y/o may require higher initial dose Transfer ONLYAP Xopenex Neb1.25 mg in 2.5 ml NS (may repeat X1)0.075 mg/kg in 2.5 ml NS (may repeat X1)AP Zofran4 mg IV/IO/IM/IN (may repeat X 1)0.1 mg/kg IV/IO/IM/IN (MAX 4 mg)Intubation & Sedation - QUICK REFERENCE GUIDE
YESNO Pre-event Equipment Checklist for IntubationAIRWAY AssessmentMallampati Classification (if possible) Mouth Opening (at least two fingers width) - Cervical mobilityIV or IO patentCardiac Monitor / Pulse Oximeter / Automatic blood pressure cuff / End-tidal CO2 monitorBVM with Oxygen / Suction (confirm working)Endotracheal Tubes / Stylet / Laryngoscope Handle & Blades / 10 mL syringe / Tube HolderADULT Intubation & Sedation GuidelinesPre-oxygenatePre-oxygenate with 100% oxygen by mask. Assist ventilations as needed. Apply cricoid pressure if victim is unconscious.Pre-medicatePre-medicate as appropriate; then WAIT 3 MINUTES after drug administration
Fentanyl (Induction): 2-10 mcg/kg IV/IO/IN for analgesia in awake patient
Versed (sedative): 0.5-4 mg IV/IO/IN for sedation & anti-anxiety in awake patient
Atropine: 0.02 mg/kg IV for child less than 5 y/o (minimum dose 0.1 mg)
Lidocaine: 1 mg/kg IV (head injury)Placement:
PerformancePerform endotracheal intubation. If unable to intubate within 20 sec. BVM for 30-60 sec.
and Reattempt. Use O2 sats as a guide.
Treat bradycardia with Atropine 0.5 mg IV push.Placement:
Primary confirmationPerform primary confirmation of ET placement:
By direct visualization of ET passing through vocal cords
By chest rise/fall with each ventilation (bilaterally)
By auscultation: epigastrium; anterior chest L and R; midaxillary line L and R.Placement: Secondary confirmationPerform secondary confirmation of ET placement:
By ETCO2 monitoring
Esophageal detector device
Monitor O2 saturationPlacement:
prevent dislodgmentSecure ET with commercial ET holder
In out-of-hospital setting immobilize cervical spine with C-CollarMaintain Sedation for Intubated Pt.For ADULT patients being transferred: Maintain sedation to prevent tube dislodgment; Fentanyl: 2-10 mcg/kg IV/IO PRN AND Versed or Vecuronium AS NEEDED
Ketamine: 1 mg/kg Slow IV push (to avoid laryngospasm)
Versed: 1-4 mg IV/IO q 15 minutes PRN or as ordered by MD
Vecuronium: 0.6-1.0 mg/kg q 30 minutes PRN or as ordered by MD MUST USE SEDATION
Propofol: (Infusion) may increase 5-15 mcg/kg/min or as ordered by MD SEE PROTOCOL
SedativeDosage IV PushOnsetDurationFentanylInduction: 2 10 mcg/kg Sedation (titrate): 3 mcg/kg60 seconds30 60 minKetamineInduction: 1.5 2 mg/kg SIVP Sedation: 1 mg/kg q 10 min PRN45 - 60 sec.10 20 minPropofolInitial start @ 20-35 mcg/kg/min (may increase 5-15 mcg/kg/min)40 seconds3 5 minVersedInduction: 0.070.3 mg/kg Sedation (titrate): 0.020.04 mg/kg2 minutes1 2 hoursVecuronium0.08-0.1 mg/kg SIDE EFFECTS: Apnea, respiratory insufficiency1 minute25 - 40 min
OTHER QUICK REFERENCE GUIDE
IV FLUID RATES IN Drops/Minute
DRIP SET:1020*60Pediatric Vital Signs 30 cc/hr51030AGEHR-AwakeHR-SleepResp. Rate 60 cc/hr102060Infant = <1 y/o85205801603060 100 cc/hr1733100Toddler = 1-4 y/o85190751602440 200 cc/hr3367200School-age = 4-96014060902234 300 cc/hr50100300Adolescent6010050901216 400 cc/hr67133400Typical Systolic BP for 1-10 y/o: 90 + (age yrs X 2) mmHg
Lower systolic limit for 1-10 y/o: 70 + (age yrs X 2) mmHg
Lower range-normal systolic BP for > 10 y/o: approx. 90 mmHg
Typical MEAN AP (50th%) = 55 + (age yrs X 1.5) mmHg 500 cc/hr 1000 cc/hr83
167167
333500
1000* Hospital Pump tubing=20 gtt/cc
COMMON LAB VALUES
HEMATOLOGYARTERIAL BLOOD GASRBC4.2 - 5.6 M/mcL 3.8 - 5.1 M/mcLpH7.35 7.45WBC3.8 11 K/mm3PaCO235 45 mmHgHgb14 18 g/dL 11 16 g/dLPaO275 100 mmHgHct39 54% 34 47%HCO322 28 mEq/LMCV78 98 fLO2 Sats96 100%Neutrophils50 81%BLOOD CHEMISTRIESBands1 5 %BUN6 23 mg/dLLymphocytes14 44 %Ca++ (calcium)8 11 mg/dLCOAGULATIONCl- (chloride)95 105 mEq/LPlatelets140,000 450,000/mlCreatinine0.6 1.5 mg/dLPlasminogen62 130%Glucose70 110 mg/dLPT10 14 sec.Mg++ (magnesium)1.5 2.5 mg/dLPTT32 45 sec.Phosphorus2.2 4.8 mg/dLFibrinogen160 450 mg/dLK+ (potassium)3.5 5.5 mEq/L INR0.9 1.1 Na+ (sodium)135 148 mEq/L3:00 am Rule
To convert lbs to Kg, divide lbs by 2 and subtract 10%IV Fluids Infusion FormulaTotal amt (ml) X drop factor= drops/minuteTotal time (in minutes)Drug Dose Calculationdose ordered(mg) X vol. of drug in pkg (mL)= volume
to adminNS - IV Fluid Burn Resuscitationamt of drug in package (mg)(% burn area) X (pt. wt. in Kg)= mL/hr (over 8 hrs)4
Section VIII Medication Guidelines
- PAGE 21 - Provider Level authorized to administer the specific medication; B = EMT & I85 A=EMTA P=Paramedic
Spearfish Emergency Ambulance Service, Inc. Medical Guidelines
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