Prehospital Medications

7/23/2019 Prehospital Medications

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Essential Pre-Hospital Medications


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Classification Confusion


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Classification of drugs

Therapeutic use.

Antiarrhythmics , analgesic, respiratory, etc.

Mechanism of action. Class I II III Similar therapeutic use with

different mechanisms of action. (Vaughn-

illiams classifications of antiarrhythmics!.

Probable effectiveness.(Class of

recommendation.! Class I, II -a, II-"

indeterminate and III (A#A!.


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Vaughn-Williams Classifications

of Antiarrhthmics

Class !$ Sodium Channel %loc&ers.

! a" Supra-'entricular myocardial effects.

! b # ! c$ Ventricular myocardial effects.

Class !! %eta "loc&er agents

Class !!!rolong depoleri)ation.

Class !VCalcium channel "loc&ers.

Miscellaneous$ Cardiac glcosides$ Sodium,otassium A* inhi"itors. (+igitalis!.

Adenosine" otassium channel acti'ator.


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Class of $ecommendation.

%ased on clinical stud evidence of

effectiveness. &AHA' Class !$ Inter'entions are always accepta"le, safe and

effecti'e. Considered st line standard of

care.

Class !!-a$ Inter'entions are safe and useful. Consideredinter'entions of choice "y most eperts.

Class !!-b$ Inter'entions are safe and useful. Considered

alternate or optional inter'entions "y maority

of eperts. !ndeterminate$ /'idence insufficient to support a class

decision

Class !!!$ 0ot accepta"le , not useful, may "e harmful.


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Therapeutic classifications" Cardiac

(rugs"

Antiarrhthmics$ Atrial 1 Ventricular

Adernergics$ (Sympathomimetics! used toincrease heart rate and "lood pressure. %eta ) #eart effects$ Increase rate, force of contraction.

%eta * 2espiratory effects$ %ronchodilation 1 'asodilation

Alpha )Vascular effects $ Vasoconstriction 1

"ronchoconstriction.

Alpha *Inhi"its release of 0orepinephrine

(opaminergicVascular effects$ dilates renal, cere"ral and

coronary arteries


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Therapeutic classifications"Cardiac(rugs cont+d"

AntiCholinergics$ (arasympatholytic! Vagal

ner'e "loc&er3 %loc&s acetylcholine receptors.

Antianginals$ (0itrate 'asodilators.! +ilate

coronary arteries, reduce cardiac oygen demand.

Analgesics$ ain relie'ers.

Thromboltics" &Platelet aggregate inhibitors're'ent "lood clot formation or dissol'e eisting

clots.


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Therapeutic Classifications"

$espirator (rugs

(iuretics$ ,oop (%loc&s sodium re-a"sorption! treatment

of C#4 induced pulmonary edema. Osmotic: (promotes

fluid shift from intra-cellular to extra-cellular space)Mannitol

%eta * selective mpathomimetics$ %eta 5 agonists$%ronchodilators.

Corticosteroids$ Inhi"it inflammatory responses.

Antihstamines" %loc&s histamine release in allergic

reactions. Paraltics" 0euromuscular "loc&er Agents

&Succinylcholine (Anectine! 6sed in rapid se7uence intu"ationto pre'ent laryngospasm..


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Therapeutic Classifications"

ther Emergenc (rugs

Carbohdrates$ (Simple sugar!

pioid antagonist(%loc&s effects of narcotics!

Vitamin (Specifically %! 0eeded for glucosemeta"olism.

Al/ali0ing agent ydrogen ion "uffer!

Anticonvulsant 1 tran7uili)ers$ sie)ure control

create retrograde amnesia.


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A look at whats in the box.


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Atrial Antiarrhthmics

Adenosine (Adenocard! otassium channel

acti'ator.

Verapamil (Calan, Isoptin! Calcium channel

"loc&er.

(igitalis &(igo1in' Cardiac glycoside

(Sodium,potassium and A* inhi"itor!0ote$ +igitalis is

not a pre-hospital drug "ut may "e the cause of arrhythmia yourpatient is in. +igitalis toicity is a maor cause of 'entricular

irrita"ility. 6sual dose 8.59 to 8.98 mg slow IV o'er 9-: minutes.


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Adenosine(Adenocard!

Class$ Atrial Anti-dysrhythmic

Action" Slows conduction through SA and AVnode. Acts as chemical cardio'erter of supra-

'entricular dysrhthmias. Acti'ates potassium

channels.


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Adenosine

!ndications" 0arrow comple tachycardiaSV* ; SV* .

Precautions$


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Adenosine

Contraindication" oison or drug-induced tachycardia.

ide effects$ 4lushing, chest pain or tightness, "rief period

of asystole or "radycardia and 'entricular

ectopy.

2ote$ Sinus "radycardia and VCs arecommon after termination of SV*.


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Adenosine

(osage and route of administration"

lace patient in mild re'erse *rendelen"erg

position. (


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Verapamil( Calan, Isoptin!

Class$ Atrial Anti-arrhythmicCalcium cannel "loc&er.

Action$ +elays AV nodal conduction and inhi"its atrial

dysrhythmias.

!ndications$

st line for treatment of atrial fi"rillation oratrial flutter with rapid 'entricular rates. 5ndline for treatment of narrow completachycardias refractory to Adenosine.


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Verapamil

Precautions$

@i'e only to patients with narrow comple

SV* or arrhythmia &nown to "e of supra-'entricular origin (narrow 2S!.

6se with caution in patients ta&ing oral "eta

"loc&ers (may cause se'ere hypotension!


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Verapamil

ide effects$

#ypotension due to decreased peripheral

'asodilation. #ypotension may "e re'ersed "y

administration of Calcium. /acer"ation of C#4 due to decreased myocardial

contractility in patients with left 'entricular

dysfunction.

Contraindications"

#ypotension3ide completachycardia


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Verapamil


5.9 to 9.8 mg IV "olus o'er 5 minutes.(slow IV

push! 2epeat at 9.8 to 8 mg (+ou"le initial dose! if

needed in 9 to ?8 minutes. =aimum dose$ 58

mg

0ote$ In elderly patient administer dose o'er ?minutes to pre'ent hypotension.


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Ventricular Antiarrhthmics

Amiodarone (Cordarone! (class III!B


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Amiodarone (Cordarone!

Classification" Ventricular Antiarrhthmic.

Action"

Class I,II ;III antiarrhythmic properties.

Sodium1potassium channel "loc&er.

!ndications$

ulseless V-*ach and V-4i" refractory to defi"rillation.

V-*ach with pulse refractory to cardio'ersion 5nd line to Adenosine for SV* refractory to

cardio'ersion. 5nd line to Verapamil for A-fi" ; A-

flutter refractory to cardio'ersion


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Amiodarone

!ndicationscontDd.$

ide comple tachycardia of undetermined

origin. *orsades de pointe following =agnesium

sulfate and refractory to cardio'ersion.


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Amiodarone

Precautions"

=ay cause hypotension due to 'asodilation.

+ue to long half life (E8 days! use with cautionin patients with renal failure.

=ay prolong * inter'al.


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Amiodarone

ide effects"

#ypotension (treat "y slowing IV rate,

dopamine may "e indicated in etremecases.!

Contraindications"

Cardiogenic shoc&, #ypotension, Sinus

%radycardia, II and III degree AV-"loc&.


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Amiodarone

(osage and route of administration$

Cardiac Arrest$ ?88 mg IV push. =ay repeat at

half initial dose in ?-9 minutes.

Ma1imum cumulative dose" 5.5 gm IV 1 5Ehrs.

Wide-Comple1 Tachcardia&table V-Tach'"98mg IV infusion o'er 8 min (9mg1 min.! $epeat

ever )3 min as needed.

Maintainance !nfusion$ mg1min IV


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,idocaine (ylocaine!

Classification" Ventricular antiarrhythmic (class "!,


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,idocaine

!ndications$ Ventricular fi"rillation and pulseless

'entricular tachycardia. ide comple

tachycardia ( sta"le V-*ach! and 'entricularectopy( malignant VCDs!.

Precautions" 2educe dosage and rate of infusion in

patients o'er >8 and patients with li'erdisease or C#4.


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,idocaine

ide effects"

0um"ness, tingling, drowsiness,

disorientation, con'ulsions, coma and

respiratory arrest. (Slow or stop IV infusion if

side effects occur.!

Contraindications"

rophylactic use in A=I patients. %radycardia

with 'entricular ectopy (treat with atropine or

pacema&er not lidocaine.!


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,idocaine

(ose and route of administration"

Cardiac arrest$ -.9 mg 1 &g IV push loading

dose. 4ollowed in 9-8 minutes "y half initial

dose. 6p to ?mg1&g total dose.

ide comple tachycardia (sta"le V-*ach!

Ventricular ectopy (VCDs! Same as a"o'e "ut

should "e pushed slowly o'er one minute. 0ote$ Initial dose of


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,idocaine Maintenance (rip

=i gm lidocaine with 598 ml +9

or 5 gm lidocaine with 988ml +9 F 8.EG

solution Emg 1ml. ( - E mg 1 minute standard

dose!

>8 gtt 1 minute F Emg1minute

E9 gtt 1 minute F ?mg1minute

?8 gtt 1minute F 5mg1min

9 gtt 1 minute F mg 1minute


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Procainamide (ronestyl!

Classification"Ventricular antiarrhythmic(class a!

Action" Suppresses depolari)ation in normal

Ventricular muscle and ur&ine fi"ers

reducing the automaticity of ectopicpacema&er sites. Suppresses reentrydysrhythmias "y slowing intra'entricularconduction.


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Procainamide

!ndications"

Control of SV* in patients resistant to Adenosine

and 'agal maneu'ers if "lood pressure is sta"le.

Sta"le ide comple tachycardia of un&own origin.

Atrial fi"rillation with rapid rate caused "y olf

ar&inson hite syndrome.

V-*ach and V-fi" refractory to Amiodrone or


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Procainamide

Precautions$

2educe dosage in patient with renal

dysfunction.

=ay cause hypotension in patients with

impaired left 'entricular function.

6se with caution with other drugs that prolong

* inter'al (Amiodarone!


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Procainamide

ide effects"

#ypotension4 "radycardia, refle tachycardia,

AV "loc&, widened 2S or prolonged -2

inter'al or -* inter'al, C0S depression,

confusion and sei)ures.

Contraindications"

5nd and ?rd degree heart "loc&. +igitalis

toicity, *orsades de pointe and tricyclic

antidepressant toicity.


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Procainamide


Cardiac arrest" 58 mg 1 minute IV infusion.

=aimum total dose of H mg 1&g Stop infusion if

patient de'elops hypotension or 98G increase

in 2S width.

$efractor V-5 and V-T" 88 mg IV push may

"e repeated in 9 minutes.


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Procainamide Maintenance (rip

After resuscitation from cardiac arrest in

response to rocainamide therapy.

=i g with 988 ml +9 F 5 mg1ml F 5mg1ml

or =i g with 598 ml +9 F E mg 1ml (same as

a


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%retlium Toslate (%retylol!

Classification"Ventricularantiarrhythmic

(class III! (5nd or ?rd line drug!

Action"

Adernergic neuronal "loc&ing agent with

direct myocardial effects suppresses'entricular ectopy raises fi"rillation

threshhold.


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%retlium

!ndications" V-4 ; V-* refractory to other 'entricular

antidysrhythmics.

2ote" 2o longer included in currentAHA *333 cardiac resuscitation

guidelines or AC, algorithms .Ho6ever it is still currentl in use inman sstems.


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%retlium

ide effects"

Vertigo, 'omiting, syncope, "radycardia,

angina pectoris and transient hypotension

lasting approimately 58 minutes.

Contraindications"

+igitalis toicity induced dysrhythmia.


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%retlium


9 mg1&g rapid IV "olus, initial dose.

2epeat in 9-8 minutes at 8mg 1&g (maimum

total IV "olus dose of ?8 mg 1 &g!

=aintenance drip$ =i 5 g with 988 ml +9 or

g with 598 ml +9 F Emg1ml solution ( same

as


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Magnesium ulfate

Classification" /lectrolyte,

Anticon'ulsant, (Class II a! 'entricular

anti-arrhythmic.

Action"

2educes striated muscle contractions and"loc&s peripheral neuromuscular transmission

"y reducing acetylcholine release.


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Magnesium ulfate

!ndication"*osades de pointe, eclampsia,

hypo-magnesemia and refractory 'entricular

fi"rillation.

Precautions" =ay cause hypotension if

administered too rapidly. 6se cautiously in renal

failure patients.


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Magnesium ulfate

ide effects"

+iaphoresis, facial flushing, hypotension,

hypothermia, reduced heart rate, respiratory

depression and diarrhea.

Contraindications"

#eart "loc&s


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Magnesium ulfate


Torsades and refractor V-5"

-5 g (5-E ml of 98G solution! diluted with 8 ml

of +9 o'er -5 minutes in *orsades. 2apid IV

push for V-4

ei0ures" 5-E g IV slow i' push.


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Parasmpatholtic

&Anticholinergic agent'

Atropine ulfate (Atropine!


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Atropine ulfate

Classification"arasympatholytic(anticholinergic!

Action "

%loc&s acetylcholine receptor sites. 2e'erses

'agal induced "radycardias. Increases heartrate. otentiates the sympathetic response

in asystolic patients.


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Atropine

!ndications"

Symptomatic "radycardia. Asystole, /A,

rganophosphate poisoning or ner'e gas (sarin!

poisoning.

Precautions"

%radycardiain acute myocardial infarct patient may"e compensatory. Increasing heart rate may increase

infarct of myocardial tissue due to increased ygen

demand. *C is treatment of choice in this case.


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Atropine

ide effects"

*achycardia, palpitations, dry mouth, headache,

di))iness, 0 ; V, flushed hot dry s&in. If pushed too

slowly or at too low of dose may worsen the"radycardia.

Contraindicated$

*achycardia, 0arrow Angle @lucoma, @I tract

o"struction, Ischemic chest pain due to A=I.Jnowndrug allergy. atients on IV diueretic therapy, maycause ina"ility to 'oid.


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Atropine


%radcardia$ 8.9 - mg IV push. =ay "e

repeated in ?-9 minutes. =aimum cumulati'e

dose of 8.E mg1&g. (? mg!

Cardiac arrest$ mg IV push e'ery fi'e minutes

up to =aimum dose of 8.E mg1&g (?mg!.

Initial dose of Atropine may "e gi'e down the /*tu"e at 5-5.9 times the IV dosage.


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mpathomimetics

&Adrenergic agents!

Cardiac" %eta )

/pinephrine (Adrenalin!

+opamine (+opastat, Intropin!

$espirator" %eta *

Al"uterol (ro'entil, Ventolin!

=etaproterenol (Alupent!


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Epinephrine (Adrenalin!

Classification"

Sympathomimetic 1 %ronchodilator.

Actions"

Stimulates alpha and "eta adrenergic

receptor sites.


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Epinephrine

!ndications" Cardiac arrest (V-*, V-4, /A and asystole! ,

symptomatic "radycardia, anaphlactic shoc&

and asthma. KIf you need C2, you need /piL.

Precautions" +o not mi with sodium "icar". 6se with other

sympathomimetic drugs causes additi'eeffects.


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Epinephrine

ide effects"

0one in cardiac arrest. alpitations, angina,

tachy-arrythmias, nausea, 'omiting,

headache, or di))iness in non-cardiac arrest

patients.

Contraindications"

0one in life threatening conditions.


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Epinephrine


/pinephrine comes in two concentrations$ )")34333 7 )mg 8 )3 ml &cardiac use'

)")333 7 )mg 8 ) ml ( respiratory use!

Cardiac arrest$ mg IV push e'ery e'ery ?-9

minutes during resuscitation. 4ollow each dose

with 58ml saline flush and minute of C2 .


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Epinephrine

Cardiac arrest$ #igh +ose$ 8.5 mg1&g IV push

e'ery ?- 9 minutes.

Continuous infusion$ ?8 mg $888 solution

added to 598 ml normal saline run at 88 ml 1hr

Tracheal$ 8.5 - 5.9 mg $888 mied with 8 ml.

normal saline down endotracheal tu"e. ften

preferred for initial dose.


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Epinephrine

%radcardia 8 Hpotension$ 5 to 8 mcg 1min.

( add mg of $888 to 988 ml normal saline!$

infuse at 5-8 mcg 1min. titrate to effect.

Anaphla1is 8 asthma$ 8.? to 8.9 mg $888

SC

Pediatric dose$ 8.8mg1&g


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(opamine (Intropin!

Classification" Sympathomimetic

Actions" Stimulates "oth alpha and "eta receptors.Effects are dose dependant.

,o6 dose$ -9 mcg1&g1min. F (2enal ; mesenteric

'asodilation!

Moderate dose$ 9 -8 mcg1&g1min. F (Cardiac,

increased rate, force of contraction!

High dose$ 8 -58 mcg1&g1min.F (Vasopressor

peripheral and renal 'asoconstriction.!


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(opamine

!ndications" #ypotension associated with cardiogenic

shoc& or "radycardia. =ay "e used to treat

hypotension caused "y hypo'olemia afterfluid replacement.

Precautions$

6se with etreme caution in patients withischemic heart disease or occlusi'e 'asculardisease. =ay worsen their condition due to'asoconstriction.


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(opamine

ide effects$ /ctopic heart "eats, tachycadrdia,

"radycardia, angina, nausea ; 'omiting,

hypertension and headache.

Contraindications"

#ypo'olemic Shoc& in prehospital setting(concentrate on fluid replacement and rapidtransport!.


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(opamine


Al6as administered !VP (rip.

=i E88mg with 598 ml +9 or 01S

or :88mg with 988 ml F .> mg 1ml

concentration F >88 mcg 1 ml.

,o6 dose$ -9 mcg 1&g 1 min.

Moderate dose$ 9-8 mcg 1 &g 1 min.

High dose$ 8-58 mcg1&g1min.


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$espirator (rugs

mpathomimetics" %eta * selective

Al"uterol$ (Ventolin, ro'entil!

=etaproterenol (Alupent!

Corticosteroids"

=ethylprednisolone$ (Solu-=edrol!

Antihstamines"

+iphenhydramine$ (%enadryl!

(iuretics" 4urosemide$ (


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Albuterol(Ventolin, ro'entil!

Classification"Sympathomimetic 1

%ronchodilator.

Action"

Selecti'ely stimulates %eta 5 adrenergic

receptor sites. 2elaes smooth muscles in the

"ronchiol tree and peripheral 'ascular system.


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Albuterol

!ndications"

2elief of "ronchospasm in patients with re'ersi"le

o"structi'e pulmonary disease (Asthma!. re'ention

of eercise induced "ronchospasm. Precautions"

6se with caution in patients ta&ing other

sympathomimetics, may cause cardiac arrythmias.

tDs. on antidepressants may "ecome hypotensi'e.%eta "loc&ers antagoni)e al"uterol.


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Albuterol

ide effects"

6sually dose dependant. 2estlessness,

apprehension, di))iness, palpitations,

tachycardia, dysrhythmias.

Contraindications"

*achycardia, &nown drug allergy.


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Albuterol


Metered (ose !nhaler$ to 5 inhalations M8

to:8 mcg7 E-> hours (9 min. "etweeninhalations! =a of 5 inhalations 1day.

* 2ebuli0er$ 5.9 mg in 9 ml o'er 9 to 8

minutes inhalation.


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Metaproterenol (Alupent!

Class " %eta 5 selecti'e Sympathomimetic

Action$ %ronchodilator.

!ndications4 ide effects4 contraindications

and precautions same as Al"uterol.


*nebuli0er9-9 inhalations of 9G solution.

or M(!5-? inhalations 5 min "etween inhalations7 ?-E hrs.


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Methlprednisolone(Solu-=edrol!

Classification"Corticosteroid (anti-

inflamatory agent!

Action"

Synthetic steroid that suppresses acute and

chronic inflammation. otentiates smooth

muscle relaation "y "eta adrenergic

agonists.


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Methlprednisolone

!ndications"

Anaphylais, asthma, acute spinal cord inury.

Precautions" Ma cause hpoglcemia

in insulin dependant diabetics.


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Methlprednisolone

ide effects"

#eadache, hypertension, sodium and water

retention, hypo&alemia, hypoglycemia,

al&alosis.

Contraindications$

+ia"etes mellitus, se'ere infection (sepsis!,

@I "leeding.


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Methlprednisolone


Asthma 8 Anaphla1is$ E8 -59 mg IV push.

pinal cord in9ur$ ?8 mg1 &g IV "olus followed

"y IV infusion of 9.E mg1&g1hour.

2ote"6se for spinal cord inury is not a pre-hospital

inter'ention at this time. Airway management, spinalimmo"ili)ation and rapid transport is priority.


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(iphenhdramine(%enadryl!

Classification$Antihistamine

Actions"%loc&s the effects of histamine


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(iphenhdramine

!ndications" =ild to moderate allergic reactions. 6se with

/pinephrine to treat anaphylactic shoc&.

Precautions" 6se with caution in patients with #ypertension,

narrow angle glaucoma, heart disease. /lderlypatients may "e etremely sensiti'e monitorclosely for hypotension and sei)ures.


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(iphenhdramine

ide effects"

+rowsiness, headache, whee)ing,

palpitations, tachycardia, hypotension,

nausea and 'omiting.

Contraindications"

Astma, C+ attac&s.


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(iphenhdramine

+osage and route of administration$

8 - 98mg IV or deep I=


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5urosemide (


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5urosemide

!ndication$

6sed to relie'e acute pulmonary edema in patients

with systolic "lood pressure a"o'e M8 mm1 #g (with

no signs and symptoms of shoc&.! #ypertensi'e crisis, increased intracranial

pressure.

Precautions$

+iuretic therapy may cause hypotension, dehydration,

hypo'olemia, hypo&alemia and other electrolyte

im"alances.


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5urosemide

ide effects"

rthostatic hypotension, dehydration, nausea

and 'omiting if administered to rapidly.

Contraindications$

regnancy, hypotension, hypo'olemia, &nown

drug allergy.


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5urosemide


8.9 to .8 mg1&g o'er -5 minutes slow IV push.

=ay repeat at dou"le initial dose in 9-8

minutes if initial dose was not effecti'e.

Standard pre-hospital dose ranges for adult.

58 - E8 mg IV (t. not on oral diuretics!

E8 - :8 mg IV (t. on oral diuretics.!


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ther Cardiac Emergenc (rugs

Anti-anginal Agent$ 0itroglycerine (0itrostat!

Platelet Aggregate !nhibitor"(Asprin!

Analgesics$ =orphine, =eperidine (+emoral!

Al/alini0ing Agent$ Sodium %icar"onate.

Electrolte" CalciumChloride


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2itroglcerine (0itrostat 10itro"id!

Classification"Vasodilator 1 Anti-anginal

Action$ 2elaes 'ascular smooth muscle, causes

'asodilation which increases coronary "lood

flow3 reduces preload.


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2itroglcerine

!ndications" Ischemic chest pain, C#4, hypertension crisis.

Precautions"


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2itroglcerine

ide effects" #eadache, hypotension, nausea, 'omiting,

tachycardia.

Contraindications" +o not administer to any patient who has

used the anti-impotence drug Viagra with inthe past 5E-?> hours. Systolic %1 less thanM8 mm1#g.


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2itroglcerine


ublingual tablets$ 8.? -8.E mg ta"let e'ery 9

minute up to a total of ? maimum. =onitor %1

"etween *a"s. ublingual pra$ 8.E mg1spray (same as

a"o'e!

Trans-dermal ointment8paste$ to 5 inches(9 -?8 mg! applied to s&in of chest wall.


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Aspirin (ASA!

Classification" latelet aggregate inhi"itor, throm"olytic,

analgesic and anti-inflammatory.

Action" Impedes clotting action and platelet

aggregation "y "loc&ing prostaglandin

synthetase action, (*hrom"oane A5theen)yme that causes platelets to stic& togetherto form a "lood clot and constricts inured'essels!.


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Aspirin

!ndications" Symptomatic ischemic chest pain. Sings and

symptoms of acute CVA.

Precautions"

6se with caution in patients with history ofasthma, post operati'e surgical patients, and

patients ta&ing arfarin (Coumadin!


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Aspirin

ide effects"

0ausea, 'omiting, heart"urn, "ronchospasm,

di))iness and occult "leeding.

Contraindications"

2ecent history of @I "leeding or ulcers.Jnown "leeding disorders. Jnown sensiti'ity

or allergy to ASA.


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Aspirin


>8 to ?59 mg chewed.

2ote"(6se of chewa"le "a"y aspirin is highly

recommended.!


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Morphine ulfate (Astramorph14!

Classification"

pioid (narcotic! Analgesic (Schedule II controlled

su"stance!

Action"

C0S depressant with analgesic and hemo-dynamic

effects. Increases systemic 'enous capacitancy which

decreases 'enous return and 'ascular resistance,relie'ing pulmonary congestion and reducing myocardial

oygen demand. 2educes sensiti'ity to pain.


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Morphine

!ndications" ain and aniety associated with acute

myocardial infarction. Acute pulmonary

edema associated with C#4. Se'ere pain.

Precautions"

atch for respiratory depression. 0aloone(0arcan! should "e a'aila"le to re'ersepossi"le ad'erse affects.


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Morphine

ide effects"

+i))iness, nausea, 'omiting, altered le'el of

consciousness and respiratory depression.

Contraindications"

#ead inury, significant hypotension,

a"dominal pain, C+, Jnown

hypersensiti'ity.


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Morphine


5 to 9 mg slow IV push no faster than 5 mg 1

minute titrate to 98G reduction of pain. +o not

eceed a total dose of 9 mg.


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Meperidine(+emoral!

Classification"pioid (narcotic!

analgesic. (Schedule II controlled

su"stance!

Action"

Synthetic opioid agonist that wor&s at opioid

receptors sites in C0S to induce analgesia

and euphoria.


93/123

Meperidine

!ndication" =oderate to se'ere pain. ain caused "y

musculos&eletal inury and &idney stones.

Precaution" =ay cause C0S and respiratory depression.

6se with caution in patients with history ofsei)ure disorder. #a'e 0aloone a'aila"le tore'erse ad'erse effects.


94/123

Meperidine

ide effects" 2espiratory depression, lightheadedness,

euphoria, nausea, 'omiting, hypotension and

"radycardia.

Contraindications"

Ischemic chest pain (unless patient is allergicto morphine.! #ead inury, a"dominal pain andhypersensati'ity to drug.


95/123

odium %icarbonate

Classification"Al&alini)ing agent3 "uffer.

Action" 0eutrali)es ecess "uild up of acid (#ydrogen

ions! caused "y se'ere hypoic states, #elps

restore normal p#.


96/123

odium %icarbonate

!ndications" *reatment of tricyclic antidepressant

o'erdose.4or se'ere acidotic states. 6sed in

prolonged cardiac arrest after defi"rillationand cardiac medications.

Precautions" 6se with caution in C#4. +osage should "e

calculated "ased on arterial "lood gasanalysis when e'er possi"le. 2ote" Ade7uate'entilation airway management and C2 are themaor "uffer agents used in cardiac arrest.


97/123

odium %icarbonate

ide effects"Al&alosis, C#4 and musclecramps.

Contraindications" Should not "e used in meta"olic or respiratory

al&alosis.

0ote$ 0o longer recommended for routineuse in cardiac arrest patients.(A#A 5888guidelines!


98/123

odium %icarbonate


m/71&g IV "olus followed "y half dose e'ery

8 minutes. Consult =edical control


99/123

Calcium Chloride

Classification$ /lectrolyte

Action" /ssential component for the proper

functioning of ner'ous, musculos&eletal and

endocrine systems. Increases force of

myocardial contractions.


100/123

Calcium Chloride

!ndications"

#ypocalcemia, #yper&alemia, o'erdose of

=agnesium Sulfate, Verapamil and other

calcium channel "loc&ers. %lac& idowspider "ite. Cardiac arrest when

hyper&alemia is suspected.

Precautions" 2enal failure and history of heart disease.


101/123

Calcium Chloride

ide effects"

Cardiac arrhythmias, headache, di))iness,

hypotension, nausea, 'omiting and

hypercalcemia.

Contraindications"

Jnown hypercalcemia, +igitalis toicity,

'entricular fi"rillation.


102/123

Calcium Chloride


E to 5 mg1&g slow IV push at rate of 8.9 to 5.8

ml per minute3 ml of 8G solutionF88mg of

drug. =ay "e repeated at same dose in 8 minutes if

needed.

(rugs :sed To Treat


103/123

(rugs :sed To Treat

:nconsciousness

Vitamin %)$ (*hiamine!

2arcotic Antagonist$ 0aloone (0arcan!

Carbohdrate$ +etrose 98G

Anti-hpoglcemic agent$ @lucagon

Anticonvulsant$ +ia)epam (Valium!


104/123

Thiamine

Classification$ Vitamin %

Action" Coen)yme necessary for car"ohydrate

meta"olism and the "rea&down of glucose.


105/123

Thiamine

!ndication"Administered prior to +etrose 98G

(particularly in &nown alcoholics! to pre'ent

ernic&eDs encephalopathy, ("rain swellingand resulting increased IC!

Precautions" Very safe in emergency setting3 anaphylactic

reactions are etremely rare.


106/123

Thiamine

ide effects" #ypotension and 1 or nausea are

possi"le "ut rare.

Contraindications" 0one in emergency setting.


107/123

Thiamine


88 mg slow IV push or I=

2 l (0 !


108/123

2alo1one(0arcan!

Classification$ 0arcotic Antagonist

Action" 2e'erses effects of narcotics and certain

synthetic analgesics.

2 l


109/123

2alo1one

!ndications"

*o re'erse C0S depression effects of narcotics and

synthetic analgesics. 6sed to rule out narcotic

o'erdose in coma of un&nown origin.

Precautions"

duration of action is less than the drug effects of agents

it is used to treat. atient may relapse and re7uirerepeat dosing. =ay induce withdrawal syndrome in

addicts. (atient should "e restrained prior to

administration.!

2 l


110/123

2alo1one

ide effects"

0ausea and 'omiting at high doses when

rapidly administered.

Contraindications"

0one3 ecept &nown hypersensiti'ity to drug.

2 l


111/123

2alo1one

(osage and route of administration$

3.; to *.3 mg !Vmay "e repeated as needed up

to maimum of 8 mg.

IV is route of choice, may also "e gi'en I=, SC,

or 'ia /*, if IV access is una'aila"le.

#igher doses may "e needed to re'erse effects

of synthetic narcotics such as 4entanyl.

( t


112/123

(e1trose


113/123

(e1trose


114/123

(e1trose


115/123

(e1trose


116/123

>lucagon

Classification"Anti-hypoglycemic agent

Action" romotes the "rea&down of glycogen to

glucose in li'er, releasing stored glucose into

"lood increasing "lood glucose le'el.

2elaes gastrointestinal smooth muscle.

>l


117/123

>lucagon

!ndications"

#ypoglycemia, /sophogitis, for relaation of

smooth muscle in cases of food o"struction of

esophagus.

Precautions" 0one in emergency setting.

>lucagon


118/123

>lucagon

ide effects"

+i))iness, lightheadedness, nausea, 'omiting

and urticaria.

Contraindications$

Jnown hypersensiti'ity.

>lucagon


119/123

>lucagon


8.9 to .8 units IV, I=, SC may "e repeated in

8-9 minutes if needed.

0ote$ "tain pre-administration "lood sample for

hospital use prior to administration.

(ia0epam (Valium!


120/123

(ia0epam(Valium!

Classification"*ran7uili)er,

Anticon'ulsant

Action"

2educes aniety, suppresses sei)ure acti'ity,

induces amnesia, relaes s&eletal muscle.

(ia0epam


121/123

(ia0epam

!ndications" @enerali)ed sei)ures and status epilepticus,

acute aniety, pre-medication "efore

cardio'ersion, relaation of s&eletal muscle.

Precautions"

Short duration of effect may re7uire repeatdosing.


122/123

(ia0epam

ide effects"

2espiratory depression, drowsiness,

hypotension, apnea.

Contraindications"

2espiratory depression of any source.

atients who ha'e ta&en alcohol or other

sedati'es, se'ere hypotension.

(ia0epam


123/123

(ia0epam


tatus epilepticus"9 to 9 mg IV

Acute an1iet" 5 to 8 mg IV or I=

Cardioversion" 9 to 9 mg IV

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