meds: Indications

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Activated Charcoal

INDICATIONS: poisoning following emesis or when emesis is contraindicated
CONTRAINDICATIONS: none in severe poisoning
ADULT DOSAGE: 1 g/kg (typically 50-75 g)mixed with a glass of water to form a slurry
PEDIATRIC DOSAGE: 1 g/kg mixed with a glass of water to form a slurry

Adenosine (Adenocard)

INDICATIONS: symptomatic PSVT
CONTRAINDICATIONS: second or third degree heart block, sick sinus syndrome, known hypersensitivity to drug, Wolf Parkinson White syndrome
ADULT DOSAGE: 6 mg rapid IV bolus over 1-2 seconds, if after 1-2 minutes, cardioversion doesn't occur, administer a 12 mg dose over 1-2 seconds
PEDIATRIC DOSAGE: safety in children has not been established

Albuterol (Proventil)

INDICATIONS: asthma, reversible bronchospasm associated with COPD
CONTRAINDICATIONS: symptomatic tachycardia, known hypersensitivity to drug
ADULT DOSAGE: 0.5 mL (2.5 mg) in 2.5 mL of NaCl over 5-15 mins via NEB
PEDIATRIC DOSAGE: 0.15 mg/kg (0.03 mL/kg) in 2.5 mL normal saline via NEB

Amiodarone (Cordarone)

INDICATIONS: life threatening cardiac dysrhythmias such as V-Tach and V-Fib
CONTRAINDICATIONS: severe sinus node dysfunction, sinus bradycardia, second and third degree AV block, hemodynamically significant bradycardia
ADULT DOSAGE: loading dose of 150 mg over 10 mins (15 mg/min), maintenance dose of 1 mg/min for 6 hrs, then 0.5 mg/min until dysrhythmia is controlled or oral therapy begins
PEDIATRIC DOSAGE: 5 mg/kg IV/IO, maximum dose of 15 mg/kg

Aspirin (ASA)

INDICATIONS: acute onset CP which is suggestive of an MI, signs and symptoms suggestive of recent stroke (CVA)
CONTRAINDICATIONS: patients with known hypersensitivity to the drug
ADULT DOSAGE: 160-324 mg PO
PEDIATRIC DOSAGE: not recommended

Atropine Sulfate

INDICATIONS: hemodynamically significant bradycardia, hypotension secondary to bradycardia, organophosphate poisoning
CONTRAINDICATIONS: none when used in emergency situations
ADULT DOSAGE: Bradycardia - 0.5 mg every 3-5 mins to maximum of 0.04 mg/kg, Organophosphate Poisoning - 2-5 mg
PEDIATRIC DOSAGE: Bradycardia - 0.02 mg/kg (minimum dose of 0.1 mg), child/adolescent maximum single dose - 0.5 mg/1.0 mg, child/adolescent maximum total dose - 1.0 mg/2.0 mg

Calcium Chloride

INDICATIONS: acute hyperkalemia, acute hypocalcemia, calcium channel blocker OD, ABD muscle spasm associated with spider bites and Portugese Man-of-War stings, antidote for Magnesium Sulfate
CONTRAINDICATIONS: patients receiving digitalis
ADULT DOSAGE: 2-4 mg/kg of 10% solution, may be repeated at 10 min intervals
PEDIATRIC DOSAGE: 5-7 mg/kg of 10% solution

Dextrose (50 Percent)

INDICATIONS: hypoglycemia
CONTRAINDICATIONS: none in the emergency setting
ADULT DOSAGE: 25 g (50 mL) or 1 ampule
PEDIATRIC DOSAGE: 0.5 g/kg (D25) slow IV

Diazepam (Valium)

INDICATIONS: major motor seizures, status epilepticus, premedication before cardioversion, skeletal muscle relaxant, acute anxiety states
CONTRAINDICATIONS: known hypersensitivity to the drug
ADULT DOSAGE: Status Epilepticus - 5-10 mg IV, Acute Anxiety - 2-5 mg IV or IM, Pre-Cardioversion - 5-15 mg IV
PEDIATRIC DOSAGE: Status Epilepticus - 0.1-0.2 mg/kg

Diltiazem (Cardizem)

INDICATIONS: to control rapid ventricular rates associated with a-fib and a-flutter, angina pectoris
CONTRAINDICATIONS: hypotension, wide-complex tachycardias, conduction system disturbances
ADULT DOSAGE: 0.25 mg/kg bolus (typically 20 mg) IV over 2 mins, followed by a maintenance infusion of 5-15 mg/hr
PEDIATRIC DOSAGE: rarely used

Diphenhydramine (Benadryl)

INDICATIONS: anaphylaxis, allergic reactions, dystonic reactions due phenothiazines
CONTRAINDICATIONS: asthma, nursing mothers
ADULT DOSAGE: 25-50 mg
PEDIATRIC DOSAGE: 1-2 mg/kg

Dopamine (Intropin)

INDICATIONS: hemodynamically significant hypotension (systolic of 70-100) not resulting from hypovolemia, cardiogenic shock
CONTRAINDICATIONS: hypovolemic shock in which complete fluid resuscitation has not occurred, pheochromocytoma
ADULT DOSAGE: Initial - 2-5 ug/kg/min, increase as needed
PEDIATRIC DOSAGE: 2-20 ug/kg/min

Epinephrine 1:1000

INDICATIONS: bronchial asthma, COPD exacerbation, allergic reactions, pediatric cardiac arrest (after initial epinephrine dosage)
CONTRAINDICATIONS: patients with underlying cardiovascular disease, hypertension, pregnancy, patients with tachydysrhythmias
ADULT DOSAGE: 0.3-0.5 mg
PEDIATRIC DOSAGE: 0.01 mg/kg up to 0.3 mg

Epinephrine 1:10000

INDICATIONS: cardiac arrest, anaphylactic shock, severe reactive airway disease
CONTRAINDICATIONS: for IV use and shouldn't be used in patients who do not require extensive resuscitation efforts
ADULT DOSAGE: Cardiac Arrest - 0.5 mg-1.0 mg every 3-5 mins, Severe Anaphylaxis - 0.3-0.5 mg (3-5 mL), occasionally an epinephrine drip is required
PEDIATRIC DOSAGE: 0.01 mg/kg initially, with repeated doses (Epinephrine 1:1000 should be used at 0.1 mg/kg)

EpiPen Autoinjector

INDICATIONS: anaphylaxis
CONTRAINDICATIONS: patients with underlying cardiovascular disease, hypertension, pregnancy, patients with tachydysrhythmias
ADULT DOSAGE: 0.3 mg
PEDIATRIC DOSAGE: 0.15 mg

Fentanyl Citrate (Sublimaze)

INDICATIONS: severe pain, RSI adjunct, maintenance of analgesia
CONTRAINDICATIONS: shock, severe hemorrhage, hypersensitivity to the drug
ADULT DOSAGE: 25-100 ug
PEDIATRIC DOSAGE: 2-12 yrs - 1.7-3.3 ug/kg

Furosemide (Lasix)

INDICATIONS: CHF, pulmonary edema
CONTRAINDICATIONS: pregnancy, dehyrdration
ADULT DOSAGE: 40-80 mg
PEDIATRIC DOSAGE: 1 mg/kg

Glucagon

INDICATIONS: hypoglycemia, beta-blocker OD
CONTRAINDICATIONS: hypersensitivity to the drug
ADULT DOSAGE: IV - 0.25-0.5 units, IM - 1.0 mg
PEDIATRIC DOSAGE: 0.03 mg/kg

Hydrocortisone (Solu-Cortef)

INDICATIONS: severe anaphylaxis, asthma and COPD disease, urticaria
CONTRAINDICATIONS: none in the emergency setting
ADULT DOSAGE: 100-250 mg
PEDIATRIC DOSAGE: 30 mg/kg

Ipratropium Bromide (Atrovent)

INDICATIONS: bronchial asthma, reversible bronchospam associated with COPD and emphysema
CONTRAINDICATIONS: hypersensitivity to the drug, should not be used as primary acute treatment of bronchospasm
ADULT DOSAGE: 500 mcg in NEB (usually mixed with a beta antagonist - Combivent)
PEDIATRIC DOSAGE: safety in children has not been established

Lidocaine

INDICATIONS: malignant PVC's, V-Tach, V-Fib, prophylaxis of dysrhythmias associated with fibrinolytic therapy
CONTRAINDICATIONS: high degree heart blocks, PVC's in conjunction with bradycardia
ADULT DOSAGE: Initial Bolus - 1.0-1.5 mg/kg, additional boluses of 0.5-0.75 mg/kg can be repeated at 3-5 min intervals until dysrhythmia is suppressed or max dose of 3 mg/kg has been reached, IV Drip - 2-5 mg/min IV infusion to maintain adequate blood levels after dysrhythmia has been suppressed
PEDIATRIC DOSAGE: 1 mg/kg

Lorazepam (Ativan)

INDICATIONS: major motor seizure, status epilepticus, premedication before cardioversion, acute anxiety
CONTRAINDICATIONS: hypersensitivity to the drug
ADULT DOSAGE: 0.5-2.0 mg IV, may be increased to 1.0-4.0 mg IV
PEDIATRIC DOSAGE: 0.05-0.10 mg/kg (max dose of 4 mg)

Magnesium Sulfate

INDICATIONS: Obstetrical - eclampsia (toxemia of pregnancy), Cardiovascular - severe refractory V-Tach, post myocardial infarction as prophylaxis for dysrhythmias, torsades de pointes (multiaxial V-Tach)
CONTRAINDICATIONS: shock, heart block
ADULT DOSAGE: 1-4 g
PEDIATRIC DOSAGE: not indicated

Metoprolol (Lopressor)

INDICATIONS: suspected or definite acute myocardial infarction in patients who are hemodynamically stable
CONTRAINDICATIONS: HR < 45 BPM, systolic < 100, heart block, shock, history of asthma
ADULT DOSAGE: Initial bolus - 5 mg slow IV injection, may repeat (up to 2 times) 5 mg bolus in 10 mins if vitals are stable
PEDIATRIC DOSAGE: safety in children has no been established

Midazolam (Versed)

INDICATIONS: premedication before cardioversion, acute anxiety states
CONTRAINDICATIONS: hypersensitivity to the drug, narrow-angle glaucoma, shock
ADULT DOSAGE: 1.0-2.5 mg IV
PEDIATRIC DOSAGE: 0.03 mg/kg

Morphine Sulfate

INDICATIONS: severe pain, pulmonary edema
CONTRAINDICATIONS: head injury, volume depletion, hypersensitivity to the drug
ADULT DOSAGE: IV - 2-5 mg followed by 2 mg every few minutes until pain is relieved or respiratory depression ensues, IM - 5-15 mg based on the patient's weight
PEDIATRIC DOSAGE: 0.1-0.2 mg/kg IV

Naloxone (Narcan)

INDICATIONS: narcotic OD including: morphine, Dilaudid, fentanyl, Demerol, paragoric, methadone, heroin, Percodan, and Tylox, Sythetic Analgesic OD including: Nubain, Stadol, Talwin, Darvon, and alcoholic coma, to rule out narcotics in coma of unknown origin
CONTRAINDICATIONS: hypersensitivity to the drug
ADULT DOSAGE: 1-2 mg
PEDIATRIC DOSAGE: <5 yrs - 0.1 mg/kg, >5 yrs - 2.0 mg

Nitroglycerin (Nitrostat)

INDICATIONS: angina pectoris, CP associated with mycardial infarction
CONTRAINDICATIONS: children < 12 yrs, hypotension (systolic <100)
ADULT DOSAGE: one tablet (0.4 mg) repeated at 5 minute intervals to a max of 3 doses or until systolic < 100
PEDIATRIC DOSAGE: not indicated

Racemic Epinephrine (MicroNEFRIN)

INDICATIONS: croup (laryngotracheobronchitis)
CONTRAINDICATIONS: epiglottitis, hypersensitivity to the drug
ADULT DOSAGE: 0.25-0.75 mL of 2.25% solution in 2.0 mL NaCl
PEDIATRIC DOSAGE: 0.25-0.75 mL of a 2.25% solution in 2.0 mL NaCl

Sodium Bicarbonate

INDICATIONS: late in the management of cardiac arrest, tricyclic antidepressant OD, severe acidosis refractory to hyperventilation
CONTRAINDICATIONS: alkalotic states
ADULT DOSAGE: 1 mEq/kg initially followed by 0.5 mEq/kg every 10 mins as indicated by ABG
PEDIATRIC DOSAGE: 1 mEq/kg initially followed by 0.5 mEq/kg every 10 mins

Thiamine (Vitamin B1)

INDICATIONS: coma of unknown origin, alcoholism, delirium tremens
CONTRAINDICATIONS: none in the emergency setting
ADULT DOSAGE: 100 mg
PEDIATRIC DOSAGE: rarely indicated

Vasopressin

INDICATIONS: cardiac arrest
CONTRAINDICATIONS: none when used in the emergency setting
ADULT DOSAGE: 40 units IV (single dose only)
PEDIATRIC DOSAGE: not indicated

Ondansetron (Zofran)

INDICATIONS: nausea/vomiting
CONTRAINDICATIONS: hypersensitivity to the drug
ADULT DOSAGE: 4 mg
PEDIATRIC DOSAGE: < 30 kg - 1 mg, > 30 kg - 2 mg

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