TRADE NAME: Adenocard
ACTIONS: Slows (decreases) AV conduction
INDICATIONS: Symptomatic PSVT, including Wolff-Parkinson-White Syndrome (WPW)
Onset: 20 - 35 seconds
Peak Effect: 20 - 35 seconds
Duration: 30 - 120 seconds
Half Life: 10 seconds
CONTRAINDICATIONS: Second or third degree heart block, sick-sinus syndrome, known
hypersensitivity to the drug, dysrhythmias other than PSVT, reactive airway diseases like asthmea.
PRECAUTIONS: Arrhythmias, including blocks, are common at the time of cardioversion.
Use with caution in patients with asthma.
CNS: Dizziness, near syncope, syncope
CV: PVCs, PACs, sinus tachycardia, sinus bradycardia, AV blocks, chest pain, facial flushing,
Resp: SOB, bronchoconstriction
ADULT: 6 mg rapid IV bolus over 1-2s; after 1-2 minutes, 12-mg dose over 1-2 seconds.
PEDIATRIC: Initial dose: 0.1mg/kg; max 1st does = 6mg; Rapid IV bolus w/5cc flush
ROUTES: IV with 20cc flush
TRADE NAME: Proventil, Ventolin
CLASS: Sympathetic Agonist
DESCRIPTION: Sympathomimetic bronchodilator selective for β2 adrenergic receptors
ACTIONS: Selective direct acting β2 agonist
INDICATIONS: Bronchial asthma, emphysema, chronic bronchitis, allergic bronchospasm,
or other reversible bronchospasm
Onset: 5 - 15 minutes
Peak Effect: 1 - 1.5 hours
Duration: 3 - 6 hours
Half Life: < 3 hours
CONTRAINDICATIONS: Know hypersensitivity to Albuterol.
CNS: Tremor, anxiety, dizziness, seizure
CV: Headache, palpations, HTN, tachycardia, chest pain
Resp: Bronchospasm (paradoxical effect)
GI/GU: Nausea, vomiting, dry mouth
DOSAGE For patients in emergency setting:
ADULT: Nebulizer: 2.5mg in 3cc normal saline or 5mg in 6cc normal saline via HHN over 5 - 15 min.
Repeat 10-20 min. prn, maximum 10mg/hr (4 treatments) MDI- 1-2 inhalations (90mcg each)
many repeat every 15 minutes prn.
PEDIATRIC: 0.15 mg/kg in 2.5-3.0 ml NS via HHN. Repeat prn.
ROUTES: Nebulizer, metered-dose inhaler (MDI)
PACKAGED: Premixed unit dose of 2.5mg in 2.5ml NS.
TRADE NAME: Cordarone, Pacerone
ACTIONS: Prolongs action potential and refractory period. Slows the sinus rate; Increases PR
and QT intervals. Decreases Peripheral vascular resistance.
INDICATIONS: Life-threatening cardiac arrhythmias such as ventriculartachycardia
and ventricular fibrillation.
Onset: 2 minutes IV. Oral: 2-3 days
Peak Effect: 6 - 20 minutes
Half Life: Varies, 30 - 100 days post oral administration
CONTRAINDICATIONS: Hypersensitivity to Amiodarone, heart failure, severe sinus node dysfunction
(sinus bradycardia, 2nd Œ 3rd degree blocks), cardiogenic shock
CV: Headache, bradycardia, hypotension, sinus arrest, prolonged PR, QRS, QT intervals, CHF,
AV block, cardiogenic shock, palpations, chest pain
Resp: Dyspnea, pulmonary fibrosis
GI/GU: Nausea, vomiting
ADULT: V-Fib / V-Tach without pulses: 300 mg IV (max is 2.2g IV/24 hrs)
Ventricular arrhythmias with a pulse: 150 mg over 10 minute. rpt every 10 min.
Maintenance Infusion: 540mg IV over 18 hours (0.5mg/min)
PEDIATRIC: Pulseless arrest: 5mg/kg rapid IV bolus,
Perfusing tachycardia: 5mg/kg IV over 20-60 min.
TRADE NAME: ASA, Bufferin, Ecotrin, Empirin, etc.
CLASS: Platelet aggregate inhibitor, analgesic, non-steroidal anti-inflammatory (NSAID), antipyretic
Description: Anti-inflammatory, inhibits platelet function
ACTIONS: Blocks platelet aggregation.
INDICATIONS: New-onset chest pain suggestive of MI signs and symptoms suggestive or recent CVA.
Onset: 5 - 30 minutes
Peak Effect: 15 - 120 minutes
Duration: 1 - 4 hours
Half Life: 15 - 20 minutes
CONTRAINDICATIONS: GI bleed, ulcer, hemorrhagic stroke, bleeding disorders, kids with flu symptoms. Hypersensitivity to salicylates, relatively contraindicated in active ulcer disease & asthma.
May cause GI upset/bleeding. Administer cautiously to patients with bleeding disorders and those who report allergies to non-steroidal anti-inflammatory (NSAID) drugs. Contraindicated in children 16 - 19 years of age with flu or chickenpox symptoms due to incidence of Reye's syndrome.
CV: Prolonged bleeding
Resp: Wheezing, bronchspasm
GI/GU: Nausea, vomiting, heartburn, GI bleeding
ADULT:324 mg PO (4 x 81 mg chewable preferred) as soon as possible after onset of chest pain.
PEDIATRIC: Not recommended for use in the field with children.
TRADE NAME: Atropine, Atropa
Description: Anticholingeric, antimuscarinic, parasympatholytic
ACTIONS: Decreases vagal tone resulting in positive chronotropic effect & increases AV conduction. Competitive antagonist for acetylcholine at muscarinic receptors. Atropine bronchodilates via parasympatholytic mechanism.
INDICATIONS: Hemodynamically significant bradycardia and asystole. Cholinergic poisoning by certain mushrooms (Amanita spp.), insecticides (carbamates, acetycholinesterase inhibitors), and nerve gas.
Onset: < 2 minutes
Peak Effect: 2 - 4 min. IV (20 - 60 min. IM)
Duration: 4 hours
Half Life: 2 - 3 hours
CONTRAINDICATIONS: No significant contraindications, however, may worsen bradycardia associated with Mobitz-Type 2 and complete heart block. Use transcutaneous pacing if available. Use with extra caution in patients with symptoms of myocardial ischemia.
CNS: Pupillary dilation, confusion, restlessness, drowsiness, seizure
CV: Tachycardia, paradoxical bradycardia
Resp: Can cause mucus plugs due to drying of secretions
GI/GU: Dry Mouth
INTERACTIONS: Additive anticholinergic effects with antihistamines, phenothiazines, antipsychotics, tricyclic antidepressants, procainamide, other anticholinergics drugs. Caution with SSRIs.
ADULT: Symptomatic Bradycardias 0.5 - 1.0mg IV push; may be repeated q 3-5 minutes to a maximum of 0.04mg/kg; (2.5 - 3mg adults) results in full vagal blockage. Doses of less than 0.5mg may cause further slowing of the heart rate.
Asystole & PEA initially 1.0mg IV; may be repeated q 3-5 minutes for total of 3mg. ETT-2.0mg
Poisoning initially 1mg rapid IV, 2nd 1mg slow IV; larger doses may be required. Dosage exceeding 4mg by physician order only.
PEDIATRIC: 0.05mg/kg IV, IM, IO every 10-15 min.
ROUTE: IV, IO, ET (May be administered via *ABT in some cases of bronchospasm. Smaller doses of atropine are indicated for the elderly.)
NOTES: Monitor vital signs carefully.
TRADE NAME: Lasix
DESCRIPTION: Potent diuretic. Causes venous dilation
ACTIONS: Causes venous dilation and therefore decreases preload and cardiac workload.
Blocks reabsorption of chloride and sodium primarily in the Loop of Henle thereby increasing urine volume/decreasing blood volume.
INDICATIONS: Congestive heart failure, acute pulmonary edema, hypertensive crisis
Onset: 5 - 10 minutes, diuresis in 5 - 30 minutes
Peak Effect: 30 minutes. (IV) 1 - 2 hr (PO)
Duration: 2 hours, Diuresis duration approx. 6 hours
Half Life: 30 minutes
CONTRAINDICATIONS: Hypersensitivity to furosemide or other sulfonamides. Renal failure.
Use with caution in cases of known urinary retention. May cause birth defects, safety has not been established in pregnancy. Extreme caution in cases of pneumonia - creates mucus plugs.
CV: Hypotension, hypokalemia, dehydration, dysrhythmias, headache
GI/GU: Nausea, vomiting, diarrhea
INTERACTIONS: Possible additive or synergistic effects with antihypertensives,
nitrates, and other diuretics. Do not mix with amrinone (Inocor) - will precipitate.
ADULT: 40 - 80 mg slow IV push at 10-20mg/minute (4 mg/min. recommended).
Titrate to maintain uterine tone
PEDIATRIC: 1 mg/kg
ROUTES: IV preferred, slow - moderate push.
May be given IM if IV route is not available.
NOTES: Protect from light, heat.
Observe patient carefully during administration, especially elderly, during diuresis is essential. Currently, furosemide is rarely administered in the field,
unless the patient is already taking furosemide.
TRADE NAME: Magnesium
CLASS: Electrolyte, Anticonvulsant, Antidysrhythmic
DESCRIPTION: Electrolyte, cation, Physiologic calcium channel blocker, CNS depressant and anticonvulsant. Acts as neuromuscular blocker.
ACTIONS: Raising magnesium level inhibits calcium flux across cell membranes, corrects hypomagnesemia, depresses CNS and inhibits muscle cell activity.
INDICATIONS: Convulsive states associated with severe preeclampsia and eclampsia, Torsades de Pointes, refractory/recurrent VF or pulseless VT, refractory bronchospasm
Onset: Immediate in IV , IM: 1 hour
Peak Effect: Varies
Duration: 1 hour
CONTRAINDICATIONS: Contraindicated in: High degree heart block, shock, patients on digitalis or who are on dialysis or who are hypocalcemic,
or persistent hypertension.
Use with caution in patients with other CNS depressants on board.
Patients with impaired renal function may not be able to eliminate excess Mg++
Use with caution in patients with asthma.
CNS: Sedation, confusion, muscle weakness, paralysis
CV: Hypotension, bradycardia, heart block
Resp: Depression, arrest
Other: Flushing, sweating, hypotension, hypocalcemia
INTERACTIONS: Incompatible with many drugs. Those present in the prehospital arena include:
digitalis, alcohol, salicylates, and sodium bicarbonate.
ADULT: VF/VT/Torsade: 1 - 2 grams. Maintenance infusion is indicated following initial IV dose at a rate of 0.5 - 1.0 g/hr. IV for control of Torsade.
PEDIATRIC: VFVT/Torsade: 25 - 50 mg/kg IV/IM
Eclampsia: 1 - 4 grams of 10% solution. Smallest effective dose should be used. Dose rate should not exceed 1.5 ml (150mg)/min.
Bronchospasm: Adults 1 - 2 grams, Pediatric: 25 - 50 mg/kg
ROUTES: IV over 1-20 minutes depending upon illness and seriousness.
It is preferred to use a more dilute solution (10%) when administering IV.
NOTES: Calcium is antidote if respiratory depression occurs. Continuous cardiac monitoring is essential.
General signs of toxicity include: sedation, thirst, diarrhea, muscle weakness.
TRADE NAME: Pitocin, Syntocinon
CLASS: Uterotonic, pituitary hormone
DESCRIPTION: Synthetic oxytocic hormone released from the posterior pituitary gland
ACTIONS: Stimulates frequency and force of uterine contraction,
decreasing bleeding from uterine vessels
INDICATIONS: Postpartum hemorrhage not controlled by fundal massage
Onset: 1 minute by IV
Peak Effect: 5 minutes by IV
Duration: 30 minutes post infusion end
Half Life: 3 - 5 minutes
CONTRAINDICATIONS: No contraindications in controlling excessive postpartum hemorrhage.
Essential to assure the placenta has delivered and that no other fetus is present prior to administering oxytocin.
Overdosage can cause uterine rupture
Check fundus q 5 mins and message
CV: Hypo/hypertension, - rare, fluid retention, cardiac dysrhythmias, anaphylaxis
Gi/GU: Nausea, vomiting, pelvic hematoma, uterine spasm/rupture
INTERACTIONS: Additive or other synergistic effects possible with other uterotonics
such as methyl ergonovine (Methergine)
ADULT: 10 - 40 units in 1,000 ml NS to be infused 250 ml then 200 ml/Hr.
Titrate to maintain uterine tone
PEDIATRIC: Not Used
ROUTES: Continuous IV, infusion, can be given IM
NOTES: Consider multiple large bore IV lines for fluid replacement.
Class: Sympathomimetic bronchodilator; relatively selective beta 2 adrenergic
Indications: Treatment of bronchospasm in patients with reversible obsructive airway disease; also an adjunct to treat hyperkalemia
Contraindications: Known hypersensitivity to albuterol or levalbuterol
Side Effects: Restlessness, tremors, dizziness, palpitations, tachycardia, nervousness, peripheral vasodilation, nausea, vomiting, hyperglycemia, HBP, paradoxical bronchospasm
Adult dose: 2.5-5.0 mg Neb
Pediatric Dose: 2.5 mg Neb (0.15 mg/kg)
Special Info: May precipitate angina pectoris and arrhythmias; beta blockers are antagonistic; may potentiate hypokalemia caused by diuretics