Download - 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
(osage and route of administration"
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
(ose and route of administration"
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.
$efractor V-5 and V-T" 88 mg IV push may
"e repeated in 9 minutes.
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Procainamide Maintenance (rip
After resuscitation from cardiac arrest in
response to rocainamide therapy.
=i g with 988 ml +9 F 5 mg1ml F 5mg1ml
or =i g with 598 ml +9 F E mg 1ml (same as
a
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%retlium Toslate (%retylol!
Classification"Ventricularantiarrhythmic
(class III! (5nd or ?rd line drug!
Action"
Adernergic neuronal "loc&ing agent with
direct myocardial effects suppresses'entricular ectopy raises fi"rillation
threshhold.
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%retlium
!ndications" V-4 ; V-* refractory to other 'entricular
antidysrhythmics.
2ote" 2o longer included in currentAHA *333 cardiac resuscitation
guidelines or AC, algorithms .Ho6ever it is still currentl in use inman sstems.
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%retlium
ide effects"
Vertigo, 'omiting, syncope, "radycardia,
angina pectoris and transient hypotension
lasting approimately 58 minutes.
Contraindications"
+igitalis toicity induced dysrhythmia.
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%retlium
(ose and route of administration"
9 mg1&g rapid IV "olus, initial dose.
2epeat in 9-8 minutes at 8mg 1&g (maimum
total IV "olus dose of ?8 mg 1 &g!
=aintenance drip$ =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
(ose and route of administration"
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
(osage and route of administration"
%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!
$espirator" %eta *
Al"uterol (ro'entil, Ventolin!
=etaproterenol (Alupent!
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Epinephrine (Adrenalin!
Classification"
Sympathomimetic 1 %ronchodilator.
Actions"
Stimulates alpha and "eta adrenergic
receptor sites.
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Epinephrine
!ndications" Cardiac arrest (V-*, V-4, /A and asystole! ,
symptomatic "radycardia, anaphlactic shoc&
and asthma. KIf you need C2, you need /piL.
Precautions" +o not mi with sodium "icar". 6se with other
sympathomimetic drugs causes additi'eeffects.
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Epinephrine
ide effects"
0one in cardiac arrest. alpitations, angina,
tachy-arrythmias, nausea, 'omiting,
headache, or di))iness in non-cardiac arrest
patients.
Contraindications"
0one in life threatening conditions.
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Epinephrine
(osage and route of administration"
/pinephrine comes in two concentrations$ )")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
(osage and route of administration"
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
(osage and route of administration"
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.
(osage and route of administration"
*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
(osage and route of administration"
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
(osage and route of administration"
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
(osage and route of administration"
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
(osage and route of administration"
>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
(osage and route of administration"
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.
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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.
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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.
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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#.
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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.
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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!
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odium %icarbonate
(osage and route of administration"
m/71&g IV "olus followed "y half dose e'ery
8 minutes. Consult =edical control
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Calcium Chloride
Classification$ /lectrolyte
Action" /ssential component for the proper
functioning of ner'ous, musculos&eletal and
endocrine systems. Increases force of
myocardial contractions.
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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.
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Calcium Chloride
ide effects"
Cardiac arrhythmias, headache, di))iness,
hypotension, nausea, 'omiting and
hypercalcemia.
Contraindications"
Jnown hypercalcemia, +igitalis toicity,
'entricular fi"rillation.
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Calcium Chloride
(ose and route of administration"
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
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(rugs :sed To Treat
:nconsciousness
Vitamin %)$ (*hiamine!
2arcotic Antagonist$ 0aloone (0arcan!
Carbohdrate$ +etrose 98G
Anti-hpoglcemic agent$ @lucagon
Anticonvulsant$ +ia)epam (Valium!
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Thiamine
Classification$ Vitamin %
Action" Coen)yme necessary for car"ohydrate
meta"olism and the "rea&down of glucose.
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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.
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Thiamine
ide effects" #ypotension and 1 or nausea are
possi"le "ut rare.
Contraindications" 0one in emergency setting.
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Thiamine
(osage and route of administration"
88 mg slow IV push or I=
2 l (0 !
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2alo1one(0arcan!
Classification$ 0arcotic Antagonist
Action" 2e'erses effects of narcotics and certain
synthetic analgesics.
2 l
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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
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2alo1one
ide effects"
0ausea and 'omiting at high doses when
rapidly administered.
Contraindications"
0one3 ecept &nown hypersensiti'ity to drug.
2 l
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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
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(e1trose
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(e1trose
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(e1trose
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(e1trose
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>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
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>lucagon
!ndications"
#ypoglycemia, /sophogitis, for relaation of
smooth muscle in cases of food o"struction of
esophagus.
Precautions" 0one in emergency setting.
>lucagon
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>lucagon
ide effects"
+i))iness, lightheadedness, nausea, 'omiting
and urticaria.
Contraindications$
Jnown hypersensiti'ity.
>lucagon
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>lucagon
(osage and route of administration"
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!
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(ia0epam(Valium!
Classification"*ran7uili)er,
Anticon'ulsant
Action"
2educes aniety, suppresses sei)ure acti'ity,
induces amnesia, relaes s&eletal muscle.
(ia0epam
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(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.
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(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
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(ia0epam
(osage and route of administration"
tatus epilepticus"9 to 9 mg IV
Acute an1iet" 5 to 8 mg IV or I=
Cardioversion" 9 to 9 mg IV