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ADULT
Eastern PA EMS Council
Regional Medication List
ADULT
MEDICATION
GUIDE
This medication guide is not designed to replace the need of your
service’s medical director to assure that you, the ALS practitioner,
are trained to use these medications.
This guide is only an adjunct to other more complete training that is
needed to ensure that you fully understand the uses, effects and
contraindications of the medications discussed.
The author, Commonwealth of Pennsylvania, and the Eastern PA
EMS Council assume no responsibility for the use or misuse of this
material. The use of this material is strictly for non-commercial use.
The author has allowed the use of this material on a free and
unencumbered basis for educational purposes only as long as this
message, and proper citation of authorship is provided.
The information contained in this section is believed to be true and
accurate at the time of publication; however you are using this
information at your own risk, and shall not hold any persons or
organizations responsible for false or inaccurate information.
Please send any requests
[email protected].
(corrections
or
USE OF THIS MATERIAL AND ANY CONSEQUENCES
ARE AT THE SOLE RISK OF THE EMS PROVIDER.
226
additions)
to
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Adenosine
Adenocard
Antiarrhythmic
Associated Protocols
5022A, 5023A
Description:
Adenosine is a naturally occurring agent that can “chemically cardiovert” SVT to a slower more perfusing rhythm. It has a
half-life of approximately five seconds and when administered intravenously, adenosine works in AV nodal re-entry
tachycardias caused by a transient heart block in the AV node.
Indications:
x
Narrow complex REGULAR supraventricular tachycardia refractory to vagal maneuvers.
Contraindications:
x
x
x
2° or 3° AV block
VT (Ventricular Tachycardia)
Irregular rhythms such as atrial fibrillation & A-Flutter
Dosage / Route Information:
x
x
Attempt vagal maneuvers first.
Used for stable narrow complex tachycardia: 6mg (2mL) IV rapidly over 1-3 seconds. Flush with 20cc NS bolus
with arm elevated.
o May repeat 12mg bolus one more time in 1-2 minutes
o 3rd dose (12mg) needs medical command before administration
Side Effects:
x
x
x
x
x
x
x
x
Asystole
Transient dysrhythmias
Bronchospasm /dyspnea
Chest pressure
Facial flushing
Hypotension
Headache
Nausea
Note:
OTHER:
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
227
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Albuterol
Proventil
Bronchodilator / Antiasthmatic
Associated Protocols
4011, 4022
Description:
Albuterol is a synthetic sympathomimetic that causes bronchodilation with less cardiac effect than epinephrine (Selective
Beta 2 properties). The duration of effect when inhaled is nearly instantaneous and with maximal effects occurring within
5 to 25 minutes.
Indications:
x
x
Bronchospasm secondary to COPD (emphysema & chronic bronchitis)
Bronchial Asthma
Contraindications:
x
x
Tachydysrhythmias
Hypersensitivity
Dosage / Route Information:
x
2.5mg in 3mL NS (Nebulizer) at 8 LPM (mask or pipe)
Side Effects:
x
x
x
Tachydysrhythmias
Anxiety
Nausea & vomiting
x
The patient may experience palpitations, anxiety, nausea, and/or dizziness. Vital signs, cardiac ECG and breath
sounds must be monitored; use caution with elderly, cardiac, or hypertensive patients.
Note:
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
228
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Amiodarone
Cordarone
Antiarrhythmic
Associated Protocols
3041A, 3080, 5023A
Description:
x
Amiodarone is used to treat life threatening ventricular and supraventricular dysrhythmias. In the EMS setting it
is used in shock-refractory ventricular fibrillation / tachycardia.
Indications:
x
x
Cardiac Arrest (V-Fib / V-Tach)
Stable wide complex tachycardias
Contraindications:
x
x
x
x
2° or 3° block
Bradycardia
Cardiogenic shock
Do NOT use with drugs that prolong QT interval.
Dosage / Route Information:
x
x
Cardiac Arrest: 300mg IV/IO. May repeat 150mg IV/IO in 10 minutes
Regular & Stable Wide Complex Tachycardia: 150mg IV/IO over 10 minutes
Side Effects:
x
x
x
x
x
x
Vasodilation, BP, HR
AV block
Hepatotoxicity
QTc
V-Tach
V-Fib
x
x
Absolute “Y-Site” incompatibility with Sodium Bicarbonate (Will precipitate).
Must dilute before giving.
o IV Push: Dilute in 10mL D5W. (If no D5W available, mix with NSS)
Note:
Pregnancy Category:
x
D – Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus.
However, the benefits of therapy may outweigh the potential risk.
Amiodarone Drip (requires command):
* 100mL bag of D5W (may use NSS if D5W is unavailable)
** Use A 15gtt/mL drip set (change # if needed, i.e. 10 or 60 gtts/mL)
*** Amount of Amiodarone added to D5W or NSS bag (Change if needed)
†Dosage rate is always 1mg/min for a drip
1mg†
100mL *
15 gtts **
1 min
150mg***
1 mL
229
=
10 Gtts
Min
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Aspirin (81mg)
Antiplatelet / NSAID
Associated Protocols
5001
Description:
x
x
Aspirin slows clot formation which may be beneficial in Acute MI
Slows clot formation associated with thrombotic stroke.
Indications:
x
x
Chest Pain
Acute Myocardial Infarctions
Contraindications:
x
x
x
Allergy
Hemorrhagic stroke
Use Caution with
o GI Bleeding
o Bleeding disorders
o Ulcers
o Asthma
Dosage / Route Information:
x
324mg (4 pills) PO chewed
Side Effects:
x
GI Bleeding
Note:
Pregnancy Category:
x
D – Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus.
However, the benefits of therapy may outweigh the potential risk.
230
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Atropine Sulfate
Antiarrhythmic
Associated Protocols
3032, 3042A, 5021A, 8083
Description:
x
Atropine increases cardiac output by reducing the parasympathetic effect associated with certain bradycardias.
Indications:
x
x
x
x
Asystole
PEA (Slow)
Hemodynamically significant bradycardia
Organophosphate poisoning
Contraindications:
x
x
x
x
None in emergency situation
Atropine is ineffective and should be avoided in heart transplant patients.
Tachycardia
Glaucoma
Dosage / Route Information:
x
x
x
Asystole / PEA: 1mg IVP every 3-5 min (maximum 3mg or 0.04mg/kg)
Symptomatic Bradycardia: 0.5 IVP every 3-5 min up to 0.04mg/kg (total dose)
Organophosphate: 2-5mg IV every 15-30 minutes, until Vital signs improve
Side Effects:
x
x
x
x
x
x
Dilated pupils
Heart rate
VT
VF
Headache
Dry mouth
x
x
x
Should be administered via a rapid IV push
Atropine may be ineffective in heart blocks.
Atropine comes in a 10mL vial (0.1mg/mL – 1mg/vial)
Note:
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
231
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Calcium Chloride 10%
Electrolyte
Associated Protocols
3041A, 3042A, 5021A, 5023A, 6004, 8031
Description:
x
Calcium Chloride is used to treat hyperkalemia, hypocalcemia, hypermagnesemia, and calcium channel blocker
toxicity.
Indications:
x
x
x
x
x
x
Hyperkalemia
Hypermagnesemia
Hypocalcemia with tetany
Beta Blocker overdose
Calcium channel blocker toxicity
Crush Syndrome
Contraindications:
x
x
x
V-Fib
Digitalis toxicity
Hypercalcemia
Dosage / Route Information:
x
x
10mL IV/IO (100mg/mL)
o May repeat doses in 10 minutes if needed
Crush Syndrome: 10 mL IV/IO just prior to extrication, and after extrication, administer same dose if QRS widens.
Side Effects:
x
x
x
x
x
x
HR
BP
Asystole
V-Fib
Coronary & Cerebral artery spasm
Extravasation causes necrosis
x
x
Absolute “Y-Site” incompatibility with Sodium Bicarbonate (Will precipitate).
Common Beta Blockers
o They end in “lol”
ƒ Carvedilol (Coreg)
ƒ Labetalol
ƒ Metoprolol (Toprol)
ƒ Atenolol
Common Calcium Channel Blockers:
o Most end in “dipine”,
ƒ Amlodipine (Norvasc)
ƒ Nifedipine (Procardia)
o Verapamil (Calan)
o Diltiazem (Cardizem)
Note:
x
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
232
ADULT
Eastern PA EMS Council
Regional Medication List
REQUIRES MEDICAL COMMAND PRIOR TO ADMINISTRATION
Generic Name
Trade Name
Class:
Captopril
Capoten
ACE Inhibitor / Antihypertensive
Associated Protocols
5002
Description:
x
Captopril is used to treat hypertension and to aid in the treatment of congestive heart failure. It reduces cardiac
afterload by vasodilation, thus reducing systemic blood pressure and work of the heart.
Indications:
x
Heart Failure where patient is hypertensive, has begun NTG therapy per protocol and has an open, patent, and
moist airway due to need to administer the medication sublingual.
o Peripheral Edema
o Sacral edema
o Ascites
o Mild dyspnea not affecting the patient’s ability to accept sublingual medications.
Contraindications:
x
x
Hypersensitivity to ACE Inhibitors
Part history of angioedema (hereditary or idiopathic)
Dosage / Route Information:
x
12.5mg or 25mg SL (one time dose only) - Can be given PO, but this is not in our Protocol.
o Onset 5 minutes, Peak 60 minutes
Side Effects:
x
x
x
x
Hypotension
Angioedema
Syncope
Cough
x
Report diuretic use, renal insufficiencies or dialysis to medical command.
Note:
OTHER:
x
ACE INHIBITOR THERAPY IS NOT A FIRST LINE MEDICATION.
Pregnancy Category:
x C (1st Trimester)
x
– Animal studies have shown an adverse effect and there are no adequate and well-controlled
studies in pregnant women. or No animal studies have been conducted and there are no adequate and wellcontrolled studies in pregnant women.
D (2nd & 3rd Trimesters) – Studies, adequate well-controlled or observational, in pregnant women have
demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk.
REQUIRES MEDICAL COMMAND PRIOR TO ADMINISTRATION
233
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Dextrose 5% in water IV Fluid
D5W
Hypotonic sugar solution
Associated Protocols
EPALS 08
Description:
x
Dextrose is a simple sugar that the body can rapidly metabolize while in hypoglycemic states.
Indications:
x
x
x
x
IV access for emergency drugs (Cardiac)
For dilution of concentrated drugs for IV infusion
Patients with actual or potential for volume overload
Patients requiring sodium restriction
Contraindications:
x
x
Fluid replacement in hypovolemic states
As a main line for blood transfusion
Dosage / Route Information:
x
IV / IO usually at KVO
Side Effects:
x
Rare
x
Normal Saline or Lactated Ringers is the preferred infusion solution during cardiac arrest, although D5W remains
acceptable.
Note:
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
234
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Dextrose 50%
Nutrient
Associated Protocols
3042A, 3080, 6081, 7002A, 7006, 7007
Description:
x
Dextrose is a simple sugar that the body can rapidly metabolize while in hypoglycemic states.
Indications:
x
x
Hypoglycemia
Coma of unknown origin
Contraindications:
x
x
x
Intracerebral bleeding
Hemorrhagic CVA
Increased ICP
Dosage / Route Information:
x
50ml of D50W (25gms) IV/IO, may be repeated.
Side Effects:
x
Tissue Necrosis if extravasation occurs.
x
x
Draw sample blood and determine glucose level before administration.
Ensure good venous access.
Note:
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
235
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Diazepam
Valium
Antianxiety / anticonvulsant / sedative
Associated Protocols
3080, 4002, 5021A, 5022A, 5023A, 7007, 7010, 8001, 8083
Description:
x
Diazepam is a skeletal muscle relaxant that reduces tremors, induces amnesia, and reduces the incidence and
recurrence of seizures.
Indications:
x
x
x
x
Major motor seizures
Status epilepticus
Premedication prior to cardioversion
Acute anxiety states
Contraindications:
x
x
x
x
Head Injuries
BP
Acute narrow angle glaucoma
Hypersensitivity
Dosage / Route Information:
x
x
x
x
Status epilepticus: 5-10mg IV/IO (0.1mg/kg); may repeat every 5 minutes until max of 0.3mg/kg.
Sedation: 5-10mg IV/IO (0.1mg/kg) titrated slowly. May repeat every 5 minutes until max of 0.3mg/kg.
Behavioral: 5-10mg IV/IO (0.1mg/kg) titrated slowly. May repeat every 5 minutes until max of 0.3mg/kg.
o Contact command if possible
ƒ Reduce dose in half for patients > 65 y/o for behavioral issues
Persistent dizziness: 5mg IV/IO slowly (Adults Only)
Side Effects:
x
x
x
x
Respirations
BP
Drowsiness
Venous irritation
x
x
Push Benzodiazepines slowly over at least 1 minute.
Due to short half life of the drug, seizure activity may recur.
Note:
OTHER:
x
x
x
REVERSED WITH FLUMAZENIL (ROMAZICON)
May be given IV / IO / IM / Intranasal
Pharmacologic: Benzodiazepine
Pregnancy Category:
x
D – Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus.
However, the benefits of therapy may outweigh the potential risk.
236
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Diltiazem
Cardizem
Antiarrhythmic
Associated Protocols
5022A
Description:
x
x
x
Diltiazem is used to control supraventricular tachydysrhythmias (A-fib, A-flutter, SVT refractory to adenosine)
Used to increased coronary artery perfusion in angina pectoris.
Diltiazem is used to treat high blood pressure and to control chest pain (angina). Diltiazem is in a class of
medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to
pump as hard and acts on the calcium pathways of the heart’s pacing system to slow impulses and reduce heart
rate.
Indications:
x
x
x
x
Narrow complex IRREGULAR Supraventricular Tachycardia (Needs Command)
Adenosine refractory REGULAR SVT.
A-fib with rapid ventricular response
Atrial Flutter
Contraindications:
x
x
x
x
x
Wide complex QRS (V-tach)
2° or 3° block
BP (SBP < 100)
Sick Sinus Syndrome - alternating slow and fast heart rhythms
WPW or short PR syndrome with a-fib or a-flutter
Dosage / Route Information:
x
x
15-20mg (0.25mg/kg) slowly IV over 2 minutes;
If no effect in 15 minutes: may repeat 20-25mg (0.35mg/kg) IV slowly over 2 minutes
x
x
Calcium Channel Blocker
Also an antianginal, antihypertensive
Note:
Other:
x
x
Refrigerated Vial: 25mg/5mL vial (Expires at room temperature after 30 days)
ADD-Vantage® Vial: 100mg reconstituted in 100mL NSS
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
237
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Diphenhydramine
Benadryl
Antihistamine
Associated Protocols
4011
Description:
x
x
Diphenhydramine is used to decrease the effects of allergic reactions and the extrapyramidal symptoms following
an antipsychotic medication.
Diphenhydramine blocks histamine release, thereby reducing bronchoconstriction and vasodilation.
Indications:
x
x
x
Anaphylaxis
Allergic reactions
Dystonic Reactions (extra pyramidal side effects)
Contraindications:
x
x
Asthma
Pregnant or lactating females
Dosage / Route Information:
x
50mg IV or IM
o A total of 50mg may be given before calling for command
Side Effects:
x
x
x
Sedation
Blurred vision
Anticholinergic effects
Note:
OTHER:
x
Anticholinergic Effects – dry mouth, dry eyes, urinary retention, constipation
Pregnancy Category:
x
B – Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well
controlled studies in pregnant women. or Animal studies have shown an adverse effect, but adequate and wellcontrolled studies in pregnant women have failed to demonstrate a risk to the fetus.
238
ADULT
Eastern PA EMS Council
Regional Medication List
REQUIRES MEDICAL COMMAND PRIOR TO INFUSION
Generic Name
Trade Name
Class:
Dopamine (Drip)
Intropin
Inotropic, Vasopressor
Associated Protocols
3080, 5002, 5021A, 6002, 7005, EPALS 05
Description:
x
x
Dopamine is used to increase end-organ perfusion in cardiogenic shock and in hemodynamically significant
hypotension (70-100 mmHg) not resulting from hypovolemia
Dopamine is a natural occurring catecholamine and a potent beta agonist that does not appreciably increase
myocardial oxygen consumption. It maintains renal and mesenteric blood flow while inducing vasoconstriction
and increasing blood pressure.
Indications:
x
x
x
x
Non-hypovolemic hypotension
Cardiogenic Shock
Neurogenic Shock
Bradycardia (with hypotension)
Contraindications:
x
x
Tachydysrhythmias
Hypertension
Dosage / Route Information:
x
Start at 5mcg/kg/min, increase every 10 minutes by 5mcg/kg/min until SBP > 100mmHG.
o DO NOT EXCEED 20mcg/kg/min unless ordered by medical command physician
Side Effects:
x
x
x
x
x
x
Tachydysrhythmias, V-Tach, V-Fib
HTN
Ischemia
AMI
Nausea & Vomiting
Headache
x
x
Mild Hypotension is defined as a SBP 70 – 100mmHg
Extravasation causes tissue necrosis.
Note:
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
REQUIRES MEDICAL COMMAND PRIOR TO INFUSION
Mathematical Equation:
* Patient’s weight in pounds
** Dosage in mcg/min (starts at 5mcg, and increases by 5mcg every 10 minutes).
*** Use A 60gtt/mL drip set
† Check bag to make sure it is 1600mcg/mL, make changes as appropriate!
___ Lbs*
1 kg
5 mcg **
1 mL
60 gtts***
1 min
2.2 Lbs.
1 kg
1600 mcg †
1 mL
239
=
Gtts
Min
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Electrical Therapy
Antiarrhythmic
Associated Protocols
Defibrillation: 3032, 3035, 3041A
Cardioversion: 5022A, 5023A
Pacing: 5021A
Description:
x
x
x
Defibrillation - Defibrillation is the definitive treatment for the life-threatening cardiac arrhythmias that delivers a
therapeutic dose of electrical energy to the affected heart that depolarizes a critical mass of the heart muscle,
terminates the arrhythmia, and allows normal sinus rhythm to be reestablished by the body's natural pacemaker,
in the sinoatrial node of the heart.
Synchronized Cardioversion - Synchronized electrical cardioversion is the process by which an abnormally fast
heart rate or cardiac arrhythmia is terminated by the delivery of a therapeutic dose of electric current to the heart
at a specific moment in the cardiac cycle.
Transcutaneous Pacing - a temporary means of pacing a patient's heart during a medical emergency. It is
accomplished by delivering pulses of electric current through the patient's chest, which stimulates the heart to
contract.
Indications:
x
x
x
Defibrillation: V-Fib, Pulseless V-Tach
Cardioversion: Narrow complex tachycardia (PSVT, A-fib, A-flutter)
Wide complex tachycardia (V-Tach w/ pulses)
Pacing: Bradycardia with hypotension, 2nd & 3rd degree heart block with poor perfusion
Contraindications:
x
None in emergency situations
Dosage / Route Information:
x
x
x
Defibrillation: 200j, 300j, 360j every 2 minutes
o Limit defibrillation to a single attempt in hypothermic patients
Cardioversion: Start at 50-100 j, if no conversion repeat @ 100j, 200j, 300j, 360j until conversion
Pacing: Start at 80mA, and 80 bpm. Adjust mA to obtain capture.
Side Effects:
x
x
x
Asystole
V-fib
V-tach
Note:
OTHER:
240
ADULT
Eastern PA EMS Council
Regional Medication List
REQUIRES MEDICAL COMMAND PRIOR TO INFUSION
Generic Name
Trade Name
Class:
Enalapril
Vasotec
ACE Inhibitor / Antihypertensive
Associated Protocols
5002
Description:
x
Enalapril is used to treat hypertension and to aid in the treatment of congestive heart failure. It reduces cardiac
afterload by vasodilatation, thus reducing systemic blood pressure and work of the heart.
Indications:
x
Heart Failure where patient is hypertensive and has begun NTG therapy per protocol. The patient may be on
CPAP or have more severe in symptoms as found in Class III or IV heart failure such as:
o Pulmonary edema
o Dyspnea at rest with pulmonary edema
o Pedal and/or sacral edema, or Ascites
o Or any combination of pulmonary edema or peripheral edema with high blood pressures.
Contraindications:
x
x
Hypersensitivity to ACE Inhibitors
Angioedema (hereditary or idiopathic)
Dosage / Route Information:
x
0.625mg – 1.25mg slow IV push (over a few minutes), followed by a NSS flush
o Onset 15 minutes, Peaks in 1-4 hours
Side Effects:
x
x
x
x
Hypotension
Angioedema
Syncope
Cough
x
Report diuretic use, renal insufficiencies or dialysis to medical command.
Note:
OTHER:
x
ACE INHIBITOR THERAPY IS NOT A FIRST LINE MEDICATION.
Pregnancy Category:
x C (1st Trimester)
x
– Animal studies have shown an adverse effect and there are no adequate and well-controlled
studies in pregnant women. or No animal studies have been conducted and there are no adequate and wellcontrolled studies in pregnant women.
D (2nd & 3rd Trimesters) – Studies, adequate well-controlled or observational, in pregnant women have
demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk.
REQUIRES MEDICAL COMMAND PRIOR TO INFUSION
241
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Epinephrine 1:1,000
Adrenaline
Non Selective Beta Angonist
Associated Protocols
4011, 4022
Description:
x
Epinephrine 1:1000 is used for treatment of allergic reactions, including anaphylaxis and status asthmatica.
Indications:
x
x
Severe anaphylaxis
Asthma (Bronchospasm) – Need medical command to give
Contraindications:
x
x
Tachydysrhythmias
Coronary Artery Disease
Dosage / Route Information:
x
x
0.3mL IM – ADULT every 5 – 15 minutes as needed (Use TB Syringe to administer)
Nebulized (Medical Command may consider nebulized epinephrine for severe upper airway swelling)
Side Effects:
x
x
x
x
x
Tachydysrhythmias
V-Tach
V-Fib
HTN
Angina
x
Drip info on next page
Note:
OTHER:
x
“Y-Site” incompatibility is possible with Sodium Bicarbonate (Will precipitate).
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
242
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Epinephrine 1:10,000
Adrenaline
Vasopressor
Associated Protocols
3032, 3033, 3041A, 3042A, 5021A
Description:
x
Epinephrine 1:10,000 is used to increases systemic vascular resistance.
Indications:
x
Cardiac Arrest
Contraindications:
x
No absolute contraindications in cardiac arrest
Dosage / Route Information:
x
1mg IV/IO repeated every 3-5 minutes until circulation is restored
Side Effects:
x
x
x
x
x
Tachydysrhythmias
V-tach
V-fib
HTN
Angina
Note:
x
OTHER:
x
“Y-Site” incompatibility is possible with Sodium Bicarbonate (Will precipitate).
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
243
ADULT
Eastern PA EMS Council
Regional Medication List
REQUIRES MEDICAL COMMAND PRIOR TO INFUSION
Generic Name
Trade Name
Class:
Etomidate
Amidate
Hypnotic
Associated Protocols
4002, EPA 05
Description:
x
Etomidate is used to induce sedation for endotracheal intubation. Etomidate has anesthetic and amnestic
properties, but has no analgesic properties.
Indications:
x
Sedation-Assisted intubations
Contraindications:
x
x
x
Marked hypotension
Severe Asthma
Severe cardiovascular disease
Dosage / Route Information:
x
Adult Dose: 15-30mg IV/IO (0.3mg/kg) IV/IO over 30 seconds.
o MAX: 30 mg
Side Effects:
x
x
x
x
x
x
Trismus (lockjaw)
CNS: Myoclonic skeletal muscle movements, tonic movements
Respiratory: Apnea, hypoventilation, or hyperventilation, laryngospasm
CV: Hypertension or hypotension; tachycardia or bradycardia; dysrhythmias
GI: Nausea, Vomiting
Misc: eye movements (common), hiccups, snoring
x
Onset is 20 seconds; peak effect in 1 minute, duration is 3-5 minutes. Half life 30-74 minutes.
Note:
OTHER:
x
x
REQUIRES 2 ALS PROVIDERS
Etomidate’s safety has not been established in children under 10 years old.
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
REQUIRES MEDICAL COMMAND PRIOR TO INFUSION
244
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Fentanyl
Sublimaze
Opioid analgesic
Associated Protocols
5001, 6003, 6071
Description:
x
x
x
Fentanyl is used to relieve moderate to severe pain.
Fentanyl is approximately 80 times more potent than morphine
Used for patient’s who cannot tolerate morphine (allergies,etc.)
Indications:
x
x
Pain
Acute Coronary Syndrome – Chest Pain (may give if pain is unrelieved after 3 doses of NTG & SBP > 100mmHg)
Contraindications:
x
x
Hypersensitivity
Use with caution in patient’s with severe pulmonary disease (i.e. Asthmatics)
Dosage / Route Information:
x
50-100mcg IV / IO / IM / Intranasal (1mcg/kg) – may repeat ½ dose every 5 minutes until max of 3mcg/kg
Side Effects:
x
x
x
x
x
x
x
x
Rigid Chest Syndrome
Respiratory Depression
Hypotension
Bradycardia
Decreased level of consciousness
Nausea / Vomiting
Laryngospasm
Arrhythmias
x
Naloxone should be readily available to counteract the effects of Fentanyl.
Note:
Other:
x
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
245
ADULT
Eastern PA EMS Council
Regional Medication List
REQUIRES MEDICAL COMMAND PRIOR TO INFUSION
Generic Name
Trade Name
Class:
Furosemide
Lasix
Loop Diuretic
Associated Protocols
5002
Description:
x
Furosemide is used to treat acute pulmonary edema associated with congestive heart failure.
Indications:
x
x
Congestive Heart Failure
Pulmonary Edema
Contraindications:
x
x
x
x
x
Pregnancy (except in life threatening circumstances)
Dehydration
Hypokalemia
Hypovolemia
Hepatic Coma
Dosage / Route Information:
x
Give IV furosemide dose equivalent to patient’s daily PO dose (40mg-100mg)
Side Effects:
x
x
x
Hypokalemia
Hypotension secondary to hypovolemia
Dehydration
Note:
x
OTHER:
x
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
REQUIRES MEDICAL COMMAND PRIOR TO INFUSION
246
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Glucagon
GlucaGen
Hormones / pancreatics
Associated Protocols
3042A, 4011, 5021A, 5023A, 7002A, 7007, 8031, EPALS 07
Description:
x
Glucagon is used to increase blood glucose levels in hypoglycemia without IV access.
Indications:
x
x
x
Hypoglycemia
Beta-blocker overdose unresponsive to Calcium Chloride
Calcium Channel Blocker overdose unresponsive to Calcium Chloride
Contraindications:
x
Hypersensitivity
Dosage / Route Information:
x
x
Hypoglycemia
o Adult: 1mg IM or Intranasal
Beta-blocker or Calcium channel blocker OD if unresponsive to Calcium Chloride: (Requires Command)
o Adult: 3-5 mg IV/IO (0.05mg/kg), may be repeated in 10-15 minutes
Side Effects:
x
Note:
x
x
Glucagon is only effective if a sufficient store of glycogen is in the liver.
Administer with caution to patient with a history of cardiovascular or renal disease.
OTHER:
x
x
Common Beta Blockers
o They end in “lol”
ƒ Carvedilol (Coreg)
ƒ Labetalol
ƒ Metoprolol (Toprol)
ƒ Atenolol
Common Calcium Channel Blockers:
o Most end in “dipine”,
ƒ Amlodipine (Norvasc)
ƒ Nifedipine (Procardia)
o Verapamil (Calan)
o Diltiazem (Cardizem)
Pregnancy Category:
x
B – Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well
controlled studies in pregnant women. or Animal studies have shown an adverse effect, but adequate and wellcontrolled studies in pregnant women have failed to demonstrate a risk to the fetus.
247
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Lactated Ringers
LR (Ringers Lactate)
Isotonic crystalloid
Associated Protocols
EPALS 08
Description:
x
Lactated Ringers is a source of electrolytes that helps increase circulating volume in the vascular system.
Indications:
x
x
x
Hypovolemic shock
Burns
Dehydration
Contraindications:
x
x
x
x
Congestive Heart Failure
Renal Failure
Lactic Acidosis
Crush Syndrome
Dosage / Route Information:
x
x
x
IV / IO
Dose dependent upon patient condition and situation being treated
o Anaphylaxis (hypotension): 1L wide open, get command for 2nd liter.
o Burns: 20mL/kg for hypotension or severe burns
o Cardiac Arrest (Traumatic, hypovolemic): Up to 2000mL wide open
o Post Partum Hemorrhage: 500mL bolus, if Hypotension, then give up to 2000mL
Shock: 500mL as rapidly as possible, up to 2000mL
Side Effects:
x
Rare
x
Normal Saline or Lactated Ringers is the preferred infusion solution during cardiac arrest, although D5W remains
acceptable.
Note:
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
248
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Lidocaine 2%
Xylocaine
Antiarrhythmic
Associated Protocols
1000, 3041A, 5023A,
Description:
x
x
Lidocaine is used to convert ventricular dysrhythmias (V-fib, V-tach) in cardiac arrest to sinus rhythm
Also used to convert V-Tach with a pulse to sinus rhythm.
Indications:
x
x
x
x
V-fib, or Pulseless V-tach
V-tach w/ pulses (Regular Wide QRS Rhythm)
Control of ventricular arrhythmias (PVC’s)
EZ – IO analgesia
Contraindications:
x
x
x
x
2° and 3° block
Bradycardias
Hypotension
Allergy to “caine” drugs
Dosage / Route Information:
x
x
x
Cardiac Arrest VT/VF: 1.5 mg/kg, repeat 0.5 - 0.75mg/kg IV/IO every 5-10 minutes to a total dose of 3mg/kg
Wide Complex Tachycardia (ie. VT w/ pulses):
o Adult: 1.5mg/kg IVP, then (after contacting medical command) repeat 0.75mg/kg IV/IO or Start drip
ASAP.
ƒ Lidocaine Drip info on next page
EZ-IO: Conscious Adults 20-40mg (administer slowly), followed by 10mL NSS Bolus
Side Effects:
x
x
x
Seizures
Slurred speech
Altered mental status
x
20mg/mL, comes in 5mL (100mg) syringe
Note:
OTHER:
x
Pregnancy Category:
x
B – Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well
controlled studies in pregnant women. or Animal studies have shown an adverse effect, but adequate and wellcontrolled studies in pregnant women have failed to demonstrate a risk to the fetus.
249
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Lidocaine drip
Xylocaine drip
Antiarrhythmic
Associated Protocols
3080, 5023A
Description:
x
x
Lidocaine is used to convert ventricular dysrhythmias (V-fib, V-tach) in cardiac arrest to sinus rhythm
Also used to convert V-Tach with a pulse to sinus rhythm.
Indications:
x
Control of ventricular arrhythmias (including PVC’s)
Contraindications:
x
x
x
2° and 3° block
Bradycardias
Allergy to “caine” drugs
Dosage / Route Information:
x
1000mg/250mL D5W (4mg/mL)
o 2 – 4 mg/min titrated to effect. (use a micro drip 60gtt/mL)
Side Effects:
x
x
x
Seizures
Slurred speech
Altered mental status
Note:
x
OTHER:
x
Pregnancy Category:
x
B – Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well
controlled studies in pregnant women. or Animal studies have shown an adverse effect, but adequate and wellcontrolled studies in pregnant women have failed to demonstrate a risk to the fetus.
Mathematical Equation:
* Dosage in mg/min (starts between 2-4mg/min, titrated to effect).
** Always Use A 60gtt/mL drip set
†1000mg = 1 gram, 2000mg = 2gm. Check the bag!!!
2 mg*
250 mL
60 gtts**
1 min
1000 mg †
1 mL
250
=
30 gtts
Min
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Lorazepam
Ativan
Benzodiazepine
Associated Protocols
3080, 4002, 5021A, 5022A, 5023A, 7007, 7010, 8001, 8083
Description:
x
Lorazepam is a short acting drug to treat seizures, anxiety, produce sedation, and act as a muscle relaxant.
Indications:
x
x
x
Severe Anxiety
Seizures, Status Epilepticus
Sedation
Contraindications:
x
x
x
x
x
Hypersensitivity
Respiratory Depression
Hypotension
ETOH or Other sedative drug use
Pregnancy
Dosage / Route Information:
x
x
x
Adult: 1-2mg IV/IO/IM/Intranasal (0.1mg/kg – max 2mg per dose)
o may repeat every 5 minutes until max of 4mg – push over 1 minute.
ƒ Usual dose is 1-2mg.
Behavioral: Contact command if possible
o Reduce dose in half for patients > 65 y/o for behavioral issues
Persistent dizziness: 1mg IV/IO slowly (Adults Only)
Side Effects:
x
x
x
x
Respiratory arrest
Cardiac Arrest
Decrease LOC
Hypotension
x
Benzodiazepine. Due to short half life of the drug, seizure activity may recur.
Note:
OTHER:
x
x
REVERSED WITH FLUMAZENIL (ROMAZICON)
May be given IV / IO / IM / Intranasal
Pregnancy Category:
x
D – Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus.
However, the benefits of therapy may outweigh the potential risk.
251
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Magnesium Sulfate
Electrolyte
Associated Protocols
3041A, 4022, 5023A, 7007
Description:
x
x
Magnesium sulfate is used to reverse refractory ventricular fibrillation and pulseless V-tach (especially torsades).
Magnesium sulfate has been shown to inhibit smooth muscle contraction and improvement patient condition with
severe airflow limitation that are unresponsive to standard treatments.
Indications:
x
x
x
x
x
Cardiac Arrest
Torsades with a pulse
Acute MI
Seizures 2° Eclampsia
Bronchodilator – Needs Command
Contraindications:
x
x
x
Renal Disease
Heart block
Hypermagnesemia
Dosage / Route Information:
x
x
x
x
Cardiac Arrest (Torsades, Hypomagnesemia): 2 g IV/IO over 1-2 min
Torsades with a pulse: 2 g IV/IO
Seizures 2° Eclampsia: 1gm/minute until seizure stops (maximum 4gm)
Bronchospasms: 2g IV/IO slowly over 1-2 min
Side Effects:
x
x
x
x
x
x
Hypotension
Asystole, Cardiac Arrest
Respiratory depression
CNS Depression
Flushing
Diaphoresis
Note:
x
OTHER:
x
Pregnancy Category:
x
D – Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus.
However, the benefits of therapy may outweigh the potential risk.
252
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Methylprednisolone
Solu-Medrol
Corticosteroid
Associated Protocols
4011, 4022
Description:
x
Methylprednisolone is used to reduce the inflammation caused by severe anaphylaxis and asthma/COPD.
Indications:
x
x
Anaphylactic reaction – Requires Command
Asthma / COPD – may administer on protocol
Contraindications:
x
No contraindications in the management of acute anaphylaxis
Dosage / Route Information:
x
Adult: 125mg IV/IO
Side Effects:
x
x
x
x
x
CNS: Euphoria, headache, insomnia, confusion, psychosis, vertigo
CV: CHF, edema, hypertension
GI: Nausea, vomiting, peptic ulcer, abdominal distension
Endocrine: Fluid retention, hyperglycemia
Other: Hypokalemia
x
If given IM, use large muscle (Avoid the deltoids)
Note:
OTHER:
x
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
253
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Midazolam
Versed
Sedative
Associated Protocols
3080, 4002, 5021A, 5022A, 5023A, 7007, 7010, 8001, 8083
Description:
x
Midazolam is used to induce sedation and amnesia prior to cardioversion and other painful procedures.
Indications:
x
x
x
x
x
Sedation assisted intubation
Cardiac Pacing
Cardioversion
Seizures (including Nerve Agent / Pesticide exposure)
Behavioral
Contraindications:
x
x
x
x
x
Benzodiazepine intolerance
Acute narrow angle glaucoma
Shock
Coma
Acute alcohol intoxication
Dosage / Route Information:
x
x
x
Sedation / Seizures: 1-5mg IV/IO/IM/Intranasal (0.05mg/kg); may repeat every 5 minutes until max of 0.1mg/kg
Behavioral: Contact command if possible
o Reduce dose in half for patients > 65 y/o for behavioral issues
Persistent Dizziness: 1mg IV/IO Slowly (Adults only – may administer on protocol)
Side Effects:
x
x
x
x
x
CNS: Retrograde amnesia, headache, euphoria, drowsiness, excessive sedation, confusion
CV: hypotension
Eye: Blurry vision, diplopia, nystagmus, pinpoint pupils
GI: Nausea, vomiting
Resp: Coughing, laryngospasm (rare), respiratory arrest
x
IM Injections go into large muscles (avoid the deltoids)
Note:
OTHER:
x
x
Absolute “Y-Site” incompatibility with Sodium Bicarbonate (Will precipitate).
May be given IV / IO / IM / Intranasal
Pregnancy Category:
x
D – Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus.
However, the benefits of therapy may outweigh the potential risk.
254
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Morphine Sulfate
Opioid analgesic
Associated Protocols
5001, 6003, 6071, EPALS 05
Description:
x
x
x
Morphine is used to relieve moderate to severe pain.
Acute Coronary Syndrome – Chest Pain (may give if pain is unrelieved after 3 doses of NTG & SBP > 100mmHg)
Additionally, it is used to reduce venous return in acute MI and acute pulmonary edema
o Causes vasodilation, which reduces myocardial oxygen demand.
Indications:
x
x
Pain
MI
Contraindications:
x
x
x
x
x
x
Head Injury
Exacerbated COPD
Depressed respiratory drive
Hypotension
Acute abdomen
Decreased level of consciousness
Dosage / Route Information:
x
2-5mg IV/IO/IM (0.05mg/kg) – may repeat dose every 5 minutes until max of 0.2mg/kg
o Reduce dose for patients > 65 y/o (by half)
Side Effects:
x
x
x
x
Respiratory Depression
Low blood pressure, Low heart rate
Decreased level of consciousness
Nausea / Vomiting
x
Naloxone should be readily available to counteract the effects of morphine.
Note:
OTHER:
x
Medical Command may order Morphine in pulmonary edema patients.
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
REQUIRES MEDICAL COMMAND PRIOR TO ADDITIONAL DOSES
255
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Naloxone
Narcan
Narcotic Antagonist
Associated Protocols
3042A, 7002A
Description:
x
Naloxone is used to reverse the effects of narcotic analgesics; to manage coma of unknown origin
Indications:
x
x
x
Narcotic Overdose (Respiratory Depression)
Alcohol induced coma
Coma of unknown origin
Contraindications:
x
May cause withdrawal symptoms – use caution
Dosage / Route Information:
x
x
Cardiac Arrest: 2 mg IV/IO
Narcotic Overdose
o IV/IO: 0.4mg. Titrate to effect – Max 2mg IV/IO
o IM/Intransal: 2mg – Max dose 2mg
Side Effects:
x
x
Withdrawal symptoms in the addicted patient (tremors, increasing BP)
Too rapid reversal: Nausea, Vomiting, sweating, tachycardia
x
Choose either intubation or Narcan.
o Never intubate and give Narcan – pt. will wake up and pull the tube.
May cause withdrawal symptoms in narcotic addicts. Use only enough to reverse respiratory depression.
Note:
x
OTHER:
x
May be given IV / IO / IM / Intranasal
Opiate Examples:
x
x
x
Natural Opiates: Morphine, Codeine, Thebaine
Semi-Synthetic Opiates: Hydromorphone, Hydrocodone, Oxycodone, Oxymorphone, Desomorphine,
Diacetylmorphine (Heroin), Nicomorphine, Dipropanoylmorphine, Benzylmorphine and Ethylmorphine.
Synthetic Opiates: Fentanyl, Pethidine, Methadone, Tramadol and Propoxyphene;
Pregnancy Category:
x
B – Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well
controlled studies in pregnant women. or Animal studies have shown an adverse effect, but adequate and wellcontrolled studies in pregnant women have failed to demonstrate a risk to the fetus.
256
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Nitroglycerin
Nitrate
Associated Protocols
2025, 5001, 5002
Description:
x
x
Nitroglycerin increases coronary artery perfusion and relieves chest pain in angina and acute myocardial
infarction
Reduces preload in acute pulmonary edema
Indications:
x
x
CHF – Decreases pulmonary venous congestion and improves cardiac output.
Suspected acute coronary syndrome (Chest pain)
Contraindications:
x
x
x
x
x
x
x
x
Low blood pressure
Hypovolemia
Intracranial bleeding
Aortic stenosis
Right ventricle infarction
Severe bradycardia or tachycardia
Recent use of Viagra, Revation or Levitra within 24 hours.
Recent use of Cialis within 48 hours
Dosage / Route Information:
x
x
Chest Pain: Administer 1 tablet or spray sublingually every 5 minutes (max of 3)
o Systolic Blood pressure must be above 100mmHg, Pulse above 60.
CHF Doses:
o CHF NTG doses may be repeated every 3-5 minutes as long as SBP >100mmHg.
o After initial single tablet/spray of NTG, give nitro dose based upon systolic blood pressure
ƒ 3 SL Tablets or sprays: SBP > 180
ƒ 2 SL Tablets or sprays: SBP 140-180
ƒ 1 SL Tablets or sprays: SBP 100-140
Side Effects:
x
x
x
x
x
Headache
Hypotension
Syncope
Tachycardia
Flushing
x
If you feel uncomfortable given 3 NTG at one time, ensure that you give the 3 NTG within 5 minutes for CHF
patients.
Note:
OTHER:
x
x
May be given as a tablet (0.4mg), or spray (0.4mg) sublingual
One NTG repeated every 5 minutes is equivalent to a NTG infusion of 80 mcg/min
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
257
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Nitroglycerin Paste
Nitrate
Associated Protocols
5002
Description:
x
x
Nitroglycerin increases coronary artery perfusion and relieves chest pain in angina and acute myocardial
infarction
Reduces preload in acute pulmonary edema
Indications:
x
x
x
Angina Pectoris
CHF
Suspected acute coronary syndrome (Chest pain)
Contraindications:
x
x
x
x
x
x
x
x
Low blood pressure
Hypovolemia
Intracranial bleeding
Aortic stenosis
Right ventricle infarction
Severe bradycardia or tachycardia
Recent use of Viagra, Revation or Levitra within 24 hours.
Recent use of Cialis within 48 hours
Dosage / Route Information:
x
x
CHF w/ CPAP: 1” to 2” of paste on chest for patient’s who are unable to tolerate NTG SL w/ CPAP applied.
Chest Pain: 0.5” to 1” paste on chest – needs command (no protocol for this use)
Side Effects:
x
x
x
x
x
Headache
Hypotension
Syncope
Tachycardia
Flushing
x
x
1” of Nitroglycerin paste delivers 15mg
There is no information available as to how many mcg/min NTG paste delivers.
Note:
OTHER:
x
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
258
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Ondansetron
Zofran
Antiemetic
Associated Protocols
7010
Description:
x
Used to control nausea and vomiting
Indications:
x
Severe nausea and vomiting
Contraindications:
x
Hypersensitivity
Dosage / Route Information:
x
2 – 4 mg IV/IO
Side Effects:
x
x
x
x
x
x
x
Headaches
Diarrhea
Dizziness
Pain
Fever
Extrapyramidal symptoms (dystonias)
Seizures
x
Absolute “Y-Site” incompatibility with Sodium Bicarbonate (Will precipitate).
Note:
OTHER:
x
Command needed for ages 6 months to 14 years of age.
Pregnancy Category:
x
B – Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well
controlled studies in pregnant women. or Animal studies have shown an adverse effect, but adequate and wellcontrolled studies in pregnant women have failed to demonstrate a risk to the fetus.
259
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Sodium Bicarbonate
Electrolyte (Alkalinizer)
Associated Protocols
3041A, 3042A, 5023A, 6004, 8031, 8081
Description:
x
x
Corrects severe acidosis refractory to hyperventilation, known hyperkalemia
Sodium Bicarbonate alkalinizes the urine to enhance excretion of drug overdose
Indications:
x
x
x
x
x
x
x
x
Cardiac Arrest (with good ventilations)
Crush Injuries
Hyperkalemia
Tricyclic OD
Phenobarbital OD
Diphenhydramine OD
ASA OD
Cocaine OD
Contraindications:
x
None, but may cause metabolic alkalosis in large quantities.
Dosage / Route Information:
x
x
Adult: 1 mEq/kg IV/IO
Crush Injuries: 1 mEq/kg IV/IO just prior to extrication
o After extrication, with QRS widening repeat 1 meq/kg
Side Effects:
x
x
x
Metabolic alkalosis
Hypokalemia
Fluid overload
x
MUST VENTILATE PATIENT AFTER ADMINISTRATION.
Note:
Other:
x
x
Absolute “Y-Site” incompatibility (precipitation) will occur with the following drugs
o Amiodarone
o Calcium Chloride
o Epinephrine
o Midazolam
o Ondansetron
Most common TCA examples (Antidepressants)
o Amitriptyline (Elavil)
o Imipramine (Tofranil, Janimine)
o Nortriptyline (Aventyl, Pamelor)
o Doxepin (Adapin, Sinequan)
o
Desipramine (Norpramin, Pertofrane)
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
260
ADULT
Eastern PA EMS Council
Regional Medication List
Generic Name
Trade Name
Class:
Sodium Chloride 0.9%
Normal Saline Solution
Isotonic Solution
Associated Protocols
6086, EPALS 08
Description:
x
Normal Saline provides fluid and sodium replacement
Indications:
x
x
x
x
x
Heat exhaustion and related heat problems
Diabetic disorders
Freshwater Drowning
Head Injury
Hypovolemia
Contraindications:
x
Congestive Heart Failure
Dosage / Route Information:
x
x
IV / IO
Dose dependent upon patient condition and situation being treated
o Anaphylaxis (hypotension): 1L wide open, get command for 2nd liter.
o Burns: 20mL/kg for hypotension or severe burns
o Cardiac Arrest (Traumatic, hypovolemic): Up to 2000mL wide open
o Crush Syndrome: 20mL/kg warmed bolus
o Dehydration: 20mL/kg bolus
o Heat Exhaustion / Heat stroke: 500mL bolus wide open
o Hypothermia: WARM NSS 20mL/kg, up to 2000mL
o Nausea / Vomiting: 20mL/kg bolus, up to 2000mL
o Post Partum Hemorrhage: 500mL bolus, if Hypotension, then give up to 2000mL
o Shock: 500mL as rapidly as possible, up to 2000mL
Side Effects:
x
x
x
x
Volume Overload
Congestive Heart Failure
Diuresis
Thirst
x
Normal Saline or Lactated Ringers is the preferred infusion solution during cardiac arrest, although D5W remains
acceptable.
Hypovolemia is defined as a SBP >100mmHg
o When bleeding has not been controlled, titrate NSS to permit moderate hypotension (SBP between 7090) unless severe head injury also present.
o When bleeding has been controlled or if severe head injury, titrate NSS to achieve SPB >90.
Maxiumum NSS dose is 2000mL before contacting Medical Command.
Note:
x
x
Pregnancy Category:
x
C – Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in
pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled
studies in pregnant women.
261
lbs
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0.01 units/kg
0.1
0.2
0.3
0.4
0.6
0.7
0.8
0.9
1.0
1.1
1.2
1.3
1.4
1.6
1.7
1.8
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0.1 units/kg
1.1
2.2
3.3
4.4
5.6
6.7
7.8
8.9
10.0
11.1
12.2
13.3
14.4
15.6
16.7
17.8
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0.02 units/kg
0.2
0.4
0.7
0.9
1.1
1.3
1.6
1.8
2.0
2.2
2.4
2.7
2.9
3.1
3.3
3.6
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0.2 units/kg
2.2
4.4
6.7
8.9
11.1
13.3
15.6
17.8
20.0
22.2
24.4
26.7
28.9
31.1
33.3
35.6
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0.04 units/kg
0.4
0.9
1.3
1.8
2.2
2.7
3.1
3.6
4.0
4.4
4.9
5.3
5.8
6.2
6.7
7.1
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0.25 units/kg
2.8
5.6
8.3
11.1
13.9
16.7
19.4
22.2
25.0
27.8
30.6
33.3
36.1
38.9
41.7
44.4
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0.05 units/kg
0.6
1.1
1.7
2.2
2.8
3.3
3.9
4.4
5.0
5.6
6.1
6.7
7.2
7.8
8.3
8.9
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0.3 units/kg
3.3
6.7
10.0
13.3
16.7
20.0
23.3
26.7
30.0
33.3
36.7
40.0
43.3
46.7
50.0
53.3
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lbs
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0.35 units/kg
3.9
7.8
11.7
15.6
19.4
23.3
27.2
31.1
35.0
38.9
42.8
46.7
50.6
54.4
58.3
62.2
lbs
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0.75 units/kg
8.3
16.7
25.0
33.3
41.7
50.0
58.3
66.7
75.0
83.3
91.7
100.0
108.3
116.7
125.0
133.3
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0.4 units/kg
4.4
8.9
13.3
17.8
22.2
26.7
31.1
35.6
40.0
44.4
48.9
53.3
57.8
62.2
66.7
71.1
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1 units/kg
11.1
22.2
33.3
44.4
55.6
66.7
77.8
88.9
100.0
111.1
122.2
133.3
144.4
155.6
166.7
177.8
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0.5 units/kg
5.6
11.1
16.7
22.2
27.8
33.3
38.9
44.4
50.0
55.6
61.1
66.7
72.2
77.8
83.3
88.9
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1.5 units/kg
16.7
33.3
50.0
66.7
83.3
100.0
116.7
133.3
150.0
166.7
183.3
200.0
216.7
233.3
250.0
266.7
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0.6 units/kg
6.7
13.3
20.0
26.7
33.3
40.0
46.7
53.3
60.0
66.7
73.3
80.0
86.7
93.3
100.0
106.7
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2 units/kg
22.2
44.4
66.7
88.9
111.1
133.3
155.6
177.8
200.0
222.2
244.4
266.7
288.9
311.1
333.3
355.6
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lbs
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5 units/kg
55.6
111.1
166.7
222.2
277.8
333.3
388.9
444.4
500.0
555.6
611.1
666.7
722.2
777.8
833.3
888.9
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20 units/kg
222.2
444.4
666.7
888.9
1111.1
1333.3
1555.6
1777.8
2000.0
2222.2
2444.4
2666.7
2888.9
3111.1
3333.3
3555.6
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50 units/kg
555.6
1111.1
1666.7
2222.2
2777.8
3333.3
3888.9
4444.4
5000.0
5555.6
6111.1
6666.7
7222.2
7777.8
8333.3
8888.9
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