Download 2011 Grand County EMS Medication Cards

ADENOSINE (Adenocard)
Intermediate- CALL IN
Paramedic
ALBUTEROL SULFATE
Basic-CALL IN
Intermediate-CALL IN
Paramedic
AMIODARONE
(Cordarone)
Intermediate- CALL IN except in
cardiac arrest- call while
administering
Paramedic
ASPIRIN
Basic
Intermediate
Paramedic
ATROPINE SULFATE
Intermediate- CALL IN except in
cardiac arrest- call while
administering
Paramedic
CALCIUM CHLORIDE 10%
Paramedic
ADULT- 1ST dose 6 mg IVP, 2ND dose 12 mg IVP
Follow both doses with 20 ml NS flush
PED1ST DOSE 0.1 mg/kg up to 6 mg
2ND DOSE 0.2 mg/kg up to 6 mg
**Contact base after 2nd dose if no improvement
ADULT- 2.5 mg/3ml
Continuous nebulizer 7.5 mg/9 ml
PED0.15 mg/kg up to 10 mg in NS
Continuous nebulizer 0.5 mg/kg/hr max 15 mg/hr
ADULTA. Cardiac Arrest, VF/Pulseless VT: 1st dose 300 mg IV/IO
bolus, May repeat once 150 mg IV/IO bolus
B. Hemodynamically unstable wide complex tachycardia
with pulse: 150 mg IV bolus infusion over 10 min
C. ROSC: 150 mg bolus infusion over 10 min-base contact
recommended
PEDA. Pulseless VF/VT: 5 mg/kg IV/IO over 5 min (300 mg
max dose)
B. Perfusing supraventricular & ventricular arrhythmias
5 mg/kg IV/IO over 20 min bolus infusion (300 mg max
dose)
ADULT- Chew four 81 mg tablets (324MG)
ADULTA. Hemodynamically Unstable Bradycardia- 0.5 mg IV/IO
every 3-5min. Max 3mg or 0.04mg/kg. Titrate to LOC
and BP. Contact base after persistant bradycardia after 2
doses
B. Symptomatic Insecticide/Organophosphate
poisoning/exposure- contact base for orders (usually 2mg
IVP q 5min until secretions dried) doses may be massive
PEDA. Symptomatic Bradycardia: 0.02 mg/kg IV/IO, max
single dose for child 0.5 mg and for adolescent 1 mg.
May repeat once for max total dose for child 1 mg and
adolescent 3 mg.
ADULTA. Magnesium sulfate overdose: 10 ml of 10% solution
(100 mg/ml) SIVP over 5min.
B. Calcium channel blocker/beta blocker toxicity- 500-1000 mg
slow IV (no faster than 200 mg in a minute)
(over 1min per 200mg)
C. Hyperkalemia: 500-1000 mg slow IV
Contact base for additional dosages and notify base physician of
usage.
PED- 0.2-0.3 ml/kg of 10% solution, may repeat in 10 min.
Do not exceed adult dosage.
DEXTROSE 50%
Basic-IV
Intermediate
Paramedic
ADULT- ½ to 1 amp of D50W, IVP (12.5-25 gm)
PED- Newborn to 1month of age- 2-4ml/kg D10W solution
Greater than 1 month- 2 ml/kg of D25W solution IV
***To make D10W – 10 ml of D50W and 40 ml of NS
***To make D5W – Remove 100 ml of NS from 1000 ml bag, add 2
amps of D50W in 1000 ml of NS
DIAZEPAM (Valium)
Intermediate-CALL IN
Paramedic
ADULT- 1-10 mg slow IV push or deep IM
PED- 0.1-0.3 mg/kg slow IV push (max dose 5 mg) or 0.5 mg/kg
rectal (max dose 5 mg)
DIPHENHYDRAMINE
(Benadryl)
Intermediate-CALL IN
Paramedic
DOPAMINE (Inotropin)
Paramedic (attempt CALL IN)
ADULT- 25-50mg SIVP, deep IM
PED- Children 8yrs and younger- 1 mg/kg Slow IV/IM
(max 25 mg)
Attempt to contact base for all doses and indications
ADULT/PED- 2-20 mcg/kg/min
Dose
Weight 5
20 kg
4
30 kg
6
40 kg
8
50 kg
9
60 kg
11
70 kg
13
80 kg
15
90 kg
17
100 kg 19
10
8
11
15
19
23
26
30
34
38
1600 mcg/ml
15 20 mcg/kg/min
11 15 microdrops/min
17 23
23 30
28 38
34 45
39 53
45 60
51 68
56 75
**should put drip on a pump
EPINEPHRINE
Basic- EPIPEN ONLY
Intermediate-CALL IN except in
cardiac arrest- call while
administering
Paramedic
ADULTA. Cardiac arrest- 1.0 mg (10 ml of 1:10,000) IV/IO q 35 min
B. Bradycardia (contact base for direct physician order)
Epinephrine drip: In 1000 ml NS, add 4 mg of Epinephrine =
Epi Concentration: 4 mcg/ml in 1000 ml of NS
Begin at 1 mcg/min, titrate to SBP 90 mmHg, to max of
10 mcg/min on IV pump.
C. Moderate/severe allergic reactions- 0.3-0.5 mg
(0.3 ml – 0.5 ml of 1:1000) SQ/IM or Epi-pen.(EMT-B, BIV
use EPI-PEN only)
D. Anaphylaxis- 0.3-0.5 mg IV/IO 1:10,000 (3-5 ml of
1:10,000)
E. Asthma- 0.3 mg (0.3 ml of 1:1,000) SQ/IM
PEDA. Cardiac arrest- 1st dose- 0.01 mg/kg (0.1 ml/kg) of
1:10,000 every 3-5 min
B. Bradycardia (unresponsive to O2/ventilation)
0.01 mg/kg (0.1 ml/kg 1:10,000) IV/IO or Epi drip (contact base)
Epinephrine Drip: In a 100 ml bag NS, Add 1 ml (0.1 mg) of
Epi 1:10,000 = Epi Concentration 1 mcg/1ml in 100 ml of NS.
Begin at 0.1 mcg/kg/min on IV pump (may titrate to effect to
1 mcg/kg/min).
C. Anaphylaxis- Racemic Epinephrine for inhalation
0.001 mg/kg (0.01ml/kg 1:1,000) SQ/IM (max single dose 0.5
ml).
May give every 15 min up to 3 doses.
D. Asthma/Croup/Epiglottitis/Reactive Airway/BronchiolitisRacemic Epinephrine for inhalation
E. Life threatening airway obstruction secondary to croup,
epiglottitis, asthma, reactive airway disease- if no
racemeic epi- plain epi can be used. (0.01ml/kg 1:1,000
in 3ml NS nebulized).
FENTANYL CITRATE
Intermediate-CALL IN
Paramedic
GLUCAGON
Intermediate-CALL IN for Beta
Blocker or Ca Channel OD
Paramedic
ADULTLoading dose- 1-2 mcg/kg SIVP/atomized IN/IM last resort
Maintenance dose- 1-2 mcg/kg SIVP/ IN/IM
PED0.5 – 1.0 mcg/kg SIVP/IN/IM
DRIP
ADULT/PEDI- To make Fentanyl infusion, remove 10 ml of NS
from 50 ml bag. Add 500 mcg Fentanyl to the 50 ml bag of NS.
Begin infusion at 0.25 ml/kg/hr. Treat any break through
pain/agitation with small boluses of Fentanyl and/orVersed.
ADULTHypoglycemia- 1 mg IM/IN
Beta Blocker/Ca++ channel Blocker OD- 2mg IV/IN
PEDHypoglycemia- 0.1 mg/kg IM/IN (>8y/o, max dose 1 mg)
Beta Blocker/Ca++ channel Blocker OD- 0.1 mg/kg IV/IN (max dose
1mg)
HALOPERIDOL
(Haldol)
Intermediate-follow written orders
Paramedic
(Medication taken from clinic)
ADULT5-10mg IM (may follow w/ Benedryl 25-50mg IV/IM for dystonic
reaction)
PED- Contact base for all orders for 13-15y/o
Contraindicated under 13y/o
HYDROMORPHONE
(Dilaudid)
Paramedic
ADULT0.5 mg-1.0 mg IV/IM q 15min until pain is managed (or 2 mg IV/IM
q 2hrs)
PED0.015 mg/kg IV/IM q 4-6hrs
Follow physician written orders
(Medication taken from clinic)
IPRATROPIUM BROMIDE
(Atrovent)
Intermediate-CALL IN
Paramedic
ADULT- 250-500 mcg nebulized 1 time dose
PED- 250 mcg nebulized 1 time dose for children < 12 years
IV SOLUTIONS
Basic-IV
Intermediate
Paramedic
ADULT/PED- NS, LR or D5W
TKO- 30 ml/hr (unless otherwise ordered by physician)
Fluid Bolus/Challenge- 20 ml/kg NS rapid IVP (250-500 ml
increments as appropriate than reassess)
LIDOCAINE
Intermediate-CALL IN except in
cardiac arrest, call while
administering
Paramedic
ADULTA. Cardiac- Contact base except in VFIB, Pulseless VTACH, and
post arrest dosing 1 - 1.5 mg/kg IV/IO bolus
B. Brain Trauma- pre-intubation single dose- 1.5 mg/kg IV
PEDPediatric ventricular dysrhythmias- 1 mg/kg IV/IO (over 1-2 min if pt
has pulse)
LORAZEPAM
(Ativan)
Intermediate-can give for pain
management and seizure control
with written orders
Paramedic
ADULT0.5-2 mg IV/IM/IO (diluted with D5W/NS prior to IV
administration)
Follow written orders by base physician
PED0.1 mg/kg IV/PR with max dose 2 mg (diluted with D5W/NS prior to
IV administration)
Follow written orders by base physician
(Medication taken from clinic)
MAGNESIUM SULFATE
Paramedic
ADULTA. Adult Cardiac Arrest - Torsade de pointes: 1-2 Gm slow IV push,
diluted in 10 ml Normal Saline
B. Torsade de Pointe with Pulse – 1-2 Gm diluted in 50-100 ml of
NS slow IV bolus infusion.
C. Acute bronchospasm: 2 Gm slow bolus infusion IV, diluted in 50100 ml NS
D. In OB associated seizures, 4 Gm in 50-100 ml NS, very slow IV
bolus infusion (over 10-20 minutes), consider
consulting base physician for order
E. For high-risk OB patients during intra-facility transport: This
should be mixed 20 grams in 1000 ml NS (Discard same amount
of ml from base fluid as added from Magnesium Sulfate). Infuse as
piggyback to NS main line.
Magnesium Sulfate is infused via IV/medication pump. Total
fluid rate of Magnesium Sulfate and NS
mainline should total 125 ml/hr.
0.5 grams = 25 ml/hour
1.0 grams = 50 ml/hour
1.5 grams = 75 ml/hour
2.0 grams = 100 ml/hour
2.5 grams = 125 ml/hour
F. Monitor vital signs, contractions, and fetal heart tones every 15
minutes
G. For all pregnancy related Magnesium Sulfate
administration: Monitor deep tendon reflexes (+1 to +4)
every 30 minutes, contact base medical control for decreased
deep tendon reflexes
H. A foley catheter is required to be in place for a patient on a
Magnesium Sulfate drip. Notify base physician for urine
output < 30 ml/hr
PEDA. Pediatric pulseless torsades de pointe: 25 to 50 mg/kg in 10 ml NS
IV/IO bolus infusion over 10 to 20 minutes, max dose 2 Gm.
B. Torsade de Pointe w/pulse – 25-50 mg/kg diluted in 50-100 ml of
NS IV/IO bolus infusion over 10-20 min, max dose 2 Gm.
C. Pediatric severe asthma: 25-50 mg/kg in 50-100 ml NS over 20
minutes IV, max dose 2 Gm
METERED DOSE INHALERS
B, BIV, Intermediate CALL IN
Paramedic
ADULT/PEDA. Confirm prescription identification.
B. Ascertain how many times the patient has used the inhaler.
C. If needed, contact Base Physician for an order to administer.
D. Up to 2 puffs
E. Contact Base Physician for additional orders if needed.
METHYLPREDNISOLONE
(Solu-medrol)
Intermediate-CALL IN
Paramedic
ADULTA. 250 mg slow IV, may mix in 50-100 ml of NS and give IV over
10-20 minutes.
PEDA. 2 mg/kg to max of 250 mg slow IV, may mix in 50-100 ml of NS
and give IV over 10-20 minutes.
MIDAZOLAM
(Versed)
Intermediate-CALL IN for
behavioral management, seizure
control
Paramedic
ADULTA. Cardioversion premedication: up to 2.5 mg slow IV/IN
B. Status seizures, pacing agitation and post intubation agitation: 1
mg every min IV, titrate to seizure cessation or
decreased agitation (max single dose= 0.1 mg/kg or 10 mg)
C. Combative behavior compromising patient care: up to 0.1
mg/kg IV or IM (maximum single dose = 10 mg)
D. Notify base physician that Midazolam has been given
E. Patients being paced may tolerate procedure without
sedation, administer only if indicated
PEDA. Analgesics/Sedative: 0.1 mg/kg IV/atomized IN max single
dose 10 mg.
B. Second dose or any other indication for children contact
base physician for order.
MORPHINE SULFATE
Intermediate -CALL IN
Paramedic
ADULTA. STEMI: 2-4 mg IV every 5-15 min to relieve chest
discomfort.
B. NSTEMI/Pain control 2-10 mg IV/IM, the goal is to decrease
anxiety and improve patient comfort.
C. Repeat as needed to effect.
PEDA. Pain Control: 0.05 mg - 0.1 mg/kg IV slowly
B. Repeat as needed to effect.
NALOXONE
(Narcan)
Basic-IV
Intermediate
Paramedic
ADULTA. 2 mg (2 ml) IV/IO/atomized IN, or IM if IV not available
B. If no response is observed, this dose may be repeated
after 5 min., if narcotic overdose is suspected.
PEDA. 0.1 mg/kg/dose IV/IO/atomized IN/IM with single max
dose 2 mg.
NITROGYCERIN
(NITRO, NTG)
B,BIV-CALL IN for patient
assisted
Intermediate
Paramedic
ADULTA. Basic/Basic-IV contact base physician to assist with patient
prescribed Nitroglycerin
B. 0.4 mg (1/150 grain) tablet sublingually, may repeat every 5
minutes as needed for effect. Maximum 3 doses in 15 min.
C. Blood pressure to be checked prior to each dose.
ONDANSETRON
(Zofran)
B, BIV (waiver)-CALL IN for ODT
only
Intermediate -CALL IN
Paramedic
ADULT (4 yrs and up)- 4 mg slow IV with max dose 12 mg
(May give ODT tablets if no IV)
PED (under 4 years)- 2 mg slow IV ,(May give ODT tablets if no
IV)
ORAL GLUCOSE
Basic
Basic-IV
Intermediate
Paramedic
ADULTA. The dosage of oral glucose is 15g
PEDA. 1gm/kg up to 15gm total one time dose.
PROMETHAZINE
(Phenergan)
Intermediate-CALL IN
Paramedic
ADULTA. 12.5 mg slow IV, dose may be repeated once for max
dose of 25 mg.
B. Dose adjustment for elderly: 6.25 mg-12.5 mg IV.
PED0.5 -1 mg/kg slow IV, up to 6.25 mg single dose.
RACEMIC EPINEPHRINE
Intermediate-CALL IN
Paramedic
ADULT/PED- 0.5 ML OF 2.25% solution in 3 ml of NS via
nebulizer
If no improvement after 2 doses contact medical control
SODIUM BICARBINATE
Intermediate-CALL IN except
during arrest, call while
administering
Paramedic
ADULTA. 1 mEq/kg (1 ml/kg) IV/IO of 8.4% solution
B. Contact base for direct physician order for tricyclic overdose.
PEDA. 1 mEq/kg (1 ml/kg) IV/IO of 8.4% solution
B. 4.2% solution should be used for newborns, 2 mEq/kg
(4 ml/kg) IV/IO
C. Contact base for direct physician order for tricyclic overdose.
TERBUTALINE
(Brethine)
Paramedic
(Medication taken from clinic)
ADULTA. 0.25 mg SQ/IH. Dose can be repeated every 15-30 minutes as
ordered by physician.
B. MDI- dose is two inhalations, 1 minute apart
C. SQ/IH only
INTERFACILITY TRANSPORT
FORMULARY
LABETALOL
(TRANDATE, NORMODYNE)
Paramedic waiver
ADULTBOLUS- 2-20 mg IVP over 2min (per .physician). Do not exceed a
total dose of 300 mg
INFUSION-2-8 mg/kg per physician orders
Normal Infusion Concentration- 200 mg/250 ml = 2 mg/3ml
**Medication must be put on Medication IV pump
INSULIN DRIP
Paramedic
ADULT- 0.1 units/kg/hour.
PED- 0.1 units/kg/hour
BGL checks are mandatory q 30min during transport or more often
if ordered by the physician. A decrease in blood sugar of 30-50 dl/hr
is anticipated. If the blood sugar decreases more than 30dl during a
30 minute recheck, contact the base physician for further orders.
**Medication must be put on Medication IV pump
NITROGYCLERIN
DRIP
Paramedic
Nitroglycerin is a concentrated medication that is administered after
dilution. Usual mixtures include 25 mg in 250 ml of D5w or NS. This
yields a concentration of 100 mcg/ml.
**Medication must be put on Medication IV pump
VECURONIUM
(NORCURON)
Paramedic Waiver
ADULT/PEDI- 0.1 mg/kg IV
ALTEPLASE
(ACTIVASE, tPA)
Paramedic Waiver
Medication drips for interfacility
transport
Verify medication dosage,
concentration, and rate are
correct. Medications are to be
infused via IV pump- verify pump
rate is correct prior to transport.
ADULT-0.9mg/kg (max 90mg)
10% total dose administered as an initial IV bolus over 1min and
remaining 90% infused over 60min
Amiodarone (Cardarone)
Collids
Diltiazem (Cardizem)
Glycoprotein IIb/IIIb inhibitors
Heparin
Solu-medrol
Oxitocin
Potassium
Sodium Bicarbinate
TPN and/or Vitamins
Hospital initiated antibotics
Intermediate, Paramedic
Intermediate, Paramedic
Paramedic
Paramedic
Paramedic
Paramedic
Paramedic
Paramedic
Paramedic
Intermediate, Paramedic
Intermediate, Paramedic