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– ADENOSINE (Adenocard) o CLASS: Antidysrhythmic o INDICATION: Narrow Complex SVT/PSVT o CONTRAINDICATION: Hypersensitivity , 2nd & 3rd degree AV block, VT, sick sinus syndrome, pt’s taking Tegretol. Asthma – Use with Caution. o DOSAGE: 6 mg IV rapidly over 1-3 secs flush with 20 cc NS, If no effect in 1-2 min give 12 mg (PEDS: 0.1 mg/kg 1st dose, 0.2 mg/kg 2nd dose) o * Half life is 6 sec. Push through large proximal vein & flush immediately. o SIDE EFFECTS: Facial flushing ,chest pn, hypotension, headache, bronchospasm – ALBUTEROL (Proventil, Ventolin) o CLASS: Sympathomimetic bronchodilator o INDICATIONS: Bronchospasm secondary to COPD, Asthma, Croup, RAD o CONTRAINDICATIONS: Hypersensitivity, Tachydysrhythmias, Known allergy to nuts o DOSAGE: 2.5 mg in 3 ml saline in neb (PEDS: Same as adult, Infants ≤ 3 months 1.25 mg) o SIDE EFFECTS: Anxiety, n/v, tachydysrhythmias – AMIODARONE (Cordarone) o CLASS: Antidysrhythmic o INDICATIONS: Life threatening recurrent ventricular & supraventricular dysrhythmias, VF, pulseless VT before lidocaine o CONTRAINDICATIONS: Hypersensitivity, cardiogenic shock, severe sinus brady, advanced heart block o DOSAGE: V-Fib: 300 mg IV/IO second dose of 150 mg in 3-5 min (PEDS: 5 mg/kg, repeat up to 15 mg/kg) o Stable Wide Complex Tachycardia: 150 mg IV/IO over 10 min (PEDS: 5 mg/kg over 20 min, repeat up to 15 mg/kg) – ASPIRIN (ASA) o CLASS: Antiplatelet, Anti-inflammatory, Antipyretic, Analgesic o INDICATIONS: Chest pain suggestive of an MI o CONTRAINDICATIONS: Hypersensitivity, active ulcer disease, asthma Precautions: Bleeding disorders, allergies to other NSAIDs o DOSAGE: 160-325 mg PO (chewable) – ATROPINE o CLASS: Parasympatholytic o INDICATIONS: Asystole, hemodynamically significant bradycardia, organophosphate poisoning o CONTRAINDICATIONS: None o DOSAGE: Asystole, PEA: 1 mg IVP q 3-5 min; max 0.04 mg/kg (PEDS: 0.02 mg/kg IV/IO) ET TUBE: Adult: 2 mg; PEDS: 0.04 mg/kg o Symptomatic bradycardia: 0.5-1 mg IVP (PEDS: 0.02 mg/kg up to 1mg) o Organophosphate: 2-5 mg IV q 10-15 min (PEDS: 0.05 mg/kg) o Asthma: 0.4-2 mg nebulized in 3 ml * Remember, if given in a dose of < 0.1 mg, or if it is given too slowly, a paradoxical (reflex) bradycardia may occur. – CALCIUM CHLORIDE o CLASS: Electrolyte o INDICATIONS: Hyperkalemia, hypocalcemia, hypermagnesemia, calcium channel blocker toxicity, muscle spasm & pain from spider bites o CONTRAINDICATIONS: V-Fib, hypercalcemia, and digitalis toxicity o DOSAGE: 2-4 mg/kg IV (250-500 mg) of 10% solution/10 min (PEDS: 20 mg/kg IV repeat at 10 min prn) – DEXAMETHASONE (Decadron) o CLASS: Steroid, Anti-inflammatory o INDICATIONS: Anaphylaxis, asthma, COPD, spinal cord trauma, cerebral edema o CONTRAINDICATIONS: No absolute contraindication in the emergency setting Relative: Uncontrolled infections, TB, varicella, ulcers o DOSAGE: 4-24 mg IV (PEDS: 0.5-1 mg/kg) – DEXTROSE 50% o CLASS: Antihypoglycemic, Carbohydrate o INDICATIONS: Hypoglycemia o CONTRAINDICATIONS: None in hypoglycemia, intracerebral bleeding, hemorrhagic CVA o DOSAGE: 25 gm (50 ml) IV/IO (PEDS: 2-4 ml/kg (0.5 to 1 g/kg) of 25% solution) (Infants: 1 y/o 0.5 to 1 g/kg of 10% solution) o SIDE EFFECTS: Tissue necrosis (administer thru freely running IV) * To convert D50W to D25W: Expel 25 ml from amp of D50W & draw up 25 ml NS. – DIAZEPAM (Valium) o CLASS: Anticonvulsant, Sedative, Benzodiazepine o INDICATIONS: Status epilepticus, sedation, anxiety, skeletal muscle relaxation o CONTRAINDICATIONS: Hypersensitivity, head injury, hypotension, acute narrow angle glaucoma o DOSAGE: Seizures: 5-10 mg IV Slowly (PEDS: 0.5-2 mg) o Sedation: 5-15 mg IV Slowly (PEDS: 0.2 mg/kg IV, IO) o Rectal 0.5 mg/kg via 2 in cath flush with 2-3 ml of air o SIDE EFFECTS: Respiratory depression, decreased BP, drowsiness – DIPHENHYDRAMINE (Benadryl) o CLASS: Antihistamine, Anti-emetic, Anticholinergic o INDICATIONS: Allergic reaction, anaphylaxis, dystonic reactions o Dystonic reactions (Extrapyramidal Reactions) = Unusual posture, muscle tone, drooling, or uncontrolled movements occasionally seen with Haldol, Thorazine, Mellaril, Phenergan, Compazine, Reglan o CONTRAINDICATIONS: Hypersensitivity, asthma & other lower respiratory diseases o DOSAGE: 25-50 mg IV or deep IM (PEDS: 0.5-1 mg/kg IV, IO slow, IM) o SIDE EFFECTS: Sedation, blurred vision – DILTIAZEM (Cardizem) o CLASS: Calcium channel blocker o INDICATIONS: Supraventricular tachydysrhythmias (a-fib, a-flutter, and PSVT refractory to adenosine) o CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome, 2nd or 3rd degree AV block, Systolic BP < 90, Diastolic BP < 60, wide-complex tachycardia, and WPW o DOSAGE: 0.25 mg/kg IV over 2 minutes, may repeat in 15 min with 0.35 mg/kg, followed by a drip of 5 to 10 mg/hr Not to exceed 15 mg/hr over 24 hours. – DOPAMINE (Intropin) o CLASS: Sympathomimetic o INDICATIONS: Nonhypovolemic hypotension, cardiogenic shock o CONTRAINDICATIONS: Tachydysrhythmias, V-Fib, pheochromocytoma o DOSAGE: 5-20 mcg/kg/min - AHA: 2-10 mcg/kg/min (PEDS: 2-20 mcg/kg/min) o Mix 800 mg/500 D5W or 400 mg/250 D5W for 1600 mcg/ml o Renal Dose: 2-4 mcg/kg/min o Beta Dose: 5-10 mcg/kg/min (Chronotropic, “Cardiac” Dose) o Alpha Dose: 10-20 mcg/kg/min o SIDE EFFECTS: VT, VF, HTN, N/V *Remember - Dopamine is deactivated by Sodium bicarbonate. – EPINEPHRINE (Adrenaline) o CLASS: Sympathomimetic o INDICATIONS: Cardiac arrest, anaphylaxis, allergic Reaction o CONTRAINDICATIONS: Narrow angle glaucoma; hemorrhagic or cardiogenic shock, pregnant women in active labor, coronary insufficiency, organic brain or heart disease, HTN, tachydysrhythmias o DOSAGE: Cardiac arrest: 1 mg 1:10,000 IV q 3-5 min (PEDS 0.01 mg/kg 1:10,000) o Allergic reaction: 0.3-0.5 mg SQ 1:1,000 (PEDS: 0.01 mg/kg. Max: 0.5 mg) o Asthma: 0.3-0.5 mg SQ 1:1,000 (PEDS: 0.01 mg/kg. Max: 0.5 mg) o Severe Anaphylaxis: 0.3-0.5 mg IV 1:10,000 o Bradycardia: drip 2-10 mcg/min IV - mix 1 mg in 250 ml D5W Clock method. o (PEDS: 0.01 mg/kg. Max: 0.5mg; Drip 0.1-1 mcg/kg/min) ET TUBE: Adult: 2-2.5 mg 1:1,000; PEDS: 0.1 mg/kg 1:1,000 o SIDE EFFECTS: VT, VF, angina, HTN *To convert a 1:1,000 conc to 1:10,000 conc: 1 ml of 1:1,000 added to 9 ml of NS = 0.1 mg/ml *Remember - Epinephrine is deactivated by Sodium bicarbonate. – FLUMAZENIL (Romazicon) o CLASS: Benzodiazipine antagonist o INDICATIONS: Respiratory depression 2 to benzodiazepine use Benzodiazepines: Valium, Versed, Ativan, Halcion, Restoril, Ambien, Dalmane, Xanax o CONTRAINDICATIONS: Hypersensitivity to benzodiazepines, tricyclic antidepressant overdose, Patients taking Flumazenil for seizures, seizure prone patients during labor & delivery o DOSAGE: 0.2 mg IV over 15 sec/min repeated at 0.3 mg over 30 sec, then 0.5 mg over 30 sec every minute to affect or 3 mg – FUROSEMIDE ( Lasix) o CLASS: Diuretic o INDICATIONS: CHF with pulmonary edema, HTN crisis o CONTRAINDICATIONS: Hypersensitivity to furosemide or sulfonamides, dehydration, hypokalemia, pregnancy o DOSAGE: 40-120 mg (0.5 to 1 mg/kg) slow IV (PEDS: 1 mg/kg slow IV, may repeat. Max: 2 mg/kg) o SIDE EFFECTS: Orthostatic hypotension, dehydration *Diuresis may take 20 min. However, Lasix causes vasodilation w/in 3-5 min of administration – GLUCAGON o CLASS: Antihypoglycemic, Hormone o INDICATIONS: Hypoglycemia without IV access & beta blocker overdose o CONTRAINDICATIONS: Hypersensitivity o DOSAGE: Hypoglycemia: 0.5-1 mg (unit) IM, SQ, IV, IO (PEDS: 0.1-0.3 mg/kg IV, IO, IM, SQ ) Beta Blocker Overdose: 3 mg IV over 1 min (PEDS: <20 kg 0.5 mg/kg may repeat X 1) – IPRATROPIUM (Atrovent) o CLASS: Anticholinergic, bronchodilator o INDICATIONS: Bronchospasm associated with COPD, asthma, & inhaled irritants o CONTRAINDICATIONS: Allergy to soy or peanuts & atropine or its derivatives, glaucoma o DOSAGE: 0.5 mg in 2.5 – 3 ml NS nebulized with albuterol (PEDS: 0.25 – 0.5 mg in 2.5 – 3 ml NS nebulized) o Never give Atrovent by itself. – LABETALOL (Trandate, Normodyne) o CLASS: Beta Blocker o INDICATIONS: Acute hypertensive crisis o CONTRAINDICATIONS: Asthma, CHF, 2nd & 3rd degree heart block, bradycardia, cardiogenic shock, hypersensitivity o DOSAGE: 20 mg slow IV over 2 min. Can repeat at 10 min intervals. o SIDE EFFECTS: Bradycardia, heart block, CHF, bronchospasms, postural hypotension – LORAZEPAM (Ativan) o CLASS: Sedative (Benzodiazepine) o INDICATIONS: Sedation for cardioversion & status epilepticus o CONTRAINDICATIONS: Hypersensitivity, renal failure, severe hypotension, glaucoma, pts < 6 m/o) o DOSAGE: Seizures: 1-2 mg IV/PR may repeat once (PEDS: 0.05 to 0.01 mg/kg slow IV/PR) Sedation: 2 – 4 mg IM, 0.5- 2 mg IV (PEDS: 0.03-0.05 mg/kg IV/IM/PR up to 4 mg ) May reduce by 50% in geriatrics. o SIDE EFFECTS: resp depression, bradycardia, hypotension *Ativan Injection is slightly viscid when cool. To facilitate injection it may be diluted 1:1 with Normal Saline or Water for Injection immediately before administration. If given IM it should always be diluted. Ativan Injection is presented as a 1ml solution in a 2 ml ampule to facilitate dilution. – LIDOCAINE (Xylocaine) o CLASS: Antidysrhythmic o INDICATIONS: Pulseless Vtach, Vfib, Vtach w/pulse, malignant PVC’s, pre-medication for RSI o CONTRAINDICATIONS: Hypersensivity , supraventricular dysrthmias, 2nd/3rd degree heart block, bradycardia, Stokes-Adams Syndrome, o DOSAGE: Cardiac Arrest: 1-1.5 mg/kg IV/IO repeated at 0.5 to 0.75 every 5-10 min up to 3 mg/kg, following cardioversion with a drip of 1-4 mg/min *Max 3mg/kg (PEDS: 1 mg/kg rapid IV/IO, to 100 mg, follow conversion with a drip of 20-50 mcg/kg/min.) V Tach with pulse: 0.5 – 1.5 mg/kg slow IV. May repeat at ½ dose every 5 to 10 min up to 3 mg/kg. Follow conversion with infusion of 1-4 mg/min. (PEDS: 1 mg/kg, followed by a drip at 20 – 50 mcg/kg/min) *Max dosage 300mg/hr Pre-medication for RSI: 0.5-1 mg/kg IV Bolus For Geriatrics (≥70 y/o): Reduce Dosage by 50% o SIDE EFFECTS: Confusion, dizziness, drowsiness, headache, hypotension, arrythmias, widening of the QRS, cardiac arrest, seizures. o *Signs and symptoms of lidocaine toxicity are dose related & include dizziness, nausea, drowsiness, speech disturbances, periorbital numbness, muscle twitching, confusion, vertigo, & tinnitus. More serious signs of toxicity are difficulty breathing, seizures, psychosis, & bradycardia. o LIDOCAINE INFUSION (20% Solution): 4mg/ml = 1g in 250ml of D5W (or NS) OR 2g in 500ml of D5W (or NS) 1mg/min = 15 gtts/min 2mg/min = 30 gtts/min 3mg/min = 45 gtts/min 4mg/min = 60 gtts/min – MAGNESIUM SULFATE 10% o CLASS: Electrolyte, Antiarrhythmic o INDICATIONS: Torsades de Pointes, eclamptic seizures, status asthmaticus o CONTRAINDICATIONS: Heart block, hypocalcemia, persistent hypertension, hypotension. Use with caution in renal impairment o DOSAGE: Torsades: 1-2 g in 50-100 ml IV/IO over 1-2 min (PEDS: 25-50 mg/kg over 5-20 min. Max dose 2 g) Asthma: Same as Torsades Eclampsia: 2- 4 gm IV Slowly or IM (PEDS: TDP & Refractory VF/VT: 25-50 mg/kg IV/IO over several minutes, to a max of 2 grams) – MIDAZOLAM (Versed) o CLASS: Sedative, Benzodiazepine o INDICATIONS: To induce sedation before cardioversion or intubation o CONTRAINDICATIONS: Hypersensitivity, narrow angle glaucoma, shock. Use with caution in COPD, renal impairment, pregnant & nursing women o DOSAGE: 1- 2.5 mg slow IV; 0.07-0.08 mg/kg IM (Usually 5 mg); 3 mg Intranasal (PEDS: 0.025-0.5 mg/kg) – MORPHINE SULFATE o CLASS: Narcotic analgesic o INDICATIONS: Moderate to severe pain, chest pain associated with ACS, CHF, pulmonary edema o CONTRAINDICATIONS: Hypersensitivity to opiates, undiagnosed head or abdominal trauma, hypotension, severe respiratory depression, shock, o DOSAGE: Chest pain: 2-4 mg IV over 1-5 min Q 5-15 min Pain: 2.5 – 15 mg IV/Deep IM (PEDS: 0.05 – 0.1 mg/kg IV, 0.1 to 0.2 mg/kg IM, SQ) *Consider Phenergen or Zofran for associated nausea. – NALOXONE (Narcan) o CLASS: Opioid antagonist o INDICATIONS: Narcotic & synthetic narcotic overdose, coma of unknown origin. o CONTRAINDICATIONS: Hypersensitivity, non-narcotic induced respiratory depression. o DOSAGE: 0.4 – 2 mg IV/IO, repeated q 2-3 mins needed, up to 10 mg (PEDS: 0.01 mg/kg up to 2 mg IV/IO) ET TUBE: 2 – 2.5 times the dose ET – NITROGLCERIN (Nitrostat, Nitrolingual Spray) o CLASS: Nitrate, Antianginal agent o INDICATIONS: Chest pain associated with angina & AMI, acute pulmonary edema o CONTRAINDICATIONS: Hypotension, hypovolemia, bleeds, recent use (within 24 hr) of any medication for erectile dysfunction o SIDE EFFECTS: Hypotension, syncope, flushing, tachycardia o DOSAGE: Tablet: 0.4 mg SL repeat 3-5 min; Max 3 doses. Spray: 0.4 mg (1 spray) SL up to 3 sprays/25 min – SODIUM BICARBONATE (NaHCO3) o CLASS: Alkalizing agent o INDICATIONS: Tricyclic antidepressant & barbiturate overdose, refractory acidosis, or hyperkalemia o CONTRAINDICATIONS: Alkalosis states o DOSAGE: 1 mEq/kg IV/IO (PEDS: 4.2% solution, 1 mEq/kg IV/IO) *To make 4.2% soln = Expel 25 ml from 50 ml 8.4% amp & Refill with 25 ml of normal saline – VASOPRESSIN (Pitressin) o CLASS: Hormone, Vasopressor o INDICATIONS: To increase peripheral vascular resistance in arrest o CONTRAINDICATIONS: None in cardiac arrest o DOSAGE: 40 U IV/IO may replace 1st or 2nd dose of epinephrine