Normal saline

(0.9% NaCl solution) for IV

5% Dextrose in water for IV infusion

Can be used for a KVO IV because the danger of fluid overload is reduced; however, a saline lock is also useful for that purpose and does not require additional storage space for bags of IV fluid.

•Class: Hypotonic carbohydrate-containing solution.

•Description: Sterile water containing 5 percent dextrose (5 g/100 mL).

•Mechanism of action: D5W combines dextrose and water in a hypotonic concentration that will not remain in the vascular space, reducing the danger of fluid overload.

•Indications: D5W is used for prophylactic IV access or to dilute concentrated drugs for IV infusion.

•Contraindications: D5W should not be used for patients who require IV fluid replacement or in patients who are hyperglycemic. Do not use in patients with TBI or stroke.

•Precautions: D5W may be more irritating to the tissues than NS, so the IV site should be closely monitored for irritation, swelling, or redness. •Side effects: Rare when given in therapeutic doses.

•Interactions: D5W should not be used for blood product infusion.

•Dosage: Usually administered at a KVO rate.

•Route: IV infusion.

•How supplied: D5W is most commonly supplied in 250-mL or 500-mL bags.

Lactated Ringer's solution

Class: Isotonic crystalloid solution.

Description: Sterile water containing the following electrolytes:

• Sodium, 130 mEq/L

• Potassium, 4 mEq/L

• Calcium, 30 mEq/L

• Chloride, 109 mEq/L

• Lactate, 28 mEq/L

§ Mechanism of action: Lactated Ringer's solution is used to replace fluid and electrolytes.

§ Indications: Significant burns and hypovolemia.

§ Contraindications: Do not use in patients with heart failure, renal failure, or suspected hyperkalemia.

§ Precautions: Monitor closely for signs of circulatory overload.

§ Side effects: Rare in therapeutic dosages.

§ Interactions: Do not use with blood product infusion.

§ Dosage: Depends on the condition for which LR solution is being administered. Follow your protocols.

§ Route: IV infusion.

§ How supplied: LR solution is commonly supplied in 1,000-mL bags.

Albuterol sulfate

Class: Beta2-selective sympathomimetic; bronchodilator.

o Description: Albuterol sulfate (Proventil, Ventolin) is a sympathetic beta2 agonist used to reverse bronchiolar smooth muscle constriction in patients with asthma and COPD

o Mechanism of action: Acts on beta2 sympathetic receptors in bronchiolar smooth muscle to cause bronchodilation.

o Indications: Wheezing caused by asthma, and COPD, and some other conditions.

o Contraindications: Hypersensitivity and symptomatic tachycardia.

o Precautions: Albuterol has minimal beta1-adrenergic effects, but may increase HR and myocardial oxygen demand. Use with caution in patients with heart disease.

o Side effects: Anxiety, palpitations, chest discomfort, headache, and perspiration.

o Interactions: Other beta agonists should not be administered concurrently with albuterol.

o Dosage: MDI - one or two 90-mcg sprays. The use of a spacer device is preferred when administering albuterol by MDI, especially in pediatric patients. SVN: 2.5 mg diluted in 2.5 mL NS over 5 to 15 minutes; pediatric dosage, 0.15 mg/kg in 2.5 NS with the max dose being 2.5.

o Route: Inhalation.

o How supplied: MDI or 2.5 mg/0.5 mL nebule.

Aspirin

o Class: Platelet aggregation inhibitor; nonsteroidal anti-inflammatory; analgesic.

o Description: Aspirin is a salicylate that reduces platelet aggregation by inhibiting the release of a prostaglandin called thrommboxane A2.

o Mechanism of action: Aspirin blocks part of the chemical reaction responsible for activating platelets.

o Indications: In the prehospital setting, acute coronary syndrome.

o Contraindications: Hypersensitivity; not given to children or adolescents with suspected viral illnesses because it is associated with an increased risk of Reye's syndrome. Also not given to stroke patients.

o Precautions: Administer with caution in patients with asthma or seasonal allergies, stomach ulcers, liver disease, alcohol abuse, kidney disease, or coagulapathies.

o Side effects: GI upset, bleeding, N/V, and wheezing.

o Interactions: Few interactions for a single dose in the hospital setting.

o Dosage: The AHA currently recommends 160 to 325 mg of chewable aspirin. Children's aspirin is preferred because it is chewable, which increases the rate of absorption, and does not require water to assist swallowing.

o Route: Oral.

o How supplied: Chewable tablets containing 81 mg/tablet.

50 percent dextrose

o Class: Carbohydrate.

o Description: High concentration (50 g/100 mL) of dextrose in sterile water for IV administration.

o Mechanism of action: Increases glucose concentration in the blood for the reersal of acute hypoglycemia.

o Indications: Hypoglycemia in adult patients.

o Contraindications: Intracranial hemorrhage (traumatic brain injury, stroke) and hyperglycemia.

o Precautions: Check the BGL prior to administration. A solution of 50 percent dextrose is hypertonic and will cause severe tissue necrosis if infiltration occurs.

o Side effects: Localized irritation of the vein.

o Interactions: There is no significant interactions in emergency situations.

o Dosage: 25 g slow IV push; may be repeated in 10 to 15 minutes if BGL remains below 70 mL/dL. Pediatric dosage: 0.5 g/kg 500 (mg/kg) of a 25 percent solution (25 g/100 mL) of dextrose; 10 percent (10 g/100 mL) for neonates.

o Route: Slow IV push through at least an 18-G IV catheter in a large vein. Monitor the IV site for infiltration during administration.

o How supplied: Prefilled syringe containing 25 g of dextrose in 50 mL.