Action

Slow electrical conduction through AV node and interupts re-entry pathway, converting SVT to NSR

BHO if patient has history of bronchospasm or COPD

BHPO for peds

• 2nd and 3rd degree AV heart blocks
• sick sinus syndrome (without pacemaker)

• SOB / dyspnea; may cause bronchospasm in asthma patients (BHO)
• Chest pressure / papatations; may be acute in some patients for breif period.
• Mild hypotension (decreased peripheral vascular resistance)
• Dizzy / lightheadedness / headache
• Nausea
• Transient arrhythmias (bradycardia, AV blocks, ventricular ectopy).  These are generaly no treated and are quickly self-limiting

• Relaxes bronchial smooth muscles by stimulating beta-2 adrenergic receptors
• Produces bronchodilation, relieves bronchospasm, and reduces airway resistance

• Respiratory distress: ?asthma/COPD/respiratory origin
• Alergic reaction: Acute allergic reactions or anaphylaxis
• Burns: Respiratory distress with bronchspasm
• Hemodialysis: symptomatic ?hyperkalemia if ≥72 hours since last dialysis

• None in adults
• Croup in peds

Tachycardia / Palpitations

Dizzyness, headache

tremors, nervousness

• blocks sodium, potassium and calcium channels in cardiac cells slowing conduction and prolongs repolarization
• Has alpha and beta adrenergic blocking properties causing negative inotorpic effects and reduces peripheral vascular resistance (afterload)

• Stable VT
• Post conversion VT/VF with pulse ≥60 (including witnessed spontanious conversion, AED or reported/witnessed ≥ 2x AICD)

• Bradycardia / AV Blocks
• Hypotension
• Hypersensitivity iodine (does not include seafood)

• Hypotension
• Exacerbation of the presenting arrhythmia
• Visual disturbances / vision loss

After days of use

• Liver Injury
• Pulmonary injury: pulmonary infiltrates, bronchospasm, SOB cough, hemoptysis, hypoxia

• Inhibits normal tendency for platelets to accumulate inside injured or occluded coronary arteries, thereby improving bloodflow through vessels to better perfuse the heart
• Blocks formation of thromboxin A2

• G.I. upset (indigestion, nausea/vomiting, epigastric pain, heartburn)
• Occult or prolonged bleeding

• Antiarrhythmic
• Anticholinergic

• Competes with acetylcholine for receptor sites blocking the PNS response at SA and AV nodes
• Increases heart rate by increasing electrical conduction through the heart
• Positive chronotropic properties with little or no inotropic effects
• Inhibits secretions by decreasing PNS effects on bronchial, salivary, sweat and G.I. glands

IV/IO 2-4 minutes

IM 10-15 minutes

• Adult Unstable bradycardia: narrow complex
• Peds unstable bradycardia: after BVM for 30 secs and third dose of epinephrine
• Symptomatic organophosphate poisoning

• Tachycardia / palpitations
• Dry mouth / nausea  / vomiting
• Pupil dilation / blurred vision
• Flushed / hot / dry skin

• Antagonizes the action of acetylcholine preventing the interaction of acetylcholine with muscarinic receptors in bronchial smooth muscle causing bronchodilation.
• Dries respiratory tract secretions

• Respiratory distress: ?asthma/COPD/respiratory origin
• Allergic reaction / anaphylaxis: acute allergic reactions or anaphylaxis

• Nausea
• G.I. distress
• Nervousness/dizziness
• Headache
• Palpitations
• Blurred vision / eye irritation (with direct contact of mist)

• Increases myocardial contractility
• Enhances ventricular automaticity
• Reverses cardio-electric changes produced by hyperkalemia
• Shifts potassium back into cell to prevent intravascular hyperkalemia

• Hemodialysis patient: symptomatic, ?Hyperkalemia if greater than or equal to 72 hours since last dialysis.
• Trauma:  crush injury of extremity or torso with extended entrapment ≥2 hours just prior to extremity being released.

• Decreased heart rate (may cause asystole)
• Hypotension
• Syncope
• Nausea/vomiting
• Metallic taste

• Binds and absorbs ingested toxins present in the G.I. tract
• Inhibits intestinal absorption, preventing systemic toxicity

• Nausea/vomiting
• Constipation/diarrhea
• Abdominal cramping

• Increases blood glucose by providing a quick release of free sugar into the circulation

Altered neurologic: ?Hypoglycemia: symptomatic patient with altered LOC or unresponsive to oral glucose agents and BS:

Adults/peds/infants = BS <60

Neonate= BS <45

• Local venous irritation/infection
• Hyperglycemia

• Binds to histamine receptor sites, blocking H1 and H2 receptors
• H1 causes bronchoconstriction, airway swelling and vasodilation
• H2 causes secretion of gastric acid
• Does not prevent histamine release

• Allergic reaction/anaphylaxis: mild and acute allergic reactions or anaphylaxis
• Poisoning/OD: extrapyramidial reactions

• Drowsiness/sedation (excitement in children)
• Dry mouth/thickened bronchial secretions
• Hypotension
• Palpitations/tachycardia
• Seizures

• Facial muscle twitch
• Full body spasm
• Neck muscle contraction 
• Head deviation 
• Occulogyrations
• etc.

• At low and medium doses, selectively dilates blood vessels supplying the brain, kidneys, heart and gastrointestinal tract
• At medium to high doses, increases cardiac output by improving contractility and stroke volume, thereby increasing blood pressure
• At high doses, causes vasoconstriction and increased heart rate

Discomfort/pain ?cardiac origin:  with associated shock. If BP is refractory to fluid boluses

Shock:  ?anaphylactic, ?neurogenic, ?septic, ?cardiac: if BP refractory to fluid boluses

Anaphylaxis: shock after fluid boluses and epinephrine IV/IO

Dysrhythmias: Bradycardia: after max atropine or initiation of TCP

• At high infusion rates, hypertension and extreme vasoconstriction may occur
• At low infusion rates, hypotension may occur
• Tachyarrhythmias / palpitations

Take the patient's weight in pounds, drop the last number and subtract 10% and then multiply x 2.  

This will get you the 10 mcg/kg/min trip rate

• On the bronchi: bronchodilation (beta-2)
• On the peripheral vasculature: vasoconstriction (alpha)
• On the heart:
• Increased heart rate (beta-1) / chronotropic
• Increased contractility / inotropic
• Increased AV conduction / domotropic
• Increased automaticity / dromotropic

IV/IO 1-2 min

IM/SC 5-10 min

IV/IO 5-10 min

IM/SC 1-4 hrs

Allergic reaction: acute (facial/cervical angioedema, bronchospasm or wheezing)

Anaphylaxis: shock or cyanosis

Respiratory distress: Asthma/COPD/respiratory origin: severe respiratory distress/failure or in adequate response to Albuterol/Atrovent

Peds: Respiratory Distress: with stridor at rest

Dysrhythmias: cardiac arrest (pulseless patient)

Peds: Dysrhythmias: Unstable Bradycardia: after BVM for 30 seconds

Peds: Newborn Delivery: if HR remains < 60 after 30 seconds of CPR

• Anxiety/restlessness
• Palpitations/tachyarrhythmias
• Ventricular irritability
• Increased myocardial 02 demands
• Hypertension
• Angina

1:10,000 = 1mg/10ml

1:1,000 = 1mg/1ml

• Increases blood glucose by converting glycogen stored in the liver to glucose
• Inhibits synthesis of glucogen from glucose

Altered neurologic: ?hyperglycemia symptomatic patient with altered LOC or unresponsive to oral glucose agents "if no IV" and BS:

Adults/peds/infants = BS < 60

Neonatal = BS < 45

• Nausea/vomiting
• Tachycardia

• CNS depressant
• Produces anterograde amnesia, then sedation
• Stops and prevents seizures

IV/IO/IN = 2 minutes

IM = 15 minutes

Seizures:

• generalized seizures lasting five minutes
• Focal seizures with respiratory compromise
• Recurrent seizures without lucid interval
• Eclamptic seizures of any duration

Dysrhythmias:

• Unstable bradycardia: discomfort associated with TCP capture, after morphine if BP ≥100
• Unstable conscious VT: precardioversion

Dysrhythmias:

• Conscious SVT: precardioversion

Dysrhythmias:

• Unstable conscious a-fib, a-flutter: precardioversion

• Laryngospasm, respiratory depression/apnea
• Drowsiness/confusion/amnesia
• Hypotension

5 mg/1 mL

10 mg/2 mL

• Opioid
• Narcotic analgesic

• CNS depressant acting on opiate receptors in the brain
• Potent analgesic and sedative

• Chronic pain states
• Isolated head injuries
• Acute onset severe headache
• Drug/EtOH intoxication
• Multiple trauma with GCS < 15
• Suspected active labor
• Abdominal pain

• Respiratory depression/apnea
• Decreased LOC
• Transient hypotension
• Palpitations/arrhythmias
• Nausea/vomiting
• Pinpoint pupils

IV/IM/IO = 10mg/1ml

PO = 10mg/5ml

• Reverses respiratory depression, sedation and hypotensive effects of opioid overdose by occupying opiate receptor sites

IV/IN = 1-2 minutes

IM = 2-5 minutes

IV 30-60 minutes

IM longer

Adult: Poisoning/OD

Adult: Altered Neurologic

- symptomatic ?opioid OD with respirations < 12

PEDS: Poisoning/OD

PEDS: Altered Neurologic

- symptomatic ?opioid OD

• Acute withdrawal symptoms
• Nausea/vomiting
• Tachycardia/hypertension

• Produces vasodilation by relaxing systemic venous and arterial vessels, thereby:
• Decreasing preload and afterload
• Decreasing myocardial workload
• Decreasing myocardial O2 consumption
• Dilates coronary arteries

SL = 2 min

Topical = 30-60 min

SL = 30-60 min

Topical = 24 hours

Discomfort/pain ?cardiac origin

Respiratory Distress: ?CHF/cardiac origin

• Patient who has taken a sexual enhancement medication such as sildenafil/Viagra, Cialis, Levitra within 48 hours
• May encounter patients taking similar medication for pulmonary hypertension (Sildenafil/Revatio, Flolan and Veletri).  NTG is contraindicated in these patients as well.

• Orthostatic hypotension (can be profound)
• Dizziness/syncope
• Temporary pulsating headache
• Facial flushing

1 metered spray or 1 tablet = 0.4 mg

Ointment/paste 1 inch = 15 mg

• Electrolyte solution, which is osmotically equivalent to blood.
• Increases the circulating volume of the vascular system. (2/3 of infused volume leaves vascular space within one hour.)

• Definitive therapy, or anticipated
• Adult: abdominal discomfort – G.I./GU (non-traumatic)
• Anaphylaxis
• Burns
• Dysrhythmias
• Adult: environmental exposure
• Adult: overdose
• Shock
• Crush injury
• Peds: respiratory distress
• With croup-like cough via nebulizer

1000 mL

Or

250 mL

Abdominal discomfort – G.I./GU (non-traumatic)

• For nausea and/or vomiting

Pain management

• For nausea and or vomiting after morphine administration

• G.I. symptoms, especially diarrhea
• Headache

4 mg/2 mL – IV/IM

or

4 mg ODT

• Electrolyte
• Alkalizing agent

Hemodialysis patient

Symptomatic, ?hyperkalemia if ≥72 hours since last dialysis

Poisoning/OD

Tricyclic OD with cardiac effects (ie. hypotension, heart block or widened QRS)

Trauma

Crush injury of extremity or torso with extended entrapment ≥2 hours just prior to extremity being released

• Depresses polarization and automaticity in the ventricles
• Increases the ventricular fibrillation threshold by increasing phase IV repolarization
• Amide-type local anesthetic

Dysrhythmias

Stable ventricular tachycardia

Dysrhythmias

Post–conversion VF/VT with pulse ≥60

ALS skills

Conscious patient with IO line

• 2nd and 3rd degree heart blocks
• Ventricular escape rhythms

(toxicity)

Early

• Anxiety
• Euphoria
• Combative
• Nausea
• Twitching
• Numbness

Late

• Seizure
• Decreased BP
• Coma
• Widening QRS
• Prolonged PRI
• V-Fib

• Prohibits the initiation and conduction of impulses thereby effecting local anesthetic action
• Decreases irritation when airway tube is inserted thereby decreasing intracranial pressure

ALS skills

-ET/intubation

Nasopharyngeal airway insertion

LEAN

Lidocaine 2%

Epinephrine

Atropine

Normal Saline

AANAL

Adenosine

Amiodarone

Nitroglycerin

Normal saline

Albuterol

Lidocaine