Morphine

Duramorph

Class:  Narcotic (opioid)

Action:  Analgesic through binding to opioid receptors

Indications:  Moderate to severe traumatic pain

Contraindications:  Allergy, hypersensitivity

Dose:  Adult: 2-10 mg; Ped: .1 mg/kg

Routes:  IV, IO, IM, SQ

Adverse Effects:  Hypotension, apnea, nausea, syncope

Other:  Naloxone is an antagonist

Fentanyl

Sublimaze

Class:  Narcotic (opioid)

Action:  Analgesic through binding to opioid receptors

Indications:  Moderate to severe traumatic pain

Contraindications:  Allergy, hypersensitivity

Dose:  Adult: 50-100 mcg; Ped: .5-1 mcg/kg

Routes:  IV, IO, IM, SQ, IN

Adverse Effects:  Respiratory depression, nausea, syncope

Aspirin

ASA

Class:  NSAID

Action:  Platelet inhibitor

Indications:  Chest pain with suspected MI

Contraindications:  Allergy, hypersensitivity, bleeding disorder

Dose:  Adult: 324 mg; Ped: not indicated

Route:  PO

Adverse Effects:  Nausea, heartburn, GI bleeding

Narcan

Naloxone

Class:  Opiate antagonist

Action:  Displaces opioids at receptor sites

Indications:  Narcotic overdose

Contraindications:  Hypersensitiviy

Dose:  Adult: 2-4 mg; Ped .1 mg/kg up to 2mg

Routes:  IV, IM, IN, IO, ET

Adverse Effects:  N/V, chills, narcotic withdrawl symptoms

Valium

Diazepam

Class:  Benzodiazepine

Action:  Binds to type A GABA receptors causing sedation

Indications:  Anxiety, seizures

Contraindications:  Allergy, hypersensitivity

Dose:  Adult: 5-20 mg; Ped: .1 mg/kg

Routes:  IV, IM, IO, rectal

Adverse Effects:  Respiratory depression, N/V, sedation

Other:  Incompaible with other medications, may cause irritation with injection, Flumazenil is an antagonist

Versed

Midazolam

Class:  Benzodiazepine

Action:  Binds to type A GABA receptors causing sedation

Indications:  Anxiety, seizures, sedation

Contraindications:  Allergy, hypersensitivity

Dose:  Adult: 2-5 mg; Ped: .1 mg/kg

Route:  IV, IO, IM, IN

Adverse Effects:  Respiratory depression, N/V, hypotension, amnesia

Other:  Flumazenil is an antagonist

Haldol

Haloperidol

Class:  Antipsychotic

Action:  Blocks dopamine receptors

Indications:  Psychosis

Contraindiations:  Hypotension, hypersensitivity

Dose:  Adult: 5-10 mg; Ped: 2-2.5 mg

Routes:  IV, IM

Adverse Effects:  Extrapyramidal reactions, insomnia, tachycardia, dry mouth

Atropine

Atropine Sulphate

Class:  Muscarinic anticholinergic

Action:  Blocks muscarinic receptors inhibiting parasympathetic stimulation

Indications:  Bradycardia, organophosphate poisoning

Contraindications:  Hypersensitivity

Dose:  Adult: .5-2 mg; Ped: .02mg/kg

Routes:  IV, IO

Adverse Effects:  Blurred vision, dry mouth, dilated pupils

Other:  Organophosphate poisonings may require a significantly higher dose

Epinepherine 1:1000

Epi 1:1

Class:  Sympathetic agonist

Action:  α and β adrenergic agonist

Indications:  Cardiac arrest, bradycardia

Contraindications:  Few in emergency setting

Dose:  Adult:1 mg; Ped: .01 mg/kg

Routes:  IV, IO

Adverse Effects:  Palpitations, anxiety, hypertension, dizziness

Epinepherine 1:10,000

Epi 1:10

Class:  Sympathetic agonist

Action:  α and β adrenergic agonist

Indications:  Anaphalaxis

Contraindications:  Few in emergency setting

Dose:  Adult: .5-1 mg; Ped: .01 mg/kg

Routes:  SQ, IM

Adverse Effects:  Palpitations, anxiety, hypertention, dizziness

Dopamine

Intropin

Class:  Sympathetic agonist

Action:  α and β adrenergic agonist

Indications:  Hypotension, bradycardia, cardiogenic and septic shock

Contraindications:  Hypovolemia

Dose:  2-20 mcg/kg/min

Routes:  IV

Adverse Effects:  Palpitations, anxiety, hypertension

Other:  Extravasation can cause localized tissue damage

Albuterol

Ventolin, Proventil

Class:  β agonist

Action:  β agonist with preferance for β₂ adrenergic receptors

Indications:  Bronchospasm secondary to asthma

Contraindications:  Hypersensitivity

Dose:  Adult: 2.5 mg in 3 cc NS; Ped: 1.5 mg in 3 cc NS

Routes:  Inhalation

Adverse Effects:  Palpitations, anxiety, tachycardia

Amiodarone

Cordarone

Class:  Class III antiarrhythmic

Action:  Prolongs action potential duration in cardiac tissue through sodium, potassium and calcium channels; blocks α and β adrenergic receptors

Indications:  V-tach, V-fib

Contraindications:  Breast feeding, bradycardia, high grade heart block

Dose:  Adult: 150-300 mg; Ped: 5 mg/kg

Route:  IV, IO

Adverse Effects:  Hypotension, bradycardia

Lidocaine

Xylocaine

Class:  Class 1B antiarrhythmic; local anesthetic

Action:  Slows depolarization and automaticity

Indications:  V-tach, V-fib, local anesthetic

Contraindications:  Patients receiving calcium channel blockers

Dose:  Adult: 1 mg/kg; Ped: 1 mg/kg

Routes:  IV, IO

Adverse Effects:  Drowsiness, slurred speach, hypotension

Adenosine

Adenocard

Class:  Nucleoside

Action:  Slows AV conduction

Indications:  SVT

Contraindications:  A-fib, torsades des pointes

Dose:  Adult: 6 mg, 12 mg; Ped: .1 mg/kg

Routes:  IV

Adverse Effects:  Flushing, headache, chest pain, nausea

Other:  Should be given by rapid push followed by saline bolus

Magnesium Sulfate

Mag Sulfate

Class:  Electrolyte

Action:  Physiologic calcium channel blocker

Indications:  Torsades des pointes, hypertension secondary to pre-eclampsia

Contraindications:  High degree heart block, hypocalcemia

Dose:  Adult: 1-2 g

Routes:  IV

Adverse Effects:  Flushing, sweating, bradycardia, hypothermia

Other:  Calcium citrate is an antagonist

Nitroglycerin

Nitrostat

Class:  Nitrate

Action:  Relaxes vascular smooth muscle causing vasodilation

Indications:  Chest pain

Contraindications:  Hypotension, increased ICP

Dose:  .4 mg

Routes:  SL tablet or spray

Adverse Effects:  Headache, hypotension

Other:  Monitor BP closely

Diphenhydramine

Benadryl

Class:  Antihistamine

Action:  Blocks H₁ and H₂ histamine receptors

Indications:  Anaphylaxis, allergies

Contraindications:  Hypersensitivity, glaucoma, pregnancy

Dose:  Adult: 25-50 mg; Ped: 1-2 mg/kg

Routes:  IV, IO, IM, PO

Adverse Effects:  Drowsiness, dry mouth

Phenergan

Promethazine

Class:  Phenothiazine

Action:  Supresses the chemoreceptor trigger zone (CTZ)

Indications:  N/V

Contraindications:  Hypersensitivity

Dose:  Adult: 12.5-25 mg; Ped: .5 mg/kg

Routes:  IV, IM

Adverse Effects:  Drowsiness, extrapyramidal symptoms

Other:  May potentiate CNS depressants, extravasation can cause local tissue injury

Zofran

Ondansetron

Class:  Serotonin antagonist

Action:  Selectively blocks 5-HT₃ serotonin receptors including those in the CTZ and vegas nerve terminals

Indications:  N/V

Contraindications:  Hypersensitivity

Dose:  Adult: 4 mg; Ped: .1 mg/kg

Routes:  IV, IM

Adverse Effects:  Dizziness

Oxytocin

Pitocin

Class:  Hormone

Action:  Causes uterine contractions and lactation

Indications:  Postpartum vaginal bleeding

Contraindications:  None if following protocols

Dose:  10-20 units in 500 ml; 3-10 units IM

Routes:  IV, IM

Adverse Effects:  Anaphylaxis, arrhythmias

Other:  Ensure placenta has delivered before administering

Glucagon

Glucagen

Class:  Hormone

Action:  Elevates blood glucose levels through conversion of glycogen to glucose

Indications:  Hypoglycemia, beta-blocker overdose

Contraindications:  Hypersensitivity

Dose:  Adult: 1 mg; Ped: .02-.03 mg/kg

Routes:  IM

Adverse Effects:  Few in emergency setting

Other:  Less effective in patients with diminished glycogen stores

Dextrose 50%

D50

Class:  Carbohydrate

Action:  Substrate for carbohydrate metabolism

Indications:  Hypoglycemia

Contraindications:  None in emergency setting

Dose:  12.5-25 g

Routes:  IV

Adverse Effects:  Local venous irritation

Other:  Extravasation will cause severe tissue injury

Dextrose 25%

D25

Class:  Carbohydrate

Action:  Substrate for carbohydrate metabolism

Indications:  Hypoglycemia

Contraindications:  None in emergency setting

Dose:  1g/kg

Routes:  IV

Adverse Effects:  Local venous irritation

Other:  Extravasation will cause severe tissue injury

Narcan

Naloxone

Class:  Opiate antagonist

Action:  Binds to opiate receptor sites displacing narcotics

Indications:  Narcotic overdose

Contraindications:  Hypersensitivity

Dose:  Adult: 2-4 mg; Ped: .1 mg/kg

Routes:  IV, IO, IM, IN

Adverse Effects:  N/V, chills, opiate withdrawl symptoms

Other:  Titrate to reverse respiratory depression and avoid full narcotic withdrawl syndrome

Ketamine

Ketalar

Class:  General anesthetic

Action:  NMDA receptor antagonist

Indications:  Anxiety, pain, RSI

Contraindications:  Allergy, hypertension

Dose:  Adult: 50-100 mg; Ped: 2-4 mg/kg

Routes:  IV, IM, IN

Adverse Effects:  Dream-like state, N/V, nystagmous