50% DEXTROSE

Therapeutic Effects  a simple sugar which body can rapidly metabolize while hypoglycemic.

Indications  1. Hypoglycemia  2. Altered LOC

Contra  None

Precautions  determine glucose level before administration. Ensure goo venous access

Adult Dosage  IV, 50ml of 50% dextrose (25gm) may be repeated

Ped Dosage  IV/IO, 1.0 ml/kg

Inf Dosage  IV/IO, 1.0 ml/kg diluted 1:1 with NS

ACETYLSALICYLIC ACID

(ASPIRIN)

Therapeutic Effects  Antipyretic, anti-inflammatory analgesic with platelet aggregation reducing properties that may reduce the size of a blood clot in coronary artery causing an AMI

Indications  For treatment of suspected AMI

Contra  Hypersensitivity to aspirin or nonsteroidal anti-inflammatory analgesics

Precautions  stomach irritation, pregnancy (use only if clearly needed)

Adult Dosage  160-325 mg chewable tablet

ACTIVATED CHARCOAL

Therapeutic Effects  it absorbs & binds toxins

Indications  In poisoning or in cases where emesis is contraindicated

Contra  an airway that cannot be controlled

Precautions  administer only after emesis or in cases where emesis is contraindicated

Adult Dosage  50 gm (2 Tbs) mixed with a glass of water, then given orally through nasal gastric tube

Ped Dosage  1gm/kg mixed with glass of water, then given orally through small nasal gastric tube

ADENOCARD

(ADENOSINE)

Therapeutic Effects  slows conduction through AV node & can interupt reentry pathways through AV

Indications  conversion to sinus rhythm of (PSVT) excluding known Wolf-Parkinson-White syndrome

Contra  second or third degree AV block, sick sinus syndrome, or hypersensitivity to adenosine

Precautions  May exacerbate asthma. Pregnancy (only if clearly needed). May cause hypotension, facial flushing, dyspnea, light headedness, or nausea. Effects are potentiated by persantine and, therefore smaller doses may be effective

Adult Dosage  Rapid IV bolus, 6 mg. Second dose of 12 mg may be given after 2 minutes as rapid IV infusion. Large AC vein preferred for administration

Ped Dosage  Rapid IV bolus, .1 mg/kg. Second dose of .2 mg/kg may be given after 2 minutes as rapid IV infusion. Large AC vein preferred for administration. Must have med control permission

AMIODARONE

Therapeutic Effects  Prolongs myocardial cell action potential duration, refractory period & inhibits alpha & beta adrenergic stimulation

Indications  1) Recurrent V-fib or recurrent V-Tac  2) recurrent hemodynamically unstable V-Tac  3) Stable V-Tac in consult with on-line med control

Contra  Hypersensitivity to drug or components*

Precautions  May prolong QT interval. Caution if renal failure is present. May produce vasodilation & hypotension. May have negative inotropic effect

Adult Dosage  Ind 1) 300mg diluted in 20ml NS IVP. Consider repeating 150mg diluted in 10ml NS IVP in 3-5 min. & repeat every 10 min. up to 2.2 g

ATIVAN

(LORAZEPAM)

Therapeutic Effects  Anticonvulsant

Indications  1) Major motor seizures

                  2) Status epilepticus

Contra  Hypersensitivity, acute narrow angle glaucoma, hypotension & respiratory failure

Relative Contra  Resp. distress & decreased LOC

Precautions  Respiratory depression, hypotension, sedation, nausea & vomiting

ATROPINE

Therapeutic Effects  Blocks parasympathetic nervous system & its inhibiting effects on HR. It doesn't increase strength of cardiac contractions

Indications  1) Bradycardia with hypotension or escape beats.  2) Asystole  3) PEA  4) Nerve agent or organophoshate poisoning  5) Prior to use of sux for intubation in children or second RSI for adults

Contra  None in emergency setting

Adult Dosage  Ind 1) IV/IO .5mg q 3-5 min. up to .04mg/kg or 3mg  Ind 2&3) IV/IO 1mg q 3-5 min. up to .04mg/kg or 3mg  Ind 4) MDV or MARK 1 kit to administer 1-3 doses (2-6mg)**, ***

Ind 5) IV/IO .5mg

Ped Dosage  Ind 1) IV/IO .02mg/kg repeated once if necessary  Ind 2) IV/IO .02mg/kg with min dose .1mg & max dose 1mg. May be repeated in 5 minutes to max 1mg dose  Ind 4) INFANT: .05-.1 mg/kg IM/IV/IO    CHILD: 1-4mg IM/IV/IO  Ind 5) .02 mg/kg up to .5mg

*      Atropine may be given ET at doulbe IV dose

**   Elderly/frail 1-4mg IM/IV/IO Peds Atropen, MDV

       or MARK1

*** If MDV not avail. IV route not established & or

       precise dosing not possible consider

       administration of MARK 1

BENADRYL

(DIPHENHYDRAMINE)

Therapeutic Effects Inhibits release of histamine, thereby reducing bronchoconstriction & vasodilation

Indications 1) Anaphylaxis  2) Allergic reactions  3) Uticaria

Contra Lower resp dist, benadryl hypersensitivity

Precautions May induce hyptension, headache, palpitations, tachycardia, sedation, drowsiness & disturbed coordination

Adult Dosage IV or IM 50mg

Ped Dosage IV or IM 1mg/kg up to max 50mg

CALCIUM GLUCONATE

Therapeutic effects Essential for transmission of nerve impulses that initiate contraction of cardiac muscle. Specific antagonist of the adverse effects of potassium.*

Indications  1) Hyperkalemia associated with bradycardia & hypotension or an unstable cardiac arrhythmia.  2) Calcium channel blocker overdose associated with bradycardia & hypotension or unstable arrhythmia

Contra Shouldn't be used during resuscitation efforts unless hyperkalemia, hypocalcemia, or calcium channel blocker toxicity is suspected

Precautions Use extreme caution in patients using digoxin as life-threatening arrhythmias can result. Use large secure vein; SQ infiltration can cause tissue necrosis. Flush line before & after use as this drug is incompatible with Sodium Bicarbonate.

Adult Dosage IV, 20ml of 10% calcium gluconate slowly over 1-2 minutes

* Onset of action is 1-3 seconds. Duration of action

   is 30-50 minutes

DOPAMINE

(INTROPIN)

Therapeutic effects Beta agonist which doesn't appreciably increase myocardial O2 consumption. It maintains renal & mesenteric blood flow while inducing vasoconstriction & increasing BP

Indications  1) Cardiogenic shock  2) Hypotension not secondary to hypovolemia

Contra Hypotension due to hypovolemia without aggressive fluid resuscitation.

Precautions Tachydysrhythmias & ventricular fibrillation or irritability. May be deactivated by alkaline solutions. Reduce the dosage if patient is on monamine oxidase inhibitors (anti-dpressant). BP should be constantly monitored.

Adult Dosage Mix 400mg/250ml of D5W (1600 mcg/ml) & initiate IV infusion at 5mcg/kg/min. titrating to BP

Ped Dosage Same as adult

EPINEPHRINE-ADULT

(ADRENALIN)

Therapeutic effects Potent alpha & beta stimulant which is diluted 1mg in 1ml (1:1,000) or 1mg in 10ml (1:10,000) of saline. It increases electrical activity of the heart through its beta activities

Indications  1) V-Fib/Pulseless V-tach  2) Asystole  3) PEA  4) Asthma  5) Anaphylaxis (a. moderate & b. severe)

Contra None in pt needing aggressive resuscitation

Precautions Protect from light, shouldn't be infused with alkaline solutions such as sodium bicarb since they will deactivate epi. Short duration of action.

Adult Dosage  Ind 1, 2 & 3) IV* 1:10,000 at

1mg q 3-5 minutes as needed

Ind 4 & 5a) SQ 1:1,000 at .01mg/kg up to .5mg q 5 minutes as needed  Ind 5b) IV* 1:10,000 at

.01mg/kg slowly up to .5mg q minutes as needed.  SQ or SL 1:1,000 at .01mg/kg up to .5mg q 5 minutes as needed

* May be given ET at double the IV dose

EPINEPHRINE -PED

(ADRENALIN)

Therapeutic effects Potent alpha & beta stimulant which is diluted 1mg in 1ml (1:1,000) or 1mg in 10ml (1:10,000) of saline. It increased electrical activity of heart through its beta activities.

Indications  1) Bradycardia  2) V-Fib  3) Asystole  4) PEA  5) Asthma  6) Anaphylaxis (mod & severe)

Contra None in pt needing aggressive resuscitaiton

Precautions Should be protected from light & shouldn't be infuse with alkaline solutions such as sodium bicarb since they will deactivate epinephrine. Drugs actions are short duration

Ped Dosage  Ind 1, 2, 3 & 4) IV/IO 1:10,000 at

.01mg/kg q 3-5 minutes. ET* 1:1,000 at .01mg/kg diluted in 3ml NS q 3-5 minutes  Ind 5 & 6) SQ 1:1,000 at .01mg/kg up to .5mg q 5 minutes as needed  Severe) IV* 1:10,000 at .01mg/kg slowly

up to .5mg q minutes as needed.  SQ or SL 1:1,000 at .01mg/kg up to .5mg q 5 minutes as needed

ETOMIDATE

(AMIDATE)

Therapeutic effects Short acting sedative-hypnotic

which appears to have GABA-like effects. Reduces subcortical inhibition at the onset of hypnosis while inducing neocortical sleep. Minimal cardiovascular & respiratory depression. No analgesic action.

Duration of Action Dose-dependent but usually 3-5 min. with avg dose of .3mg/kg may be prolonged by a sedative premedication or repeat dose

Indications Induce sedation prior to ET intubation particularly to patients at risk of hypotension

Contra Sensitivity to etomidate. Safety & efficacy haven't been established for children < 10

Precautions May depress resp. Nausea, vomitting & invol. twitching may occur. May cause adrenal suppression when used on pts. with septic shock. Other sedatives should be considered in this sit.

Adult Dosage  .3mg/kg IV/IO over 30-60 seconds

Ped Dosage Children 10 & older same as adult

GLUCAGON

Therapeutic effects Converts liver glycogen to glucose. Produces relaxation of smooth muscle of stomach, duodenum, small bowel & colon

Indications Hypoglycemia

Contra Adrenal gland vascular tumor or Glucagon hypersensitity

Precautions Occasional nausea & vomitting

Adult Dosage IV, IM, or SQ  1mg

Ped Dosage IV, IM or SQ .05mg/kg up to 1mg

HEPARIN

Therapeutic effects rapid anti-coagulant which acts as a catalyst to accelerate the rate at which antithrombin III neutralizes thrombin & activated coagulation factor X(X_a)

Indications  1) Unstable angina & or MI  2) Pulmondary embolism  3) Deep vein thrombosis

Contra  Hemorrhage

Precautions Use with extreme caution when there's

increased risk of hem. Risk factors: GI lesions, recent surgery, blood dyscrasias, menstruation, uncontrolled hypertension & indwelling catheters

Adult Dosage Dosage var., typically initial loading dose of 5,000 units is given by IV injection followed by a continuous infusion from 500 to 2,300 units/hr

IPECAC SYRUP

Therapeutic effects Acts on the emetic centers of the brain & on the stomach to induce vomiting. Emesis usually occurs within 10 minutes

Indications Poisoning & overdose

Contra Reduced level of consciousness, corrosive ingestion, petroleum distillate ingestion or antiemetic ingestion (especially phenothiazine)

Adult Dosage 15 to 30 ml orally followed by 2 to 3 glasses of warm water or carbonated beverage

Ped Dosage 15ml orally followed by 2 to 3 glasses of warm water or carbonated beverage

IPRATROPIUM BROMIDE

(ATROVENT)

Therapeutic effects Anticholinergic (parasympatholytic) that inhibits vagally-mediated reflexes by antagonizing the action of ACh resulting in bronchodilation. In combination with albuterol the median duration is five to seven hours.

Indications  1) Bronchial asthma  2) Bronchospasm in emphysema  3) Chronic bronchitis

Contra Hypersensitivity to the drug or atropine

Adult Dosage 500 mcg (1 unit dose vial) added to 1 unit dose vial albuterol in small volume nebulizer attached to O₂ at 6 liters to vaporize solution*

Ped Dosage Shouldn't be used on peds < 12

* Ipratropium Bromide is also supplied in premix unit dose with albuterol

LASIX

(FUROSEMIDE)

Therapeutic effects Potent diuretic which inhibits sodium reabsorption by kidney. Water is eliminated with the sodium. Its effects are noted within 5 min. Also causes vasodilation which reduces preload.

Indications Pulmonary edema

Contra Fever & or hypotension. Pregnancy, except in life threatening circumstances

Precautions Severe dehydration & electrolyte depletion may fresult from excessive Lasix doses. Hypotension may occur. Admin. of Lasix to patients for whom pneumoonia, COPD or emphysema is the cause of their resp. distress has been associated with increased mortality. Therefore, it should only be used when provider is confident that patient's symptoms are caused by pulmonary edema.

Adult Dosage IV/IO slowly .5 - 1 mg/kg*

LIDOCAIN

(XYLOCAINE)

Therapeutic effects Increases fibrillation threshold reducing ectopy & development of V-Fib & reduces intra-cranial pressure assoc. with ET intubation. Local anesthetic which may reduce IO infusion pain

Indications  1) Used for RSI prior to use of Sux in head injury patients  2)  Alternative to Amiodarone in cardiac arrest from VF/VT  3) Alternative to amiodarone in a) recurrent hemodynamically unstable V-Tach & b) stable V-Tach (after consult with med control)  4) Pain relief for conscious patients during IO infusion of fluid bolus or flush.

Contra Hypersensitivity to Lid. 2^nd degree Mobitz II & 3^rd degree heart block & bradychardias even when assoc. with wide complex ventricular escape beats

Precautions High plasma concentration may cause myocardial & circulatory depression, possible CNS symptoms (seizures). Reduce infusion dose if severe CHF or low cardiac output is compromising hepatic & renal blood flow

Adult Dosage  Ind 1) IV/IO  1mg/kg  Ind 2) Initial dose 1 - 1.5 mg/kg IV/IO. For refractory VF may give additional .5 - .75 mg/kg IVP, repeat in 5-10 min.; max 3 doses or total 3 mg/kg*,***,****

Ind 3a) 1 - 1.5mg/kg IV/IO. May repeat .5 - .75mg/kg IV/IO every 5-10 minutes. Max dose 3mg/kg IV/IO ****

CONTINUED ON NEXT CARD

LIDOCAINE

(XYLOCAINE)

CONTINUED

Ind 3b) .5 - .75mg/kg IV/IO. May repeat .5 - .75mg/kg IV/IO every 5-10 minutes. Max total dose 3mg/kg IV/IO****  Ind 4) 20-40mg 2% lidocaine into EZ IO port prior to initial bolus or flush

Ped Dosage  Ind 1) IV/IO 1mg/kg  Ind 2) 1mg/kg rapid IV/IOP (max dose 100mg) **,***  Ind 3a) 1-1.5mg/kg IV/IO. May repeat .5 - .75mg/kg IV/IO every 5-10 minutes (max dose 3mg/kg IV/IO ****  Ind 3b) .5 - .75mg/kg IV/IO. May repeat .5 - .75mg/kg IV/IO q 5-10 min. max dose 3mg/kg IV/IO****  Ind 4) .5mg/kg 2% lidocaine into EZ IO port prior to initial bolus or flush

*     May be given via ET tube 2-4mg/kg

**    May be given via ET tube 2-3mg/kg

***  Continuous IV/IO infusion may be initiated at

       30-50ug/kg per minute if mech pump avail

**** Repeat boluses should be increased by 50% in

        patients: 70 years & older, pulmonary edema,

        hypotensive & liver disease

MAGNESIUM SULFATE

Therapeutic effects Blocks neuromuscular transmission & decreases amount of ACh liberated at the end plate of the motor nerve impulse

Indications  1) Control seizures in severe toxemia of pregnancy  2) May be effective in treatment of V-Fib or pulseless V-Tach if hypomagnesemic state of torsades de pointes suspected

Contra Magnesuim should not be given to mothers with toxemia of pregnancy during the two hours immediately preceding delivery

Precautions Because Mg is removed from the body solely by kidneys, this drug should be used with caution in pts. with renal impairment. Clinical indications of safe dosage include presence of

patellar reflex & absence of respiratory depression

Adult Dosage  Ind 1) IV/IO 4g of 50% solution diluted with 20ml NS, IM 4g of 50% solution

Ind 2) IV/IO 1-2g of 50% solution diluted with 20ml NS

Ped Dosage  Ind 2) IV/IO 25-50mg/kg of 50% solution diluted with 5-10ml NS over 10-20 minutes. Max dose 2gm

DEMEROL

(MEPERIDINE)

Therapeutic effects Potent narcotic analgesic

Indications Severe pain associated with MI, kidney stones isolated extremity trauma & burns for patients hypersensitive to morphine

Contra Shouldn't be given in patients with head or abdominal pain, hypersensitivity to the drug, hypotension or volume depletion.

Precautions Narcan should be readily available to counteract effects of Demerol. Receiving physician should be informed directly of prehospital admin of Demerol at the time of hospital arrival

Note May cuase repiratory depression & vomitting

Adult Dosage IV 12.5mg q 5 min. up to 50mg

Ped Dosage IV .25 - .5mg/kg q 5 min up to 1mg/kg

MORPHINE

Therapeutic effects Potent analgesic which causes some vasodilation. Reduces myocardial O₂ demand

Indications  Ind 1) severe pain associated with MI, isolated extemity trauma & burns exluding those involving airway unless pt intubated  Ind 2) may be given for pulmonary edema in absence of pain

Contra Shouldn't be given in patients with head or abdominal pain, hypersensitivity to the drug, hypotension or volume depletion

Precautions May cause resp depression. Narcan should be avail to counteract morphine effects.

Phys should be informed directly of prehospital admin of morphine at time of hospital arrival

Adult Dosage IV push 2-6mg with 2mg q 5 min. 5-15mg may be given IM based on pt weight

Ped Dosage IV push 1mg q 5 min not to exceed .1mg/kg. Appropriate dose may be given IM based on patient's weight

NARCAN

(NALOXONE)

Therapeutic effects An effective agent blocking

the effects of both narcotics & synthetic narcotics. It may be helpful in coma due to alchohol ingestion

Indications  1) suspected opiate narcotic &/or synthetic narcotic overdose  2) known narcotic overdose with respiratory depression  3) coma of unknown origin

Contra Hypersensitivity

Precautions Narcan should be admin. cautiously to pts known or suspected of dependence on narcotics. Abrupt & complete reversal by Narcan can cause withdrawal-type effects. This includes newborn infants of mothers known or suspected of narcotic dependence. Narcan has shorter half life than most narcotics, hence pt may reutrn to overdose state

NITROGLYCERIN

Therapeutic effects Rapid acting smooth muscle relaxant which reduces cardiac workload & to a lesser degree dilates the coronary arteries

Indications  1) Chest pain or symptoms suggestive of angina &/or MI  2) Acute pulmonary edema  3) Prevent angina &/or improve myocardial perfusion in patients with probable or proven coronary disease

Contra  1) Hypotension  2) Suspected increased intracranial pressure  3) Admin of Viagra or Levitra within 24 hrs. Admin of Cialis within 96 hrs

Precautions Hypotension. May induce headache which is sometimes severe. Patients may develop tolerance. Nitroglycerin is also light sensitive & will lose potency when exposed to air

Adult Dosage  Ind 1 & 2) SL 1 tablet .4mg. If BP>100 give q 5 min. upt to 3 tablets as long as BP remains over 100  Ind 3) IV initiated at 5mcg/min increased in 5mcg/min increments q 3-5 min until some response is obtained. If no response seen at 20mcg/min, increments of 10 & later 20 mcg/min can be used as long as BP remains over 100

AFRIN

(OXYMETAZOLINE HYDROCHLORIDE)

Therapeutic effects Long acting topical vasoconstrictor that reduces mucosal edema & may help slow intranasal bleeding

Indications  1) An adjunct to direct pressure to help control epistaxis  2) Facilitate placement of nasotracheal tube & reduce the likelihood of bleeding associated with this technique

Contra Hypersensitivity

Precautions Unlikely to benefit in bleeding assoc

with severe nasal trauma. Normal pupillary reflex may be effected if this preparation gets in the eyes. Possible adverse side effects in patients with heart disease, hypertension, thyroid disease, diabetes, prostatic hypertrophy, pregnancy & nursing mothers

Adult Dosage 2 or 3 sprays in each bleeding nsotril

PRALIDOXIME CHLORIDE

(2-PAM)

Therapeutic effects Oximes attach to nerve agent that's inhibiting cholinesterase & break the agent-enzyme bond to restore normal activity to enzyme

Indications Symptoms of nerve agent exposure or organophoshorus pesticides. 2-PAM Chloride is most effective if admin immediately after exposure. Less effective if given 6 hours after exposure

Contra None

Precautions Morphine, theophylline, aminophylline or Sux should only be used with caution for pts treated with 2-PAM. Avoid reserpine or phenothiazine tranquilizers including phenergan. Adverse reactions may include following symptoms:  blurred vision, headache, nausea, hypertension, dizziness, drowsiness, tachycardia, hyperventilation

Adult Dosage*  Ind 1) Mild to moderate symp:  administer 1-2 doses IM sequentially from the Mark I kit (or administer 600-1800mg IM/IV from MDV)  Ind 2) Severe symp: admin 3 doses IM from the Mark I kits (or administer 1800mg IM/IV from MDV)

Ped Dosage  Ind 1) Infant: (0-3 years < 13kg) administer 25-50 mg/kg IM/IV (or 150-600mg MDV)  Ind 2) Child: (3-10 years 13-35kg) administer 25-50mg/kg IM/IV (or 300-1200mg MDV or in Mark I)

* Elderly frail administer 10-25mg/kg IM/IV MDV or

   Mark I

PHENERGAN

Therapeutic effects Antiemetic sedative & tranq.

Indications Provide relief from severe nausea & vomitting

Contra Shouldn't be given to comatose pts or pts who have recvd large amount of depressants or to any pt with a history of hypersensitivity to the drug

Precautions May impair mental & physical ability. Take care to avoid accidental intra-arterial inj. It should never be administered subcutaneously. Should be avoided in patients suffering from nerve agent or organophosporus pesticide exposure

Adult Dosage IV, IM 6.25 - 25mg (use lower dose range for initial treatment in pts >75 years old)

RACEMIC EPINEPHRINE

(PEDIATRIC)

Therapeutic effects Potent alpha & beta stimulant containing + amts of d & 1 isomer of epi. When adm via inhalation it reduces upper airway edema assoc with stridor in peds patients with viral croup

Indications Severe ped resp distress with stridor

Conta Not indicated for use in adults

Precouations Shouldn't be used instead of assisted ventilation in pts with obvious resp failure. Tachy likely to result. Effects temporary & a resurgence of symp may occur from min to hours after treatment

Ped Dosage Administered via small vlume nebulizer:  PT>2YR .5ml (2.25%) diluted in 3ml NS  PT<2YR .25ml (2.25%) diluted in 3ml NS

SODIUM BICARBONATE

(NaHCO₃)

Therapeutic effects Assist buffer system in reducing effects of acidosis

Indications  1) Cyclic anti-depressant overdose with QRS duration >100msec  2) Post-resuscitation hypotension  3) PEA with hydrogen ion acidosis  4) Crush injury

Contra None when used in severe hypoxia or late cardiac arrest

Precautions May cause alkalosis if given too aggressively. It may also deactivate vasopressors & may precipitate with calcium chloride

Adult Dosage  Ind1) 1mEq/kg IV/IO bolus & may repeat q 10 miuntes x3 for persistant QRS>than 100 msec  Ind 2 & 3) 1mEq/kg IV/IO initially & may be followed by .5mEq/kg q 10 min  Ind 4) 1mEq/kg IV/IO & in case of hyperkalemia followed by sodium bicarb 1mEq/kg added 1,000 cc NS wide open

Ped Dosage Same as with adult

SUCCINYLCHOLINE

(ANECTINE)

Therapeutic effects Biphasic skeletal muscle relaxant with rapid onset & short duration of action. Paralyzes skeletal muscles including resp muscles & gag reflex. Doesn't produce sedation, sedative such as versed should be used for patient comfort

Indications Inadequate oxygenation or unprotected airway where intubation is indicated but difficult due to gag, clenched teeth, seizure or other compl

Contra Relative to life threat of patient. Sux should only be used if an airway cannot be estabilished by other methods. Alternative means of estabilishing an airway should be used for patients with severe cellular damage, i.e. crush injuries or burns greater than 8 hours old, or atrophy due to neurogenic damage, & patients with known renal faiure with EKG evidence of hyperkalemia. These patients may develop cardiac dysrhytmias or arrest after admin. Med control should be contacted for consideration for the use of vecuronium when a paralytic is necessary for airwary managemant

Precuations Patients requiring a 2^nd  dose may experience increased intracranial pressure. The use of Sux should also be avoided in patients with potential penetrating eye injuries

Prelim Drug Therapy To sedate conscious patient administer etomidate or versed. To protect patient  Lidocaine (increased intracranial pressure) or Atropine (bradycardia)

Adult Dosage IV 1.5mg/kg with one repeat dose if necessary. IM 3mg/kg up to 150mg

Ped Dosage Same as adult

VALIUM

(DIAZEPAM)

Therapeutic effects CNS depressant that induces amnesia & reduces incidence & recurrence of seizure

Indications  1) Major motor seizures secondary to nerve agent exposure or organophosphate poisoning

Contra Hypersensitivity

Relative Contra Repiratory depression, hypotension

Precautions Due to short half-life of drug seizure activity may recur. Watch for respiratory depression

Dosage* Infant (0-3 years <13kg)   .2 - .5mg/kg IM/IV (1.25mg - 5mg MDV)  Child (3-10 years 13-25kg)  .2 - .5mg/kg IM/IV (2.5 - 10mg MDV or MARK I)  Adolescent to adult 5-10mg IM/IV MDV or MARK I  Elderly/frail 1.25 - 10mg IM/IV MDV or MARK I

VECURONIUM BROMIDE

(NORCURON)

Therapeutic effects Nondepolorizing neuromuscular blocking agent with rapid onset & intermediate duration of action. Paralyzes all skeletal muscles including resp muscles & gag reflex. Agent doesn't produce sedation, sedative such as versed should be used for patient comfort

Indications Maintain paralysis of intubated patients when renewed muscular activity following admin of Sux imperils patient care & transport time to hosp is greater than 15 min. In rare circumstances, when there's no alternative to the use of a paralytic to achieve adequate airway management, med control shall be contacted for consideration of use in RSI

Contra Short prehospital transport times &/or lack of definitive airway stabilization via ET intubation. In general, not to be used for RSI unless there are no alternative means of facilitating ET intubation & contact, for permission is made with direct online medical control

Precautions Adminsitation of Sux or lidocaine prior to vecuronium bromide appears to increase & prolong the duration of neuromuscular blockade. When magnesium sulphate has been adminsitered for the mangagement of toxemia of pregnancy neuromuscular blockade induced by vecuronium bromide may be prolonged. Vecuronium bromide should be admin with caution in pts with hepatic dyfunction & patients with neuromuscular diseases

Adult Dosage IV .1mg/kg*. One repeat dose may be givien if unusually prolonged prehospital time requires reparalysis

ALBUTEROL

(VENTOLIN)

Therapeutic effects Synthetic sympthomimetic causing bronchodilation with less cardiac effect than Epinephrine. Duration of effect is about four hours

Indications  1) Bronchial asthma  2) Bronchospasm in emphysema  3) Chronic bronchitis

Contra Hypersensitivity

Precautions Pt may exp palpitation, anxiety, nausea & dizziness. Vital signs must be monitored; use caution with cardiac or hypertensive patients

Adult Dosage 2.5mg (3ml) Provental (Albutrol Sulfate) in small volume nebulizer attached to O₂ at 6 liters to vaporize solution

Pediatric Dosage In small vlume nebulizer attached to O₂ at 6 liters to vaporize solution. PT>2YR .5ml in 3ml NS (3ml pre-mix)

PT<2YR .25ml in 3ml NS (1.5 ml pre-mix)

VERSED

(MIDAZOLAM)

Therapeutic effects Sedation