Microsoft word - mt state protocols drugs.doc
(Adenocard)
Conversion of paroxysmal supraventricular tachycardia to sinus rhythm. Adenosine slows conduction through the AV node and can interrupt reentry pathways.
INDICATIONS
CONTRAINDICATIONS
• Second or third-degree AV block, Sick Sinus
Syndrome unless patient with a functional artificial pacemaker.
• Adenosine is ineffective in converting atrial flutter,
atrial fibrillation, or ventricular tachycardia to sinus rhythm, but may slow the rhythm momentarily to aid in arrhythmia diagnosis.
• Repeat doses of adenosine are not indicated if
the dysrhythmia reoccurs after conversion.
SIDE EFFECTS
Bradycardia, asystole, ventricular arrhythmias, facial flushing, headache, sweating, palpitations, chest pain. Due to short half-life, adverse effects are generally self-limiting.
ADULT DOSE
PEDIATRIC DOSE
0.1 mg/kg; subsequent doses at 0.2 mg/kg. For use in SVT only; do not exceed adult dose.
DURATION OF ACTION
By rapid IV bolus followed by a 12 mg bolus if the first is unsuccessful within 1 to 2 minutes. A third dose of 12 mg may be given in 1-2 min if needed. (To assure solution reaches systemic circulation, administer into IV line as proximal as possible over 1 to 2 seconds followed with rapid saline flush).
MD CONSULT REQUIRED No
ALBUTEROL
(Proventil)
Sympathomimetic/selective for Beta 2 adrenergic receptors
INDICATIONS
Acute bronchospasm-first dose Anaphylaxis with wheezing-first dose
CONTRAINDICATIONS
SIDE EFFECTS
Tachycardia, palpitations, anxiousness, headache
ADULT DOSE
2.5 mg in 3 mL NS via nebulizer. Repeat up to three times q 10 minutes.
PEDIATRIC DOSE
2.5 mg in 3 mL NS via nebulizer. Discontinue medication if the patient becomes tremulous or respiratory status improves.
MD CONSULT REQUIRED No
(Cordarone)
Blocks sodium and potassium channels, prolonging ventricular repolarization.
INDICATIONS
CONTRAINDICATIONS
SIDE EFFECTS
Hypotension, asystole, PEA, cardiogenic shock, bradycardia and AV block
ADULT DOSE
• 300 mg IV for V-Fib/Pulseless V-Tach, repeat q 3-
• 150 mg IV over 10 minutes for tachycardia
PEDIATRIC DOSE
5 mg/kg IV/IO repeat up to 15 mg/kg or max of 300mg
MD CONSULT REQUIRED No
(Acetylsalicylic Acid)
INDICATIONS
Cardiac chest pain, suspected acute myocardial infarction
CONTRAINDICATIONS
Allergy, Coumadin use, ulcers, bleeding disorders
SIDE EFFECTS
ADULT DOSE
PEDIATRIC DOSE
MD CONSULT REQUIRED No
ATROPINE
(ATROPINE SULFATE)
• Cholinergic blocking agent
• Increase rate of SA node discharge
• Increase conduction through AV node
INDICATIONS
• Hemodynamically significant bradycardia (HR < 60) • Hemodynamically significant bradycardia (HR > 60) • Ventricular asystole • Bradycardic PEA • Antidote for organophosphate toxicity
CONTRAINDICATIONS
SIDE EFFECTS
Tachycardia, mydriasis, dry mouth, urinary retention, and acute glaucoma
ADULT DOSE
• HEMODYNAMICALLY SIGNIFICANT BRADYCARDIA
0.5 mg to 1.0 mg every 3-5 minutes until heart rate of 60 or clinical condition improves or maximum dose of 3.0 mg
• CARDIAC ARREST 1 mg IVP every 3-5 minutes.
• ORGANOPHOSPHATE POISONING 2-5 mg every 5
minutes until control of hypersecretion is obtained
PEDIATRIC DOSE
• HEMODYNAMICALLY SIGNIFICANT BRADYCARDIA
0.02 mg/kg IVP every 3-5 minutes not to exceed adult dose. Minimum dose: 0.1 mg. Max single dose of 0.5 mg.
PRECAUTIONS
Caution should be used when giving this
medication to a patient with MI.
MD CONSULT REQUIRED Antidote for organophosphate toxicity only
ATROVENT
(Ipratropium)
INDICATIONS
Acute bronchospasm with no relief from albuterol
CONTRAINDICATIONS
Known sensitivity to Atrovent or atropine
SIDE EFFECTS
Tachycardia, palpitations, headache, allergic reaction
ADULT DOSE
PEDIATRIC DOSE
PEDIATRIC USE BY PHYSICIAN ORDER ONLY
MD CONSULT REQUIRED No
BENADRYL
(Diphenhydramine)
• Blocks histamine receptors • Has some sedative effects • Anticholinergic for EPS
INDICATIONS
• Hives or angiodema • Anaphylaxis • Extrapyramidal Syndrome
CONTRAINDICATIONS
Asthma, hypersensitivity, pregnant or lactating females
SIDE EFFECTS
Sedation, palpitations, hypotension, headache, thickens bronchial secretions, blurred vision
ADULT DOSE
PEDIATRIC DOSE
MD CONSULT REQUIRED No
BENADRYL (tablets) (Diphenhydramine)
• Blocks histamine receptors • Has some sedative effects
INDICATIONS
CONTRAINDICATIONS
Asthma, hypersensitivity, pregnant or lactating females
SIDE EFFECTS
Sedation, palpitations, hypotension, headache, thickens bronchial secretions, blurred vision
ADULT DOSE
PEDIATRIC DOSE
MD CONSULT REQUIRED No
CHLORIDE CLASS
• Increase cardiac contractility • Decreases vasodilation due to calcium channel
• Stabilize cardiac muscle cells in patients with
INDICATIONS
• Calcium channel blocker toxicity • Hyperkalemia
CONTRAINDICATIONS
• V-fib, digitalis toxicity, hypercalcemia. • Precipitates with Bicarb
SIDE EFFECTS
• Bradycardia, asystole, hypotension, V-fib,
coronary and cerebral artery spasm, nausea and vomiting.
ADULT DOSE
2-4 mg/kg IV of a 10% solution may be repeated in 10 mins
PEDIATRIC DOSE
MD CONSULT REQUIRED Hyperkalemia only
(Meperidine)
INDICATIONS
CONTRAINDICATIONS
Head injury, known respiratory conditions
SIDE EFFECTS
Hypotension, sedation, apnea, increased ICP, nausea, tachycardia, respiratory depression
ADULT DOSE
PEDIATRIC DOSE
MD CONSULT REQUIRED No
DEXTROSE 50%
Quick infusion of sugar into blood for metabolism
INDICATIONS
CONTRAINDICATIONS
SIDE EFFECTS
ADULT DOSE
PEDIATRIC DOSE
2 mL/kg of D25 IV slowly into secure vein.
MD CONSULT REQUIRED No
DIAZEPAM
(Valium)
INDICATIONS
• Status epilepticus • Moderate to severe pain
CONTRAINDICATIONS
Hypersensitivity to the drug, hypotension
SIDE EFFECTS
Drowsiness, slurred speech, transient hypotension, blurred vision, nausea and vomiting, respiratory depression
ADULT DOSE
2-5 mg IV or 5-10 mg IM, repeat to total of 10 mg
PEDIATRIC DOSE
0.3 mg/kg IV/IM (0.5 mg/kg rectally); not to exceed adult dose.
MD CONSULT REQUIRED No
DILTIAZEM
(Cardizem)
INDICATIONS
• Atrial Fibrillation • Atrial Flutter • PSVT refractory to adenosine
CONTRAINDICATIONS
SIDE EFFECTS
Chest pain, congestive heart failure, syncope, ventricular dysrhythmia
ADULT DOSE
0.25 mg/kg IV bolus over 2 min, may repeat in 15 min with 0.35 mg/kg if response is inadequate (usual adult dose 20 mg)
PEDIATRIC DOSE
NOT FOR USE IN PEDIATRICS
MD CONSULT REQUIRED Yes
DOPAMINE
(Intropin)
HYDROCHLORIDE
CLASS
INDICATIONS
CONTRAINDICATIONS
SIDE EFFECTS
Ventricular tachycardia, ectopic beats, nausea and vomiting, dyspnea, hypertension, hypotension
ADULT DOSE
PEDIATRIC DOSE
MD CONSULT REQUIRED No
EPINEPHRINE
(auto-injector)
INDICATIONS
CONTRAINDICATIONS
(Relative) cardiovascular disease, angina, hypertension, pregnancy, hyperthyroidism
SIDE EFFECTS
Palpitations, tachycardia, arrhythmia, hypertension,
ADULT DOSE
PEDIATRIC DOSE
Pre-loaded 0.15 mg ampule of epinephrine
Inserted perpendicular (90 degree angle) to the mid
thigh and held for 10 seconds while the entire dose
MD CONSULT REQUIRED
EPINEPHRINE
(1:1,000) CLASS
• Bronchodilation • Positive chronotrope • Positive inotrope
INDICATIONS
• Angioedema and/or stridor • Anaphylaxis • Acute asthma
CONTRAINDICATIONS
(Relative) cardiovascular disease, angina, hypertension, pregnancy, hyperthyroidism
SIDE EFFECTS
Palpitations, tachycardia, arrhythmia, hypertension, headache, anxiousness
ADULT DOSE
0.3 to 0.5 mg every 5-15 minutes as required
PEDIATRIC DOSE
0.01 mg/kg to maximum single dose of 0.5 mg
MD CONSULT REQUIRED No
EPINEPHRINE
(1:10,000) CLASS
• Positive chronotrope • Positive inotrope • Bronchodilator
INDICATIONS
• Ventricular fibrillation • Asystole • Pulseless electrical activity (PEA) • Anaphylaxis (severe bronchospasm, BP <80
CONTRAINDICATIONS
SIDE EFFECTS
Palpitations, tachycardia, arrhythmia, hypertension, headache, anxiousness
ADULT DOSE
• 1 mg every 3-5 minutes IV until the desired effect
• Severe anaphylaxis dose: 0.1 mg IVP may be
repeated every 5-15 minutes as required.
PEDIATRIC DOSE
MD CONSULT REQUIRED No
FENTANYL
Binds to the opiate receptor to block pain response
INDICATIONS
CONTRAINDICATIONS
SIDE EFFECTS
Hypotension, decrease LOC, nausea, bradycardia
ADULT DOSE
25 to 100 mcg IVP or IM to max of 100 mcg
PEDIATRIC DOSE
May give one dose of 1-2 mcg/kg IVP or IM
MD CONSULT REQUIRED
FUROSEMIDE
Inhibits sodium and chloride re-absorption in the
kidneys, causes venous dilation and reduces
INDICATIONS
CONTRAINDICATIONS
SIDE EFFECTS
ADULT DOSE
If patient already on furosemide, 80 mg slow IVP
PEDIATRIC DOSE
MD CONSULT REQUIRED
GLUCAGON
Increases the breakdown of glycogen into glucose
INDICATIONS
• For hypoglycemic patients in whom IV access
• In any suspected hypoglycemic patient who is
CONTRAINDICATIONS
SIDE EFFECTS
May cause allergic reaction in rare instances
ADULT DOSE
1 mg vial reconstituted with 1 ml dilute (age 12 and up)
PEDIATRIC DOSE
MD CONSULT REQUIRED No
(Haloperidol)
INDICATIONS
CONTRAINDICATIONS
SIDE EFFECTS
ADULT DOSE
PEDIATRIC DOSE
MD CONSULT REQUIRED Yes
LIDOCAINE
(Xylocaine)
• Suppresses ventricular ectopy by suppressing
• Increases ventricular fibrillation threshold
INDICATIONS
• Ventricular fibrillation and pulseless VT
CONTRAINDICATIONS
SIDE EFFECTS
Seizures, respiratory depression, dizziness,
restlessness, confusion, blurred vision, numbness,
hypotension, bradycardia, heart block, nausea and
ADULT DOSE
1.0-1.5 mg/kg repeat in 3-5 minutes to a total of 3
PEDIATRIC DOSE
1 mg/kg IVP slowly. Total dose is 3 mg/kg
MD CONSULT REQUIRED
PRECAUTIONS: Administer ½ the dose in patients
MAGNESIUM
SULFATE CLASS
Acts as a calcium channel blocker and as a smooth and skeletal muscle relaxant as well as a CNS depressant
INDICATIONS
• Torsades des Pointes, refractory VF/VT • Eclamptic seizures
CONTRAINDICATIONS
SIDE EFFECTS
Respiratory, CNS depression, hypotension, cardiac arrest
ADULT DOSE
1-2 Gm IV over 1-2 minutes For eclamptic seizures, mix 2 Gm in 500cc NS and infuse over 30 min.
PEDIATRIC DOSE
NOT FOR USE IN PEDIATRICS
MD CONSULT REQUIRED Eclamptic seizures
MORPHINE
(Astramorph)
INDICATIONS
• Severe pain • Pulmonary edema and CHF • Chest pain, suspected AMI
CONTRAINDICATIONS
Hypersensitivity to opiates, head injuries, chest or abdominal injury
SIDE EFFECTS
Respiratory depression, nausea, vomiting, bradycardia, hypotension, altered level of consciousness
ADULT DOSE
PEDIATRIC DOSE
MD CONSULT REQUIRED Intermediate/99
(Naloxone Hydrochloride)
INDICATIONS
CONTRAINDICATIONS
Patients with a history of hypersensitivity to the drug
SIDE EFFECTS
Rapid administration causes projectile vomiting, pt may quickly awaken agitated and combative.
ADULT DOSE
0.5-2 mg slow IV push, titrated to effect up to 10 mg total
PEDIATRIC DOSE
0.1 mg/kg up to 20kg, not to exceed adult dose
MD CONSULT REQUIRED No
PRECAUTIONS: Restrain patient prior to
administering
NITROGLYCERIN
(Nitrostat)
• Dilates coronary arteries • Dilates systemic arteries
INDICATIONS
• Angina • Suspected myocardial infarction • Acute pulmonary edema
CONTRAINDICATIONS
Hypotension, cerebral bleeding, Pt taking Viagra, Cialis or Levitra.
SIDE EFFECTS
Headache, hypotension, syncope, tachycardia, flushing
ADULT DOSE
0.4 mg tablet or spray every 3-5 minutes until relief of discomfort, or total of 3 doses.
PEDIATRIC DOSE
Not recommended for pediatric use.
0.4 mg tablets or nitrolingual aerosol spray
MD CONSULT REQUIRED No
ORAL GLUCOSE
Infusion of sugar in the digestive system to be metabolized into the blood
INDICATIONS
CONTRAINDICATIONS
Decrease level of consciousness, unconsciousness, possible CVA or TIA
SIDE EFFECTS
ADULT DOSE
PEDIATRIC DOSE
MD CONSULT REQUIRED No
OXYTOCIN
(Pitocin)
Causes contraction of uterine smooth muscle
INDICATIONS
CONTRAINDICATIONS
Rule out multiple births before administration, only after delivery of the placenta.
SIDE EFFECTS
ADULT DOSE
20 units in 1000 cc NS to infuse at wide open for first liter or 10 units IM
PEDIATRIC DOSE
MD CONSULT REQUIRED No
PHENERGAN
(Promethazine HCL)
INDICATIONS
• Control of nausea and recurrent vomiting • Adjunct for analgesia
CONTRAINDICATIONS
• Patients with a known hypersensitivity to
• Patients who are allergic to sulfites • Altered level of consciousness
SIDE EFFECTS
Extrapyramidal reactions, excessive sedation
ADULT DOSE
PEDIATRIC DOSE
MD CONSULT REQUIRED No
SPECIAL NOTE: Subcutaneous injection or
extravasations may result in tissue necrosis
BICARBONATE CLASS
Increases blood pH Combines with H+ ions to form a weak volatile acid, resulting in the generation of CO and water
INDICATIONS
• Cardiac arrest • Tricyclic anti-depressant overdose • Hyperkalemia
CONTRAINDICATIONS
SIDE EFFECTS
ADULT DOSE
1 mEq/kg initially, then ½ the initial dose
PEDIATRIC DOSE
1 mEq/kg initially, then ½ the initial dose
MD CONSULT REQUIRED For Hyperkalemia
EMT-I for Tricyclic anti-depressant overdose
THIAMINE
(Betaxin)
INDICATIONS
• Coma of unknown origin
• Delirium tremors
• Hypoglycemia
CONTRAINDICATIONS
SIDE EFFECTS
ADULT DOSE
PEDIATRIC DOSE
Not recommended for use in children
MD CONSULT REQUIRED No
(Ketorolac Tromethamine)
INDICATIONS
CONTRAINDICATIONS
• Allergy to aspirin or other NSAIDs • Use with caution in renal disease, liver disease,
COPD, asthma, ulcers, bleeding disorders, Coumadin use, elderly pt., diabetes.
SIDE EFFECTS
Nausea, GI bleeding, edema, renal failure
ADULT DOSE
• 30 mg IV or 60 mg IM • 15 mg IV or 30 mg IM if >65 years of age or <50
PEDIATRIC DOSE
Not recommended for pediatrics
MD CONSULT REQUIRED No
PRECAUTIONS: Give with caution to patients over
50 years of age, decrease dose if >65 years of age
(Midazolam HCL)
INDICATIONS
• To facilitate intubation • Seizures • Sedation for Cardioversion and Pacing • Severe pain
CONTRAINDICATIONS
SIDE EFFECTS
Respiratory depression, hypotension, decreased heart rate
ADULT DOSE
1-5 mg IV to a total of 5 mg or 5 mg IM/IN
PEDIATRIC DOSE
MD CONSULT REQUIRED Yes for EMT-I
Source: http://www.westyellowstonefire.com/Files/WYFD%20Approved%20Drugs.pdf
SURGERY HOURS GRANGETOWN OUT OF HOURS SERVICE Our surgery is closed between 6pm and 9am, but you can still receive advice or information. Please telephone NHS Direct on 0845 4647. For urgent medical care please telephone 0845 603 3131. Middlesbrough Primary Care Trust is commissioning our out of hours service and can also be contacted on www.nhsdirect.nhs.ukDetails of all pri
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