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