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Adenosine
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Adenosine
Adenocard
Antidysrhythmic
A naturally occurring agent that can chemically convert PSVT to a
NSR. It has a half-life of 10 seconds and does not cause hypotension.
Narrow-complex PSVT refractory to vagal maneuvers
Hypersensitivity, 2nd and 3rd-degree heart blocks, sinus node disease, or
asthma
May cause transient dysrhythmias, COPD
Smoking : increased tachycardia ; Methylzanthines antagonize adenosine
(caffeine, theophylline); Carbamazepine may potentiate the AV nodal
blocking effect of adenosine.
Facial flushing, headache, SOB, dizziness, nausea
6 mg rapidly (1-2 sec) IV, then flush line with 20 mg NS. If ineffective,
12 mg in 1-2 min, may be repeated once. Ped: 0,1 mg/kg (1-2 sec) IV
followed by rapid NS flush, then 0.2 mg/kg in 1-2 min to max of 12 mg.
Onset: immediate; Duration: 10 seconds
Albuterol
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Albuterol
Proventil, Ventolin
Amiodarone
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Amiodarone
Cordarone, Pacerone
Antidysrhythmic
Prolons the duration of the action potential and refractory period and relaxes
smooth muscles, reducing peripheral vascular resistance and increasing coronary
blood flow.
Life-threatening ventricular and supraventricular dysrhythmias, frequently A-Fib
Hypersensitivity, cardiogenic shock, sever sinus bradycardia, or advanced heart
block
Hepatic impairment, pregnancy, nursing mothers, children
Bradycardia: beta blockers, calcium channel blockers; Increased anticoagulant
effects of warfarin; Increased levels of digoxin, quinidine, procainimide,
disopyramide, theophylline, phenytoin
Hypotension, nausea, anorexia, malaise, fatigue, tremors, pulmonary toxicity,
vetricular ectopic beats
150-300 mg IV over 10 min, then 1 mg/min over next 6 hours. Ped: 5 mg/kg
IV/IO, then 15 mg/kg/day
Onset: unknown; Duration: variable
Aspirin
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Atropine Sulfate
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Atropine Sulfate
Parasympatholytic
Blocks the parasympathetic nervous system, specifically the vagal effects on heart
rate. It does not increase contractility but may increase myocardial oxygen
demand. Decreases airway secretions.
Hemodynamically significant bradycardia, brady asystolic arrest, and
organophosphate poisoning
None in the emergency setting
AMI, glaucoma
Use with other anticholinergic agents may increase vagal blockade, potential
adverse effects when used with digitalis, cholinergics, effects may be enhanced by
antihistamines, procainimide, quinadine, antipsychotics, antidepressants and
thiazides
Palpations, tachycardia, headache, dizziness, dry mouth, pupilary dilation, blurred
vision, urinary retention (especially in older men)
Symptomatic bradycardia: 0.5-1 mg IV (2 mg ET) q 3-5 min to 0.04 mg/kg.
Ped: 0.02 mg/kg IV (0,04 mg/kg ET) q 5 min to max 1 mg. Asystole: 1 mg IV (2
mg ET), q 3-5 min up to 0.04 mg/kg. Organophosphate poisoning: 2-5 mg
IV/IM/IO over 10-15 min; Inhalation: 0.5-1.0 mg in 2-3 mL NSS
Onset: rapid; Duration: 2-3 hours
Ca l c i u m C h l o ri d e
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Calcium Chloride
Electrolyte
Increases myocardial contractile force and increases ventricular
automaticity
Hyperkalemia, hypocalcemia, hypermagnesemia, and calcium channel
blocker toxicity
V-Fib, hypercalcemia, and possible digitalis toxicity
May precipitate toxicity in patients taking digoxin. Ensure the IV line is
in a large vein and flushed before and after using calcium. May
precipitate with sodium bicarbonate.
Calcium may worsen dysrhythmias secondary to digitalis; May
antagonize the peripheral vasodilatory effect of calcium channel blockers
Arrhythmias (bradycardia and asystole), hypotension
2-4 mg/kg IV (10% solution) over 10 min, repeat PRN. Ped: 20 mg/kg
IV (10% solution) over 10 min, repeat PRN; SLOW PUSH ONLY
Onset: 5-15 min; Duration: dose dependant, may persist for up to 4 hours
Dexamethasone
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Dexamethasone
Decadron
Steroid
Long-acting synthetic adrenocorticoid with intense anti-inflammatory activity. It
prevents the accumulation of inflammatory generating cells at the sites of
infection or injury.
Anaphylaxis, asthma, COPD, spinal cord edema
No absolute contraindications in the emergency setting. Relative: systemic fungal
infections, acute infections, tuberculosis, varicella, or vaccinia or live virus
vaccinations.
Precautions:
Herpes simplex, keratitis, myasthenia gravis, hepatic or renal impairment, diabetes, CHF,
seizures, physic disorders, hypothyroidism, and GI ulceration.
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Di a z e p a m
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Diazepam
Valium
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Interactions:
Psychoses, depression, myasthenia gravis, hepatic or renal impairment, addiction, elderly or very ill patients, or
COPD. Due to short half-life of the drug, seizures may recur.
Cigarette smoking may decrease the effectiveness of this drug. antihistamines; cimetadine; digoxin; disulfiram;
fluoxetine (Prozac); levodopa (Larodopa, Sinemet); medications for depression, seizures, pain, Parkinson's
disease, asthma, colds, or allergies; muscle relaxants; oral contraceptives; propoxyphene (Darvon); propranolol;
ranitidine; sedatives; sleeping pills; theophylline (Theo-Dur); tranquilizers; valproic acid (Depakene); and
vitamins. These medications may add to the drowsiness caused by diazepam.
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Di l t i a z e m
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1
Diltiazem
Cardizem
Diphenhydramine
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Benadryl
Diphenhydramine
Antihistamine
Blocks histamine release, thereby reducing bronchoconstriction,
vasodilation, and edema
Anaphylaxis, allergic reactions, and dystonic reactions
Asthma and other lower respiratory diseases
May induce hypotension, headache, palpitations, tachycardia,
sedation, drowsiness, and/or disturbed coordination
Monoamine oxidase (MAO) inhibitor ---these medicines
should not be used together. Anticholinergics (medicine for
abdominal or stomach spasms or cramps)Side effects,
such as dryness of mouth, of antihistamines or
anticholinergics may be more likely to occur.
Sedation, dries bronchial secretions, blurred vision, headache,
palpations
25-50 mg IV/IM
Dopamine
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2
Dopamine
Intropin
Sympathomimetic
A naturally occurring catecholamine that increases cardiac output without
appreciably increasing myocardial oxygen consumption. It maintains renal and
mesenteric blood flow while inducing vasoconstriction and increasing systolic
blood pressure.
Nonhypovolemic hypotension (70-100 mmHg) and cardiogenic shock
Hypovolemic hypotension without aggressive fluid resuscitation,
tachydysrhythmias, V-Fib, and pheochormocytoma2.
Occular vascular disease, cold injury, arterial embolism. Assure adequate fluid
resuscitation of the Hypovolemic patient.
Deactivated by alkaline solutions; MAOIs may potentiate the effects of
catecholamines; Beta adrenergic antagonists may blunt the inotropic response;
Sympathomimetics may exacerbate dysrhythmia response
Ventricular tachydysrhythmias, HTN, palpitations
2-5 mcg/kg/min up to 20 mcg/kg/min, titrated to effect. Ped: same as adult
Onset: 2-4 min; Duration: 10-15 min
A tumor of the adrenal gland that causes the release of too much epinephrine and norepinephrine.
Epinephrine 1:1000
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Epinephrine 1:1000
Adrenalin
Sympathomimetic
A naturally occurring catecholamine that increases heart rate, cardiac contractile force,
myocardial electrical activity, vascular resistance, and systolic BP, and decreases
overall airway resistance and automaticity. It also, through bronchial artery
constriction, may reduce pulmonary congestion and increases tidal volume and vital
capacity.
Bronchial asthma, exacerbation of CODP, allergic reactions pediatric cardiac arrest
Patients with underlying cardiovascular disease, HTN, pregnancy, patients with
tachyarrhythmias
Should be protected from light, BP, pulse and ECG results must be constantly
monitored
MAOIs may potentiate the effect of epinephrine; beta adrenergic antagonists may blunt
inotropic effects; sympathomimetics may exacerbate dysrhythmias response; May be
deactivated by alkaline solutions
Palpations and tachycardia, anxiousness, headache, tremors
0.3-0.5 mg SC, repeat q 5-15 min PRN, or 0.5-1 mg of 1:10,000 IV if SC dose
ineffective or severe reaction. Ped: 0.01 mg/kg of 1:1,000 SC, repeat q 10-15 min or
0.01 mg/kg of 1:10,000 IV if SC dose ineffective or severe reaction.
Onset: IV/ET 1-2 min, SQ 5-10 min (1 :1000); Duration: 5-10 min
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Adrenalin
Sympathomimetic
A naturally occurring catecholamine that increases heart rate, cardiac contractile force,
myocardial electrical activity, vascular resistance, and systolic BP, and decreases
overall airway resistance and automaticity. It also, through bronchial artery
constriction, may reduce pulmonoary congestion and increases tidal volume and vital
capacity.
Cardiac arrest, anaphylactic shock, severe airway disease
For IV or endotracheal tube (ET) use; it should not be used in patients who do not
require extensive resuscitative efforts.
Elderly, debilitated patients, HTN, diabetes, hyperthyroidism, Parkinsons disease,
tuberculosis, asthma, emphysema, and in children < 6 years of age. Can be deactivated
by alkaline solutions.
MAOIs may potentiate the effect of epinephrine; beta adrenergic antagonists may blunt inotropic effects;
sympathomimetics may exacerbate dysrhythmia response; May be deactivated by alkaline solutions
Furosemide
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Furosemide
Lasix
Diuretic
Rapid-acting, potent diuretic and antihypertensive that inhibits sodium
reabsorption by the kidney. Its vasodilating effects reduce venous return and
cardiac workload.
CHF and pulmonary edema
Hypersensitivity to furosemide or the sulfonimides, fluid and electrolyte depletion
states, hepatic coma, pregnancy (except in life-threatening circumstances)
Infants, elderly, hepatic impairment, nephrotic syndrome, cardiogenic shock
associated with acute MI, gout, or patients receiving digitalis or potassiumdepleting steroids.
Digitalis toxicity; increased ototoxic potential of aminoglycoside antibiotics;
Lithium toxicity; May potentiate therapeutic effect of other antihypertensive
drugs; Should not be administered in same line as Inocor.
Few in emergency setting; Hypokalemia; Hypercalcemia
40-120 mg slow IV. Ped: 1 mg/kg slow IV.
Onset: IV 15-20 min; Duration: 2 hours
Glucagon
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Glucagon
GlucaGen
Hormone, antihypoglycemic
A protein secreted by the alpha pancreatic cells that causes a breakdown
of stored glycogen into glucose and inhibits the synthesis of glycogen
from glucose.
Hypoglycemia without IV access and to reverse beta-blocker overdose.
Hypersensitivity to glucagon or protein compounds.
Cardiovascular or renal impairment. Effective only if there are sufficient
stores of glycogen in the liver.
Few in the emergency settings
Hypoglycemia: 1 mg IM/SC repeat 5-20 min. Ped: 0.01 mg/kg
IM/SC/IV for child < 10 kg; 1 mg/kg IM/SC/IV for child > 10 kg. Betablocker overdose: 50-150 mg/kg IV over 1 min. Ped: 50-150 mg/kg IV
over 1 min.
Lactated Ringers
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Lactated Ringers
Hartmanns solution
Li doc ai ne
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Lidocaine
Xylocaine
Antidysrhythmic
Suppresses automaticity and raises stimulation threshold of the ventricles. Also
causes sedation, anticonvulsant, and analgesic effects.
Pulseless V-Tach, V-Fib, V-Tach (with pulse)
Hypersensitivity to amide-type local anesthetics, supraventricular tachydysrhythmias, Stokes-Adams
syndrome, 2nd- and 3rd-degree heart blocks, and bradycardia.
Hepatic or renal impairment, CHF, hypoxia, respiratory depression, hypovolemia, myasthenia gravis, shock,
debilitated patients, elderly, family Hx of malignant hypothermia.
Metabolic clearance may be decreased in patients taking beta adrenergic blockers or in patients with
decreased cardiac output or liver impairment; Additive neurologic effects may occur with procainimide;
decreased effects of lidocaine with barbiturates.
L o ra z e p a m
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Ativan
Lorazepam
Benzodiazepine, sedative
The most potent benzodiazepine available. It has a strong
antianxiety, sedative, hypnotic, and skeletal muscle relaxant
properties, and a relatively short half-life.
Sedation for cardioversion and status epilepticus.
Sensitivity to benzodiazepines
Narrow angle glaucoma, depression or psychosis, coma, shock,
acute alcohol intoxication, renal or hepatic impairment, organic
brain syndrome, myasthenia gravis, GI disorders, elderly,
debilitated, limited pulmonary reserve.
Drowsiness, hypotension, respiratory depression and apnea
Sedation: 2-4 mg IM, 0.5-2 mg IV. Ped: 0.03-0.05 mg/kg
IV/IM/PR up to 5 mg. Status epilepticus: 2 mg slow IV/PR (2
mg/min). Ped: 0.1 mg/kg slow IV/PR (2-5 min).
Magnesium Sulfate
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Magnesium sulfate
Magnesium
Methylprednisolone
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Solu-Medrol
Methylprednisolone
Corticosteroid, Anti-inflammatory
Synthetic corticosteroid, effective as an anti-inflammatory and used in
the management of allergic reactions and in some cases of shock. It is
sometimes used in the treatment of spinal cord injury.
Spinal cord injury, asthma, severe anaphylaxis, COPD
No major contraindications in the emergency setting
Only a single dose should be given in the prehospital setting.
Hypoglycemic response to insulin & oral hypoglycemic agents may be
blunted; Potassium-depleting agents may potentiate hypokalemia
induced by corticosteroids.
GI Bleeding, prolonged wound healing, suppression of natural steroids
Asthma/COPD/Anaphylaxis: 125-250 mg IV/IM. Ped: 1-2 mg/kg/dose
IV/IM. Spinal cord injury: 30 mg/kg IV over 15 min, after 45 min an
infusion of 5.4 mg/kg/hr.
Onset: 1-2 hrs; Duration: 8-24 hrs
Midazolam
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Versed
Midazolam
Sedative
Short-acting benzodiazepine with CNS depressant, muscle
relaxant, anticonvulsant, and anteroretrograde amnesic effects.
To induce sedation before cardioversion or intubation.
Hypersensitivity to benzodiazepines, narrow angle glaucoma,
shock, coma, or acute alcohol intoxication.
COPD, renal impairment, CHF, elderly.
Drowsiness, hypotension, amnesia, respiratory depression and
apnea
1-2.5 mg slow IV; 0.07-0.08 mg/kg IM (usually 5 mg). Ped: 0.050.2 mg/kg IV; 0.1-0.15 mg/kg IM; 3 mg intranasal..
Morphine Sulfate
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Morphine Sulfate
Morphine
Na l o x o n e
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Narcan
Naloxone
Narcotic antagonist
Pure narcotic antagonist that blocs the effects of both natural and
synthetic narcotics and may reverse respiratory depression.
Narcotic and synthetic narcotic overdose, coma of unknown
origin.
Hypersensitivity. Non-narcotic respiratory depression.
Possible dependency (including newborns). It also has a half-life
that is shorter than most narcotics; hence, the patient may return
to the overdose state.
Rare
0.4-2 mg IV/IM (2-2.5 for ET dose), repeated q 2-3 min PRN up
to 10 mg. Ped: 0.01 mg IV/IM (2-2.5 for ET dose), repeated q 2-3
min PRN up to 10 mg.
Ni t ro g l y c e r i n
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Nitroglycerin
Nitrostat
Nitrate
A rapid smooth muscle relaxant that reduces peripheral vascular
resistance, BP, venous return, and cardiac workload.
Chest pain associated with angina and acute myocardial infarction, and
acute pulmonary edema.
Hypersensitivity, tolerance to nitrates, severe anemia, head trauma,
hypotension, increased ICP, patients taking sildenafil, glaucoma, and
shock, under 12 years old
May induce headache that is sometimes severe. NTG is light sensitive
and will lose potency when exposed to air.
Other vasodilators may have additive hypotensive effects; May cause
severe hypotension when administered to patients who have recently
ingested alcohol.
Headache, dizziness, hypotension
1 tablet (0.4 mg) SL. May be repeated q 3-5 min up to 3 tablets, or 0.4
mg (1 spray) SL up to 3 sprays in 25 minutes.
Onset: 1-2 min; Duration: 30-60 min
Nitroglycerin Paste
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Nitro-Bid
Nitroglycerin
Nitrate
A rapid smooth muscle relaxant that reduces peripheral vascular
resistance, BP, venous return, and cardiac workload.
Chest pain associated with angina and acute myocardial
infarction, and acute pulmonary edema.
Hypersensitivity, tolerance to nitrates, severe anemia, head
trauma, hypotension, increased ICP, patients taking sildenafil,
glaucoma, and shock, under 12 years old
May induce headache that is sometimes severe. NTG is light
sensitive and will lose potency when exposed to air.
Other vasodilators may have additive hypotensive effects
Headache, dizziness, hypotension
to 1 inch of topical ointment
Onset: 15-60 min; Duration: 2-12 hours
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Oxygen
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Class:
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Oxygen
Sodium Bicarbonate
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Class:
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Indications:
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Precautions:
Interactions:
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Sodium Bicarbonate
Alkalizing Agent
NaHCO3
T e rb u t a l i n e
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Terbutaline
Brethine, Bricanyl
Sympathetic Agonist
Causes bronchodilation with less cardiac effect than epinephrine.
Bronchial asthma and bronchospasm in COPD
Hypersensitivity to the drug.
Patient may experience palpitations, anxiety, nausea, and/or
dizziness. Vital signs and breath sounds must be monitored; use
caution with cardiac or HTN patients.
Increased effects with other sympathomimetics; decreased action
with beta-blockers; hypertensive crisis with MAOIs.
Palpations, tachycardia, PVCs, anxiety, tremors, headache
2 inhalations with a metered-dose inhaler, repeated once in 1 min
or 0.25 mg SQ repeated in 15-30 min.
Onset: SQ 15 min, Inh 5-30 min; Duration: SQ 1.5-4 hrs, Inh 3-6
hrs
Thiamine
Name(s):
Class:
Actions/Uses:
Thiamine
Vitamin B1
Vitamin
Thiamine is required to convert glucose into energy. It
is not manufactured in the body and must be
constantly provided from ingested foods or
supplements.
Indications:
Coma of unknown origin, chronic alcoholism with
associated coma, and delirium tremens.
Contraindications: None
Precautions:
Known hypersensitivity to the drug
Interactions:
Side Effects:
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Onset/Duration:
Rare, if any
50-100 mg IV/IM. Ped: 10-25 mg IV/IM.
Vasopressin
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Precautions:
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Pitressin
Vasopressin
Hormone, Vasopressor
Hormone with a strong vasopressive and antidiruretic properties
but that may precipitate angina and/or AMI.
To increase peripheral vascular resistance in arrest (CPR) or to
control bleeding from esophageal varices.
Chronic nephritis with nitrogen retention, ischemic heart disease,
PVCs, advanced arteriosclerosis, or 1st stage of labor.
Epilepsy, migraine, heart failure, angina, vascular disease,
hepatic impairment, elderly, and children.