Emergency Med Review

DOSE: 10-15mcg/kg IV
ADENOSINE (Adenocard)
Slows AV conduction
Given for supraventricular tachycardia (SVT) DILTIAZEM (Cardizem)
Contraindications: A-Fib, A-Flutter, VT, 2nd or 3rd degree block Calcium channel blocker
may cause brochospasm in asthma patients. For PSVT with or with out WPW, A-Fib, A-Flutter
DOSE: 6mg rapid IV bolus given in 1-2 seconds, Repeat with Not for AV blocks unless pt has a pacemaker
12 mg IV push if PSVT not eliminated. May cause decreased BP, caution with renal pts
DOSE: 20mg IV, cont. infusion 5-15mg/hr
AMIODARONE (Cordarone)
Increase VF threshold, prolongs repolarization and refractory DOUBUTAMINE (Dobutrex)
period. Positive inotrope with vasodilatation effect
Given for V-Fib, V-Tach, stable wide complex. Tachycardia For depressed myocardial contractility
Contraindicated with heart block, severe bradycardia, Not for idiopathic hypertrophic sub-aortic stenosis
decreased K DOSE: 2.5-20mcg/kg/min IV
Dont use with heparin, HCO3 and be cautious when using
Beta blockers, Ca+ channel blockers DOPAMINE (Intropin)
DOSE: During arrest = 150mg IV push in 3-5 min with stable V- Action dose related
Tach with pulse = longer infusing same dose o Low dose: inotropic support and renal perfusion
increased.
AINONE (Incor) o Med dose: Increase contraction, HR, CO, BP
Positive inotropic and potent vasodilator o High dose: Increase BP and CO
For CHF For hemodynamic imbalances in shock syndrome.
Monitor hemodynamics, I?O and electrolytes Monitor BP, I&O, peripleural pulse
DOSE: 2-5mcg/kg/min IV
ATROPINE
Enhances AV conduction (increase HR) DROTRECOGIN ALFA (Xigris)
For symptomatic bradycardia inflammation, coagulation
May extend ischemia into MI For severe Sepsis
DOSE: Bradycardia=0.5mg up to 3mg IV, ET Not for internal bleeding, stroke, head injury
May cause bleeding
CALC IUM CHLORIDE
Electrolyte ENOXAPARIN (Lovenox)
For hyperkalemia, calcium channel blocker overdose Inhibits thrombos formation
Contraindicated for pts with increased Ca+, risk of digitalis FOR: preventing ischemic complications of unstable Angina
toxicity and Non-Q wave MI
IV use only use 5-10mg IV of 10% solution for increased K and NOT FOR: severe thrombocytopenia, bleeding. Watch for
1-4g administered slowly for Ca+ blocker OD increased bleeding if used with camomile, garlic, gingko,
ginsing, or penicllins. Not for IM use.
DEXTROSE
Elevates serum glucose EPINEPHRINE
For hypoglycemia (Diabetes) (Racemic 2.25%)
DOSE: 2.5g IV Bronchodilation, vasoconstriction
Check blood sugar with Accu check For croup, upper airway edema,
DOSE: 0.25ml -1ml
DIAZEPAM (Valium) (Epi 1-1,000 soln)
Elevates seizure threshold, relaxes skeletal muscle Bronchodilation, vasoconstriction
For seizures For Bronchospasm, allergic reaction, anaphalactic shock
May cause BP and resp. drive Given IM, SC
DOSE: 2-10mg IV DOSE: 0.2-0.5mg
(EPI 1-10,000 soln)
DIGOXIN Cardiac stimulation
Positive inotrope For VF, PEA, asystole, anaphylaxis
For heart failure, A-Fib, A-Flutter, PSVT DOSE: 1mg IV, ET every 3-5min
Not for blocks, VG
Toxicity may produce rhythm disturbances, HR, blurred ESMOLO (Brevibloc)
vision, especially with renal pts.
 Blocks stimulation of Beta 1 receptor sites leading to LABETALOL (Normodyne)
decreased HR, BP and contractility Alpha and Beta blockers
For SVT, A-Fib, A-Flutter For severs hypertension, Aortic Aneurysm
Not for Pulmonary Edema, cardiogenic shock, bradycardia, 2nd Not for Asthmatics, cardiac failure, decreased HR
& 3rd degree block
May cause decrease BP, decrease HR, chest pain

CLOMIDTE (Amidate)
Sedation
For rapid sequence intubations
LIDOCAINE
Not for pregnant women or people less then 10 y.o
Elevates VF threshold
DOSE: 0.3 mg/kg IV
For VF, VT, PVC;s
FENTANYL (Sublimaze) Not for AV blocks, decrease BP, decreased HR
Alters perception of pain DOSE: 1.0 1.5 mg/kg IV
For pain Also used as local Anesthtic, cough suppressant
Not for pts on MAO inhibitors, Myasthenia Gravis, acute
asthma or Hx seizures. LORAZEPAM (Adivan)
Have Narcan on hand to reverse Sedation
For seizures, watch for decreased RR
FLUMAZENIL (Romazicon) DOSE: 2-4 mg IV
Benxodiazepine antagonist
Reverses the effects of Ativan, Versed, Xanaz, Valium MAGNESIUM SULFATE
Not for cyclic antidepressant OD May reduce incidence of post infarction ventricular Arrhythmias
DOSE: 0.2mg IV For cardiac arrest due to decreased mg or Torsades de
Pointes
FOSPHENYTOIN (Cerebyx) DOSE: 1-2g IV for arrest
Anticonvulsant Torsades 1-2g IV diluted in 50-100ml D5W
Status epilepticus
MANNITOL (20%)
FUROSEMIDE (Lasix) Reduces ICP and Cerebral Edema
Diuretic, vasodilation Osmotic diuretic
For Pulmonary Edema, 2nd to CHF For severed head injury
Not for Anuria, decreased K+, Hepatic coma Not for Active bleeding, pulmonary edema
May cause hypokalemia, hypocalcemia, hypomagnesemia,
volume depletion, and decreased BP METHYLPREDNISOLONE (Solu-medrol)
DOSE: 20-80 mg IV over 1-2 min Systemic steroid, decreased inflammation
For Asthma, Acute spinal cord injury, Anaphylactic shock
HALOPERIDOL (Haldol) Not for Fungal infections, GI ulcers
Antipsychotic May cause decrease K+, increase sugar
For psychotic disorders (schizophrenia) DOSE: Asthma 10-250 mg/IV q 4-6 hrs
Not for Parkinsons disease, bone marrow depression,
Epilepsy METOPROLOL (Lopressor)
Given by deep IM Beta blocker, decreases BP
For acute MI, Angina
HEPARIN Not for Cardiogenic shock, AV blocks, CHF, COPD
Inhibits coagulation DOSE: 5mg IV
For MI, venous thrombosis, pulmonary embolism, Peripheral
arterial embolism. MIDAZOLAM (Versed)
Not for hemorrhagic stroke, active bleeding, thrombocytopenia Produces calming effect
DOSE: 60 u/kg IV, cont. infusion 12 u/kg hr For sedation (many procedures)
May cause decreased BP, RR, laryngospasm
INSULIN (Regular) DOSE: 1.5mg 2.5mg IV
Decreases blood sugar (short acting)
For diabetes mellitus, keto acidosis MILRINONE (Primacor)
Overall tx of DKA includes replacing intravascular fluid volume Vasodilator, inotrope
before administering insulin. Check blood sugar every 30 min For acute heart failure
during infusion. Administer in separate IV line from Lasix
 DOSE: 50mcg/kg DOSE: 40 U IV push, IO or ET 1 time only

NALOZONE (Narcan) VERAPAMIL (Calan)

Narcotic antagonist Calcium channel blocker
For acute opioid overdose For PSVT
DOSE: 0.4 2mg IV Not for AV blocks, people on beta blocker

NITRODLYCERIN (sublingual, spray, past) BETA BLOCKER

Vasodilatation, reduces myocardial O2 demand by decreasing Any drug that inhibits the sympathemetic Beta Adrenergic
preload, increasing blood flow within coronary vessels. recepotor sites in the cardiac smooth muscle and bronchial
For angina, CHF, HTN smooth muscle. Used to slow conduction, and thus slow
Not for Hypovolemia, severe hypotension excessively high rates. Used for A-Fib, A-Flutter, SVT.
Side effect: headache
CALCIUM CHANNEL BLOCKER
NITROPRUSSIDE (Nitropress) Blocks the influx of calcium into myocardium thus decreasing
Decreases BP contraction and HR
Dilates peripheral arteries and veins
ATRIAL FIBRILLATION (A-Fib)
For hypertensive crisis
Erratic/chaotic Atrial contractions with normal or narrowed QRS
Wrap container in aluminum foil to protect from light complexes.
No P wave present
NOREPINEPHRINE (Levophed)
Rates are very high in atrium > 200, overall HR 180-200
Inotrope, vasoconstrictor, dilates coronary arteries
Fix by cardioverting Atrium or medication to slow AV
For acute hypotensive states (MI, sepsis)
conduction
Not for Hypovolemia, profound hypoxia
May cause ischemic injury, bradycardia, decrease renal
perfusion

PHENYTOIN (Dilantin)
Stabilizes neuronal membranes
For seizures
Not for decreased HR, blocks, hypoglycemia seizures ECG of
atrial fibrillation (top) and sinus rhythm (bottom). The purple arrow
PROCAINAMIDE (Pronestyl) indicates a P wave, which is lost in atrial fibrillation.
Peripheral vasodilator, decreases PVCs
For PVCs, VT refractory to Lidocain ATRIAL FLUTTER (A-Flutter)
Not for AV blocks P waves fire without conduction in a saw tooth pattern
Unlike A-Fib HR slower and P-waves are present and countable
PROPOFOL
Decreases cerebral blood flow, cerebral O2 consumption and
ICP
Used for sedation
May cause bradycardia, decreased BP, apnea

SUCCINYLCHOLINE (Anectine) BLOCKS

Skeletal muscle relaxation & paralysis A heart block occurs before a ischemic event such as and MI. The
Rapid intubations hearts electrical conduction system is slowed as conduction travels
Short acting 4-6min, must be able to ventilated pt around dead (necrotic) myocardium to reach its intended site. 1 st
Not for pts with hyperkalemia (caused arrest), renal failure degree block delayed PR interval (not serious)
DOSE: 1 1.5 mg/ IV
2nd DEGREE TYPE 1
TENECTEPLASE (TNKase) Progressively longer PR intervals until and entire QRS complex is
Thrombolytic dropped. The HR is generally slower then normal
Acute MI
2nd DEGREE TYPE 2
Not for active bleeding
More dangerous and may progress to 3rd degree block
Consistent missing QRS complexes HR slowed
VASOPRESSIN (may be used instead of Epi in code)
Pressor and antidiurectic hormone activities
3rd DEGREE
For shock-refractory V-Fib
 Complete dissociation of Atrias and ventricles. The P waves fire
without any association to QRS which fires independently. Life
threatening will require pacemaker.

HYPERKALEMIA
Dangerous condition leading to cardiac arrest.
Signs/Symptoms: Bradycardia, aystole, muscle weakness,
confusion, P wave flat.
To correct: Give calcium chloride, to neutralize give sodium Bicarb,
insulin or Albuterol 10-20 mg over 15 min. To remove from body=
Lasix or dialysis