• Antiarrhythmic

Actions

• Slows AV Conduction

Indications

• Symtomatic pSVT

CONTRAINDICATIONS

• Second or third degree heart block
• Sick-sinus syndrome
• Known hypersensitivity

Side Effects

• Facial flushing
• Headache
• Shortness of breath
• dissiness
• nausea

Precautions

• Arrhythmias including blocks are common at the time of cardioversion
• Use with caution in patients with asthma

Routes

• IV/IO

Dosage

• Adult
  • Cardiac Arrest 6mg rapid push
  • Cardiac Arrest 12mg rapid push if needed
• Pediatric
• Not used

• Pharmacological: adrenergic
• Therapeutic: bronchodilator

Indications / Dosage

• Respritory Distress If WHEEZING or STRIDOR is present

  Can be usded in conjuction with CPAP

  • Adult
    • MDI with spacer: 4 puffs q 5 minutes until symptoms improve
    • Nebulized 2.5mg (3ml of 0.083%) q 10 minutes until symptoms improve (O2 @ 8lpm)
  • Pediatric
    • MDI with spacer:2 puffs q 5 minutes until symptoms improve
    • Nebulized 2.5mg (3ml of 0.083%) q 10 minutes until symptoms improve (O2 @ 8lpm)

CONTRAINDICATIONS

• Hypersensitivity
• Hypertension
• Coronary artery disease
• Congestive heart failure
• Seizures
• Diabetes
• Hyperthyroidism
• Tricyclic antidepressant use

• Class III Antiarrhythmic

Actions

• Prolongs action potential and refractory period.
• Slows the sinus rate
• Increases PR and QT intervals
• Decreases periphreal vascular resistance

Indications

• Life-threatening cardiac arrhythmias such as VT and V-fib

CONTRAINDICATIONS

• Severe sinus node dysfunction
• Sinus bradycardia
• second and third-degree block
• hemodynamically significant bradycardia

Side Effects

• Dizziness
• fatigue
• constipation
• nausea, vomitting
• photosensitivity
• tremors

Precautions

• Can cause pulmonary toxicity, bradycardia, hypotension
• Use with caution in patients with CHF

Routes

• IV/IO

Dosage

• Adult
  • Pulseless VT/VF300mg IV/IO
    • repeat at 150mg if needed
• Pediatric
• 5mg/kg repeat times 2 if needed

• Platelet inhibitor/anti-inflammatory

Actions

• Blocks platelet aggregation

Indications

• new-onset chest pain suggestive of MI

CONTRAINDICATIONS

• Known hypersensitivity

Side Effects

• Heartbun
• Wheezing
• nausea, vomitting

Precautions

• GI bleeding, upset stomach
• Use with caution in patients with asthma

Routes

• Oral (PO)

Dosage

• Adult
  • Chestpain 325mg
• Pediatric
  • not used

• Parasympatholytic (anticholinergic)

Actions

• Blockes acetylcholine receptors, increases heartrate, decreases gastrointestinal secretions

Indications

• Heymodynamically-significant bradycardia, hypotension secondary to bradycardia, asystole, organophosephate poisoning

CONTRAINDICATIONS

• None when used in emergency situations

Side Effects

• palpitations and tachycardia
• headache
• dizziness
• anxiety
• blurred vision
• urinary retention
• facial flushing
• psychosis

Precautions

• Monitor for tachycardia

Routes

• IV/IO

Dosage

• Adult
  • Symotomatic bradycardia 0.5-1mg IV/IO q 3-5 minuts as needed Max dose 3mg
  • Cardiac Arrest 12mg rapid push if needed
• Pediatric
  • Symotomatic bradycardia 0.02 mg/kg IV/IO may repeat once
    • min dose: 0.1 mg
    • max dose 0.5 mg
  • Rapid Sequence Intubation0.02mg/kg IV/IO after sedation

• Carbohydrate

Actions

• Rapidly elevates blood glucose level

Indications

• Hypoglycemia

CONTRAINDICATIONS

• None with documented Hypoglycemia

Side Effects

• Local venous irritation

Precautions

• Check blood sugar before and every 15 minutes during/after administration

Routes

• IV/IO

Dosage

• Adult
  • Hypoglycemia D10 infuse 125ml repeat if BG < 100
• Pediatric
  • HypoglycemiaD10 5ml/kg repeat as needed

• Antihistamine

Actions

• Blocks histamine receptors, has some sedative effect

Indications

• Anaphylaxis, allergic reactions

CONTRAINDICATIONS

• Athsma
• Nursing Mothers

Side Effects

• Sedation
• dries bronchial secretions
• blurred vision
• headache
• palpitations

Precautions

• Monitor for hypotension

Routes

• IV/IO/IM

Dosage

• Adult
  • Anaphylaxis / Alergic Reaction 50mg
• Pediatric
  • Anaphylaxis / Alergic Reaction 1mg/kg to max of 50mg

• Anticholinergic
• Bronchodilator

Indications

• Respritory Distress If WHEEZING or STRIDOR is present

  Can be usded in conjuction with CPAP

CONTRAINDICATIONS

• Hypersensitivity to atrovent, atropine, or derivatives, broide, fluorcarbons, belladonna alkaloids

Precautions

• Monitor BP, EKG, Pulse

Routes

• Inhalation

Dosage

• Adult
  • Nebulized 3ml (3mg albuterol/0.5mg Ipatropium)
    • May repeat every 60 minutes as needed
• Pediatric
  • Nebulized 3ml (3mg albuterol/0.5mg Ipatropium)
    • May repeat every 60 minutes as needed

• Vasopressor
• sympathomimetic

Actions

• Beta-adrenergic agonist
• Increases heart rate, contractility, and automaticity
• Causes bronchodilation

Indications

• Cardiac Arrest
• Anaphylaxis
• Hypoperfusion secondary to overdose (COLMC)

CONTRAINDICATIONS

• None in patient with Life-threatening Anaphylaxis
• None in patient with Cardiac Arrest

Side Effects

• Nervousness
• Restlessness
• Tremors
• Angina
• arrhythmias
• Hypertension
• Tachycardia
• Palpitations

Precautions

• Monitor heart rate, BP
• Contraindicated for hypotension in hypovolemia
• Should be protected from light
• Can be deactivated by alkaline solutions

Routes

• IV/IO/IM/SQ
• IM Autoinjector

Dosage

• Adult
  • Cardiac Arrest
    • 1mg 1:10,000 IV/IO push q 3-5 minutes
  • Anaphylaxis
    • 0.3 SQ or IM of 1:1,000 repeat q 10 minutes until symptoms improve
    • Paramedic Only1mg IV/IO 1:10,000 severe or persistant hypotension q 5 minutes
    • Paramedic Only (COLMC)2-10mg/min IV/IO infusion for Hypoperfusion. Titrate to maintain MAP > 60 mmHG
  • Hypoperfusion (overdose)
    • Paramedic Only (COLMC)2-10mg/min IV/IO infusion for Hypoperfusion. Titrate to maintain MAP > 60 mmHG
• Pediatric
  • Cardiac Arrest
    0.1ml/kg 1:10,000 IV/IO q 3-5 minutes
  • Anaphylaxis
    • 0.15 cc IM (autoinjector JR) q 10 minutes until symptoms improve
    • Paramedic Only0.01mg/kg IV/IO 1:10,000 severe or persistant hypotension q 5 minutes
    • Paramedic Only (COLMC)0.1mg/kg/min IV/IO infusion for Hypoperfusion. Titrate to maintain MAP > 70 + (age in years x 2) mmHG
  • Hypoperfusion (overdose)
    • Paramedic Only (COLMC)0.1-2mcg/kg/min IV/IO infusion for Hypoperfusion. Titrate to maintain MAP > 70 + (age in years x 2) mmHG

• Anesthetic, Hypnotic

Actions

• Produces anesthetic without analgesic effects

Indications

• Rapid sequence intubation

CONTRAINDICATIONS

• Known hypersensitivity

Side Effects

• Myoclonic skeletal movements
• post-op nausea/vomitting
• pian at the injections site
• apnea
• lyngospasm
• hypertension or hypotension
• tachycardia or bradycardia

Precautions

Etomidate is not intended for prolonged infustion due to suppression of cortisol and aldosterone production. Causes respritory praralysis; supportive airway control must be continuous and under direct observation at all times

Routes

• IV Push

Dosage

• Adult
  • RSI 0.3mg/kg
• Pediatric
• 0.3mg/kg

• Opioid analgesic

Actions

• Produces analgesia

Indications

• Pain > 6/10
• RSI

CONTRAINDICATIONS

• Use cautiously in elderly and COPD patients
• Known hypersensitivity

Side Effects

• Confusion
• Apnea
• Respiratory depression
• lyrngospasm
• bradycardia
• hypotension
• nausea
• vomitting

Precautions

• Administer IV over 1-2 minutes. Monitor respirations, pule oximetry. Reversal agent: Naloxone

Routes

• IV/IO/IN/IM

Dosage

• Adult
  • AEMT 50-100mcg IV, IO, IN every 30 minutes
  • Paramedic 25-100mcg IV, IO, IN every 10 minutes as needed
• Pediatric
• AEMT 1mcg/kg IV/IO/IN every 30 minutes as needed for severe pain
• Paramedic1mcg/kg (max 50mcg/dose) IV/IM/IO/IO every 10 minutes as needed
  • Use 2mcg/kg for IN (max of 100mcg/dose)

• Pancreatic hormone

Actions

• Glucagon stimulates the liver to breakdown glycogen into glucose resulting in an increase in blood glucose. Also stimulates glucose synthesis.

Indications

• Hypoglycemia (when IV access is not available),

CONTRAINDICATIONS

• Known hypersensitivity

Side Effects

• Tachycardia, hypotension, nausea/vomiting, urticaria

Routes

• IM

Dosage

• Adult
  • Hypoglycimeia1mg IM
• Pediatric
• Hypoglycimeia0.1mg/kg (max dose of 1mg)

• Nonbarbiturate anesthetic

Actions

Acts on the limbic system and cortex to block afferent transmission of impulses associated with pain perception. It produces short-acting amnesia without muscular relaxation. A derivative of phencyclidine (PCP).

Indications

• Pain, sedation

CONTRAINDICATIONS

• : Stroke, hypersensitivity, severe hypertension, cardiac instability. Caution with schizophrenia.

Side Effects

• Hypertension, increased heart rate, hallucinations, delusions, explicit dreams

Precautions

• Arrhythmias including blocks are common at the time of cardioversion
• Use with caution in patients with asthma

Routes

• IV/IO

Dosage

• Adult/Pediatric
  • 1-2 mg/kg IV/IO

• Class 1B Antidysrhythmic

Actions

• Lidocaine is a sodium channel blocker that acts primarily on the ventricles of the heart during phase 4 diastolic depolarization which decreases automaticity, suppresses premature ventricular complexes, and raises the V-Fib threshold.

Indications

• IO initiation

CONTRAINDICATIONS

• Hypersensitivity, prophylactic use in an acute MI, 2nd or 3rd degree heart block in the absence of a pacemaker, Stokes-Adams syndrome

Side Effects

• Blurred vision, dizziness, hypotension, bradycardia, seizures, altered LOC

Precautions

• Arrhythmias including blocks are common at the time of cardioversion
• Use with caution in patients with asthma

Routes

• IV/IO

Dosage (per EZIO directions)

• Adult
  • 40mg IO over 4 minutes
• Pediatric
  • 0.5mg/kg IO over 4 minutes (Not to exceed 40mg

• Electrolyte, anticonvulsant

Actions

• Reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction.

Indications

• Seizures due to eclampsia after seizure activity is stopped, status asthmaticus unresponsive to beta-adrenergic drugs

CONTRAINDICATIONS

• Any heart block or myocardial damage, hypotension

Side Effects

• Hypotension, facial flushing, hyporeflexia (decreased reflexes), bradycardia, respiratory depression, diaphoresis

Routes

• IV/IO

Dosage

• Adult
  • Respiratory Distress 2gm IV over 15-30 minutes
  • Seizures (pregnancy with eclampsia/seizures)4gm IM or 4gm IV/IO over 15 minutes
• Pediatric
• Respiratory Distress 40mg/kg/IV over 15-30 minutes

• Benzodiazepine

Actions

• Increases the activity of the inhibitory neurotransmitter GABA, thereby producing a sedative effect, relaxing skeletal muscles, and raising the seizure threshold.

Indications

• Seizures and anxiety. Premedication for intubation, cardioversion or conscious sedation procedures.

CONTRAINDICATIONS

• Hypersensitivity, shock, respiratory depression, depressed VS. Use caution with CNS depressants including barbiturates, alcohol, and narcotics and glaucoma.

Side Effects

• Hypotension, respiratory depression or arrest, CNS depression, hiccups, oversedation, blurred vision.

Routes

• IV/IO/IM/IN

Dosage

• Adult
  • Seizures
    • IV/IO: 5 mg, may repeat in 5 minutes
    • IM/IN 10mg
  • Pain Management
    • IV/IO/IN – 5 mg may repeat once in 10 minutes
    • IM – 10 mg once
  • Environmental Emergencies
    • 2 mg IV/IN
• Pediatric
  • Seizures
    • IV/IO 0.1 mg/kg (max 5 mg), may repeat times one in 10 minutes
    • IN 0.3 mg/kg (max 5 mg), may repeat times one in 10 minutes
    • IM 0.15 mg/kg (max 5 mg) once
  • Pain Management
    • IV/IO 0.1 mg/kg (max 5 mg), may repeat times one in 10 minutes
    • IN 0.3 mg/kg (max 5 mg), may repeat times one in 10 minutes
    • IM 0.15 mg/kg (max 5 mg) once
  • Environmental Emergencies
    • 0.3mg/kg IV/IN

• Opioid antagonist

Actions

• Narcan is a competitive opiate antagonist used in known or suspected opioid overdose.

Indications

• Suspected or known opioid overdose with respiratory depression.

CONTRAINDICATIONS

• Hypersensitivity. Caution with narcotic dependent pt’s who may experience withdrawal syndrome to include neonates of narcotic-dependent mothers. Avoid use with Meperidine induced seizures.

Side Effects

• Withdrawal symptoms, dysrhythmias, nausea/vomiting, hypertension, tachycardia, seizures, blurred vision.

Routes

• IV/IO/IM/IN

Dosage

• Adult 0.4-2 mg (per dose) IV/IM/IO/IN May repeat q 5 minutes as needed for respiratory depression
• Pediatric 0.1 mg/kg (max 2 mg per dose) IV/IM/IO/IM May repeat q 5 minutes as needed for respiratory depression

• Nitrate, vasodilator

Actions

• Nitroglycerin is an organic nitrate and potent vasodilator. It relaxes vascular smooth muscle resulting in coronary artery dilation while also reducing blood pressure, preload, afterload, and myocardial oxygen demand.

Indications

• Chest pain, acute coronary syndromes (ACS), pulmonary edema associated with CHF, hypertensive emergencie

CONTRAINDICATIONS

• Hypersensitivity, pts that have taken erectile dysfunction drugs (Cialis, Levitra, Viagra, etc.) within the last 24-72 hours , head injury, SBP < 100, cerebral stroke or hemorrhage, extreme bradycardia or tachycardia, right ventricular infarction, volume depletion.

Side Effects

• Headache, hypotension, palpitations, dizziness, reflex tachycardia, nausea/vomiting, postural syncope, diaphoresis.

Precautions

• NTG must be kept in an airtight container and, if exposed to light, air or heat, it decomposes which is why most pt’s own prescription doesn’t relieve their symptoms since pt’s need to refill every 30 days if opened/used.

Routes

• IV/IO

Dosage

• Adult
  • 0.4 mg SL, or 1 NitroSpray SL every 5 minutes as long as chest pain symptoms persist and SBP >100 mmHg, maximum of 3 doses
• Pediatric
• Not used

• Sympathomimetic, vasopressor

Actions

• : Alpha-1 and beta-1 agonist, causing vasoconstriction and increased myocardial contractility.

Indications

• Cardiogenic shock, neurogenic shock, hemodynamically significant hypotension refractory to other sympathomimetics.

CONTRAINDICATIONS

• Hypotension due to hypovolemia

Side Effects

• Headache, dysrhythmias, tachycardia, reflex bradycardia, angina pectoris, hypertension.

Precautions

• : Beta-adrenergic antagonists may blunt inotropic response. Can cause tissue necrosis if extravasation occurs.

Routes

• IV/IO

Dosage

• Adult
  • Head Injury: Persistent hypotension0.3-3 mcg/min IV/IO infusion, titrate SBP >100 mmHg
  • Shock 2-20 mcg/min IV/IO. Titrate to maintain SBP >90 mmHg. Refractory shock: 8-30 mcg/kg/min
• Pediatric
  • Head Injury: Persistent hypotension 0.05-0.1 mcg/kg/min IV/IO infusion, titrate to max of 2 mcg/kg/min to maintain SBP >70 + (age in years x 2) mmHg
  • Shock 0.05-0.1 mcg/kg IV/IO, titrate to maintain SBP >70 + (age in years x 2) mmHg

• Antiemetic

Actions

• First selective serotonin blocking agent to be marketed. Blocks the serotonin 5-HT3 receptors that are found centrally in the chemoreceptor trigger zone and peripherally at the vagal nerve terminals in the intestines which in turn minimizes nausea and vomiting.

Indications

• Nausea and vomiting

CONTRAINDICATIONS

• Hypersensitivity, GI obstruction, and use caution with liver disease pt’s.

Side Effects

• ECG irregularities (rare), dizziness, headache, hiccups, pruritus, chills, drowsiness

Routes

• IV/IO/IM/PO

Dosage

• Adult
  • 4mg IV/PO/IO
• Pediatric
  • 4 mg IV/IO/IM/oral pt over 40kg
  • 0.1mg/kg IV/IO/PO/IO pt under 40kg

• Carbohydrate

Actions

• Directly increases blood glucose levels

Indications

• Known or suspected hypoglycemia

CONTRAINDICATIONS

• Unconscious, unable to swallow, unable to protect airway. Use caution with ALOC.

Side Effects

• Hyperglycemia, nausea/vomiting

Routes

• Buccal

Dosage

• Adult & Peds
  • 15 g buccal, variable depending on manufacturer

• Gas

Actions

• Odorless, tasteless, colorless gas that is present in room air at 21% concentration. Oxygen enters the body through the respiratory system and is transported to the body tissues for energy. Used to reverse hypoxemia and, in doing so, helps oxidize glucose to produce adenosine triphosphate (metabolic energy).

Indications

• Hypoxia, hypoperfusion, ischemic chest pain, respiratory insufficiency, suspected stroke, confirmed/suspected carbon monoxide poisoning, cardiac insufficiency or arrest

CONTRAINDICATIONS

• None in the prehospital emergency setting

Side Effects

• nausea/vomiting, irritation to respiratory tract

Precautions

• Administer and titrate to maintain a minimum SpO2 of 94%. Use caution with high flow oxygen in patients with stroke and acute coronary syndrome patients.

Routes

• Inhalation

Dosage

• Adult
  • 1-6 lpm via nasal cannula and 10-15 lpm via nonrebreather mask
• Pediatric
  • Same as adult using appropriate sized devices

• Sympathomimetic

Actions

• Racemic Epinephrine is an inhaled version of epinephrine that is used as a bronchodilator and as an anti-inflammatory to treat laryngeal/tracheal swelling and edema. Its actions are the same as epinephrine but since it is inhaled it has both systemic and localized effects.

Indications

• STRIDOR in infant less than 18 months of age

CONTRAINDICATIONS

• Hypertension, epiglottitis.

Side Effects

• Tachycardia, hypertension, anxiety, cardiac dysrhythmias, tremors

Routes

• Nebulized

Dosage

• Adult
  • Not Used
• Pediatric
  • 0.5 ml in 3 cc NS (2.25% solution) every 15 minutes as needed

• Non-depolarizing neuromuscular blocker

Actions

• Acetylcholine antagonist. Paralyzes skeletal muscles, including respiratory muscles

Indications

• Intubation

CONTRAINDICATIONS

• Known hypersensitivity

Side Effects

• Anaphylaxis, bronchospasm, hypertension, tachycardia, excessive salivation, rash

Precautions

• Should not be administered unless persons skilled in endotracheal intubation and equipment are available Does not affect mental status, be sure to give a sedative beforehand. Paralysis occurrs within 1 minute and can last up to 30 mins. Use caution in patients with myasthenia gravis

Routes

• IV/IO

Dosage

• Adult & Pediatric
  • 1 mg/kg

• PH buffer, alkalizing agent, electrolyte supplement

Actions

• Sodium bicarbonate is a short acting, potent acid buffer. The bicarbonate (HCO3) binds to hydrogen ions (H+ ) to make carbonic acid (H2CO3). This is broken down in the lungs and exhaled as water (H2O) and carbon dioxide (CO2). Plasma hydrogen ion concentration decreases causing blood pH to rise.

Indications

• Tricyclic antidepressant (TCA) overdose

CONTRAINDICATIONS

• Hypocalcemia, suspected metabolic and respiratory alkalosis, hypokalemia, hypernatremia, pt’s with chloride loss due to vomiting and GI suction, severe pulmonary edema

Side Effects

• Metabolic alkalosis, seizures, electrolyte disturbance

Precautions

• Should not be given at the same time as other electrolytes or vasopressors, be sure to flush IV thoroughly or use separate IV sites. Not recommended for and ineffective in hypercarbic acidosis such as seen in cardiac arrest and CPR without intubation

Routes

• IV/IO

Dosage

• Adult
  • 1 meq/kg slow IV/IO push for tricyclic antidepressant overdose with sustained HR>120, hypotension unresponsive to fluids, or ventricular dysrhythmias
• Pediatric
• Not used

• Depolarizing neuromuscular blocker

Actions

• Succinylcholine is a short acting, depolarizing neuromuscular blocking agent that binds to acetylcholine receptor sites. This produces complete muscle paralysis but since it is a depolarizing agent it causes fasciculations and muscular contractions making it the drug of choice for rapid sequence intubation.

Indications

• To facilitate endotracheal intubation

CONTRAINDICATIONS

• Hypersensitivity, burns or crush injuries > 72 old, skeletal muscle myopathies, inability to control the airway or support ventilations with O2 and positive pressure (BVM), family or personal history of malignant hyperthermia, rhabodomyolysis. Use with caution in pt’s that may have hyperkalemia (renal failure, trauma/burns, electrolyte disturbances, crush injury etc.)

Side Effects

• Fasciculations, bradycardia, hypotension, tachycardia, hypertension, dysrhythmias, malignant hyperthermia, hyperkalemia, respiratory depression, excessive salivation, hyperkalemia

Precautions

• Although after administering Succinylcholine it may appear that the patient is not conscious, it has NO effect on the central nervous system, so the patient will be completely aware of procedures unless appropriate sedation is also given.

Routes

• IV/IO

Dosage

• Adult & Pediatric
  • 1.5 mg/kg IV/IO
    • duration of action – 5 minutes
    • consider 10% of loading dose as defasciculating dose