Contra Costa County Emergency Medical Services Drug Reference. Indication Dosing Cautions Comments

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1 Drug Adenosine Albuterol Indication Dosing Cautions Comments Narrow complex tachycardia Bronchospasm Crush injury - hyperkalemia Initial 6mg rapid IV Repeat 12mg rapid IV Follow each dose with 20ml NS rapid IV Repeat as needed Repeat as needed continuously May cause transient heart block asystole. Use caution when patient is taking carmbamazepine, dipyramidole, methylxanthines. Do not administer if patient is experiencing acute asthma exacerbation. taking MAOIs (antidepressants Nardil and Parnate) Side effects include: chest pressure/pain, palpitations, hypotension, dyspnea, feeling of impending doom. Initial 300mg IV/IO Amiodarone V-Fib Pulseless V-Tach Symptomatic stable V-Tach Repeat 150mg IV/IO if rhythm persists Initial 150mg IV/IO drip over 10 minutes Repeat 150mg IV/IO if needed In patients with pulses, may cause hypotension. Do not administer if patient is hypotensive. Do not use filter needle. When creating infusion, careful mixing is needed to avoid foaming of medication. Aspirin Chest pain suspected cardiac STEMI 32 PO Contraindicated in aspirin salicylate allergy. Blood thinner use is not a contraindication. Atropine Symptomatic bradycardia Organophosphate Initial 0. IV/IO Repeat every 3-5 minutes to a max of 3mg Initial 1-2mg IV/IO Repeat every 3-5 minutes until relief of symptoms is achieved Doses less than 0. can cause paradoxical bradycardia. Can dilate pupils, aggravate glaucoma, cause urinary retention, confusion, and dysrhythmias including V- Tach and V-Fib. Increases myocardial oxygen consumption. Bradycardia in children is primarily related to respiraty issues assure adequate ventilation first. Page 1 of 5

2 Drug Atropine Calcium Chlide Dextrose 10% Indication Dosing Cautions Comments Organophosphate Hydrofluic acid exposure 500mg IV/IO f tetany cardiac arrest Crush injury 1g IV/IO over 60 Hyperkalemia seconds Hypoglycemia Initial - 100ml IV Repeat 150ml if glucose remains 60mg/dl Doses less than 0. can cause paradoxical bradycardia. Use cautiously not at all in patients on digitalis. Avoid extravasation. Rapid administration can cause dysrhythmias arrest. Can cause tissue necrosis if IV is infiltrated Can dilate pupils, aggravate glaucoma, cause urinary retention, confusion, and dysrhythmias including V- Tach and V-Fib. Increases myocardial oxygen consumption. Bradycardia in children is primarily related to respiraty issues assure adequate ventilation first. Recheck blood glucose 50mg IV/IO/IM Diphenhydramine Allergic reaction Epi 1:10,000 Dystonic reaction Cardiac arrest Cardiac arrest/ Bradycardia Anaphylactic shock 25-50mg IV/IO 50mg IM 1mg IV/IO every 3-5 minutes 0.1mg slow IV/IO increments titrated to effect to a max of 0. May cause serious dysrhythmias exacerbate angina. In adult anaphylactic patients, should be used if patient is hypotensive no improvement after Epi 1:1,000 IM dose. In pediatric anaphylactic patients, should only be administered if Epi 1:1,000 IM dose is ineffective. Alpha and beta sympathomimetic. Use ½ dose f patients: with histy of CAD; > 50 years of age Page 2 of 5

3 Epi 1:1,000 Anaphylactic shock Asthma/COPD Pediatric respiraty distress 0.3mg IM 0.3mg IM Never administer IV/IO. Use with caution in asthma patients with a histy of hypertension conary artery disease. May cause serious dysrhythmias exacerbate angina. Use ½ dose f patients: with histy of CAD; > 50 years of age EpiPen EpiPen Jr. Allergic reaction/ Anaphylaxis 1 auto-inject See Epinephrine 1:1,000 1 auto-inject and Epinephrine 1:10,000 See Epinephrine 1:1,000 and Epinephrine 1:10,000 Fentanyl Pain control Initial mcg IV/IO mcg IM 100mcg IN May repeat to max of 200mcg Can cause hypotension respiraty depression. Recheck vital signs between each dose. Hypotension is me common in patients with low cardiac output volume depletion. Respiraty depression is reversible with naloxone. Additional IV/IO doses can be administered every 5 minutes. IM and IN doses can be repeated once in 15 minutes. Glucagon Hypoglycemia 1mg IM Effect may be delayed minutes Initial 40mg IO Lidocaine IO anesthetic Repeat dose 20mg if painful Effect may be delayed minutes IV/IO/IM/IN Midazolam Seizure 10mg over 60 years of age. Observe respiraty status Page 3 of 5

4 Initial - IM/IN 1-3mg IV in 1mg increments Behavial emergency F excited delirium Initial IM/IN 10mg Midazolam 1mg IV/IO over 60 years of age. Observe respiraty status Sedation f pacing cardioversion Titrate in 1-2mg increments to a max of 2- IV/IO Sedation of patient with an advanced airway Naloxone Respiraty depression apnea 2mg IN 1-2mg IV/IM Abrupt withdrawal symptoms and combative behavi may occur. IN administration preferred unless patient is in shock has copious secretions/blood in nares. Shter duration of action than that of narcotics. Titrate to effect of nmal respirations; it is not necessary to fully wake the patient. 1 preload syringe Naloxone Overdose See Naloxone See Naloxone Page 4 of 5

5 Nitroglycerin Chest pain Pulmonary edema 0.4mg SL 3 doses 0.4mg SL if systolic BP > 90mmHg 0.8mg SL if systolic BP > 150mmHg May repeat appropriate dose every 5 minutes Do not administer if STEMI is detected. Can cause hypotension and headache. Do not administer if systolic BP < 90mmHg heart rate < 50. Do not administer if patient has taken Viagra, Levitra, Staxyn, Stendra within past 24 hours Cialis if taken within 36 past hours. Perfm 12-Lead ECG pri to administration. Ondansetron Vomiting severe nausea 4mg IV/IO/IM/ODT May repeat after 15 minutes Administer IV/IO dose over 1 minute as rapid administration may cause syncope. Sodium Bicarbonate Tricyclic antidepressant Crush injury Hyperkalemia 1mEq/kg IV/IO 50mEq IV/IO Can precipitate with inactivate other drugs. Use only if life-threatening in the presence of hemodynamically significant dysrhythmias. Page 5 of 5