MEDICATIONS MEDS PROTOCOLS DOSAGES

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Question Answer Acetaminophen Oral, RectalPain, Fever ( Greater than / Equal to 100.4* F/38*C) Adult: 15 mg/kg PO (typical adult 500-1000mg)Pedi: 15 mg/kg PO/PR (1000mg MAX dose) Activated Charcoal OralOral ingestion occurring less than 1 hour prior Adult: 25-50 GRAM POPedi: 1 gm/kg PO Adenosine IV Narrow Complex Tachycardia Adult: 12 mg rapid push IV ( may repeat x 1) Adenosine IV Wide Complex Tachycardia Regular w/ Monomorphic Complexes Adult: 12 mg rapid IV push (may repeat x 1) Albuterol 0.083% INHALATION PEDI & ADULT SAME DOSEAllergic reaction – Anaphylaxis – Asthma – COPD – RAD – Preterm Labor Adult: 2.5 – 5.0 mg (+/- ipratropium) via SVN may repeat x 3Pedi: SAME AS ADULT Amiodarone IV ADULTVF – Ventricular Fibrillation / PVT – Pulseless Ventricular Tachycardia / Cardiac Arrest Adult: 300 mg IV: Repeat 150mg for VF/VT refractory to the first dose and at least one defibrillation attempt. Amiodarone IV PEDINarrow complex tachycardia NO EFFECT WITH ADENOSINE Pedi: 5mg/kg (MAX 150 mg) IV over 20 min Amiodarone IV INFUSION – CARDIACS MUST CALL MEDICAL CONTROL – STANDING ORDER FOR PARAMEDICSWide complex tachycardia WITH A PULSE Adult: 150 mg IV over 10 min ( may repeat x1 in 10 min) If amiodarone is effective in terminating the arrhythmia consider maintenance infusion of 1 mg / min.Pedi: 5 mg/kg (max dose 150 mg) IV over 20 min (may repeat x1 in 10min) (P) Amiodarone IV INFUSIONPost Cardiac Arrest Adult: 1mg / min Aspirin POPain Adult: 324-650mg POASPIRIN IS NEVER ADMINISTERED TO CHILDREN Aspirin POAcute decompensated heart failure, chest pain, ACS- Acute Coronary Syndrrome, STEMI Adult: 324mg POASPIRIN IS NEVER ADMINISTERED TO CHILDREN Atropine Sulfate IVSymptomatic Bradycardia Adult 0.5-1.0 mg IV, repeat every 3-5 min to achieve a HR greater than 60. MAX DOSE TOTAL OF 3mg Atropine Sulfate IVNerve Agent Organophosphate Toxicity Adult MILD SYMPTOMS: 2mg IV IM every 5 min until symptoms resolve. Adult MAJOR SYMPTOMS: 6mg IV IM every 5 minutes until symptoms resolve. (P) Atropine Sulfate IV IMHypersalivation folloing KETAMINE administration Adult: 0.5 mg IV / IM Calcium Chloride 10% IVHyperkalemia (high Potassium), Cardiac Arrest in the dialysis patient Adult: 1 GRAM (give concurrently with Sodium Bicarbonate 50 mEq IV Calcium Chloride 10% IVExposure to hydrofluoric acid Adult: 1 GRAM slow IV push (may repeat x1) Calcium Chloride 10% IVSevere muscle spasms related to marine envenomation Adult: 1 GRAM IV Over 3 minutes Calcium Chloride 10% IVSuspected Calcium Channel Blocker or Beta Blocker Overdose Adult 1 gram Calcium Gluconate 10% IVHyperkalemia (high Potassium), Cardiac Arrest in the dialysis patient Adult: 3 GRAM (give concurrently with Sodium Bicarbonate 50 mEq IV Calcium Gluconate 10% IVSevere muscle spasms related to marine envenomation Adult: 1 GRAM IV Over 3 minutes Calcium Gluconate 10% IVSuspected Calcium Channel Blocker or Beta Blocker Overdose Adult: 3 GRAM IV (may repeat x1) Calcium Gluconate 2.5% GEL TOPICALSkin exposure to hydrofluoric acid (HF) Apply topical gel to all contact points. If the hands of digits are involved the gel should be placed in an exam glove and the glove worn on the affected hand. How can you MAKE Calcium Gluconate Gel if you do not have a PREMIXED TUBE? Mix 7.5 ml of 10% calcium gluconate to 22.5 ml of water soluble surgical lubricant Calcium Gluconate 1% OphthalmicOcular exposure to Hydroflouric Acid HA Irrigate the affected Calcium Gluconate2.5% INHALATIONInhalation injury due to Hydroflouric Acid HA Administer via SVN (P) Cefazolin IV/IOOpen Fractures, Amputations, Grossly contaminated wounds Adult: 2 GRAM IV over 3-5 min Dexamethasone IVAdrenal Insufficiency Adult: 10 mg IV Dextrose 10% IVHypoglycemia Adult: D10W 250 ml 25 GRAM IV over 5 min. Repeat in 5 min if BG less than 60 mg / dl. Dextrose 50% IVHypoglycemia Adult: D50 (25 Gram / 50 mL) IV. Repeat in 5 min if BG is less than 60 mg / dl. Diazepam (Valium) IV/IM/ RECTALPatient requiring electrical therapy Adult: 2.5 mg IV / IM Diazepam (Valium) IV/IM/ RECTALSeizures Adult: 5 – 15 mg / hour Ditiazem (Cardizem) IV Narrow Complex Tachycardia Adult: 0.25 mg / kg IV (max dose 20 mg)if the SBP is greater than or equal to 100 may repeat x1 at 0.35 mg/kg IV (max dose 25mg) (P) Diltiazem IVNarrow Complex Tachycardia Adult: 5-15 mg / hour Diphenhydramine (Benadryl) IV / ORALAllergic reaction – anaphylaxis dystonic reaction Adult: 50 mg PO / IV / IM (P) Dopamine IV INFUSION (P) Droperidol DuoDote Antidote Kit (P) Enalaprilat IVAcute Decompensated Heart Failure Adult: 1.25mg IV BP greater than 140/ unresponsive to NTG (P) Epinephrine 1:10000 IVAllergic Reaction, Anaphylaxis SEVERE SYMPTOMS PERI ARREST Adult: 0.1mg (100mg) diluted in 10ml 0.9% Saline, slow IV for PERRI ARREST anaphylaxis (may repeat x2) (P) Epinephrine 1:10000 IVAllergic Reaction, Anaphylaxis SEVERE SYMPTOMS PERI ARREST Pedi: 0.01 mg / kg diluted in 10ml 0.9% Saline, slow IV for PERRI ARREST anaphylaxis (may repeat x2) *****Epinephrine 1:10000 IVCardiac Arrest Adult: 1mg IV every 3-5 minutes *****Epinephrine 1:10000 IVCardiac Arrest PEDIATRIC: 0.01 mg / kg every 3-5 minutes *****Epinephrine 1:10000 IV NEONATE: 0.01 – 0.03 mg / kg every 3-5 minutes IV0.05-0/01 mg / kg ETT *****Epinephrine 1:1000 IM ADULT LESS THAN 50 YOAllergic Reaction, Anaphylaxis Moderate Severity ADULT Adult Less than 50 years old: 0.3 mg IM (Lateral Thigh)**Avoid in adults greater than 50 years old or with history of cardiac disease** *****Epinephrine 1:1000 IM PEDIAllergic Reaction, Anaphylaxis Moderate Severity PEDI Pedi: 0.15mg IM for patients 15-30 kg (33-66 lbs) {{{or 0.3mg IM for patients greater than 30 kg (66 lbs)}}} *****Epinephrine 1:1000 IM ADULT LESS THAN 50 YOAllergic Reaction, Anaphylaxis Severe Symptoms ADULT Adult Less than 50 years old: 0.3mg IM (lateral thigh) every 5 minutes if no improvement to a maximum of 3 doses *****Epinephrine 1:1000 IM ADULT GREATER THAN 50 YO orwith a KNOWN CARDIAC HISTORYAllergic Reaction, Anaphylaxis Severe Symptoms ADULT Adult greater than 50 years old or with a known cardiac history: 0.15 mg IM (lateral thigh) every 5 minutes if no improvement to a maximum of 3 doses *****Epinephrine 1:1000 IM PEDIAllergic Reaction, Anaphylaxis Severe Symptoms PEDI Pedi: 0.15mg IM for patients 15-30 kg (33-66 lbs) {{{or 0.3mg IM for patients greater than 30 kg (66 lbs)}}} every 5 minutes if no improvement to a max of 3 doses *****Epinephrine 1:1000 IM ADULT ASTHMA Adults in EXTREMIS: 0.3 mg IM *****Epinephrine 1:1000 IM PediASTHMA Pedi in continued distress: 0.15-0.3 mg IM (lateral thigh) *****Epinephrine 1:1000 IM PediBRADYCARDIA Pedi: 0.1mg/kg via ETT (P) Epinephrine INFUSION Epinephrine 2.25% Solution INHALED Pedi respiratory distress / CROUP (seal like barking cough) Pedi: 0.5ml bullet may repeat x1 (P)Famotidine Fentanyl IV/IM/IO/IN AdultPAIN (Severe greater than 6/10) Adult: 0.5-1 mcg/kg IV/IM/IN (Max SINGLE dose 100 mcg), may repeat every 10 minutes to a maximum of 300 mcg cumulative dose. IV dose given over 2 minutes. Fentanyl IV/IM/IO/IN PediPAIN (Severe greater than 6/10) Pedi: 0.5-1 mcg/kg IV/IM/IN (Max SINGLE dose 75 mcg), may repeat every 10 minutes to a maximum of 150 mcg cumulative dose. IV dose given over 2 minutes. (P) FentanylPatient with advanced airway in place (P) FentanylPatient requiring electrical therapy Furosemide IV AdultAcute Decompensated Heart Failure Adult: If ALLof the following apply: Transport time greater than or equal to 30 min AND patient is prescribed Furosemide (Lasix) at home AND Systolic BP greater than or equal to 100/ administer daily dose of Lasix IV to max of 80mg ONLY Glucagon INTRAMUSCULARLY – IMHypoglycemiaState the Adult AND Pedi doses Adult: 1 mg IM (P) Glucagon IVAllergic Reaction, Anaphylaxis (P) Glucagon IV Overdose – beta blocker or CCB Glucose (ORAL)Hypoglycemia Adult / Pedi: 1 Tube (15 Grams) PO If the patient is awake and able to swallow ONLY (P) Haloperidol Hydrocortisone (Solu-Cortef) IVAdrenal Insufficiency, Allergic Reaction, Anaphylaxis, Asthma, COPD, RAD Adult: 100 mg IVPedi: 2 mg/kg (100 mg MAX) (P) Hydroxycobalamin IV INFUSION Ibuprofen OralPain, Fever 100.4 F or greater Adult / Pedi: 10mg / kgAdult consider: APAP taken in last 4 hours and still greater than or equal to 100.4 F: 400-800 mg POPedi consider: 800 mg MAX Dose (P) 20% Fat Emulsion Ipratropium Bromide INHAsthma / COPD / RAD Adult / Pedi: 0.5 mg unit dose alone or combine with albuterol dose inhaled (Duoneb) (P) Ketamine (P) Ketorolac Lactated Ringers IVIndications for use Shock, Sepsis, PEA, Suspected Hypovolemia Lactated Ringers OCCULAR IRRIGATIONEYE IRRIGATION irrigation of minimum of 2 liters into affected eye for 15 minutes (P) (IFT) Labetalol (P) Levalbuterol Lidocaine IVVF / Pulseless VT Adult: 100 mg IV repeat every 10 min x 2 Lidocaine IVWCT w/ pulse Adult: 1 – 1.5 mg / kg IV (may repeat x1 in 5 min) Lidocaine IV – CARDIACS MUST CALL MEDICAL CONTOL UNDER THIS PARTICULAR PROTOCOL – STANDING ORDER FOR PARAMEDICSWide Complex Tachycardia – WITH A PULSE Adult: 1-1.5 mg / kg May repeat x1 in 5 minutes (P) Lorazepam (Ativan) IVPatient with advanced airway in place Lorazepam (Ativan) IVSeizures Adult: 4 mg IV May repeat 2mg every 3-5 min to a max of 10 mg. (P) Lorazepam (Ativan) IVAnxiolysis during CPAP therapy (P) Lorazepam IVSympathomimetic / Stimulant Toxicity Adult: 1 mg IV May repeat in 5 min (P) Magnesium Sulfate IVAsthma Magnesium Sulfate INFUSION – CARDIACS MUST CALL MEDICAL CONTROL / PARAMEDIC STANDING ORDERPolymorphic VT Torsades WITH pulse 1-2 Grams IV over 5 minutes (P) Magnesium Sulfate INFUSIONPolymorphic VT Torsades WITHOUT pulse Mark 1 NAAK Methylprednisolone (Solu-Medrol) IVAdrenal Insufficiency, Allergic Reaction, anaphylaxis, asthma, COPD RAD Adult: 125 mg IV (P) Metoprolol Midazolam IV IM IN DO NOT NEED MEDICAL CONTROLExcited Delerium Syndrome, Electrical Therapy Adult: 2.5 – 5 mg IV over 1 minutes then repeat x1 every 10 minutes x3 if SBP greater than 100. May be given IM IN 5mg. (P) Midazolam iVCPR induced Consciousness Adult: 1 mg IV may repeat every 5-10 minutes PRN. (P) Midazolam iVPatient with advanced airway in place Adult: 2.5 – 5 mg IV every 5 – 10 min as needed. Midazolam IV IM INAggressive or Aggitated NO ALCOHOL ON BOARD Adult: 2.5 – 5 mg IV or 5 mg IM IN. May repeat PRN if SBP is greater than 100 for a cumulative dose of 10mg. (Cummulative dose of 5mg if the patient is over 65 mg) Midazolam IM or IN OnlySeizures No IV access Adult: 10mg IM —–OR—– 2 mg IN Midazolam IVSeizures WITH IV access Adult: 2.5 mg IV (5mg IM or 2mg IN), may repeat 2mg every 3-5 min to a max of 20 mg) Midazolam IV IN IMSympathomimetic / Stimulant Toxicity Adult: 2.5 mg IV / IN. May repeat in 5 min. 2.5 mg IM. May repeat IM dose in 20 min. Midazolam IV IN IMSevere Muscle Spasm related to stings, bites, or envenomations Adult: 0.5 -2 mg IV over 2-3 min or 1-2 mg IN or 5 mg IN (max 5 mg) Naloxone IV IN IM AdultSuspected Opioid Overdose Adult: 0.4 mg IN IV IM. Every 3-5 min until adequate ventilation is restored or 10 mg is administered. Naloxone IV IN IM PediRepeat dose at 3-5 Suspected Opioid Overdose Pedi: 0.1 mg / kg IN IV IM —- MAX DOSE 2 MG—-repeat dose at 3-5 min intervals until ventilation is restored. For patient's greater than or equal to 20 kg consider Narcan 2mg IN IV IM, repeat at 3-5 min intervals until adeq vent restored (P)(IFT) Nifedipine Nitroglycerin SLChest Pain; Acute Decompensated Heart Failure Adult: 0.4 mg SL (tablet or sub lingual spray / powder) every 5 min if the Systolic BP is greater than 100 (P) NicardipineAcute Decompensated Heart Failure (P) NicardipineChest Pain (P) Nitrous Oxide (50/50) INHMild / Moderate pain and as a bridge to IV analgesia (P) Norepinephrine IV INFUSIONShock, Sepsis, Hypotension Adult Mix only in what? D5 (P) Norephinephrine IV INFUSIONShock, Sepsis, Hypotension Adult Concentrations 4mg / 250 ml OR 8mg / 500 ml (P) Norepinephrine IV INFUSIONShock, Sepsis, Hypotension Adult Dose 2-20 mcg / min (P) Norepinephrine IV INFUSIONShock, Sepsis, Hypotension Pedi Dose 0.1 – 2.0 mcg / kg / min Ondansetron IV PO IM ODT AdultNausea Vomiting Adult: 4 mg PO/IV/IM/ODT (may repeat x1 in 15 min) (P) Pitocin IV ConcentrationPostpartum Hemorrhage 20 Units / 1000 LR (P) Pitocin IV DosePostpartum Hemorrhage 10 – 20 units IM – Followed by 40 mU /min Oxymetazoline Nasal Adults ONLYEpistaxis Adults ONLY: 2 sprays into affected nostril followed by direct pressure (P) Phenobarbital IVPersistent Seizures Pedi: 20 mg / kg IV at a rate of less than 50 mg / min. May repeat 5 mg / kg IV every 5 min until seizure activity terminated. (P) Phenylephrine IV INFUSIONNeurogenic Shock Adult: 10 – 180 mcg / min IV Infusion (P) Phenylephrine IV INFUSIONPost CA Hypotension Adult: 10 – 180 mcg / min IV Infusion to achieve a BP of greater than or equal to 100 or MAP greater than or equal to 65 (P) Phenylephrine IV AdultUndifferentiated and Hypovolemic Shock Adult: 100 mcg IV every 10 min (max dose 500 mg) (P) Phenylephrine IV AdultPersistent Hypotension following the administration of 60 ml / kg of IV Fluids PEDIATRIC Pedi: 5 mcg / kg (max single dose 100 mcg) every 10 min (max total 500 mcg) (P) Phenylephrine AdultSeptic Shock Adult: 100 mcg IV every 10 min (max dose 500 mg) to achieve a SBP of greater than or equal to 100 or MAP greater than or equal to 65. Pralidoxime IM Nerve agent or organophosphate toxicity Pralidoxime IV IMNerve agent or organophosphate toxicity (P) Prednisone Oral AdultAllergic reaction, Anaphylaxis, Asthma, COPD, RAD Adult: 60 mg PO (P) Prednisone Oral PediAllergic reaction, Anaphylaxis, Asthma, COPD, RAD Pedi: 2 mg / kg PO (Max 60 mg) (P) PrednisOLONE Oral PediAllergic reaction, Anaphylaxis, Asthma, COPD, RAD Pedi: 2 mg / kg PO (Max 60 mg) (P) Procainamide IV INFUSIONCardiac Arrest – Recurrent / Refractory VF / PVT Adult: 1.5 Gram IV infused over 15 min (P) Procainamide IV INFUSIONMonomorphic Wide Complex Tachycardia Adult: 25-50 mg / min until the arrhythmia is suppressed, hypotension ensues, QRS durations increases by 50%, or a cumulative dose of 17 mg / kg is administered (P)Procainamide ADMIXTURE 1.5 Grams / 100 ml NS or D5W (P) Promethazine IV IMNausea / Vomiting refractory to Ondansetron Adult: 6.25 mg – 12.5 mg IV IM (P) Proparacaine OPHTHALMICChemical / Occular Injuries / Flash Injuries Adult: 2 drops into affected eye(s) to facilitate flushing Pseudoephedrine OralEar or sinus squeeze related to decompression sickness Adult: 30 mg PO (P) Rocuronium IVPatient with advanced airway in place Adult: 1 mg / kg IV (MUST HAVE WAVEFORM CAPNOGRAPHY IN PLACE) (P) Saline 3% IV INFUSION ADULT / PEDI DOSESIncreased ICP Adult: 3 ml / kg over 15 minPedi: 1 ml / kg over 15 min Sodium Bicarbonate IV IO ADULTOverdose Adult: 50 mEq IV for seizures or if the QRS is greater than 0.12 sec (may repeat every 5 min) Sodium Bicarbonate IV IO PEDIOverdose Pedi: 1 mEq / kg Max 50 mEq IV for seizures or if the QRS is greater than 0.09 sec (may repeat every 5 min) Sodium Bicarbonate IV IO ADULT INFUSION Crush Injury Adult: 150 mEq / 1000ml D5W or 1000ml NS run at 1.5 ml / hour then 500 ml / hour after extrication or crush has resolved Sodium Bicarbonate IV IO PEDI INFUSIONCrush Injury 150 mEq / 1000ml D5W or 1000ml NSPedi: 20 ml / kg x3 Sodium Bicarbonate IV IO AdultCardiac Arrest secondary to excited delirium or suspected hyperkalemia Adult: 50 mEq IV (P) Sodium Thiosulfate IVCyanide Toxicity Adult: 12.5 Gram / 100 ml D5W over 10 min Terbutaline IM SC Asthma – Adults in Extremis Adult: 0.25 SC / IM (may repeat every 15 minutes x2) (P) Tetracaine Adult OphthalmicChemical / ocular flash injuries Adult: 2 drops in affected eye(s) to facilitate flushing Thiamine (Vitamin B1) IV / IMAlcohol abuse or malnourished hypoglycemia Adult: 100 mg IV IM (P)(IFT) Tissue Plasminogen Activator (IFT) (P) Transexamic Acid IV INFUSIONShock from hemorrhage 1 Gram / 100 Normal SalineAdult: 1 gram / 100 ml Normal Saline Rapidly infused (only if under 3 hours after injury) (P) Vaecuronium IV Patient with advanced airway in place Adult: 0.1 mg / kg IV (MUST HAVE WAVEFORM CAPNOGRAPHY IN PLACE) Adenosine PEDINarrow Complex Tachycardia Pedi: 0.1 mg/kg rapid IV push (max 6mg), may repeat 0.2 mg/kg rapid IV push (max 12 mg) ***** Define the word REFRACTORY: Resistant to treatment or cure. EXAMPLE: Iif Ventricular Fibrillation if REFRACTORY to Amiodarone you may administer a second dose of Amiodarone 150 mg IV. What do the following mean? PO PR IN IM IV SL TD ODT PO-by mouth / oral; PR-per rectum; IN-intranasal/nose; IM-Inramuscular; IV-Intravenous; SC-Subcutaneous; SL-Sublingual; TD-transdermal; ODT-Orally Disolvable Tablet Glucagon IM – INTRAMUSCULARLY PEDIHYPOGLYCEMIA Pedi: 0.1 mg / kg (1mg MAX) Amiodarone IV PEDIVF – Ventricular Fibrillation / PVT – Pulseless Ventricular Tachycardia / Cardiac Arrest Pedi: 5 mg/kg IV (MAX 300mg) (may repeat x2) You have a patient in Cardiac Arrest. There is an organized rhythm but no pulse (PEA) and, based on the story family from family members, you suspect the patient may have been been hypovolemic prior to the arrest. You may consider what intervention? Fluid bolus of Lactated Ringers or Normal Saline 500 -1000ml repeated x1. You have been working a cardiac arrest and have defibrillated the patient several times along with several administration of Epinephrine and Amiodarone. As it pertains solely to electrical therapy what are two options for refractory VF / VT? 1> Change defibrillator pads and apply a new set of pads at the same site.2> Double Sequential External Defibrillation Protocol if resources allow (two monitors – 4 pads – defib simultaneously) True or False: While treating a patient in Cardiac Arrest you must never use both Amiodarone AND Lidocaine? False. If you have administered Amiodarone 300mg, repeated at 150mg and VF / VT is still refractory to at least one Defibrillation you may switch to Lidocaine 100 mg repeat every 10 min x 2. In a Cardiac Arrest, if you decide to use the IO is placement above or below the level of the diaphragm preferred? (for example: In the leg or in the arm?) ABOVE the level of the diaphragm as it is closer to the heart. "Reversible Causes of Cardiac Arrest" are known as the "5 H's and 5 T's" – It is believed that if you can isolate and manage these conditions you may increase the likelihood of survival Can you name all of them? Hypovolemia. Hypoxia. Hydrogen Ion (Acidosis). Hypothermia. Hypo-Hyperkalemia (Potassium). Tension Pneumothorax. Tamponade (Cardiac). Toxins. Thrombosis (Pulmonary Embolism). Thrombosis (Coronary) Explain the 30 minute CPR rule illustrated by the RI Protocols. Regardless of proximity to a receiving facility. Absent concern for provider safety or traumatic etiology for cardiac arrest. Continue resuscitative efforts for a MINIMUM of 30 minutes PRIOR TO MOVING THE PATIENT to the ambulance OR transporting You are working a Cardiac Arrest and a BLS provider is performing CPR. You have intubated the patient successfully and have good lung sounds with no sounds over the epigastrum. The initial EtCO2 12 mmHg but is now 8. What should you do first? Attempt to improve the quality of CPR. Good CPR will reflect an EtCO2 greater than or equal to 10 mmHG. True / False: Pulse checks should be performed after each defibrillation? FALSE!!!!! IMMMEDIATE CPR after each defibrillation attempt NO PULSE CHECKS Midazolam IV CARDIACS MUST OBTAIN MEDICAL CONTROL ORDERS FOR THIS PARTICULAR PROTOCOLAssisting people with compliance with CPAP 1-2 mg IV

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