review sheet

Mannitol: Side Effects

Cardiovascular: chest pain Neurological: mental status change

Dexamethasone: Side Effects

Cardiovascular: hypertension, CHF, edema Neurological: headache, convulsions, increased ICP Gastrointestinal: abdominal distention, nausea, increased appetite

Nitroglycerin: Side Effects

Cardiovascular: hypotension, bradycardia, rebound hypertension/tachycardia, palpitations Neurological: headache Other: flushed skin, sublingual burning

Calcium Chloride: Side Effects

Cardiovascular: hypotension, dysrhythmias, cardiac arrest Neurological: syncope, tingling sensations Gastrointestinal: metallic taste Other: sense of heat waves, necrosis/cellulitis upon infiltration of IV

Thiamine: Side Effects

Cardiovascular: mild hypotension Respiratory: pulmonary edema Gastrointestinal: nausea/vomiting

Glucagon: Side Effects

Cardiovascular: tachycardia, hypertension CNS: dizziness, headache

Naloxone: Side Effects

Cardiovascular: tachycardia, hypertension, dysrhythmias Neurological: tremors/seizures, aggressive/combative Gastrointestinal: nausea/vomiting

Thiamine: Mechanism of Action

Coenzyme necessary for carbohydrate metabolism of glucose

Dopamine: Side Effects

Dose Dependent Cardiovascular: tachycardia, hypertension/hypotension, chest pain, ventricular irritability Respiratory: dyspnea

Calcium Chloride: Classification

Electrolyte

Oxygen: Classification

Gas

Acetylsalicylic Acid: Side Effects

Gastrointestinal: bleeding, heartburn, epigastric pain CNS: dizziness, confusion, drowsiness ENT: tinnitus, hearing loss Other: may impair renal function, may prolong labor in pregnancy with increased bleeding

Glucagon: Classification

Hormone

Thiamine: Routes & Dosages

IV, IO, IM Adult: 10-100 mg Pediatric: 10-25 mg

Oxygen: Mechanism of Action

Increases percentage of oxygen in inspired air (FiO2)

Naloxone: Indications

Known or suspected narcotic overdoses with inadequate respiratory function

Dopamine: Mechanism of Action

Low Dose or Renal/Mesenteric Dose (1-5 mcg/kg/min): 1. Dilates renal and mesenteric arteries by stimulating dopaminergic receptors 2. Increases urinary output Moderate Dose or Inotropic Dose (5-10 mcg/kg/min): 1. Increases inotropy without increasing chronotropy 2. Increases blood pressure by stimulating the beta1 receptors High Dose or Vasopressor Dose (10-20 mcg/kg/min): 1. Causes vasoconstriction (alpha); increasing blood pressure 2. Increase inotropy and chronotropy (beta 1); increasing blood pressure

Naloxone: Mechanism of Action

Mechanism of Action: Reverses the respiratory depression and CNS sedation of narcotics by competing for opiate receptor sites in the brain

Naloxone: Classification

Narcotic (Opiate) Antagonist

Sodium Bicarbonate: Side Effects

Neurological: headache, confusion, tetany (intermittent tonic spasms, seizures. Respiratory: Pulmonary Edema Other: Metabolic Alkalosis, hypokalemia, hypocalcemia, tissue acidosis

Albuterol Sulfate: Contraindications

No absolute contraindications

Oxygen: Contraindications

None

Sodium Bicarbonate: Contraindications

None

Thiamine: Contraindications

None

Naloxone: Contraindications

Not be used if patient has adequate respiratory status

Glucagon: Contraindications

Not significant

Morphine Sulfate: Classification

Opioid Narcotic, CNS Depressant

Mannitol: Classification

Osmotic Diuretic

Dextrose 50%: Mechanism of Action

Provides immediate source of glucose for cellular metabolism

Activated Charcoal: Side Effects

Respiratory: choking Gastrointestinal: vomiting, black stools, abdominal cramping/bloating

Oxygen: Side Effects

Respiratory: dry mucous membranes, upper respiratory irritation, pulmonary Edema, oxygen toxicity

Dexamethasone: Routes & Dosages

Routes: IV IO, IVPB Adult: 4-24 mg IV/IO Pediatric: 0.2-0.5 mg/kg IV/IO

Sodium Bicarbonate: Routes & Dosages

Routes: IV, IO Adult: 1 mEq/kg IV/IO Pediatric: 1 mEq/kg IV/IO

Dextrose 50%: Routes & Dosages

Routes: IV, IO Adult: 25 gm (50 ml solution preload) IVP/IO May repeat once in 5 minutes Pediatric: Birth - 1 month: 5-10 ml/kg (0.5-1g/kg) slow IVP of a 10% solution. May repeat once in 10 minutes. 1 month+-2 years: 2 ml/kg (0.5-1g/kg) slow IVP/IO of a 25% solution May repeat once in 5 minutes Over 2 years: 1 ml/kg (0.5-1g/kg) slow IVP/IO of a 50% solution (same solution as for the adult) May repeat once in 5 minutes

Calcium Chloride: Routes & Dosages

Routes: IV, IO Adult: Known or suspected hyperkalemia or Beta Blocker OD, cardiac arrests: 500 mg to 1 gm IVP/IO over 5-10 minutes (may repeat every 10 minutes prn). Repeat as clinically indicated Calcium channel blocker (prophylaxis): 2-4 mg/kg Pediatric: 20 mg/kg (0.2ml/kg) slow IVP/IO (no faster than 100mg/min). Repeat as clinically indicated

Glucagon: Routes & Dosages

Routes: IV, IO, IM Adult: Hypoglycemia: 1 mg IM; May repeat in 20 minutes Beta Blocker OD: 1 mg IV/IO Pediatric: 0.03 - 0.1 mg/kg IM; Max dose 1 mg (must have documented hypoglycemia)

Morphine Sulfate: Routes & Dosages

Routes: IV, IO, IM Adult: Pain Relief: 1.0 - 10.0 mg IV titrated to pain relief or 5.0 - 10.0 mg IM as a single dose only Pulmonary Edema: 5.0 - 10.0 mg slow IV push (2.0 mg/minute) Pediatric: 0.1 - 0.2 mg/kg slow IV push (1.0 mg/minute) titrated to pain relief or 0.1 mg/kg IM

Midazolam: Routes & Dosages

Routes: IV, IO, IM, IN Adult: Pre-cardioversion or transcutaneous pacing: 1.0 - 2.5 mg slow IV/IO/IN Seizure: 0.1 mg/kg slow IV/IO/IN or 0.2 mg/kg IM to a maximum of 5.0 mg Pediatric: Seizure: 0.1 mg/kg slow IV/IO/IN or 0.2 mg/kg IM to a maximum of 5.0 mg

Naloxone: Routes & Dosages

Routes: IV, IO, IM, IN, ET Adult: 1.0 - 2.0 mg IV/IM/IN. Titrate IV dose to adequate respiratory rate and tidal volume. May repeat dose every 5 minutes as needed Pediatric: 0.1 mg/kg IV/IM/IN. Titrate IV dose to adequate respiratory rate and tidal volume. May repeat dose every 5 minutes as needed

Diazepam: Routes & Dosages

Routes: IV, IO, IM, PR, PO Adult: Seizures: 5-10 mg IV/IM. May repeat every 5-15 minutes prn to a max dose of 20 mg Anxiety:5-10 mg IV/IM Cardioversion: 5-10 mg IV titrated to effect Pediatric: 0.1 mg/kg IV/PR. May repeat every 5-15 minutes prn to a max dose of 20 mg

Mannitol: Routes & Dosages

Routes: IV, IO, IVPB Adult: 1.5 - 2 gm/kg slow IV infusion Pediatric: 0.25 - 0.5 gm/kg over 60 minutes

Dopamine: Routes & Dosages

Routes: IVPB Adult: Low dose: 1-5 mcg/kg/min Moderate dose: 5-10 mcg/kg/min High dose: 10-20 mcg/kg/min Pediatric: Low dose: 1-5 mcg/kg/min Moderate dose: 5-10 mcg/kg/min High dose: 10-20 mcg/kg/min

Acetylsalicylic Acid: Routes & Dosages

Routes: PO Adult:162-325mg Pediatric:not recommended

Nitroglycerin: Routes & Dosages

Routes: SL, TM (Transmucosal, TD (Transdermal) Adult: 0.4 mg as a single spray or single tablet. May repeat every 3-5 minutes, Nitropaste is 15 mg per one inch, doses are protocol dependent. Pediatric: not recommended

Oxygen: Routes & Dosages

Routes: inhaled Nasal Cannula 2-6 LPM Simple Face Mask 6-10 LPM Non-rebreather Mask 10-15 LPM HHN/Neb Mask 6-8 LPM BVM 15 LPM

Dexamethasone: Classification

Steroid

Activated Charcoal: Indications

Suspected ingestion of drugs or chemicals

Dopamine: Classification

Sympathomimetic Catecholamine Vasopressor

Albuterol Sulfate: Classification

Sympathomimetic Bronchodilator

Nitroglycerin: Classification

Vasodilator, Nitrate, Antianginal

Thiamine: Classification

Water Soluble Vitamin

Activated Charcoal: Routes & Dosages

or PO via nasogastric/orogastric tube Adult: 1g/kg PO Pediatric: 1g/kg PO

Glucagon: Indications

1. ALOC with hypoglycemia when no IV can be established 2. Beta-Blocker Overdose

Acetylsalicylic Acid: Contraindications

1. Active gastrointestinal bleeding 2. Relative Contraindication: Asthma patients with nasal polyps (anaphylaxis is common)

Mannitol: Indications

1. Acute cerebral edema 2. Blood transfusion reactions

Midazolam: Contraindications

1. Acute narrow-angle glaucoma 2. Shock (from hypovolemia) 3. Hypotension (from hypovolemia) 4. Alcohol or drug intoxication

Mannitol: Contraindications

1. Acute pulmonary edema 2. Severe pulmonary congestion 3. Hypovolemia

Morphine Sulfate: Contraindications

1. Altered level of consciousness 2. Abdominal pain of unknown etiology (relative) 3. Patients at risk of respiratory depression 4. Head injury 5. Hypovolemia

Morphine Sulfate: Mechanism of Action

1. Alters pain perception and produces euphoria 2. Decreases myocardial oxygen demand by decreasing preload (venous pooling due to peripheral vasodilation) and decreasing afterload (decreased systemic vascular resistance due to peripheral vasodilation) 3. Depresses the CNS by interacting with opiate receptors in the brain

Midazolam: Mechanism of Action

1. Binds to benzodiazepine receptors 2. Increases the inhibitory neurotransmitter GABA leading to decreased agitation, relaxation of skeletal muscles, and in high doses sleep.

Dexamethasone: Mechanism of Action

1. Binds with intracellular corticosteroid receptors decreasing capillary permeability and dilation

Nitroglycerin: Contraindications

1. Blood pressure less than 90 mmHg systolic 2. Patients who have taken Erectile Dysfunction (PDE5 inhibitors) medications in the last 24-48 hours 3. Signs and symptoms of head trauma (increased intracranial pressure) or cerebral hemorrhage 4. Poor systemic perfusion

Calcium Chloride: Indications

1. Calcium Channel Blocker or Beta blocker overdose 2. Acute hyperkalemia or cardiac arrest when hyperkalemia is suspected 3. Hypocalcemia 4. Suspected hypermagnesemia with respiratory depression 5. Crush injury greater than 4 hours

Dopamine: Indications

1. Cardiogenic shock 2. Distributive shock after fluids 3. Hemodynamically significant hypotension 4. Symptomatic bradycardia (second line drug)

Sodium Bicarbonate: Indications

1. Cardiopulmonary arrest with: a. unsucessful drug therapy and defibrillation b. suspected hyperkalemia (elevated potassium in dialysis patients. 2. Crush Syndrome or crush injury greater than 4 hours. 3. Suspected TCA overdose (acidosis) with cardiac dysrhythmias.

Dexamethasone: Indications

1. Cerebral edema 2. Spinal cord injury 3. Anaphylaxis 4. Status asthmaticus 5. COPD exacerbation 6. Severe Croup

Nitroglycerin: Indications

1. Chest pain of cardiac origin 2. Acute pulmonary edema

Thiamine: Indications

1. Coma associated with delirium tremens (DTs) or alcohol withdrawal prior to Dextrose 50% 2. Alcoholism or malnutrition 3. Coma of unknown origin

Calcium Chloride: Contraindications

1. Digitalis toxicity 2. Hypercalcemia 3. Ventricular fibrillation

Diazepam: Indications

1. Generalized seizure activity and status epilepticus 2. Sedation prior to cardioversion or pacing of a conscious patient 3. Acute anxiety 4. Muscle relaxer 5. Chemical restraint

Dexamethasone: Contraindications

1. Has no absolute contraindications in the emergency setting 2. Relative contraindications include: patients with active systemic infections or resting tuberculosis

Diazepam: Contraindications

1. Head injury/CNS Depression 2. Respiratory depression 3. Hypotension / depressed vital signs 4. Infants < 30 days old

Dopamine: Contraindications

1. Hypovolemia 2. Tachydysrhythmias 3. Hyperthermia

Oxygen: Indications

1. Increased oxygen demand 2. Hypoxemia or hypoxia 3. Respiratory insufficiency 4. Hypoperfusion state or trauma

Sodium Bicarbonate: Mechanism of Action

1. Increases blood pH by neutralizing excess buildup of acids. 2. Decreases precipitation of myoglobin in the renal tubules.

Acetylsalicylic Acid: Mechanism of Action

1. Inhibits aggregation (clumping) of platelets by blocking the formation of the substance thromboxane (A2); prolonging bleeding time 2. Provides analgesia by inhibiting prostaglandins and other substances that sensitize pain receptors (blocking of prostaglandins also accounts for the drug's anti-inflammatory effects). 3. Relieves fever by acting upon the hypothalamic heat regulating center

Mannitol: Mechanism of Action

1. Inhibits sodium and water absorption in the kidneys 2. Promotes fluid movement from the intracellular into the extracellular space 3. Dehydrates brain tissue to decrease ICP

Morphine Sulfate: Indications

1. Moderate to severe pain 2. Chest pain of suspected myocardial origin 3. Pulmonary Edema from CHF with or without chest pain 4. Burns

Calcium Chloride: Mechanism of Action

1. Necessary for the proper function of the nervous, muscular, skeletal, digestive and endocrine systems 2. Positive Inotropic activity increases the strength of the myocardial contractions 3. Increases ventricular automaticity

Dextrose 50%: Side Effects

1. Patients may complain of warmth, pain or burning at the injection site. 2. Dextrose can cause severe neurologic symptoms (Wernicke's encephalopathy or Korsakoff's psychosis) if patient is thiamine deficient.

Activated Charcoal: Contraindications

1. Patients with a compromised airway - need to minimize chance for aspiration or obstruction 2. Ingestion of Iron or multi-vitamins

Nitroglycerin: Mechanism of Action

1. Relaxes smooth muscles causing venous dilation 2. Reduces preload and afterload to the heart 3. Dilates the coronary arteries resulting in increased perfusion of the myocardium

Albuterol Sulfate: Mechanism of Action

1. Relaxes the smooth muscles of the respiratory tract dilating the bronchioles to decrease airway resistance. 2. Reduces mucus secretion and inhibits histamine release from mast cells - thus lessening the respiratory effects of an allergic reaction

Midazolam: Indications

1. Seizures 2. Premedication for synchronized cardioversion/TCP 3. One of the premeditations for RSI

Diazepam: Mechanism of Action

1. Suppresses the spread of seizure activity and raises the seizure threshold in the motor cortex 2. Sedative effects depress the CNS and reduce anxiety 3. Skeletal muscle relaxant 4. Induces amnesia

Acetylsalicylic Acid: Indications

1. Suspected MI 2. Thrombotic stroke 3. AFIB/AFLU

Dextrose 50%: Contraindications

1. There are no absolute contraindications to the IV administration of dextrose 50% in the emergency setting. 2. Relative contraindication: Use with caution in patients with increasing intracranial pressure as the added glucose may worsen the cerebral edema.

Glucagon: Mechanism of Action

1. elevates blood glucose level by converting stored liver glycogen into glucose 2. Increases heart rate and myocardial contractility and improves AV conduction in a manner similar to that produced by catecholamines

Activated Charcoal: Mechanism of Action

1.Binds (adsorbs) toxic substances inhibiting gastrointestinal absorption, leaving less toxic substance in body circulation. 2. Increases fecal elimination of drug/charcoal complex

Dextrose 50%: Indications

ALOC due to documented or suspected hypoglycemia

Activated Charcoal Classification

Adsorbent

Sodium Bicarbonate: Classification

Alkalinizing Agent

Midazolam: Classification

Amnesic Agent, Sedative/hypnotic, Anticonvulsant, Benzodiazepine, Tranquilizer, Anti-anxiety (anxiolytic)

Acetylsalicylic Acid: Classification

Analgesic Antipyretic Non-Steroidal Anti-Inflammatory Drug (NSAID) Platelet Aggregate Inhibitor

Diazepam: Classification

Anticonvulsant Benzodiazepine sedative-hypnotic anti-anxiety (anxiolytic)

Albuterol Sulfate: Indications

Bronchospasms/bronchoconstriction caused by: 1. Acute Asthma 4. COPD 2. Toxic Gas Inhalation/OD 5. Near Drowning 3. Allergic reaction 6. Pulmonary Edema

Dextrose 50%: Classification

Carbohydrate

Morphine Sulfate: Side Effects

Cardiovascular: bradycardia, hypotension, (rebound tachycardia/hypertension) Neurological: sedation, agitation, tremors/seizures, hallucinations Respiratory: depression, arrest Gastrointestinal: nausea/vomiting

Diazepam: Side Effects

Cardiovascular: bradycardia, hypotension, rebound tachycardia Neurological: dizziness, drowsiness, headache Respiratory: respiratory depression/arrest Gastrointestinal: nausea/vomiting

Midazolam: Side Effects

Cardiovascular: bradycardia, rebound tachycardia, hypotension Neurological: amnesia, drowsiness, agitation, ALOC Respiratory: respiratory depression or arrest Gastrointestinal: nausea/vomiting