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