emergengy mediation list pdf 2020

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20 EMERGENCY DRUGS LIST



[1]
ACTIVATED CHARCOAL


Activated Charcoal, Activated Carbon
[Basic / Intermediate / RN/ Paramedic]
Class: Absorbent
Actions: Absorbs toxins by binding to them to prevent GI absorption.
Indications: Adsorbent used in overdoses and poisonings, if emesis is not indicated.
Contraindication
                     s:
1. Acetaminophen [Tylenol] ingestion
2. Petroleum product ingestion
3. Corrosive (mineral acids, strong bases) ingestion
4. Alcohol (ethanol, methanol, isopropanol, ethylene glycol) ingestion
5. Lithium ingestion
6. Metals (iron, lead, mercury, etc.) ingestion
Side Effects: Vomiting, aspiration
Dosage: Adults: 50 gm PO
              Peds: 1 gm/kg PO, up to 50 gm
Supply: 25 gm bottles
Comments: 1. Activated Charcoal interferes with Ipecac and many antidotes.
                   2. Patient must be alert to avoid aspiration.
3. Shake vigorously before using.
[2]

Adenosine, (Adenocard)

[Paramedic]
Class: Antiarrhythmic
Actions: Slows conduction through the AV node.
Indications:
Unstable Narrow-QRS Tachycardia refractory to vagal maneuvers
1. Chest pain, systolic BP < 90, decreased LOC, or CHF
2. Rate  150/min. (adult),  220 (children)
3. Regular rhythm
4. QRS < 0.12 seconds
Contraindications:
Wide QRS (> 0.12 seconds) Tachycardia
Second or Third degree H.B.
Sick Sinus Syndrome
Hypersensitivity to the drug
Side Effects: Transient asystole, AV block, PVCs, hypotension
Dosage:
Adults:
Peds:
6 mg (2 ml) IV/IO over 1-2 sec.
If not effective after 2 min., administer 12 mg [4 ml] IV/IO.
Free-flowing IV. Use injection port closest to body. Follow with
a 10 ml IV flush from a separate syringe.
0.1 mg/kg IV/IO over 1-2 sec.
If not effective after 2 min., give 0.2 mg/kg. MAX dose: 12 mg.
Free-flowing IV. Use injection port closest to body. Follow with
a 5 ml IV flush from a separate syringe.
Supply: 6mg/2ml Prefilled syringe
             12mg/4ml Prefilled syringe
Comments:
1. Does not convert atrial flutter, atrial fibrillation, or ventricular
tachycardia. May cause temporary slowing.
2. Adenosine antagonized by Methylxanthines, such as caffine,
Theophylin. May require larger dose to treat.
3. Adenosine effects are potentiated by dipryidomole and will require
smaller doses to treat.
4. Presence of carbamazepine (Tegretol), may produce higher degrees
of HB. or may develop asystole (1%) and can last for 3 days.
[3]

ALBUTEROL

Albuterol, (Proventil, Ventolin)
[Intermediate / RN/ Paramedic]
   Class: Sympathomimetic (2 selective)
Actions: Bronchodilation
Indications: Asthma, Emphysema, COPD, Anaphylactic respiratory distress
Contraindications:
Avoid in the following unless symptoms are severe:
1. Chest pain
2. Pulse > 140/min. (adults) or > 180/min. (children)
3. Systolic BP > 180
Side Effects: Tachycardia, hypertension, arrhythmias, tremor, anxiety, headache
Dosage:
< 4 yrs old: nebulizer held under the face
 4 yrs old: nebulizer with mouth piece or face mask
Set oxygen at 6-10 LPM [until nebulizer mists]
May repeat every 10 minutes
Supply: Bottle of 0.083% solution contains 2.5 mg in 3 ml.
Comments: EMT-B’s may assist with use of patient’s own prescribed inhaler
[4]

AMIODARONE

Amiodarone
[Intermediate / RN/ Paramedic]
Class: Antiarrhythmic
Actions: Depresses automaticity of SA node. Slows conduction & increases
              refractoriness of the AV node. Increases Atrial & Ventricular
              refractoriness
Indications: Pulseless VF / VT, V-tach with pulse, Wide complex Tachycardia
Contraindications: None in the face of pulseless VF / VT
Side Effects: May produce vasodilation, hypotension, a prolonged QT interval, and a
                     negative inotropic effect
Dosage:
1. V-fib / Pulseless V-tach. 300 mg IV/IO may repeat once in 3 – 5 min.
   at 150 mg IV/IO. If pt converts administer drip at rate of 1mg/min
2. V-tach with pulse / Wide complex Tachycardia. 150 mg in 100 ml LR
   or NS. Rapid infusion of 15 mg/min over 10 min., may repeat 150mg
   rapid infusion in 10 min. If pt converts administer drip at rate of
   1mg/min
Supply: 150mg in 3 ml preload
             150mg in 3 ml vial
Comments:
Maintenance drip: May mix drip 150 mg in 100ml LR or NS and
administer at 45 gtts to give 1mg/min on Micro drip set.
Rapid Infusion: Mix in macro solu-set, or 150 mg in 100 ml LR or NS
and administer at 150 gtts/min. over 10 min. for 15 mg/min infusion.
(Approx. 37 gtts/15 sec.)
[5]

AMYL NITRITE

Amyl Nitrite
[Paramedic]
Class: Inhalant
Actions: Amyl Nitrate has affinity for cyanide ions; reacts with hemoglobin to form
              methemoglobin.
Indications: Cyanide or hydrocyanic poisoning
Contraindications:
        Side Effects: Headache
Dosage: Adults & Pediatric: Breathe Amyl Nitrate vapors for 30 seconds, then
              breathe Oxygen for 30 seconds repeat this procedure continuously
     Supply:
Comments: Protect yourself from exposure to cyanide sources. DO NOT BECOME
A VICTIM YOURSELF.
[6]

ACETYLSALICYLIC ACID

, Aspirin

Acetylsalicylic Acid , Aspirin
[Basic / Intermediate / RN / Paramedic]
Class: Analgesic, antipyretic
Actions: Blocks platelet aggregation
Indications: Chest pain suggestive of new AMI
Contraindications: Hypersensitivity, intolerance, Allergy
Side Effects: Urticaria, angioedema, bronchospasm, anaphylactic shock, nausea,
                     vomiting, heartburn, GI bleed and prolonged bleeding
Dosage: 4 chewable baby aspirin (81 mg each) PO
Supply: 81 mg tablets
Comments: Avoid in pediatric
[7]

ATIVAN (Lorazepam)

Ativan (Lorazepam)
[Paramedic]
Class: Tranquilizer, Anti-convulsant and Skeletal muscle relaxant.
Actions: Binds specifically to sites in the brain acting to inhibit the chaotic
              neurotransmission seen in seizures.
Indications: 1. Status seizures
                    2. As an amnesic / anxiolytic prior to cardioversion
                    3. Chemical restraint
Contraindications: Hypersensitivity to the drug, acute narrow-angle glaucoma
Side Effects:
1. Drowsiness, dizziness, fatigue and ataxia.
2. Most likely to produce respiratory depression in patients who have
taken other depressant drugs, especially alcohol and barbiturates, or
when given rapidly.
Dosage:
1. Generalized convulsive status epilepticus (GCSE)
1 Adult 0.5-2.0 mg IV/IO/IM Pediatric 0.1mg/kg IV/IO/IM
2. Cardioversion premedication Adult 0.5-2.0 mg IV/IO/IM
3. Chemical Restraint 0.5-2.0 mg IV/IO/IM slow push to a maximum
    dose of 4.0 mg. If given IM, do not dilute. Dilute 1 – 1 for IV/IO.
4. For pain management with MS, 0.5 -1 mg IV/IO/IM.
Supply: 2 mg/ml Carpuject / Vial
             2 mg/ml – 2 ml Vial
Comments:
1. Lorazepam’s advantage over Diazepam is that it is shorter acting and
   does not markedly suppress respirations as does Diazepam.
2. Consider rectal administration (if unable to administer IV) in seizing
children. Contact Medical Control hospital prior to doing so.
[8]

ATROPINE SULFATE

Atropine Sulfate
[Intermediate / RN / Paramedic]
Class: Parasympatholytic (anticholinergic)
Actions: Blocks acetylcholine receptors (decreases vagal tone thus increasing
              heart rate)
Indications:
1. Narrow-QRS (< 0.12 sec) Bradycardia with systolic BP < 90,
    decreased LOC, chest pain, or PVC’s
2. Asystole
3. Narrow-QRS (< 0.12 sec) PEA with rate < 60/min.
4. Severe organophosphate (insecticide) poisoning
Contraindications: 1. Wide-QRS ( 0.12 sec) Bradycardia in (adults only)
                             2. Glaucoma
Side Effects: Tachycardia, chest pain, blurred vision, headache, dry mouth, flushing,
                     urinary retention
Dosage:
Bradycardia: 0.5 mg IV/IO. Repeat in 5 min. if needed. Total Max dose
= 0.04mg/kg.
Asystole: 1 mg IV/IO or 2 mg ET. Repeat in 5 min. if needed. Max
Dose = 0.04 mg/kg
Children: 0.02 mg/kg IV/IO or 0.04 mg/kg ET (Avoid age < 1 month).
Repeat dose in 5 min. if the heart rate is < 80/min.
MINIMUM DOSE: 0.1 mg
MAXIMUM TOTAL DOSE (child): 1.0 mg
0.04 mg/kg
MAXIMUM TOTAL DOSE (adolescent): 2.0 mg 0.04 mg/kg
Organophosphate Poisoning: 1 – 2 mg IV, IO, IM repeated q. 20 to 30
min. until muscarinic symptoms disappear or atropine toxicity appears.
Supply: Prefilled syringe contains 1 mg (10 ml)
             Vial: 20 ml – 0.4 mg/ml
Comments:
1. Use cautiously in patients with chest pain
2. Severe organophosphate poisoning requires double doses if:
    Systolic BP < 90
    Decreased LOC
    Respiratory distress
    Excessive oral secretions
 Pulse < 60
[9]

ATROVENT (Ipratropium Bromide)

Atrovent (ipratropium Bromide)
[Intermediate / RN / Paramedic]
Class: Anticholinergic
              Actions: Inhibits interaction of acetylcholine at receptor sites of the bronchial
                             smooth muscle resulting in bronchial dilation.
         Indications: For Relief of Bronchospasms in those with COPD
Contraindications: Glaucoma,
        Side Effects: N/V, Dry mouth, cramps, anxiety, dizziness, H/A, cough , worsening of
                             Bronchospasms
              Dosage: Adult and pediatric 0.5 mg nebulized mixed with albuterol dose.
               Supply: 2.5 ml of solution per preloaded dose for nebulization
          Comments: Mix with Albuterol to form “Duoneb” – Administer once, all subsequent
                             Neb treatments are to be Albuterol. Duoneb will be second treatment
                             for pediatric patients if Albuterol treatment does not break asthma.
NOTE: Atrovent (meter dose inhaler, auto inhaler only) should not be
administered to individuals allergic to soya lecithin or related food
products, e.g. soya beans or peanuts. Current formulations of
NEBULIZED Atrovent do not contain these agents and can be
administered to individuals allergic to soya lecithin.
[10]

CALCIUM GLUCONATE

[ RN / Paramedic]
   Class: Membrane stabilizer and antidote
Actions: Calcium is the most common cation in the human body and
             the majority of the body stores are located in bone. It is
             critical in many different cellular processes and is essential
             for the functional integrity of muscle (skeletal, smooth and
             cardiac) and nervous tissues.
Indications: 1. As a membrane stabilizer in suspected hyperkalemia.
                     Reverses EKG changes pending correction of the
                     extracellular potassium concentration.
                  2. As a potential antidote in suspected calcium channel
                     blocker overdoses, hydrofluoric acid poisoning and
                     iatrogenic magnesium intoxication.
Contraindications: 1. Digoxin Poisoning.
                           2. Hypercalcemia
Side Effects: Rapid IV administration can cause bradycardia,
                  vasodilatation, hypotension, syncope and local burning.
Dosage: 10 – 20 mL calcium gluconate (0.2 – 0.3 mL/kg children) over
             10 – 20 minutes
Supply: 10 mL of 10% solution contains 93 mg (4.65 mEq) of
            calcium.
Comments:
 Administer slowly (no faster then 2.0 ml/min) and stop if
  the patient complains of pain.
 Inject using a small needle in large vein and do not mix
  with bicarbonate.
 Avoid use with patients who are on Digoxin since
  calcium can augment the positive inotropic and negative
  chronotropic effects of digitalis preparations.
 Suspect hyperkalemia in patient with wide complex
  arrhythmia or tall peaked T-waves and Hx of renal
failure.
[11]

CAPTOPRIL (Capoten)

Captopril (Capoten)
                    Class: Ace Inhibitor
[Paramedic]
Actions:
Prevents conversion of agiotensin I to agiotensin II, a potent
vasoconstrictor. Decreases peripheral arterial resistance so there is
reduced sodium and water retention and lowers blood pressure.
Onset occurs in 15-30 minutes. Persist for 6-12 hours.
Indications:
1. Flash pulmonary Edema
2. CHF
Contraindications:
1. Pts. Hypersensitive to the drug
2. Pts. Sensitive to any other ACE inhibitor
Precautions:
1. Use with caution in Pts. With impaired renal function
2. Pts. with serious auto-immune disease (Lupus, etc.)
3. Elderly may be more sensitive to drug’s hypotensive effects.
Side Effects:
1. May cause tachycardia, hypotension, angina.
2. Nausea, vomiting, abdominal pain.
3. Severe Reaction may be rash, swelling of tongue, angioedema
    of the face and extremities.
Dosage: 12.5 mg Sub lingual 1 time. (May dampen with small amount of sterile
              water or normal saline to help tablet to dissolve.)
Supplied: 12.5 mg white tab
[12]

DEXAMETHASONE (Decadron)

Dexamethasone (Decadron)
[ Paramedic]
   Class: Corticosteroid
Actions: Dexamethasone is a synthetic steroid that suppresses acute
             and chronic inflammation. In addition, it potentiates vaxcular
             smooth muscle relaxation by beta-adrenergic agonists and
             may alter airway hyperactivity.
Indications: Moderate to severe asthma/COPD.
                  Severe allergic reactions.
                  Croup
Precautions: May cause hypertension and hyperglycemia.
Dosage: Adult (>40): 10mg IV, IO, IM, PO.
           Pediatric (<40): 0.3mg/kg, up to 10 mg, IV, IO, IM, PO.
Comments: May cause nausea, vomiting, headache or dizziness
[THESE ALL IMERGENCY DRUGS ARE USE IN COMENELY AND MORE DRUGS ARE 
COMING SOON…
THANKS FOR READING]
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