Lucas Fire Department Protocols

Albuterol Actions

Predominantly beta-2 selective, causing relaxation of bronchial smooth muscle

Albuterol Therapeutic Effects

Bronchodilation

Albuterol Indications

Bronchospasm/ Asthma

Albuterol Contraindications

Known Allergy

Albuterol Route

SVN (Small Volume Nebulizer) / Updraft

Albuterol Special Notes

Monitor heart rate and EKG carefully. Discontinue treatment if any of the following occurs:
HR> 150bpm (or200bpm in a child)
Pt complains of chest pain
EKG reveals ectopy

Albuterol Side Effects

Tachycardia Nervousness Headache Nausea

Albuterol Adult Dose

5mg SVN updraft

Albuterol Pediatric Dose

2.5 SVN updraft

Adenosine Actions

Directly blocks re-entrant mechanism in the atria and AV node
Decreases AV conduction

Adenosine Therapeutic Effects

Converts SVT

Adenosine Indications

SVT, including WPW Wolf-Parkinson-White syndrome

Adenosine Contraindications

Known allergies
Sick-Sinus Syndrome
2
or 3
heart block

Adenosine Route

Rapid IVP

Adenosine Special Notes

Must be given very rapidly and as directly into the vein as possible
Repeat doses may be given in 2 minutes.
Will not convert A-fib or A-flutter
Use with caution in pt with severe reactive airway disease (asthma. COPD) as bronchospasm may result

Adenosine Side Effects

Brief Dyspnea
Chest Pressure
Nausea/Vomiting
Hypotension
Significant cardiac pauses

Adenosine Adult Dose

6mg-12mg rapid IVP

Adenosine Pediatric Dose

0.1mg/kg-0.2mg/kg rapid IVP

Amiodarone

Also known as Cordarone

Amiodarone Actions

Class III antiarrhythmic agent
prolongs the repolarization phase
increases the refractory period

Amiodarone Indications

V- Fib, V-tach, AFib (RVR)

Amiodarone Contraindications

Bradycardia and 2 or 3 degree heart block

Amiodarone Route

IV, IO

Amiodarone Side effects

interstitial lung disease
Pulmonary fibrosis
thyroid abnormalities

Amiodarone Adult dose

150mg-300mg

Amiodarone Pediatric dose

5mg/kg

Aspirin

also known as Salicylic Acid

Aspirin actions

inhibits platelet aggregation
also has anti-inflammatory effects

Aspirin Therapeutic effects

decreased platelet aggregation which may result in less intracoronary clot formation

Apsirin indications

chest pain felt to be cardiac in origin

Aspirin Contraindications

known allergy
history of recent GI bleed
history of recent hemorrhagic CVA
hemophilia

Aspirin route

PO (by mouth)

Aspirin side effects

possible increased bleeding

Aspirin adult dose

324mg

Aspirin pediatric dose

not used in the pediatric protocols

Atropine actions

anticholinergic agent, parasympatholytic, increases vagal tone

Atropine therapeutic effects

increases vagal tone resulting in increased HR
reverses anticholineterase poisoning from organophosphate insecticides

Atropine indications

bradycardia, organophosphate poisoning

Atropine contraindications

glaucoma pyloric, stenosis, prostatic hypertrophy

Atropine route

IV, IO, ETT

Atropine side effects

dry mouth, tachycardia, restlessness, tremor, blurred vision, palpations, dizziness, ataxia

Atropine adult dose

.5mg

Atropine pediatric dose

.02mg/kg minimum dose .1mg

Calcium chloride actions

calcium replacement

Calcium chloride indications

hyperkalemia, calcium channel blocker, overdose, arrhythmias

Calcium chloride contraindications

hypercalcemia, V-Fib, digoxin toxicity

Calcium chloride route

IV, IO

Calcium chloride side effects

tissue necrosis, flushing, vomiting, rapid push causes phlebitis

Calcium chloride adult dose

1 gram

Calcium chloride pediatric dose

20mg/kg

Dextrose actions

a cellular nutrient

Dextrose therapeutic effects

reverses hypoglycemia

Dextrose indications

hypoglycemia

Dextrose contraindications

suspected CVA

Dextrose route

IV, IO (diluted)

Dextrose side effects

phlebitis at injection site, hyperglycemia, tissue necrosis if extravasation occurs

Dextrose adult dose

25g D50

Dextrose pediatric dose

.5g/kg D25 or D10

Benadryl

also known as diphenhydramine

Benadryl actions

antihistamine, blocks histamine receptors

Benadryl indications

allergic reactions/anaphylaxis, motion sickness, extrapyramidal symptoms

Benadryl contraindications

caution if EtOH intoxication

Benadryl route

IV, IM

Benadryl side effects

sedation, dry mouth, dizziness, hypotension

Benadryl adult dose

50mg

Benadryl pediatric dose

1mg/kg

Epinephrine Actions

Direct stimulation of cardiac muscle
Increases strength and rate of contraction
Bronchodilation
Prevents release of histamine

Epinephrine Indications

Pulseless Arrythmias
Bradycardia Anaphylaxis
Asthma/Bronchospasm

Epinephrine Contraindications

NONE

Epinephrine Route

IV
IO
ETT
IM

Epinephrine Side Effects

Tachydysrythmias
Hypertension
Ectopic beats on EKG
Anxiety

Epinephrine Adult Dose

1mg IV/IO (1:10,000-Cardiac)
0.3 mg IM (1:1,000) - Allergic Reaction)

Epinephrine Pediatri8c Dose

0.01mg/kg (1:10,000-cardiac)
0.01mg/kg IM (1-1,000-allergic reaction)

Etomidate Actions

Depresses brain stem reticular formation activity
Hypnosis
GABA-Like Effects

Etomidate Indications

Sedation for intubation[ (PAI)

Etomidate Contraindications

Adrenal Insufficiency

Etomidate Route

IV
IO

Etomidate Side Effects

Burning at injections site
Tonic movements
Bradypnea
Amnesia

Etomidate Adult Dose

20 mg IV/IO

Etomidate Pediatric Dose

0.3mg/kg IV/IO

Fentanyl Actions

Schedule II Narcotic
Alters Pain perception by binding to opiate receptors
CNS depressant

Fentanyl Indications

Pain Control
May be used in conjunction with sedation post intubation

Fentanyl Contraindications

Myasthenia gravis
Caution if on other narcotics

Fentanyl Route

IV/IO
M.A.D.

Fentanyl Side Effects

Respiratory depression sedation
UNDERDOSE-can cause respiratory arrest which is treated with additional Fentanyl dosing

Fentanyl Adult Dose

1mcg/kg IV/IO/M.A.D.

Fentanyl Pediatric Dose

1mcg/kg IV/IO/M.A.D.

Glucagon Actions

Raises blood glucose levels by causing liver to
convert stored glycogen into glucose
Counteracts ?-blocker overdose

Glucagon Indications

Hypoglycemia

Glucagon Contraindications

Insulinoma tumor patient

Glucagon Route

IM
M.A.D.

Glucagon Side effects

Headache
Nausea
Vomiting

Glucagon Adult Dose

1mg IM/M.A.D.

Glucagon Pediatric Dose

Not used in pediatric protocols

Haldol Actions

Selective dopamine receptor antagonist
Antipsychotic

Haldol Indications

Violent patient in need of chemical restraint

Haldol Contraindication

Widened QRS
Prolonged QT

Haldol Side Effects

Dystonic reaction
Hypotension
Lower seizure threshold

Haldol Adult Dose

5mg M.A.D.

Haldol Pediatric Dose

Not Used in Pediatric Protocols

Hydrocortisone Actions

Glucocorticoid steroid
Mineralocorticoid steroid
Anti-inflammatory

Hydrocortisone Indications

Adrenal Crisis
Other Steroid dependent
conditions
Asthma/Croup/COPD
Allergic Reactions

Hydrocortisone Contraindications

Caution with Diabetes
Caution with fungal
infections

Hydrocortisone Route

IV/IM

Hydrocortisone Side Effects

Immunosuppression
GI bleeding
HTN
Hyperglycemia

Hydrocortisone Adult Dose

100mg IV/IM

Hydrocortisone Pediatric Dose

2mg/kg IV/IM

Lidocaine Actions

Antiarrhythmic agent Shortens
the refractory period
Suppresses ectopic foci

lidocaine Indications

Ventricular dysrhythmias
Decrease intracranial pressure during intubation
Provide anesthesia for flushing IO

Lidocaine Contraindications

All forms of AV block
Wolff-Parkinson-White
Bradycardia

Lidocaine Route

IV
IO
ETT

Lidocaine Side Effects

Seizures Hypotension
Aggravation of dysrhythmia
Respiratory depression

Lidocaine Adult Dose

1mg/kg IV/IO

Lidocaine Pediatric Dose

1mg/kg IV/IO

Magnesium Sulfate Actions

Antiarrhythmic
Smooth muscle relaxation
Bronchodilation

Magnesium Sulfate Indications

Asthma / Bronchospasm Torsades des
Pointes
Refractory Ventricular Fibrillation/Tachycardia
Eclampsia

Magnesium Sulfate Contraindications

Heart block

Magnesium Sulfate Route

IV/IO

Magnesium Sulfate Side Effects

Depressed reflexes
Drowsiness
Vision changes
Hypothermia

Magnesium Sulfate Adult Dose:

1g IVPB (Respiratory Depression)
2g IV (Eclamptic Seizure)
2g IV (Suspected Torsades de Pointes)

Magnesium Sulfate Pediatric Dose

25mg/kg IVPB (Respiratory Depression)

Morphine Actions

Schedule II Narcotic
Binds to opioid receptors producing
analgesia and sedation
Mild vasodilator

Morphine Indications

Pain control
Chest pain / STEMI / Angina
Congestive Heart Failure

Morphine Contraindications

Respiratory depression
CNS depression

Morphine Route

IV
IO

Morphine Side Effects

Respiratory depression
Hypotension
Sedation Disorientation

Morphine Adult Dose

2mg IV/IO

Morphine Pediatric Dose

Not in Pediatric Protocols

Narcan Actions

Synthetic narcotic antagonist

Narcan Indications

Reverses the effects of known or suspected
narcotic toxicity

Narcan Contraindications

None

Narcan Route

IV IO
M.A.D.
IM
ETT

Narcan Effects

Nausea Vomiting Seizures
Abrupt withdrawal syndrome

Narcan Adult Dose

0.4mg IV/IO/M.A.D./IM

Narcan Pediatric Dose

0.01mg/kg IV/IO/M.A.D./IM

Nitroglycerine Actions

Vasodilatation of arteries and veins
Relaxation of vascular smooth muscle
Reducing blood pressure
Reduces left ventricular pressure
Decreases workload on the heart

Nitroglycerine Indications

Chest pain / Angina / STEMI
Acute angina
Congestive heart failure

Nitroglycerine Contraindications

Hypotension ( <90mmHg systolic)
Patients who have taken Viagra, Levitra, or Cialis
in the last 24 hours

Nitroglycerine Route

SL

Nitroglycerine Side Effects

Headache
Hypotension
Skin flushing

Nitroglycerine Adult Dose

0.4mg SL

Nitroglycerine Pediatric Dose

Not used in pediatric protocols

Succinylcholine Actions

Depolarizing neuromuscular
blocker
Paralyzes patient
Lasts about 5 minutes

Succinylcholine Indications

Rapid Sequence Intubation

Succinylcholine Contraindications

Kidney Disease
Adrenal Disease
History/Family history of malignant
hyperthermia
Major trauma or burns
Paralysis
Prolonged immobility
Any non-intubated patient
Any patient you don't think you can
intubate or ventilate

Succinylcholine Route

IV/IO/IM

Succinylcholine Side Effects

Paralysis
Apnea
Hyperkalemia

Succinylcholine Adult Dose

100mg

Succinylcholine Pediatric Dose

1.5mg/kg IV/IO

Vecuronium Actions

Non-depolarizing
neuromuscular blocker
Paralyzes patient
Lasts 30-60 minutes

Vecuronium Indications

Rapid sequence intubation
Paralysis post intubation

Vecuronium Contraindications

Any non-intubated patient
Any patient you don't think
you can intubate or ventilate

Vecuronium Route

IV/IO

Vecuronium Side Effects

Paralysis
Apnea

Vecuronium Adult Dose

10mg IV

Vecuronium Pediatric Dose

0.1 mg/kg IV

Versed Actions

Benzodiazepine
Anticonvulsant
Enhances GABA effects

Versed Indications

Intubation (PAI)
Post-Intubation sedation
Chemical restraint/sedation
Seizure
Sedation to assist procedures

Versed Contraindications

Neonates
Premature infants

Versed Route

IV IO
M.A.D.

Versed Side Effects

Respiratory depression
Syncope
Amnesia Nausea
Vomiting

Versed Adult Dose

5mg IV/IO
0.1mg/kg IV/IO
5mg M.A.D.
2mg IV/IO
(PAI)
(Post-Intubation)
(Psychiatric sedation)
(Cardiac sedation)

Versed Pediatric Dose

0.1mg/kg IV/IO
0.1mg/kg IV/IO
2.5mg M.A.D.
0.1mg/kg IV/IO
(PAI)
(Post-Intubation)
(Psychiatric sedation)
(Cardiac sedation)

Zofran Actions

Selective serotonin receptor antagonist

Zofran Indications

Prevention or treatment of nausea or vomiting

Zofran Contraindications

Congenital long-QT syndrome

Zofran Route

IV
IM
ODT

Zofran Side Effects

Headache
QT prolongation
Extrapyramidal symptoms
Diarrhea

Zofran Adult Dose

8mg ODT
4mg IV/IM

Zofran Pediatric Dose

4mg ODT
0.1mg/kg IV/IM