ACETAMINOPHEN (TYLENOL) Indications
• Mild pain, moderate, or severe pain. Consider IV administration for moderate or severe pain.
Acetaminophen (Tylenol) onset and duration
Onset of analgesia: oral 20-30 minutes; IV within 5 minutes • Peak effect: 1 hour • Duration: 4 hours
Acetaminophen Contraindications
• History of allergy to acetaminophen • Chronic liver disease • Therapeutic dose of acetaminophen within past 6 hours or greater than 3 gm in last 24 hours.
Acetaminophen drug interactions
Avoid concomitant administration with other acetaminophen-containing medication, such as many prescription opioids (e.g. Percocet) or OTC cough and cold medications.
Acetaminophen dose
1000mg PO or 1000 mg IV infused over 15 minutes
ADENOSINE (ADENOCARD) onset and duration
Onset: almost immediate • Duration: 10 sec
Adenosine indications
Narrow-complex supraventricular tachyarrhythmia after obtaining 12 lead ECG (This may be the only documented copy of the AVRNT rhythm) • Pediatric administration requires call in for direct verbal order
Adenosine contraindications
• Any irregular tachycardia. Specifically never administer to an irregular wide-complex tachycardia, which may be lethal • Heart transplant
Adenosine adverse reactions
• Chest pain • Shortness of breath • Diaphoresis • Palpitations • Lightheadedness
Adenosine drug interactions
Methylxanthines (e.g. caffeine) antagonize adenosine, a higher dose may be required • Dipyridamole (persantine) potentiates the effect of adenosine; reduction of adenosine dose may be required • Carbamazepine may potentiate the AV-nodal blocking effect of adenosine
Adenosine dose adults
12 mg IV bolus, rapidly, followed by a normal saline flush. Additional dose of 12 mg IV bolus, rapidly, followed by a normal saline flush. Contact medical control for further considerations
Adenosine dose peds
Children who are stable with AVNRT generally remain so and transport is preferred over intervention. CONTACT BASE 0.1 mg/kg IV bolus (max 6 mg), rapidly followed by normal saline flush. Additional dose of 0.2 mg/kg (max 12 mg) rapid IV bolus, followed by normal saline flush.
ALBUTEROL SULFATE (PROVENTIL, VENTOLIN) onset and duration
• Onset: 5-15 minutes after inhalation• Duration: 3-4 hours after inhalation
Albuterol indications
• Bronchospasm • Known or suspected hyperkalemia with ECG changes (i.e.: peaked T waves, QRS widening) • Crush or suspension injury with suspected hyperkalemia
Albuterol contraindications
• Severe tachycardia is a relative contraindication
Albuterol Adverse Reactions
• Tachycardia • Palpitations • Dysrhythmias
albuterol drug interactions
• Sympathomimetics may exacerbate adverse cardiovascular effects. • ß-blockers may antagonize albuterol.
albuterol how supplied
MDI: 90 mcg/metered spray (17-g canister with 200 inhalations) Pre-diluted nebulized solution: 2.5 mg in 3 ml NS (0.083%)
albuterol Dosage and Administration
Adult and Pediatric: Single Neb dose Albuterol sulfate solution 0.083% (one unit dose bottle of 3.0 ml), by nebulizer, at a flow rate (6-8 lpm) that will deliver the solution over 5 to 15 minutes. May be repeated twice (total of 3 doses). Continuous Neb dose In more severe cases, place 3 premixed containers of albuterol (2.5 mg/3ml) for a total dose of 7.5 mg in 9 ml, into an oxygen-powered nebulizer and run a continuous neb at 6-8 lpm.
AMIODARONE (CORDARONE) indications
• Pulseless arrest in patients with shock-refractory or recurrent VF/VT • Wide complex tachycardia not requiring immediate cardioversion due to hemodynamic instability
Amiodarone Precautions
Wide complex irregular tachycardia • Sympathomimetic toxidromes, i.e. cocaine or amphetamine overdose • NOT to be used to treat ventricular escape beats or accelerated idioventricular rhythms
Amiodarone Contraindications
2nd or 3rd degree AV block • Cardiogenic shock
Amiodarone adverse reactions
hypotension bradycardia
amiodarone adult dose
Pulseless Arrest (Refractory VT/VF): 300 mg IV bolus. Administer additional 150 mg IV bolus in 3-5 minutes if shock refractory or recurrent VF/VT. Symptomatic VT and undifferentiated wide complex tachycardia with a pulse: CONTACT BASE 150 mg IV bolus infusion over 10 minutes.
ANTIEMETICS: ONDANSETRON (ZOFRAN), PROMETHAZINE (PHENERGAN), METOCLOPRAMIDE (REGLAN) indications
nausea and vomiting
Odansetron (Zofran) contraindications
Very low rate of adverse effects, very well tolerated.
Promethazine contraindications
Hypotension, CNS depression, altered mental status, pain on injection, including tissue necrosis with extravasation, extrapyramidal symptoms, urinary retention
Metoclopramide contraindications
Restlessness, agitation, extrapyramidal symptoms, sedation. Increased GI motility - do not use if suspected bowel obstruction.
Odansetron adult dose
4 mg IV/IM/PO/ODT. May repeat x 1 dose as needed.
Odansetron Pediatric ≥ 4 years old dose:
4 mg IV/PO/ODT
Odansetron Pediatric 6 months to 4 years old:
2 mg IV/PO/ODT
Odansetron Pediatric < 6 months:
BASE CONTACT
Promethazine ADULT DOSE
12.5 mg IV/IM. May repeat x 1 dose as needed
Promethazine Pediatric 2-12 years old:
1 mg/kg IV/IM to a maximum single dose of 12.5 mg
Metoclopramide adult dose
10mg IV/IM
Metoclopramide peds dose
5mg iv/im
Aspirin indications
• Suspected acute coronary syndrome
Asprin Contraindications
Active gastrointestinal bleeding • Aspirin allergy
Aspirin how supplied
Chewable tablets 81mg
Aspirin dose
324mg
atropine indications
Symptomatic bradycardia • 2nd and 3rd degree heart block • Organophosphate poisoning
Atropine Precautions
Should not be used without medical control direction for stable bradycardias • Closed angle glaucoma
atropine Adverse Reactions
Anticholinergic toxidrome in overdose, think "blind as a bat, mad as a hatter, dry as a bone, red as a beet
Atropine adult dose Hemodynamically Unstable Bradycardia Adult:
0.5 mg IV/IO bolus. Repeat if needed at 3-5 minute intervals to a maximum dose of 3 mg. (Stop at ventricular rate which provides adequate mentation and blood pressure)
Atropine PEDS dose hemodynamically unstable bradycardia
Pediatric: 0.02 mg/kg IV/IO bolus. Minimum dose is 0.1 mg, maximum single dose 0.5 mg
Atropine poisonings/overdose doses ADULT
40kg and up: 2mg IV/IM for signs of moderate/severe toxicity. Contact base for additional doses.
Atropine poisonings/overdose doses peds
Under 40kg: 0.02mg/kg IV/IM moderate to severe toxicity. Minimum dose is 0.1 mg. Contact base for additional doses.
BENZODIAZEPINES onset and duration
Any agent given IV will have the fastest onset of action, typical time of onset 2-3 minutes. Intranasal administration has slower onset and is less predictable compared to IV administration, however, it may still be preferred if an IV cannot be safely or rapidly obtained. Intranasal route has faster onset compared to intramuscular route. Diazepam should not be given intranasally as it is not well absorbed. IM administration has the slowest time of onset.
Indications for benzos
Status epilepticus, Sedation of the severely agitated/combative patient, Hyperactive delirium with severe agitation, Sedation for cardioversion or transcutaneous pacing (TCP) Adjunctive agent for treatment of severe pain(WITH CALLIN ONLY)
Contra Indications for Benzos
Respiratory Depression and hypotension
Benzos adverse reactions
Respiratory depression, including apnea. Hypotension Consider ½ dosing in the elderly for all benzodiazepines
Midazolam (Versed) IV/IO Seizure/Pacing sedation dose ADULT
2mg(Dose may be repeated x 1 after 5 minutes if still seizing. Contact Base for more than 2 doses.)
Midazolam (Versed) IM/IN Seizure/Pacing sedation dose ADULT
5MG(Dose may be repeated x 1 after 5 minutes if still seizing. Contact Base for more than 2 doses.)
Midazolam (Versed) IV/IO Seizure/Pacing sedation dose PEDS
IV/IO route 0.1 mg/kg(Maximum single dose is 2 mg IV. Dose may be repeated x 1 after 5 minutes if still seizing. Contact Base for more than 2 doses)
Midazolam (Versed) IM/IN Seizure/Pacing sedation dose PEDS
IM/IN 0.2mg/kg (Maximum single dose is 5 mg IN or IM. Dose may be repeated x 1 after 5 minutes if still seizing. Contact Base for more than 2 doses)
versed severely agitated adult doses
IV 2mg. Im 5mg
peds severly agitated adult doses
Contact Base before any consideration of sedation of severely agitated/combative child.
Hyperactive delirium with severe agitation
IM route: 10 mg. Contact Base for additional sedation orders.
DIAZEPAM seizure or sedation adult dose
IV/IO 5mg (Dose may be repeated x 1 after 5 minutes. Contact Base for additional sedation orders.)
pediatric diazepam dose for seizures/sedation
Contact Base before any consideration of sedation of severely agitated/combative child.
peds diazepam dose
Neonate: Not indicated. Neonate to <5 years: 0.5 mg, dose may be repeated x 1 after 5 minutes if still seizing. Contact Base for more than 2 doses. 5 to 12 years: 1 mg, dose may be repeated x 1 after 5 minutes if still seizing. Contact Base for more than 2 doses.
Sedation of severely agitated or combative patient diazepam dose
5mg IV for adults. peds contact base
lorazepam seizure dose adults
2mg iv/im/io. Can repeat after 5 minutes 1x if still seizing. Contact base after
Lorazepam seizure dose
.1mg/kg max single dose 2mg. May give 2x times. Contact base for more
lorazepam for shocking or pacing
1mg IV/IO IM is 2mg
Sedation of severely agitated or combative patient lorazepam
IV/IM 2mg
Calcium indications(Denver metro)
Adult pulseless arrest associated with any of the following clinical conditions: Known or suspected hyperkalemia, Renal failure with or without hemodialysis history, Calcium channel blocker overdose, Not indicated for routine treatment of pulseless arrest. Renal failure with known or suspected hyperkalemia. Crush or suspension injury with known or suspected hyperkalemia. Calcium channel blocker overdose with hypotension and bradycardia
Calcium Contraindications(Denver metro)
• Known or suspected hypercalcemia • Known or suspected digoxin toxicity (i.e. digoxin overdose)
Calcium Gluconate 10% Solution pulseless arrest assumed due to hyperkalemia calcium dose adult
3 gm (30 mL) slow IV/IO push.
Calcium Gluconate 10% Solution Renal Failure with known or suspected hyperkalemia Crush or suspension injury with known or suspected hyperkalemia calcium dose adult
3 gm (30 mL) IV/IO over 5 minutes
Calcium Gluconate 10% Solution Calcium channel blocker overdose with hypotension and bradycardia calcium adult dose
Contact Base for order. 3 gm (30 mL) IV/IO over 5 minutes. Dose may be repeated every 5 minutes for total of 3 doses.
Calcium Gluconate 10% Solution Calcium channel blocker overdose with hypotension for age and bradycardia pediatric
Contact Base for order. 60 mg/kg (0.6 mL/kg), not to exceed 1 g, IV/IO over 5 minutes. May repeat every 5 minutes for total of 3 doses.
Calcium Chloride 10% Solution Pulseless arrest assumed due to hyperkalemia adult dose
1 g (10 mL) slow IV/IO push
Calcium Chloride 10% Solution Renal failure with known or suspected hyperkalemia Crush or suspension injury with known or suspected hyperkalemia
1 gm (10 mL) IV/IO over 5 minutes.
Calcium Chloride 10% Solution Calcium channel blocker overdose with hypotension and bradycardia
Contact Base for order. 1 g (10 mL) IV/IO over 5 minutes. Dose may be repeated every 5 minutes for total of 3 doses
Calcium Chloride 10% Solution Calcium channel blocker overdose with hypotension for age and bradycardia PEDIATRIC
Contact Base for order. 20 mg/kg (0.2 mL/kg), not to exceed 1 g, IV/IO over 5 minutes. May repeat every 5 minutes for total of 3 doses.
DEXTROSE indications
Hypoglycemia . The unconscious or altered mental status patient with an unknown etiology.
dextrose percations
none
dextrose adult dose
25 gm (250 mL of a 10% solution) IV/IO infusion Alternative: 25 gm (50 mL of a 50% solution) IV/IO bolus
dextorse pediatric dose
<50 kg administer 5 mL/kg of 10% solution (maximum of 250 mL)
DIPHENHYDRAMINE indications
Allergic reaction • Dystonic medication reactions or akathisia (agitation or restlessness)
DIPHENHYDRAMINE
Asthma or COPD, thickens bronchial secretions. Narrow-angle glaucoma. Patients over 65 years old are at greater risks of serious side effects including confusion, urinary retention, and diizziness that could lead to fall risk. For these reasons, half dosing is recommended.
DIPHENHYDRAMINE side effects
Drowsiness • Dilated pupils • Dry mouth and throat • Flushing
diphenhydramine drug interactions
CNS depressants and alcohol may have additive effects. MAO inhibitors may prolong and intensify anticholinergic effects of antihistamines.
diphenhydramine dose adult
50 mg IV/IO/IM. For patients over 65 years old, administer half-dose of 25 mg IV/IO/IM.
diphenhydramine dose pediatric
1 mg/kg slow IV/IO/IM (not to exceed 50 mg)
DROPERIDOL indications
Primary use for management of agitated/combative patients. Hyperactive delirium with severe agitation. Second line medication for management of intractable vomiting. Combative head injured patients
Droperidol Contraindications
Suspected acute myocardial infarction/ACS • Systolic blood pressure under 100 mm/Hg, or the absence of a palpable radial pulse • Signs of respiratory depression
droperidol side effects
Due to the vasodilation effect, droperidol can cause a transient hypotension that is usually self-limiting and can be treated effectively with leg elevated position and IV fluids. Droperidol may cause tachycardia which usually does not require pharmacologic intervention. • Some patients may experience unpleasant sensations manifested as restlessness, hyperactivity, or anxiety following droperidol administration. This is called akathisia and is treated with diphenhydramine. • Extra-pyramidal reactions have been noted hours to days after treatment. • Rare instances of neuroleptic malignant syndrome have been known to occur following treatment using droperidol.
Adult droperidol dose(agitation)
5 mg slow IV or IM administration. Dose may be repeated x1 after 5 minutes. CONTACT BASE for additional sedation orders.
pediatric droperidol dose
less than 12 years old contact base
Hyperactive Delirium with Severe Agitation droperidol dose
10mg im
Antiemetic droperidol dose
1.25mg
DuoDote Indications
Suspected nerve agent exposure accompanied with signs and symptoms of nerve agent poisoning
DuoDote IM sites
butt or outer thigh
Epinephrine indications
Pulseless Arrest, Anaphylaxis, Asthma, Bradycardia with poor perfusion
epinephrine adverse reactions
Tachycardia and tachydysrhythmia, Hypertension, Anxiety, May precipitate angina pectoris
epinephrine Drug Interactions
Should not be added to sodium bicarbonate or other alkaloids as epinephrine will be inactivated at higher pH.
epi adult pulseless arrest dose
1 mg (10 ml of a 1:10,000 solution), IV/IO bolus. Repeat every 3-5 minutes up to maximum of 3 doses. Additional dose may be considered for recurrent arrest after ROSC or narrow complex PEA.
adult wheezing epi dose
0.3 mg (0.3 ml of a 1:1,000 solution) IM. May repeat dose x 1.
adult systemic allergic reaction dose
0.3 mg (0.3 ml of a 1:1,000 solution) IM. May repeat dose x 1
ALTERNATIVE to racemic epinephrine: (for stridor at rest) adult
5 mL of 1:1,000 epinephrine via nebulizer x 1
pediatric pulseless arrest epi dose
0.01 mg/kg IV/IO (0.1 ml/kg of 1:10,000 solution). Subsequent doses repeated every 3-5min: 0.01 mg/kg IV/IO (0.1 ml/kg of 1:10,000 solution)
peds bradicarida epi dose(base contact)
0.01 mg/kg (0.1 ml/kg of 1:10,000 solution) IV/IO
Pediatric Wheezing 1 to 12 years old epi dose
0.01 mg/kg (0.01 ml/kg of 1:1,000 solution) IM. May repeat dose x 1 after 20 minutes. Alternative: 0.15 mg (0.15 mL of 1:1,000) for <25 kg and 0.3 mg (0.3 mL of 1:1,000) for >25 kg. May repeat dose x 1 after 20 minutes.
Moderate to Severe Allergic Reactions 4 months to 12 years peds epi dose
0.01 mg/kg (0.01 ml/kg of 1:1,000 solution) IM. May repeat dose x 1 after 5 minutes. Alternative: 0.15 mg (0.15 mL of 1:1,000) for <25 kg and 0.3 mg (0.3 mL of 1:1,000) for >25 kg. May repeat dose x 1 after 5 minutes.
Moderate to Severe Allergic Reactions term to 4 months epi dose
0.01 mg/kg (0.01 ml/kg of 1:1,000 solution) IM. May repeat dose x 1 after 5 minutes. Alternative: 0.1 mg (0.1 mL of 1:1,000) May repeat dose x 1 after 5 minutes
Severe systemic allergic reaction (Anaphylaxis) refractory to IM epi (Contact Base): peds base
0.01 mg/kg (0.1 ml/kg of 1:10,000 solution) IV/IO
ALTERNATIVE to racemic epinephrine: (for stridor at rest) peds epi dose
5 mL of 1:1,000 epinephrine via nebulizer x 1
HALOPERIDOL (HALDOL) onset and duration
Onset: Within 10 minutes after IM administration. Peak effect within 30 minutes • Duration: 2-4 hours (may be longer in some individuals)
HALOPERIDOL (HALDOL) indications
Sedation of a severely agitated and/or combative patient
HALOPERIDOL (HALDOL) Contraindications
Suspected myocardial infarction, Hypotension, Respiratory or CNS depression, Pregnancy
HALOPERIDOL (HALDOL) adult dose
5 mg IM. Dose may be repeated x1 after 5 minutes. CONTACT BASE for additional sedation orders
HALOPERIDOL (HALDOL) peds dose
Ages 6-12: 2 mg IM
HYDROXOCOBALAMIN (CYANOKIT®) indications
Adult or pediatric patient with suspected cyanide poisoning from any route, including smoke inhalation in an enclosed space, with any of the following clinical signs: o Pulseless arrest o Coma/unresponsiveness o Signs of shock
HYDROXOCOBALAMIN (CYANOKIT®) adverse reactions
Hypertension and Allergic reaction/anaphylaxis
HYDROXOCOBALAMIN (CYANOKIT®) adult dose
5gm IV/IO
HYDROXOCOBALAMIN (CYANOKIT®) peds dose
70 mg/kg up to 5 gm IV/IO
IPRATROPIUM BROMIDE (ATROVENT) Onset & Duration
Onset: 5-15 minutes. • Duration: 6-8 hours
IPRATROPIUM BROMIDE (ATROVENT) indications
bronchospasm
IPRATROPIUM BROMIDE (ATROVENT) Contraindications
Soy or peanut allergy is a contraindication to the use of Atrovent metered dose inhaler, not the nebulized solution, which does not have the allergen contained in propellant.
IPRATROPIUM BROMIDE (ATROVENT) adverse reactions
• Palpitations • Tremors • Dry mouth
IPRATROPIUM BROMIDE (ATROVENT) how supplied
Premixed Container: 0.5 mg in 2.5ml NS
IPRATROPIUM BROMIDE (ATROVENT) dose bronchospasm adult
0.5 mg along with albuterol in a nebulizer
IPRATROPIUM BROMIDE (ATROVENT) bronchospasm 2-12 dose
0.5 mg along with albuterol in a nebulizer
IPRATROPIUM BROMIDE (ATROVENT) bronchospasm 1-2 dose
0.25 mg along with albuterol in a nebulizer Not indicated for repetitive dose or continuous neb use
lidocane 2% indications
Analgesic for intraosseous infusion
lidocane 2% side effects
Seizures, Drowsiness, Tachycardia, Bradycardia, Confusion, Hypotension
lidocane 2% precautions
Lidocaine is metabolized in the liver. Elderly patients and those with liver disease or poor liver perfusion secondary to shock or congestive heart failure are more likely to experience side effects
lidocane 2% dose
50mg IO slow push
indications for MAGNESIUM SULFATE
Torsade de pointes associated with prolonged QT interval Respiratory. Severe bronchospasm unresponsive to continuous albuterol, ipratropium, and IM epinephrine. Obstetrics Eclampsia, Pregnancy ≥20 weeks gestational age or up to 6 weeks post-partum with seizures
MAGNESIUM SULFATE precautions
Bradycardia, Hypotension, Respiratory depression
MAGNESIUM SULFATE Adverse Reactions
Bradycardia, Hypotension, Respiratory depression
magnesium Torsades de Pointes suspected caused by prolonged QT interval dose
2 gm, IV/IO bolus.
magnesium Refractory Severe Bronchospasm: Adult: dose
2 gm, IV bolus, over 3-4 minutes
magnesium eclampsia dose
2 gm IV/IO over 2 minutes, then mix 4 gm diluted in 50 ml of normal saline (0.9 NS), IV/IO drip over 15 minutes
solu-medrol indications
Anaphylaxis, Severe asthma, COPD, Suspected Addisonian crisis (cardiovascular collapse in patient at risk for adrenal insufficiency)
Solu-Medrol Contraindications
Evidence of active GI bleed
solu-medrol adverse reactions
Most adverse reactions are a result of long-term therapy and include: Gastrointestinal bleeding, Hypertension, Hyperglycemia
adult solu-medrol dose
125 mg, IV/IO bolus, slowly, over 2 minutes
pediatric solu-medrol dose
2 mg/kg, IV/IO bolus, slowly, over 2 minutes to max dose of 125 mg
types of NSAIDS(DM)
IBUPROFEN (ADVIL, MOTRIN) and ketorolac (torodol)
NSAIDS onset and durations
Onset of analgesia: oral 30-60 minutes, IV within 5 minutes. Peak effect: 1 hour. Duration: 4 hours
nsaid indication
Acute treatment of mild, moderate, or severe pain. Consider IV ketorolac for moderate to severe pain. Pain due to suspected kidney stones, acute exacerbations of chronic pain, musculoskeletal pain
nsaid contraindications
Allergy to NSAIDs including aspirin and naproxen (Naprosyn, Aleve). Pregnancy or breast feeding. History of GI bleeding or active stomach ulcer. History of chronic kidney disease or kidney transplant. Anticoagulation/antiplatelet (patient taking blood thinners) or history of a blood clotting disorder. In setting of multisystem trauma. Acute head trauma or suspected intracranial bleed. Ketorolac is contraindicated for ages less than 12-years-old and over 65-years-old. Severe dehydrationnsaid
nsaid adverse reactions
Allergic reactions: anaphylaxis, urticaria, angioedema, bronchospasm, rash, hypotension, etc. Nausea and vomiting. GI bleeding with chronic use. Acute kidney injury
nsaids Drug Interactions
Avoid concomitant administration with other NSAIDS or anticoagulant/antiplatelet medications such as apixaban (Eliquis), aspirin, dabigatran (Pradaxa), enoxaparin (Lovenox), heparin, rivaroxaban (Xarelto), warfarin (Coumadin).
Ibuprofen adult dose
600 mg PO
ibuprofen peds dose
10mg/kg PO
adult Ketorolac dose
15mg IV or IM
peds ketorolac dose
not indicated *******
opioids indications
Treatment of hemodynamically stable patients with moderate to severe pain due to traumatic or medical conditions. (No AEMT administration of opioids for cardiac chest pain)
opioid contraindications
Fentanyl - Hemodynamic instability or shock. Morphine and hydromorphone: Hypotension, hemodynamic instability, or shock, Respiratory depression
opioid cautions
Opioids should only be given to hemodynamically stable patients and titrated slowly to effect. The objective of pain management is not the removal of all pain, but rather, to make the patient's pain tolerable enough to allow for adequate assessment, treatment and transport. Respiratory depression, including apnea, may occur suddenly and without warning, and is more common in children and the elderly. Start with ½ traditional dose in the elderly. Coadministration of opioids and benzodiazepines is discouraged and may only be done with direct physician verbal order. Chest wall rigidity has been reported with rapid administration of fentany
fentanyl dose adult dose
1-2 mcg/kg. • Dose may be repeated after 5 minutes and titrated to clinical effect to a maximum cumulative dose of 3 mcg/kg • Additional dosing requires BASE CONTACT
fent adult IV/IO/IM dose
1-2 mcg/kg. Dose may be repeated after 5 minutes and titrated to clinical effect to a maximum cumulative dose of 3 mcg/kg. Additional dosing requires BASE CONTACT
adult in fentanyl route
1-2 mcg/kg. Administer a maximum of 1 ml of fluid per nostril. Dose may be repeated after 10 minutes after initial IN dose to a maximum cumulative dose of 4 mcg/kg. IV route is preferred for repeat dosing. Additional dosing requires BASE CONTACT
pediatric IV/IO/IM route kids aged 1-12 fentanyl dose
1-2 mcg/kg. Dose may be repeated after 5 minutes and titrated to clinical effect to a maximum cumulative dose of 3 mcg/kg. Additional dosing requires BASE CONTACT
pediatric IN route 1-12 dose
2 mcg/kg. Administer a maximum of 1 ml of fluid per nostril. Dose may be repeated after 10 minutes after initial IN dose to a maximum cumulative dose of 4 mcg/kg. IV route is preferred for repeat dosing.
morphine adult IV/IO/IM dose
5-10 mg. Dose may be repeated after 10 minutes and titrated to clinical effect to a maximum cumulative dose of 10 mg. Additional cumulative dosing > 10 mg requires BASE CONTACT. Morphine may not be given IN as it is poorly absorbed
1-12 yr peds morphine dose
0.1 mg/kg. Maximum single dose is 6 mg • Dose may be repeated after 10 minutes and titrated to clinical effect up to maximum cumulative dose of 0.2 mg/kg or 10 mg. • Additional cumulative dosing requires BASE CONTACT. • Morphine may not be given IN as it is poorly absorbed
HYDROMORPHONE adult dose
0.5 mg • Dose may be repeated after 10 minutes and titrated to clinical effect up to maximum cumulative dose of 1.5 mg. • Additional cumulative dosing requires BASE CONTACT.
HYDROMORPHONE peds dose
not indicated
PHENYLEPHRINE (INTRANASAL) indications
Prior to nasotracheal intubation to induce vasoconstriction of the nasal mucosa. Nosebleed (epistaxis).
PHENYLEPHRINE (INTRANASAL) precautions
Avoid administration into the eyes, which will dilate pupil.
phenylephrine dose and administration
Instill two drops of 1% solution, or 2 sprays, in the nostril prior to attempting nasotracheal intubation. • For patients with active nosebleed, first have patient blow nose to expel clots. Then, administer 2 sprays into affected naris(es).
RACEMIC EPINEPHRINE onset and duration
Onset: 1-5 minutes Duration: 1-3 hours
racemic epi indications
Stridor at rest
racemic epi side effects
Tachycardia, Palpitations, Muscle tremors
racemic epi dose
0.5 ml racemic epinephrine (acceptable dose for all ages) mixed in 3 mL saline, via nebulizer at 6-8 LPM to create a fine mist and administer over 15 minutes.
sodium bicarbonate indications
Sodium bicarbonate therapy is indicated in patients with tricyclic antidepressant (TCA) poisoning who develop widening of the QRS interval >120 msec, hypotension due to the TCA poisoning, or a ventricular arrhythmia. Suspected hyperkalemic pulseless arrest: consider in patients with known renal failure/dialysis. Hyperactive delirium with severe agitation that develops widening of QRS interval >120 msec or pulseless arrest. Crush or suspension injury with known or suspected hyperkalemia
sodium bicarbonate contraindications
Metabolic and respiratory alkalosis, Hypocalcemia, Hypokalemia
sodium bicarbonate adverse reactions
Metabolic alkalosis, Paradoxical cerebral intracellular acidosis, Sodium bolus can lead to volume overload
sodium bicarbonate drug interactions
May precipitate in calcium solutions. Alkalization of urine may increase half-lives of certain drugs. Vasopressors may be deactivated.
8.4 percent sodium bicarbonate dose Pulseless arrest suspected due to hyperkalemiaa (e.g., typically patient with dialysis, end-stage renal disease, hyperactive delirium with severe agitation)
1 mEq/kg slow IV push. Repeat if needed x 2 every 5 minutes
TCA poisoning with wide QRS >120 msec or ventricular arrhythmia Hyperactive delirium with severe agitation that develops wide QRS >120 msec Crush or suspension injury with known or suspected hyperkalemia sodium bicarbonate dose
1 mEq/kg slow IV push. Repeat if needed x 2 every 5 minutes or until QRS is narrowed.
TOPICAL OPHTHALMIC ANESTHETICS indications
Pain secondary to eye injuries and corneal abrasions. Topical anesthetic to facilitate eye irrigation.
TOPICAL OPHTHALMIC ANESTHETICS contraindications
Known allergy to local anesthetics. Globe lacerations or rupture.
TOPICAL OPHTHALMIC ANESTHETICS precautions
Transient burning/stinging when initially applied.
TOPICAL OPHTHALMIC ANESTHETICS dose and administration
Instill 2 drops into affected eye. Contact Base for repeat dosing.
epinephrine as a vasopressor MIX
inject 1 mg epinephrine into 1000 mL Normal Saline bag to achieve 1mcg/mL concentration (This means 1 mL of 1:1000 or 10 mL of 1:10,000 - either way 1 mg of drug). Use macro drip set.
adult epi vasopressor dose
Begin IV/IO infusion wide open to gravity to give small aliquots of fluid. Typical volumes are less than 100 mL of total fluid, as typical doses are expected to be < 100 mcg. Titrate to desired hemodynamic effect with goal BP of > 90 mmHg systolic, improved respiratory status (bronchodilation), and improved perfusion/mentation.
Dopamine vasopressor mix
400 mg in 250 ml NS or 800 mg in 500 ml NS to produce concentration of 1600 mcg/mL
dopamine as a vasopressor dose
5-20 mcg/kg/min, start at 5 mcg/kg/min, Titrate dose up 5 mcg/kg/min every 5 min to a max of 20 mcg/kg/min to desired hemodynamic effect.