ADENOSINE (Adenocard) Intermediate- CALL IN Paramedic. ALBUTEROL SULFATE Basic-CALL IN Intermediate-CALL IN Paramedic

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1 ADENOSINE (Adenocard) - CALL IN ALBUTEROL SULFATE Basic-CALL IN AMIODARONE (Cordarone) - CALL IN except in cardiac arrest- call while ASPIRIN Basic ATROPINE SULFATE - CALL IN except in cardiac arrest- call while CALCIUM CHLORIDE 10% 1 ST dose 6 mg IVP, 2 ND dose 12 mg IVP Follow both doses with 20 ml NS flush 1 ST DOSE 0.1 mg/kg up to 6 mg 2 ND DOSE 0.2 mg/kg up to 6 mg **Contact base after 2 nd dose if no improvement 2.5 mg/3ml Continuous nebulizer 7.5 mg/9 ml 0.15 mg/kg up to 10 mg in NS Continuous nebulizer 0.5 mg/kg/hr max 15 mg/hr A. Cardiac Arrest, VF/Pulseless VT: 1 st dose 300 mg IV/IO bolus, May repeat once 150 mg IV/IO bolus B. Hemodynamically unstable wide complex tachycardia with pulse: 150 mg IV bolus infusion over 10 min C. ROSC: 150 mg bolus infusion over 10 min-base contact recommended A. Pulseless VF/VT: 5 mg/kg IV/IO over 5 min (300 mg max dose) B. Perfusing supraventricular & ventricular arrhythmias 5 mg/kg IV/IO over 20 min bolus infusion (300 mg max dose) Chew four 81 mg tablets (324MG) A. Hemodynamically Unstable Bradycardia- 0.5 mg IV/IO every 3-5min. Max 3mg or 0.04mg/kg. Titrate to LOC and BP. Contact base after persistant bradycardia after 2 doses B. Symptomatic Insecticide/Organophosphate poisoning/exposure- contact base for orders (usually 2mg IVP q 5min until secretions dried) doses may be massive A. Symptomatic Bradycardia: 0.02 mg/kg IV/IO, max single dose for child 0.5 mg and for adolescent 1 mg. May repeat once for max total dose for child 1 mg and adolescent 3 mg. A. Magnesium sulfate overdose: 10 ml of 10% solution (100 mg/ml) SIVP over 5min. B. Calcium channel blocker/beta blocker toxicity mg slow IV (no faster than 200 mg in a minute) (over 1min per 200mg) C. Hyperkalemia: mg slow IV Contact base for additional dosages and notify base physician of usage ml/kg of 10% solution, may repeat in 10 min. Do not exceed adult dosage.

2 DEXTROSE 50% Basic-IV DIAZEPAM (Valium) ½ to 1 amp of D50W, IVP ( gm) Newborn to 1month of age- 2-4ml/kg D10W solution Greater than 1 month- 2 ml/kg of D25W solution IV ***To make D10W 10 ml of D50W and 40 ml of NS ***To make D5W Remove 100 ml of NS from 1000 ml bag, add 2 amps of D50W in 1000 ml of NS 1-10 mg slow IV push or deep IM mg/kg slow IV push (max dose 5 mg) or 0.5 mg/kg rectal (max dose 5 mg) DIPHENHYDRAMINE (Benadryl) DOPAMINE (Inotropin) (attempt CALL IN) EPINEPHRINE Basic- EPIPEN ONLY except in cardiac arrest- call while 25-50mg SIVP, deep IM Children 8yrs and younger- 1 mg/kg Slow IV/IM (max 25 mg) Attempt to contact base for all doses and indications ADULT/ 2-20 mcg/kg/min Dose 1600 mcg/ml Weight mcg/kg/min 20 kg microdrops/min 30 kg kg kg kg kg kg kg kg **should put drip on a pump A. Cardiac arrest- 1.0 mg (10 ml of 1:10,000) IV/IO q 3-5 min B. Bradycardia (contact base for direct physician order) Epinephrine drip: In 1000 ml NS, add 4 mg of Epinephrine = Epi Concentration: 4 mcg/ml in 1000 ml of NS Begin at 1 mcg/min, titrate to SBP 90 mmhg, to max of 10 mcg/min on IV pump. C. Moderate/severe allergic reactions mg (0.3 ml 0.5 ml of 1:1000) SQ/IM or Epi-pen.(EMT-B, BIV use EPI-PEN only) D. Anaphylaxis mg IV/IO 1:10,000 (3-5 ml of 1:10,000) E. Asthma- 0.3 mg (0.3 ml of 1:1,000) SQ/IM A. Cardiac arrest- 1 st dose mg/kg (0.1 ml/kg) of 1:10,000 every 3-5 min B. Bradycardia (unresponsive to O2/ventilation) 0.01 mg/kg (0.1 ml/kg 1:10,000) IV/IO or Epi drip (contact base)

3 Epinephrine Drip: In a 100 ml bag NS, Add 1 ml (0.1 mg) of Epi 1:10,000 = Epi Concentration 1 mcg/1ml in 100 ml of NS. Begin at 0.1 mcg/kg/min on IV pump (may titrate to effect to 1 mcg/kg/min). C. Anaphylaxis- Racemic Epinephrine for inhalation mg/kg (0.01ml/kg 1:1,000) SQ/IM (max single dose 0.5 ml). May give every 15 min up to 3 doses. D. Asthma/Croup/Epiglottitis/Reactive Airway/Bronchiolitis- Racemic Epinephrine for inhalation E. Life threatening airway obstruction secondary to croup, epiglottitis, asthma, reactive airway disease- if no racemeic epi- plain epi can be used. (0.01ml/kg 1:1,000 in 3ml NS nebulized). FENTANYL CITRATE GLUCAGON for Beta Blocker or Ca Channel OD HALOPERIDOL (Haldol) -follow written orders (Medication taken from clinic) HYDROMORPHONE (Dilaudid) (Medication taken from clinic) IPRATROPIUM BROMIDE (Atrovent) Loading dose- 1-2 mcg/kg SIVP/atomized IN/IM last resort Maintenance dose- 1-2 mcg/kg SIVP/ IN/IM mcg/kg SIVP/IN/IM DRIP ADULT/PEDI- To make Fentanyl infusion, remove 10 ml of NS from 50 ml bag. Add 500 mcg Fentanyl to the 50 ml bag of NS. Begin infusion at 0.25 ml/kg/hr. Treat any break through pain/agitation with small boluses of Fentanyl and/orversed. Hypoglycemia- 1 mg IM/IN Beta Blocker/Ca++ channel Blocker OD- 2mg IV/IN Hypoglycemia- 0.1 mg/kg IM/IN (>8y/o, max dose 1 mg) Beta Blocker/Ca++ channel Blocker OD- 0.1 mg/kg IV/IN (max dose 1mg) 5-10mg IM (may follow w/ Benedryl 25-50mg IV/IM for dystonic reaction) Contact base for all orders for 13-15y/o Contraindicated under 13y/o 0.5 mg-1.0 mg IV/IM q 15min until pain is managed (or 2 mg IV/IM q 2hrs) mg/kg IV/IM q 4-6hrs Follow physician written orders mcg nebulized 1 time dose 250 mcg nebulized 1 time dose for children < 12 years

4 IV SOLUTIONS Basic-IV ADULT/ NS, LR or D5W TKO- 30 ml/hr (unless otherwise ordered by physician) Fluid Bolus/Challenge- 20 ml/kg NS rapid IVP ( ml increments as appropriate than reassess) LIDOCAINE except in cardiac arrest, call while LORAZEPAM (Ativan) -can give for pain management and seizure control with written orders (Medication taken from clinic) A. Cardiac- Contact base except in VFIB, Pulseless VTACH, and post arrest dosing mg/kg IV/IO bolus B. Brain Trauma- pre-intubation single dose- 1.5 mg/kg IV Pediatric ventricular dysrhythmias- 1 mg/kg IV/IO (over 1-2 min if pt has pulse) mg IV/IM/IO (diluted with D5W/NS prior to IV administration) Follow written orders by base physician 0.1 mg/kg IV/PR with max dose 2 mg (diluted with D5W/NS prior to IV administration) Follow written orders by base physician MAGNESIUM SULFATE A. Adult Cardiac Arrest - Torsade de pointes: 1-2 Gm slow IV push, diluted in 10 ml Normal Saline B. Torsade de Pointe with Pulse 1-2 Gm diluted in ml of NS slow IV bolus infusion. C. Acute bronchospasm: 2 Gm slow bolus infusion IV, diluted in ml NS D. In OB associated seizures, 4 Gm in ml NS, very slow IV bolus infusion (over minutes), consider consulting base physician for order E. For high-risk OB patients during intra-facility transport: This should be mixed 20 grams in 1000 ml NS (Discard same amount of ml from base fluid as added from Magnesium Sulfate). Infuse as piggyback to NS main line. Magnesium Sulfate is infused via IV/medication pump. Total fluid rate of Magnesium Sulfate and NS mainline should total 125 ml/hr. 0.5 grams = 25 ml/hour 1.0 grams = 50 ml/hour 1.5 grams = 75 ml/hour 2.0 grams = 100 ml/hour 2.5 grams = 125 ml/hour F. Monitor vital signs, contractions, and fetal heart tones every 15 minutes G. For all pregnancy related Magnesium Sulfate administration: Monitor deep tendon reflexes (+1 to +4) every 30 minutes, contact base medical control for decreased deep tendon reflexes

5 H. A foley catheter is required to be in place for a patient on a Magnesium Sulfate drip. Notify base physician for urine output < 30 ml/hr A. Pediatric pulseless torsades de pointe: 25 to 50 mg/kg in 10 ml NS IV/IO bolus infusion over 10 to 20 minutes, max dose 2 Gm. B. Torsade de Pointe w/pulse mg/kg diluted in ml of NS IV/IO bolus infusion over min, max dose 2 Gm. C. Pediatric severe asthma: mg/kg in ml NS over 20 minutes IV, max dose 2 Gm METERED DOSE INHALERS B, BIV, CALL IN ADULT/ A. Confirm prescription identification. B. Ascertain how many times the patient has used the inhaler. C. If needed, contact Base Physician for an order to administer. D. Up to 2 puffs E. Contact Base Physician for additional orders if needed. METHYLPREDNISOLONE (Solu-medrol) MIDAZOLAM (Versed) for behavioral management, seizure control MORPHINE SULFATE -CALL IN A. 250 mg slow IV, may mix in ml of NS and give IV over minutes. A. 2 mg/kg to max of 250 mg slow IV, may mix in ml of NS and give IV over minutes. A. Cardioversion premedication: up to 2.5 mg slow IV/IN B. Status seizures, pacing agitation and post intubation agitation: 1 mg every min IV, titrate to seizure cessation or decreased agitation (max single dose= 0.1 mg/kg or 10 mg) C. Combative behavior compromising patient care: up to 0.1 mg/kg IV or IM (maximum single dose = 10 mg) D. Notify base physician that Midazolam has been given E. Patients being paced may tolerate procedure without sedation, administer only if indicated A. Analgesics/Sedative: 0.1 mg/kg IV/atomized IN max single dose 10 mg. B. Second dose or any other indication for children contact base physician for order. A. STEMI: 2-4 mg IV every 5-15 min to relieve chest discomfort. B. NSTEMI/Pain control 2-10 mg IV/IM, the goal is to decrease anxiety and improve patient comfort. C. Repeat as needed to effect. A. Pain Control: 0.05 mg mg/kg IV slowly B. Repeat as needed to effect.

6 NALOXONE (Narcan) Basic-IV NITROGYCERIN (NITRO, NTG) B,BIV-CALL IN for patient assisted ONDANSETRON (Zofran) B, BIV (waiver)-call IN for ODT only -CALL IN ORAL GLUCOSE Basic Basic-IV PROMETHAZINE (Phenergan) A. 2 mg (2 ml) IV/IO/atomized IN, or IM if IV not available B. If no response is observed, this dose may be repeated after 5 min., if narcotic overdose is suspected. A. 0.1 mg/kg/dose IV/IO/atomized IN/IM with single max dose 2 mg. A. Basic/Basic-IV contact base physician to assist with patient prescribed Nitroglycerin B. 0.4 mg (1/150 grain) tablet sublingually, may repeat every 5 minutes as needed for effect. Maximum 3 doses in 15 min. C. Blood pressure to be checked prior to each dose. ADULT (4 yrs and up)- 4 mg slow IV with max dose 12 mg (May give ODT tablets if no IV) PED (under 4 years)- 2 mg slow IV,(May give ODT tablets if no IV) A. The dosage of oral glucose is 15g A. 1gm/kg up to 15gm total one time dose. A mg slow IV, dose may be repeated once for max dose of 25 mg. B. Dose adjustment for elderly: 6.25 mg-12.5 mg IV mg/kg slow IV, up to 6.25 mg single dose. RACEMIC EPINEPHRINE ADULT/ 0.5 ML OF 2.25% solution in 3 ml of NS via nebulizer If no improvement after 2 doses contact medical control SODIUM BICARBINATE except during arrest, call while A. 1 meq/kg (1 ml/kg) IV/IO of 8.4% solution B. Contact base for direct physician order for tricyclic overdose. A. 1 meq/kg (1 ml/kg) IV/IO of 8.4% solution B. 4.2% solution should be used for newborns, 2 meq/kg (4 ml/kg) IV/IO C. Contact base for direct physician order for tricyclic overdose.

7 TERBUTALINE (Brethine) (Medication taken from clinic) A mg SQ/IH. Dose can be repeated every minutes as ordered by physician. B. MDI- dose is two inhalations, 1 minute apart C. SQ/IH only INTERFACILITY TRANSPORT FORMULARY LABETALOL (TRANDATE, NORMODYNE) waiver BOLUS mg IVP over 2min (per.physician). Do not exceed a total dose of 300 mg INFUSION-2-8 mg/kg per physician orders Normal Infusion Concentration- 200 mg/250 ml = 2 mg/3ml **Medication must be put on Medication IV pump INSULIN DRIP NITROGYCLERIN DRIP 0.1 units/kg/hour. 0.1 units/kg/hour BGL checks are mandatory q 30min during transport or more often if ordered by the physician. A decrease in blood sugar of dl/hr is anticipated. If the blood sugar decreases more than 30dl during a 30 minute recheck, contact the base physician for further orders. **Medication must be put on Medication IV pump Nitroglycerin is a concentrated medication that is administered after dilution. Usual mixtures include 25 mg in 250 ml of D5w or NS. This yields a concentration of 100 mcg/ml. **Medication must be put on Medication IV pump VECURONIUM (NORCURON) Waiver ADULT/PEDI- 0.1 mg/kg IV

8 ALTEPLASE (ACTIVASE, tpa) Waiver Medication drips for interfacility transport Verify medication dosage, concentration, and rate are correct. Medications are to be infused via IV pump- verify pump rate is correct prior to transport. 0.9mg/kg (max 90mg) 10% total dose administered as an initial IV bolus over 1min and remaining 90% infused over 60min Amiodarone (Cardarone) Collids Diltiazem (Cardizem) Glycoprotein IIb/IIIb inhibitors Heparin Solu-medrol Oxitocin Potassium Sodium Bicarbinate TPN and/or Vitamins Hospital initiated antibotics,,,,

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