ACTIVATED CHARCOAL. Classification: Absorbent. Binds and absorbs ingested toxins. Action:. Indications:. Poisoning. Contraindications: None

Transcription

1 ACTIVATED CHARCOAL Absorbent Action:. Binds and absorbs ingested toxins. Poisoning Contraindications: None Nausea,vomiting,abdominal cramping & bloating, constipation 19ram/kg Altered mental status Ingestion of caustics or hydrocarbons Inability to swallow

2 / ADENOSINE ( Adenocard ) Antiarrhythmic Decreases conduction of electrical impulses through the A V node & interrupts A V re-entrypathways in PSVT, referred to as chemical cardioversion. PSVT refractory to vagal maneuvers Contraindications: Second or Third Degree Heart Block, Sick Sinus Syndrome or Hypersensitivity to the drug. Facial flushing, headache, shortness of breath, dizziness & nausea. 6 mg, followed by 12 mg x 2 if necessary, should be given by a rapid N bolus over 1-2 sec. immediately followed by a saline flush. Use with caution in patients with Asthma, typically causes arrhythmias at the time of cardioversion.

3 ., ALBUTEROL (Proventil, Vento lin ) Sympathetic Agonist Causes bronchodilation Bronchial Asthma Bronchospasm associated with COPD Contraindications: Hypersensitivity to drug. Palpitations, :mxiety,di77iness, headache, nervousness, tremor, hypertension, arrhythmias, chest.. pain, nausea & vomiting 2.5mg via Nebulizer Use caution when administering to elderly and patients with a history of Cardiovascular disease & Hypertension. Monitor vital signs closely & auscultate lungs before & after treatments.

4 Amiodarone (Cordarone) '" - Contrindications: Side Effects : Antidysrhythmic Prolongs the d(jration of the action potential and refractory period. Acts on all cardiac tissues. Blocks sympathetic stiml".llation. Life threatening ventricular and supraventricular dysrhythmias. Severe SA node dysfunction, second and third degree block and hemodynamically significant bradycardia. N<=III"'ea... _,I hypot<:>n'".._11 Inn 11,... <:>nnr<:>vi<:> 1 _1_'..., malaise, fati.gue, tremors, pulmonary toxcity,ventricular ectopic beats. Cardiac arrest from VF and VT : 300mg Recurrent VF or VT: 150mg Maximum dose: 2.2 grams over 24 hrs Route: IV Heart Failure

5 . ASPIRIN. Analgesic,Antiinflarnmatory,Antipyretic,Antiplatelet Blocks pain impulses in the CNS, D'G!ftaSes platelet aggregation Acute coronary syndrome, Unstable angina./ Contraindications: Hypersensitivity to salicylates, Bleeding disorders, Hemorrhagic stroke, Children with flu-like symptoms, Asthmatic conditions Stomach irritation, heartburn or indigestion,nausea and vomiting, slight increase ill bleeding time 162 mg (2 chewable baby aspirin)

6 ATROPINE SULFATE Indi cations: Parasympathetic Blocker. Increases Heart Rate in. symptomatic Bradycardias by blocking Acetylcholine. Symptomatic Bradycardias Asystole Organophosphate Poisoning C ontraindi cati ons: Blurred vision, dilated pupils,. dry mouth, tachycardia, drowsiness & confusion Bradycardia -.5 mg IV repeated every 3-5 min to a max. of.04 mg/kg Asystole - 1 mg IV or ET ( ET dose x IV dose) to a max of.04 mg/kg Organophosphate Poisoning - As per Medical Control May worsen Bradycardias associated with Second Degree Mobitz Type n & Third Degree Heart Block

7 ATROVENT Anticholinergic Bronchodilation. Asthma & bronchospasm associated with COPD Contraindications: Hypersensitivity to the drug Palpitations, Amciety, dizziness, headache, nervousness, rash, nausea & vomiting 500mcg in 2.5 ml Use caution when administering to elderly and patients with a history of Cardiovascular disease and Hypertension. Monitor vital signs closely and ascultate lungs before and after treatments.

8 .. BRETYLIUM TOSYLATE (Bretylol) Contraindications: Precauti ons: Antiarrhythmic Appears to elevate V-Fib threshold sometimes converting V - Fib or V Tach to a Supraventricular rhythm, Chemical Defibrillator V-Fib & V- Tach refractory to Lidocaine None when treating life threatening Ventricular Arrhythmias DIzziness, syncope, seizures, hypotension, hypertension, angina, nausea & vomiting Initial dose - 5 mglkg IV followed by 10 mglkg doses every 5 mins. up to a max. of 30 mglkg if arrhythmia persists Keen natient suoine due to oossible.l.1.l occurance of postural hypotension, may worsen arrhythmias due to Digitalis Toxicity

9 DEXTROSE (D50, D25). Carbohydrate Supplies supplemental glucose in cases of Hypoglycemia Hypoglycemia Coma of unknown origin Contraindications: None when administered for Hypoglycemia, should be used with caution in patients with increased intracranial pressure, can worsen cerebral edema Precauti ons: Can cause tissue necrosis at the injection site Adult -25 gms, D50 IV ( 50 ml) Pediatric - 4 ml/kg D25 IV Test for blood glucose level hfi ri", f ve are a~m!mstratlon 0_ Dextrose,use large veins to prevent infiltration

10 DIAZEPAM (Valium). Anti-Convulsant I Sedative Supresses the spread of seizure activity Major Motor Seizures Status Epilepticus Contraindications: Hypersensitivity to drug - Hypotension; drowsiness, headache, amnesia,respiratory depression, blurred vision, nausea & vomiting Adult - 5 mg IV or 1M Pediatric -.2 mglkg May be repeated once Should be administered slowly IV ( not faster than I ml/min) into a large vein to reduce irritation. Can cause an additive effect if given with other depressants or alcohol. Monitor patient for respiratory depression. Flumazenil should be available for use as an antidote.. '...

11 ) DIPHENHYDRAMINE (Benadryl) Antihistamine Inhibits histamine release to limit Bronchoconstriction & Peripheral Vasodilation Anaphylaxis Allergic Reactions. Contraindications: Lower respiratory diseases such as Asthma Hypotension,headache, palpitations, tachycardia, sedation,drowsiness & disturbed coordination Adult mg IV or I Pediatric - 1 mg/kg to 25 mg Sedative effects can be potentiated by depressants, narcotics, alcohol & other antihistimines

12 DOPAMINE Intropin chss: Sympathetic Agonist ~hemically related to Epinephrine & Norepinephrine, increases blood pressure by acting on alpha & beta 1 receptors. Effects on beta 1 receptors causes a positive intropic effect on the heart,effects on the alpha receptors causes peripheral vasoconstriction. It maintains renal & mesenteric blood flow due to it's effects on the dopaminergic receptors. It will increase both systolic blood pressure & pulse pressure. Hemodynamically significant hypotension not related to hypovolemia Cardiogenic Shock Contraindications: Hypovolemic shock ( unless fluid resusitation is well under way) Pheochromocytoma ( Adrenal gland tumor) Nervousness, headache, dysrhythmias, palpitations chest pain, dyspnea, nausea & vomiting Prepare a drip by adding 800 mg to 500 m! ofd5w or 400 mg to 250 ml ofd5w resuiting ia a concentration of 1600 mcg / ml. Effects are dose dependent, 2-5 mcg / kg / min increases renal blood flow & urine output, 5-20 meg / kg / min i~lereases cardiac out put & blood pressure.

13 Donot useinthe presence oftachyarrhythmias or V - Fib Can be deactivated by alkalinesolutions Dosage should be reduced for patients taking monoamine oxidase inhibitors May cause hypotension when used with Dilantin.,-~-

14 EPINEPHRINE 1:1,000 Action.s: Sympathetic Agonist Increased Heartrate, force, automaticity & electrical activity, increased systemic vascular resistance Bronchodilation Asthma Acute Respiratory Distress Anaphylaxis Pediatric Cardiac Arrest Contraindications: Patients with underlying Cardiovascular disease or Hypertension, patients in profound shock from anaphylaxis may require Epi I: I 0,000 IV since vasoconstriction will cause a delayed absorption via the subcutaneous route Palpitations, anxiety, tremulousness, headache, dizziness, nausea, vomiting, increases myocardial oxygen demand mg Subcutaneously Pediatric: Per Protocol

15 Monitor vital signs carefully, protect from light, can be deactivated by alkaline solutions,. effects can be intensified in patients taking antidepressants..

16 EPINEPHRINE 1: Sympathetic Agonist Increased Heart rate, force, automaticity & electrical activity, increased systemic vascular resistance Asystole, V-Fib, Pulseless V-Tach, PEA, severe Anaphylaxis 0,.., ;... rl;f'o.ro-t;r..... ~ C"h 1" _1 r t t~ vulllfallluj,-,allvll21. LJ1l0UH..l only De usee Tor pa.. len~.j requiring extensive Cardiopulmonary resuscitative efforts Palpitations, anxiety, tremulousness, headache, dizziness, nausea, vomiting, increases myocardial oxygen demand Adults: Asystole, V-Fib, Pulseless V-Tach & PEA- 1 mg every 3-5 min. IV, ET dose 2 mg every 3-5 min, Severe Anaphylaxis mg IV,2mgET Pediatric: As per Protocol Only effective when Myocardium

17 .' is adequately oxygenated, protect from light, can be dectivated by alkaline solutions, IV lines need to be flushed between administration. ofepi & Sodium Bicarb, effects can be intensified in patients. taking antidepressants.

18 FUROSEMIDE ( Lasix). Diuretic Potent diuretic, inhibits sodium & chloride reabsorption in the Kidneys & causes venous dilation Congestive Heart Failure Pulmonary Edema Contraindications: Pregnancy Hypotension, ECG changes, chest pain, dry mouth, hypochloremia, hypokalemia,hyponatremia & hyperglycemia mg slow rv push May cause dehydration & electrolyte depletion

19 GLUCAGON Antihypoglycemic Increases blood glucose levels Hypoglycemia when an IV can not be established Contraindications: Hypersensitivity to drug Hypotension, dizziness, headache, nausea & vomiting Adult - 1 mg 1M Pediatric mg IM Must be reconstituted before administration Only effective if there is a sufficient stores of Glycogen within the Liver, administer with. caution in patients with Renal or Cardiovascular disease

20 HALOPERIDOL (Haldol) Classification : Contrindications : drug Antipsychotic Alters mood & behavior Combative or violent patients CNS depression,coma,pregnancy,severe liver or cardiac disease, hypersensitivity to Hypotension,orthostatic hypotension,nausea and vomiting 2-5 mg 1M Use with caution in patients with seizure disorders, Parkinson's disease and those with alcohol dependence. Can cause hypotension if used with nitrates or antihypertensive agents. Phenobarbital can decrease effectiveness.

21 LIDOCAINE Antiarrhythmic Suppresses Ventricular Ectopic Activity & increases fibrillation threshold in AMI V-Tach, V-Fib & Malignant pves Contraindications: Second degree Mobitz II & Third degree Heart Block Drowsiness,seizures, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, respiratory & cardiac arrest Adult mglkg IV or ET may be repeated at above dose for V-Fib or Pulseless V -Tach, & at mglkg for Ventricular Ectopy up to a max. of 3 mg/kg Pediatric - 1 mg/kg Once the arrhythmia has been supressed a Lidocain Drip should be initiated at 2-4 mg/min CNS depression may occur when the doseage'exceeds 300 mg/hr

22 LORAZEPAM (Ativan) / Colitraindications : Precautions. Anticonvulsant Cessation of seizure activity,relieves anxiety,skeletal muscle relaxant & induction of amnesia Seizures,anxiety Shock,coma,respiratory depression,hypotension, use of CNS depressants or alcohol, glaucoma Respiratory depression,apnea;hypotension, dizziness,ataxia,fatigue,confusion & drowsiness 2-4 mg IV or 1M Pediatric -.1 mglkg Administer IV slowly, monitor respirations,pulse & B/P,causes venous irritation, use large vein. Use with caution in patients with hepatic dysfunction, renal insufficiency or history of drug addiction. Must be refrigerated..

23 MAGNESIUM SULFATE Electrolyte Affects electrical myocardial stability Cardiac Arrest Contraindications: None for Cardiac Arrest Hypotension, hyporeflexia, diaphoresis & drowsiness Aduh - 2 g/lomlllmin

24 Methylprednisolone (Solu-Medrol) Classification : Contraindications : Synthetic Corticosteroid Supresses acute & chronic inflammation, potentiates beta relaxation of smooth muscle, suppresses the immune system by binding to intracellular corticosteroid receptors. Acute exacerbation of Asthma & capo Respiratory distrees associated with anaphylaxis Other allergic reactions Spinal cord injury Hypersensitivity to adrenocorticoids None associated with a single dose Adult dose mg, Pediatric 1-2mg/kg (Max. dose 125 mg) Spinal Cord Injury - 30mg/kg Must be reconstituted before use. CHF,renal disease, hypertension, diabetes, & myasthenia gravis

25 METOCLOPRAMIDE (Reglan) Classification : Action: Contraindications : Side Effects : Antiemetic Stimulates motility of upper GI tract, promotes stomach emptying, reduces reflux. Nausea, vomiting and reflux. GI bleeding, bowel obstruction or perforation Drowsiness, fatigue, sedation, dizziness, depression.hypertension,tachycardia, bradycardia and diarrhea. 10 mg IV slowly or 1M Effects can be antagonized by anticholinergic drugs (ex. Atropine). ens effects are increased when administered with narcotics, sedatives, hypnotics and alcohol.hypotension can occur if patient takes MAOls (ex. Marplan,Nardil, Parnate)

26 METOPROLOL (Lopressor) Classification : Action: Contrindications ± Side Effects : Selective Beta - Blocker Reduces heart rate, SBP and cardiac output. Inhibits tachycardia following AMI. Patients with suspected or definite AMI who are hemodynamically stable. Bradycardia,SBP < 100,CHF,heart block, shock or history of Asthma Bradycardia, hypotension,lethergy, CHF,dyspnea, wheezing and weakness 5mg IV slowly, if vital signs remain stable may be repeated x 2 every 5 minutes Vital signs and EKG must be monitored continuously during administration. Be alert for signs and symptoms of CHF, bradycardia, shock, heart block or bronchospasm.

27 MORPHINE SULFATE Ciassification: Narcotic analgesic Provides analgesia & sedation, increases peripheral venous capacitance & decrease venous return Severe pain Pulmonary edema Contraindications: Hypotension, hypovolemia,. head injury, abdominal pain, hypersensitivity to drug Nause~ vomiting, abdominal cramps, blurred vision, constricted pupils, altered mental status, headache & respiratory depression Adult - 2 mgiv, may be repeated every 5 min up to a max. of 10 mg Pediatric -.1 mg/kg IV (max dose 2mg), may be repeated every 5 min up to a max. of 10 mg Classified as a Schedule II drug requiring special handjing,causes severe respiratory depression at

28 high doses, Nalaxone should be readily available whenever Morphine is administered,cns depression can be enhanced when administered with antihistamines, anti emetics, sedatives, hypnotics, barbituates & alcohol

29 NALOXONE ( Narcan) Narcotic antagonist Can reverse respiratory depression due to narcotic overdose Narcotic overdose Coma unknown origin \,. \ \ Contraindications: Hypersensitivity to drug. Dodage: Hypotension, hypertension, ventricular arrhythmia, nausea & vomiting Adult - 2 mg IV, 1M, ET Pediatric -.1 mglkg IV, 1M, ET to a max. of2 mg May cause withdrawl -type effects if patient is physically dependent on narcotics

30 NITROGLYCERIN. Nitrate Smooth muscle relaxant Chest pain Pulmonary Edema Contraindications: Hypotension, shock,. increased intracranial pressure Headache, dizziness, weakness, tachycardia, hypotension,orthostasis, skin rash, dry mouth, nausea & vomiting.4 mg SL, may be repeated x 2 if BIP remains above 100 systolic Protect from air & light, monitor BIP closely

31 SODIUM BICARBONATE. Alkalinizing agent Buffers metabloic acidosis Cardiac arrest Contraindications: None when used for arrest Precauti 0 ns : Metabolic alkalosis 1 meq/kg IV Should not be administered with Calcium Chloride, can deactivate catecholamines & vasopressors

32 SYRUP of IPECAC Emetic. Causes vomiting Poisoning Overdose Contraindications: Decreased level of consciousness, ingestion of a caustic, petroleum product or antiemetic Arrhyth.'11ias, hypotension, diarrhea,. depression & bleeding from esophageal varices Adult - 30 ml PO followed by water Pediatric - 15 ml followed by water Monitor patient's airway during & following emesis, use with caution in patients with heart disease

33 THIAMINE 1 nd'icati ons: Vitamin Assists with the metabolism of glucose Coma of unknown origin Contraindications: None in emergensy setting Hypotension, dyspnea & respiratory failure Adult mg IV A few cases of hypersensitivity have been noted

34 : TORADOL., (Ketorolac) Indications : Contraindications :. Analgesic, Antiinflammatory, Antipyretic Pain relief ' Allergy to aspirin or other antiinflammatory drugs, bleeding disorders, renal failure, peptic ulcer disease & hypersensitivity to drug Anaphylaxis,headache,bIee'd~ disorders & deep sedation- 30 mg IV, 60 rug IM half dose for patients over 65 Not recommended for pediatric patients