Utah Valley University Paramedic ALS Guide

Transcription

1 Utah Valley University Paramedic ALS Guide

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4 Contraindication: Pediatric Dose: Max: Acetaminophen Within 30 minutes Half-life 2.8 hours (range 2-4 hours) Tylenol Non-narcotic Analgesic, Antipyretic Antipyretic Activity, Analgesic Activity Inhibition of central & peripheral prostaglandin synthesis Fever, Pain Hypersensitivity Possible Sleepiness mg PO or Rectal (every 4 hours) 15mg/kg PO in liquid form or PR *in bullet form (caution on previous doses not to overdose) 4gms per day Extreme caution liver dysfunction.

5 Contraindication: Adult & Pediatric Dose: Activated Charcoal Immediate Continual while in the GI tract Actidose, Super Char, Charcodate, Liqui-Char, Aqua-Char Antidote, Adsorbent A fine black powder with liquid that adsorbs poisonous compounds to its surface, reducing the absorption. Oral poisonings Over dose of a non caustic or other burning poison Do NOT use in caustic acids, alkalis, irons tablets & lithium. There is NO value for the ETOH OD pt. Constipation is possible, vomiting due to pt. intolerance 1gm/kg PO or slow Nasogastric or Orogastric tubes Some people like to spit it out at YOU!

6 Adenosine (Adenocard) Immediate 10 sec Adenocard Antiarrhythmic Slows supraventricular tachycardia, decreasing the electrical activity by interrupting the reentry pathways through the AV node. Symptomatic SVT, monomorphic wide complex v-tach Contraindication: Hypersensitivity, 2nd or 3rd degree heart block, sick-sinus syndrome, A- Fib, A-Flutter Syncope, Chest Pain, facial flushing, SOB, dizziness, hypotension Initial dose rapid bolus 6 mg. rapid IV/IO push 1-3 sec. quickly followed by a 20 cc saline flush. Elevate extremity Repeat 12 mg. in 1-2 min. if needed Pediatric Dose: 0.1mg/kg rapid IV/IO push followed by 5cc bolus, repeat 0.2mg/kg x 1 Half life is 10 seconds. Pediatric doses don t exceed adult doses

7 Contraindications: Routes: Pediatric Dose: Albuterol 5-15 min after inhalation 3-4 hr after inhalation Proventil, Ventolin Bronchodilator, Sympathomimetic (ß2 selective) A beta2-adrenergic agonist which helps relax the bronchial smooth muscles Asthma reversible bronchospasm associated with COPD Known hypersensitivity to the drug, symptomatic tachycardia, cardiac dysrhythmia, angina, HTN, diabetes Palpitations, anxiety, headache, dizziness, sweating, tremors, tachycardia Inhalation 2.5mg/3ml of NS 2.5mg in 3cc NS > 1 year old, 1.5mg in 3cc NS < 1 year old Be aware of prior doses/ can interact with diuretics, digoxin, betablockers, & MAO inhibitors/ can have toxicity effects on vascular system if used with tricyclic antidepressants

8 Drug Interactions: Contraindication: Pediatric Dose: Amiodarone HCL Within minutes Variable Cordarone Antidysrhythmic Prolongs phase 3 of the cardiac action potential. Amiodarone increases the refractory period of sodium and potassium channels. This intern slows the cardiac action potential. Ventricular arrhythmias, cardiac arrest (V-Fib, pulseless V-Tac) refractory paroxysmal SVT with cardioversion Potentiate bradycardia and hypotension with beta and calcium blockers, increased risk of AV block and hypotension with calcium blockers, Y-site incompatibilities with furosemide, heparin, and sodium bicarbonate Hypersensitivity, Pulmonary congestion, cardiogenic shock, hypotension, bradycardia Lung problems, Liver Problems, Epididymitis in long term use mg rapid IV/IO push (Expected 300mg IV loading dose) Check your protocols. (Expected 150 mg 2nd dose if needed) 5mg/kg IV/IO (Check your protocols for additional doses)

9 Contraindication: Amyl Nitrate 30 seconds inhaled 3-20 minutes Vaporole Vasodilator, Cyanide Antidote Causes oxidation of hemoglobin to the compound of methemoglobin. Vasodilatation, including coronary artery dilation. Smooth muscle relaxant Cyanide poisoning None when given for cyanide poisoning Hypotension with syncope, Headache, Nausea & Vomiting 0.3ml or an Amyl Nitrate glass pearl (similar to ammonia) Break ampule & inhale for 30 seconds, then 100% O2 for seconds, monitor blood pressure

10 Contraindication: Pediatric Dosage: Expected Dose: Aspirin 15 min 2-4 hours ASA, Baby Aspirin, Bayer Platelet inhibitor, anti-inflammatory, Antipyretic, NSAID Decreases platelet aggregation, prolongs clotting time. Antipyretic Activity New-onset chest pain suggestive of MI Hypersensitivity, Pt. already on anticoagulants, Bleeding Disorders Heart Burn, Nausea, Wheezing, Tinnitus mg PO chewable (2-4 tablets 81mg per tablet) Not recommended. 324 mg (total of 4 baby aspirin) Pediatrics, GI bleeds

11 Contraindication: Atropine Sulfate Rapid 2-6 hours Atropine Parasympatholytic, Anticholinergic agent Increases HR, Contractility, Automaticity, Conduction, & Dilation of the peripheral vessels. Works mainly on the Atrium Symptomatic Bradycardia, Organophosphate Poisoning Hypersensitivity, Tachycardia, Relative Increased or Cardiac not functional consumption, uses:2nd Dryness & 3rd in degree mouth, AV Headache, heart block Dizziness, Nausea & Vomiting Brady 0.5mg q 3-5 min IV/ET/IO Pediatric Dose: 2-5mg 0.02mg/kg for Organophosphate IV/IO/ET Minimum Poisoning dose (Vary 0.1mg w/pt. symptoms) A-Fib, A-Flutter, Glaucoma, and COPD

12 Contraindication: Calcium Chloride Calcium Chloride Electrolyte Increases the force of myocardial contraction hypocalcemia, hyperkalemia, calcium channel blocker toxicity, antidote for magnesium sulfate Patients receiving digitalis hypotension, asystole, bradycardia 2-4mg/kg of a 10% solution repeat every 10 min if necessary, IV Precipitate digitalis toxicity, precipitate sodium bicarbonate, tissue necrosis.

13 Contraindication: Expected Dose: Pediatric Dose: Diazepam IV: Rapid, IM: minutes, ET: Rapid 15 min 1 hour Valium Benzodiazepine, Anticonvulsant Antianxiety & anticonvulsant activity. Acts on the CNS to relax the nervous system Status Epilepticus, Severe Anxiety, Pacing Hypersensitivity, Depressed Vital Signs, CNS depressions due to head trauma Respiratory Depression, Hypotension, Slurred Speech, Confusion, Nausea, Ataxia 5-20mg IV/IO 5 mg IV increasing to desired effects, smaller doses for elderly patients are needed (2-5mg) Pediatric 0.1mg/kg IV/ET/IO 0.5mg/kg PR EMT s carry nothing to reverse a benzodiazepine over dose.

14 Contraindication: Expected Dose: Pediatric Dose: Note: Diphenhydramine max effects 1-3 hours 6-12 hours Benadryl Antihistamine Blocks histamine receptors. This is at the H1 sites High dose cause Anticholinergic activity. Anaphylaxis, moderate to severe allergic reactions (secondary to epinephrine) acute Asthma, extrapyramidal Hypersensitivity, (dystonic) Pregnancy, reactions nursing mothers Sedation, hypotension, dry mouth/throat, blurred vision, headache, palpitations, tachycardia, bradycardia, paradoxical excitement in children 25-50mg IM/IV/IO, min onset 25mg IM 1-2mg/kg IM/IV/IO Deliver IM injections into deep muscle mass & alternate sites

15 Contraindication: Dopamine 2-4 min min Intropin Sympathomimetic, Inotrope and chronotropic effects Naturally occurring neurotransmitter. Stimulates dopaminergic, beta1/alpha1 adrenergic receptors in a dose dependant amount. Cardiogenic shock & hypotension not resulting from hypovolemia Hypersensitivity, V-Fib, tachydysrhythmias Adult/Pediatric Dose: Ventricular irritability, Hypertension, Headache, Infiltration causes necrosis, Nausea, Vomiting 800mg in a 500cc D5W or NS IV/IO Expected Dose: 5-20mcg/kg/min titrating to increase systolic to mcg/kg/min are renal effects for lowering BP If possible correct hypovolemia before Dopamine treatment with a fluid bolus cc DO NOT MIX with NaHCO3

16 Dopamine Conversion with 800 mg in 500cc mcg/kg/min w/60 ggts Kg lbs mcg mcg mcg mcg mcg mcg mcg This formula is based on a 60gtts being used

17 D5W (Dextrose 5%) Contraindication: Expected Dose: Pediatric Dose: N/A Short term therapy 5% dextrose in water Hypotonic Solution D5W provides nutrients in the form of dextrose as well as free water. Mixing medications (Lidocaine, Dopamine) D5W should not be used as a fluid replacement for Hypovolemic states. Rare in therapeutic dosages. Medication Dependent N/A N/A Use caution if used for main IV solution

18 Epinephrine 1-1,000 (SQ) 5-10 min (IV) 1-2 min 5-10 min Adrenalin 1-1,000 Bronchodilator, Cardiac Stimulant, Sympathomimetic SQ = Bronchodilator & relief of bronchial edema, Beta 1&2 IV = Increases HR, Vasoconstricts, Alpha 1 & Beta 1 Anaphylaxis, Acute Allergic Reactions, Asthma, Shock Pediatric Dose: Note: Tremors, Dizziness, Anxiety, Palpitations, Tachycardia, Acute Hypertension Anaphylaxis: mg SQ./IM/IO Upper Airway Stridor: 2mg of 1:1,000 in 3ml of NS Shock treatment= Infusion: as inotrope/pressor. 2 mg in 500ml NS = 4 mcg/ml titrated to effect: Usual range 2-10 mcg/minute ( mcg/kg/minute). (Raise BP S ) 0.01mg/kg with a max dose of 0.3mg for anaphylaxis *0.1mg/kg ET (1-1,000) q 3-5 min w/3-5cc flush for cardiac Use caution with pregnancy & preexisting heart disease Be sure you are using the correct Epinephrine. Both Epinephrines can have the same uses depending route.

19 Epinephrine Drip The epi drip is similar to the lidocaine drip but with much less medication. With the epi drip, add only 1mg to a 250ml bag to achieve a concentration of 4mcg/ml. Epi drips are administered at a rate of 1-4mcg/min.

20 Epinephrine 1-10,000 (SQ) 5-10 min (IV) 1-2 min 5-10 min Adrenalin 1-10,000 Expected Dose: Max: Pediatric Dose: Sympathomimetic, Cardiac Stimulant, Bronchodilator Increases cardiac resistance, BP, Electrical activity, O2 Needs, contractility, & myocardial activity. Alpha 1 & Beta 1 Cardiac Arrest V-Fib, Pulseless V-Tach, Asystole, PEA, & profound Bradycardia Hypertension, Peripheral constriction 0.5-1mg IV/IO every 3-5 minutes (ET is 2-2 ½ time the dose w/20cc flush) 1mg IV/IO None in a life threatening emergency 0.01mg/kg IV/IO with a max dose of 1mg IV/IO 0.1mg/kg ET (1-1,000) q 3-5 min w/3-5cc flush DO NOT mix with NaHCO3, Heat destroys this drug

21 Adverse Reactions: Contraindication: Drug Interactions: Fentanyl < 1 minute IV minutes IV Sublimaze Opioid Analgesic Combines with receptors sites in brain to produce potent analgesic effects. Analgesia, sedation during RSI, 2nd drug choice for chest pain if morphine allergy. Possible sedation with approved protocol. (RSI) Sedation, nausea, respiratory depression, miosis, hypotension rapid administration may result in chest wall rigidity that will not respond to neuromuscular blockade. Respiratory Depression, Hypotension, Head injury, Dysrhythmias, MAO inhibitors, myasthenia gravis (Muscles tires easy), Hypersensitivity. Alcohol and other CNS depressants potentiate effects.mao inhibitors may precipitate hypertensive crisis. Respiratory depression, Bradycardia, Hypotension or Hypertension, ICP, Nausea 25-50mcg IV/IO/ IM Max: 200mcg Ped Dose:Over 2 y/o 1 mcg/kg IV (75 micrograms max) or 2 mcg/kg nasal (100 micrograms max) Pregnancy, Incompatible with pentobarbital and thiopental, Schedule II controlled substance.

22 Contraindication: Pediatric Dose: Furosemide Diuretic effects within minutes, vasodilatory effects within 5 minutes when given IV. 4-6 hours Lasix Loop Diuretic Inhibits the reabsorption of sodium & chloride in the kidney tubule & promotes increased urine formation & excretion Pulmonary Edema, CHF Pregnancy, Hypovolemic, & Hypokalemia Dehydration, hypotension, Tinnitus/hearing impairment with long term affects 20-80mg IV/IO SLOW push to prevent tinnitus 1mg/kg IV/IO SLOW push to prevent tinnitus PUSH slowly & lower doses to avoid Tinnitus.

23 Contraindication: Pediatric Dose: Glucagon Within 1 minute 9-17 minutes GlucaGen Pancreatic Hormone, Insulin Antagonist Raises glucose level by using the glycogen in the liver for glucose. Stimulating glucose synthesis Hypoglycemia with altered level of consciousness, Beta-blocker overdose. Hypersensitivity Hypotension, Nausea, Hypokalemia 1mg IM/IV/IO but usually given IM mg/kg IM/IV/IO with max of 1mg Pt. may have home emergency glucagon kit May be used w/calcium channel blocker and beta-blocker toxicity

24 Contraindication: Expected Dose: Pediatric Dose: Glucose or Dextrose N/A Short term therapy D 50, 50% Dextrose Carbohydrate Raises BSL, using electrolytes Hypoglycemia Intracranial Hemorrhage, & possible CVA. Consider D25 Tissue necrosis if infiltration occurs with IV 25-50gms IV/IO only (lower doses may be given) 25gm/50ml given slowly 0.5-1gm/kg IV/IO with a max of 25gms (D25 for Under 1y/o) (D10 for Under 1 month old) Tissue necrosis if infiltration occurs with IV

25 Contraindication: Expected Dose: Haloperidol IV: minutes, IM: minutes hours Haldol Antipsychotic, Butyrophenone Blocks the stimulation of dopamine receptors in the brain, altering mood & behavior Acute psychotic episodes Pregnancy, Severe toxic CNS depression, Coma, Parkinson s disease, Head injury, Hypersensitivity Orthostatic Hypotension, Parkinson like symptoms, N & V, blurred vision, headache, drowsiness, diaphoresis 5-10mg IM / IV/IO 5mg IM Use cautions with patients that have cardiovascular disorders, Receiving Anticonvulsants, and anticoagulants. Not recommended for pediatrics.

26 Contraindication: Hydroxocobalamin Cyanokit Cyanide Antidote Hydroxocobalamin combines with cyanide to form cyanocobalamin which is excreted through the kidneys Known or suspected cyanide exposure None prehospital Turns the patient bright red, transient hypertension. 5.0 g (in two vials of 2.5 g) each reconstituted with 100 ml of NS infused over 15 minutes Pediatric Dose: Contact medical control. 70 mg/kg up to 5 g. None prehospital. Suspect cyanide intoxication in victims of smoke inhalation from closed space with altered mental status, unstable vital signs, or cardiorespiratory arrest.

27 Contraindication: Pediatric Dose: Ibuprofen 30 min. 4-6 hours Advil, Motrin Non-narcotic Analgesic, Antipyretic, NSAID Antipyretic Activity, Analgesic Activity Inhibition of central & peripheral prostaglandin synthesis. Reduces inflammatory response through chemotaxis. Fever, Pain, Inflammation Reducer Hypersensitivity G.I. intolerance, many others possible effects mg PO every 6-8 hours (not a common treatment for adults in EMS) 10mg/kg PO max of 40mg/kg per day (liquid form) You may want to alternate with Acetaminophen

28 Precautions: Pediatric Dose: Max: Lactated Ringers LR Isotonic fluid but is slightly more hypertonic than NS Assist in fluid replacement for dehydration or blood loss IV fluid for IV maintenance or Electrolyte replacement CVA, Diabetics, Mixing with blood sets cc 20cc/kg for fluid replacement 60cc/kg for pediatrics or 2-3 liters of fluid for adults

29 Contraindication: Adult & Pediatric Dose: Expected Dose: Max: Lidocaine HCL seconds 2-4 hours Xylocaine, Xylocard Antiarrhythmic Agent Decreases the depolarization, automaticity, & excitability in the ventricles during the diastolic phase by the direct action on the tissue, especially the Purkinje network. V-fib/ V-Tach, Post V-fib/ V-Tach (after conversion), possible symptomatic PVC s Hypersensitivity to other amide type anesthetics, Stokes-Adams syndrome, Second or Third degree AV Block without an artificial pacemaker, Bradycardia Seizures, Coma, Respiratory depression may occur if given rapidly or in high doses, Sinus Brady, Hypotension 1mg-1.5mg/kg IV/ET/IO q 3-5 min followed by a drip of 1-4mg/minute depending on prior boluses. Pain related to IO use: Lidocaine mg administered SLOWLY through attached pre-primed extension set prior to IO bolus or flush on alert patient. Initial dose: 1mg/kg IV/IO/ET or 2 ½ times the dose for ET 2 nd doses: ½ initial dose for 2 nd and subsequent dosing 3mg/kg ½ doses for over 70 years old, ½ dose for liver disease pt

30 Lidocaine Clock The lidocaine clock is based on a 4mg/ml concentration. Add 1gram into a 250ml bag and use a 60gtt/ml infusion set. If you want to give 1mg/min, run your drip at 1 drop every 4 seconds (15gtts/min). For 2mg/min, run 1 drop every 2 seconds (30gtts/min) and so on.

31 Contraindication: Magnesium Sulfate Magnesium Sulfate Electrolyte, antiarrhythmic and anticonvulsant CNS depressant seizures of ecclampsia and pulseless ventricular tachycardia myocardial damage, shock and tachydysrhythmias hypotension, flushing, drowsiness, respiratory depression and circulatory collapse 1-4 grams, IV ( intravenous ) and IM ( intramuscular ) Pediatric Dose: Max: hypotension, use caution when administering to patients who are taking digitalis or have renal failure, administer slowly to reduce potential for side effects..

32 Contraindication : Meperidine HCL IV (5 min), IM (10-15 min) 2-4 hr Demerol Narcotic Analgesic, Opioid Analgesic Addictive narcotic that depresses the CNS & may relieve pain Relief of moderate to severe pain Hypersensitivity, Non-localized injury (cranial, abdomen), hypotension, bradycardia, patient taking MAO or selective serotonin reuptake inhibitors Expected Dose Pediatric Dose: Nausea, CNS depression, hallucination, seizures, headache, hypotension, coma mg IM/IV/IO 50mg followed by an anti-emetic slow IVP 1-2mg/kg May mix with promethazine for increase and potentiate analgesics, protect from light, May aggravate seizures especially in patients with renal insufficiency, use with caution in patients with asthma and COPD

33 Midazolam IV (1-3 min), IM (15-30 min) 2-6 hr Versed Tranquilizer, Benzodiazepine, CNS depressant, Anti-seizure Anti-seizure, anti-convulsant, sedative, muscle relaxant Seizures, Conscious sedation, Chemical restraint Contraindication : Adult & Pediatric Dose: Expected Dose Hypersensitivity, depressed CNS, shock Pregnancy, Should not be used in patients who have taken other CNS depressants Depressed CNS, N/V, blurred vision, headache, retrograde amnesia IV /IO 0.1mg/kg up to 5mg [1-5min onset] IN 0.2mg/kg up to 10mg dose [3-7min onset] 1cc per nostril IM 0.1mg/kg up to 10mg dose[15-30min] ADULT IV (not faster than 1 ml/min), IM, rectal [never bolus] IV 2-5mg, IN/IM 5-10mg 2nd doses may be given

34 Morphine Sulfate 1-2 min 2-7 hours (Morphine) MS Narcotic analgesic, Opioid analgesic CNS depressant causes peripheral vasodilation, Vasodilator, reducing venous return and myocardial oxygen demand, decreases sensitivity to pain. Moderate to severe pain with trauma. Chest pain associated with MI Contraindication: Hypersensitivity, Head injury, CVA, Hypotension, and respiratory depression Drug Interactions: CNS depressants potentate effects, phenothiazines potentiate analgesia, MAO inhibitors cause paradoxical excitation Depressed CNS, constipation, dry mouth IV/IO 2-4mg titrated to max of 15mg max. [immediate onset] IM/SC 5-20mg [10-30min onset] Pediatric Dose: IV/IO 0.1mg/kg. IM/IO/SC mg/kg Expected Dose: IV/IO 2-4mg titrated to max of 15 Caution: Have Narcan ready in case of severe adverse reaction.

35 Naloxone Within 2 minutes min Narcan Narcotic Antagonist, Opioid Antagonist Displace narcotics at the receptor sites in the CNS. Attaches to the receptors & inhibits the narcotics action indication: Narcotic overdoses including the following: Codeine, Demerol, Dilaudid, fentanyl, Heroin, Lortabs, Methadone, Morphine, Paregoric, Percodan, Tylox, Vicodin, synthetic analgesics, Darvon, Nubain, Stadol, Talwin, alcoholic coma To rule out narcotics in coma of unknown origin, Respiratory depression Contraindication Hypersensitivity : N/V, Seizures, tachycardia, HTN, diaphoresis, blurred vision, withdrawal Possible Dose: Pediatric Dose: 2-4mg IV/IM/IN/ET/IO mg IV/IO, 2mg IM/IN 0.1mg/kg IV/IO/IM with max of 2mg Administer with caution to narcotic dependent patients due to withdrawal effects. It can cause seizure from withdrawal in chronic opiate users, Short-acting, should be augmented every 5 minutes

36 Nitroglycerin 1-3 minutes minutes Nitrostat Coronary Vasodilator Decreases cardiac work, increases circulation to the heart, dilates coronary & systemic arteries. AMI, Pulmonary Edema, Hypertension emergencies, CHF Contraindication: EMT-P Systolic <90, EMT-I Systolic <100, CVA, head injury, Hypersensitivity, Use of recent use of ED drugs (Cialis, Levitra,Viagra)within past 24 hours will cause hypotension Severe Hypotension, Weakness, Headache, Syncope, dizziness, N/V mg Sublingual q 5min up to 3x (May come in spray or tablet) (Most doses are 0.4mg) If the pt. is wearing a nitroglycerin patch or paste, additional administration may not be effective.

37 0.9% Sodium Chloride Injection USP Normal Saline, NS Isotonic Fluid IV Assists in the rehydration of fluid & electrolytes in the vascular system IV maintenance, Fluid Bolus, Combination with blood sets on trauma PT s, volume replacement, dehydration, hypotension Contraindication: Hypersensitivity, pulmonary Edema Dose: Pediatric Dose: Max: 3rd spacing of fluid is possible on bolus dosing, Pulmonary Edema cc bolus or TKO, after listening to lung sounds 20cc/kg with a max of 60cc/kg, 10cc/kg pre-term to28days 3 L max for Trauma PT s may be suggested. Heat Exhaustion or Dehydrated PT s you may exceed the 3L max. Overloading pediatrics/geriatrics/ & Pulmonary Edema

38 Contraindication : Ondansetron P.O. I.V min, I.M. 40 min P.O., I.V. 4-8 hr Zofran Anti-emetic, Serotonin type 3 (5-HT 3) antagonis Prevention & control of severe nausea. Calms vomiting reflex through vagal afferent nerves. Non-sedating anti-emetic is desirable for preventing nausea Hypersensitivity Headache, Dizziness, Diarrhea 4mg IV/IO Slow push 2-5 minutes, 4mg IM Max: 8mg Ped Dose: Over 2 y/o Caution: 0.1mg/kg IV/IO/ IM Max: 4mg Give undiluted by direct I.V. if nausea and vomiting occur. Administer slowly, over at least 30 seconds (preferably over 2 to 5 minutes). Use caution in patients with impaired liver function. Note: Zofran has no effect on motion sickness

39 Contraindication : Dose: Expected Dose: Oxytocin IV immediate, IM within 3-5 minutes IV 20 minutes after the infusion stops, IM minutes Pitocin Pituitary Hormone Stimulates uterine smooth muscle contraction, & helps expedite constricting uterine blood vessels & controlling excessive hemorrhage. Post-partum hemorrhage, AFTER infant and placenta delivery Hypertonic & hyperactive uterus, 2 nd fetus, maternal bradycardia Hypo/hypertension, N/V, seizures, anxiety, dysrhythmias, Fetal Bradycardia. Stimulates lactation 3-10 units IM/IO, AFTER infant and placenta 10 units IM

40 Contraindication : Adult Dose Range: Expected Dose: Pediatric Dose: Promethazine < 1 min IV 4-6 hours Phenergan Antiemetic, CNS depressant, Antihistamine Produces an antihistamine and Antiemetic response, It also potentiates narcotics and increases the effectiveness Nausea & vomiting, Potentiates sedative effects of analgesics (Meperidine) Hypersensitivity Pronounced sedation, confusion, and Tissue irritation 25-50mg IV/IM/IO (Dilute with 10cc when given IV to lesson tissue damage and reduces pt. discomfort.) mg with 10cc NS. Slow push 0.5mg/kg Tissue irritation is possible on IV infiltration or SQ area injection. Use caution with pediatrics.

41 Contraindication : Adult & Pediatric Dose: Sodium Bicarbonate 2-10 minutes minutes NaHCO3 Alkalinizing Agent Neutralizes acids, returning blood & body fluid to a more normal PH instead of an acidosis state. (Increases ph) Metabolic acidosis, Prolonged CPR or down time (more than 5-10 minutes), Tricyclic overdoses. (Tricyclic meds = Amitriptyline, Desipramine, Endep, Janimine, Norpramin, Nortriptyline, Pamelor, Surmontil, Tofranil, Triavil, Trimpramine) Hypersensitivity, Alkalosis patient. Pushing a PH to an alkalosis state instead of neutralizing the ph. 1mEq/kg followed ½ the initial dose q 10 minutes. Use 4.2% solution for pediatrics Avoid mixing with Epinephrine or Calcium.

42 Contraindication: Ped Dose: Caution: Vasopressin Immediate Variable Pitressin Antidieretic Hormone directly stimulates smooth muscle V1 receptors, resulting in vasoconstriction Alternate to Epi, Vasodilitory shock Hypersensitivity, Responsive patients with coronary artery disease MI,water intoxication, bradycardia, angina, arrhythmias, HTN anaphylaxis, bronchospasm, angioedema, venous thrombosis 40 units IV/IO push may replace Epi 1 st or 2 nd dose Cardiac unit/kg IV/IO bolus

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