Drug: OXYGEN

Generic
Class of medication: Oxidizing agent (gas)
ACTION: Reverses Hypoxia, Increases arterial oxygen, Increases hemoglobin saturation, Increases tissue oxygenation
Indications: Hypoxia or anticipated hypoxia, or in any medical
or trauma patient to improve respiratory efficiency.

Contraindications: There are no contraindications to oxygen
therapy.
Dose: Route: Oral
DOSAGE: Adult: 1-6 LPM via NC; 10-15 LPM via NRB; 15 LPM via
BVM
Pediatric: 1-6 LPM via NC; 10-15 LPM via NRB; 15 LPM via BVM

Common side effects:
Dry or bloody nose, skin irritation from the nasal cannula or face mask
Precautions/major interactions:
Chronic obstructive pulmonary disease (COPD) and very
prolonged administration of high concentrations in the
newborn.

Drug: Oral Glucose
Generic Glutose, Insta-Glucose
Class of medication: Monosaccharide
Carbohydrate
ACTION: After absorption from GI tract, glucose is distributed in the tissues and provides a prompt increase in circulating
blood sugar
Onset: 10 min
Indications: Patients with altered mental status and known
history of diabetes mellitus

Contraindications:
Unconsciousness; known diabetic who has not taken insulin for
days; patient who is unable to swallow
Dose: Route: Oral
DOSAGE/ROUTE:Adult: One tube or packet; repeat based on BGL
Pediatric: One tube or packet; repeat based on BGL minimum age
3 yrs
Common side effects:
Nausea, may be aspirated by the patient without a gag reflex
Precautions/major interactions
Assure patient has control of swallowing and airway.

Drug: Glucagon
Generic: GlucaGen
Class of medication: Hormone, antihypoglycemic
ACTION: Glucagon is a protein secreted by pancreatic cells that causes a breakdown of stored glycogen into glucose and inhibits
the synthesis of glycogen from glucose.
Indications:
Hypoglycemia without IV access.
Contraindications:
Hypersensitivity to glucagon or protein compounds.
Dose: Route: Intramuscular
Adult:1-2mg IM, repeat in 15 minutes if BGL <60.
Ped:0.1 mg/kg IM, repeat in 15 minutes if BGL <60;age > 3 years


Common side effects:
Nausea, vomiting
Precautions/major interactions
Cardiovascular or renal impairment. Effective only if
there are sufficient stores of glycogen in the liver.



Drug: 50% Dextrose in water (D50)
Generic
Class of medication: Monosaccharide, Carbohydrate
ACTION: Dextrose is a simple sugar that the body can rapidly metabolize to create energy.
Indications: Hypoglycemia confirmed by glucometer.
(Coma or seizure of unknown etiology)
Contraindications:
None in hypoglycemia.
Dose: Route: IV
Adult:1 amp or 25g D50WIV bolus, repeat based on BGL.


Common side effects:
Tissue necrosis and phlebitis at injection site.
Precautions/major interactions: Increased ICP. Determine
blood glucose level before administration. Ensure good venous access.


Drug: Lactated Ringer's
Generic LR
Class of medication: Isotonic crystalloid solution
ACTION:
Assist in fluid replacement for dehydration or blood loss
Indications:
Manage hypovolemia (uses lactate as a buffer and contains
electrolytes)
Contraindications:
CHF or renal failure
Dose: Route: IV
Adult Dose: 200-500cc
Pediatric Dose:20cc/kg for fluid replacement
Max:60cc/kg or 2-3 liters of fluid




Common side effects:
Rare
Precautions/major interactions
CVA, Diabetics, Mixing with blood sets.


Drug: 0.9% NaCl
Generic Normal Saline
Class of medication: Isotonic crystalloid solution
ACTION:
- Electrolyte solution which equivalent osmotically to blood.
- Increases the circulating volume in the vascular system. (2/3 of infused volume leaves vascular space within 1 hour.)
Indications:
Replaces water and electrolytes; useful in heat exhaustion, freshwater
dorwning, hypovolemia, DKA
Contraindications: CHF and circulatory overload, Rales for
fluid bolus
Dose: Route: IV
Hypolemia
1. 1 L blood lost = 3 L of NS to infuse
2. Attempt to achieve SBP of 100 mmHg





Common side effects:
Rare
Precautions/major interactions
Be conservative in use of fluids with a suspected head injury patient to minimize
the risk of developing cerebral edema. Judicious fluid use may be needed for
hypotension associated with head injury to maintain cerebral perfusion.
Check BP and lung sounds to determine if fluid overload may be developing.
Drug: albuterol sulfate (nebulized)
Generic: Proventil, Ventolin
Class of medication: Sympathomimetic Bronchodilator
(sympathomimetic = mimics effects of sympathetic nervous system)
ACTION: Albuterol is a synthetic sympathomimetic that causes bronchodilatation with less cardiac effect than epinephrine and
reduces mucus secretion, pulmonary capillary leaking, and edema in the lungs during allergic reactions.
Indications: Bronchospasm and asthma in COPD.

Contraindications: Hypersensitivity to the drug, history of cardiac
disease, heart rate >150 in adults, heart rate >200 in pediatrics
Dose: Adult: 2.5-5.0 mg (3cc)via nebulizer continuously, x3
doses,if no history of cardiac disease and heart rate 150.
Ped:2.5mg (3cc) via nebulizer continuously, x3 doses, if no
history of cardiac disease and heart rate 200

Common side effects: Increased pulse rate (tachycardia)
,anxiety, nausea, cough, wheezing, tremors, and/or dizziness
Precautions/major interactions
The patient may experience tachycardia, anxiety, nausea, cough,
wheezing, and/or dizziness. Vital signs and breath sounds must be
monitored; use caution with elderly, cardiac, or hypertensive patients.




Drug: ipatromium bromide
Trade: Atrovent, Apovent, Ipraxa, Aerovent and Rinatec
Class of medication: Anticholinergic
ACTION: Ipratropium bromide is an anticholinergic agent. It blocks muscarinic cholinergic receptors, without specificity for subtypes, resulting
in a decrease in the formation of cyclic guanosine monophosphate
Indications: Bronchospasm associated with COPD
Can be used alone or combined with albuterol

Contraindications: Hypersensitivity to ipratropium or
atropine. Use caution in patients with narrow angle glaucoma
Dose:
500 mcg in 2.5 mL unit dose via SVN or in-line with ventilator device.
Repeat per Medical Direction. May mix one unit of ipratropium with one
unit of albuterol
Common side effects Resp: coughing, sputum increased
CNS: dizziness, insomnia, tremor, nervousness
GI: nausea GU: Urinary retention.
Precautions/major interactions
Ipratropium bromide inhalation solution is not a fast-acting medication
and cannot replace fast-acting rescue inhalers. Treatment of acute
episodes of bronchospasm where rescue therapy is required for rapid
response



Drug: Nitroglycerine
Trade: (Nitrostat)
Class of medication: Nitrate
ACTION: Relaxes blood vessels, decreases workload of heart
Indications: Chest pain associated with angina and acute
myocardial infarction.

Contraindications: Hypersensitivity, tolerance to nitrates, severe
anemia, head trauma, hypotension, increased ICP, patients taking
sildenafil (Viagra), glaucoma, and shock.
Dose: Route: Oral
Adult: 1 tablet or spray (0.4 mg) SL every 5 minutes
until pain- free or 3 doses. If SBP <100, contact medical control.
Ped:Not indicated.
Common side effects: Hypotension (lowers blood pressure),
headache, pulse rate changes.
Precautions/major interactions May induce headache
that is sometimes severe. Nitroglycerin is light sensitive and will
lose potency when exposed to the air

Drug: epinephrine (for anaphylaxis only)
Generic: Adrenalin
Class of medication: Sympathomimetic
ACTION: Epinephrine is a naturally occurring catecholamine that increases heart rate, cardiac contractile force myocardial electrical activity,
systemic vascular resistance, and systolic blood pressure and decreases overall airway resistance and automaticity. It also, through bronchial artery
constriction, may reduce pulmonary congestion and increase tidal volume and vital capacity
Indications: severe allergic reactions.

Contraindications: Hypersensitivity to sympathomimetic amines,
narrow angle glaucoma, hemorrhagic, organic brain or or during labor
Dose: Allergic reactions
Adult:0.3 mg of 1:1000 IM (if age <50)
0.15 mg of 1:1000 IM (if age >50)
Ped:0.01 mg/kg of 1:1000 IM (use Broselow);
max dose 0.3 mg
Common side effects: Increased heart rate, pallor, dizziness,
chest pain, headache,nausea, vomiting, excitability, anxiety.
Precautions/major interactions Elderly, debilitated
patients, hypertension, diabetes,hyperthyroidism, Parkinsons
disease, tuberculosis, asthma,emphysema, and in children < 6 year










Drug: nitrous oxide (50/50 mix)
Generic: Nitronox
Class of medication: Gaseous Analgesic/Anasthetic
ACTION: CNS depressant
Indications: Patients that are alert and complaining of pain caused
by the following: Musculoskeletal injuries/fractures, kidney stones,
suspected AMI (if NTG or morphine are ineffective or contraindicated),
active labor during an uncomplicated delivery, thermal burns

Contraindications:Any altered level of consciousness or head
injury.
Chronic Obstructive pulmonary disease.
Chest trauma or actual/suspected pneumothorax.
Abdominal distention
major facial trauma
acutely psychotic patients
Decompression sickness
Patients who cannot self-administer
Dose: Route: Self-administered via mask
Self-administer and self-regulated by the patient, who must hold the
mask to face to create an airtight seal until the pain is significantly
relieved or the patient drops the mask.
Common side effects Hypotension/Dizziness
Precautions/major interactions
Must be self-administered
Check machine gauges daily for proper concentrations.
Monitor blood pressure and pulse oximetry values




Drug: naloxone
Generic: NARCAN
Class of medication: Narcotic antagonist
ACTION: Naloxone is a pure narcotic antagonist that blocks the effects of both natural and synthetic narcotics and may reverse
respiratory depression.
Indications: Narcotic and synthetic narcotic overdose, coma
of unknown origin
Contraindications: Hypersensitivity to the drug, non-narcotic
induced respiratory depression.
Dose: Adult: 0.5-2 mg IV bolus titrated to patients respiratory
response; may be given IM if unable to establish IV.
Ped:0.1 mg/kg IV (max 2 mg), repeated in 5 minutes if no effect.

Common side effects: Abrupt reversal of narcotic depression
may result in nausea, vomiting, sweating, tachycardia, increased
blood pressure, tremulousness, seizures and cardiacarrest
Precautions/major interactions Possible dependency.
Short also half-life than that of mostnarcotics; hence the patient
may return to the overdose state.



Drug: activated charcoal
Generic:
Class of medication: Adsorbent (binding agent)
ACTION: Activated charcoal is a specially prepared charcoal that will adsorb and bind toxins from the gastrointestinal tract;
combined with Sorbitol to promote GI motility
Indications: Acute ingested poisoning

Contraindications: An airway that cannot be controlled;
ingestion of cyanide, mineral acids, caustic alkalis, organic solvents,
iron, ethanol, methanol.
Dose: Adult: 50 gms PO Route: Oral
Ped:1g/kg PO, max 25 gms

Common side effects Constipation, diarrhea, temporary
darkening of the stool, vomiting.
Precautions/major interactions
Administer only after emesis or in those cases where
emesis is contraindicate





Drug: acetaminophen
Trade: Tylenol, Anacin-3
Class of medication: Non-narcotic Analgesic, Antipyretic
ACTION: Antipyretic Activity, Analgesic Activity - Inhibition of central &amp; peripheral prostaglandin synthesis
Indications: For pain and fever control

Contraindications: Hypersensitivity, children under 3 years
Dose:
Adult: 1000mg PO
Pediatric: 10mg/kg PO

Common side effects: When used appropriately, side effects
with acetaminophen are rare. The most serious side effect is liver
damage due to large doses
Precautions/major interactions
Extreme caution must be used when considering the use on a suspected
liver dysfunction.

Drug: ibuprofen
Trade: Advil, Motrin
Class of medication: Analgesic, Antipyretic, Anti-inflammatory,
NSAID
ACTION: Reduces the inflammatory response through the chemotaxis. Reduces the fever by blocking the prostaglandin synthesis
Indications: Fever, Pain, Inflammation Reducer
Contraindication:
Contraindications: Hypersensitivity
Dose: Adult Dose: 200-800mg p.o. every 6-8 hours
Pediatric Dose:10mg/kg p.o. max of 40mg/kg per day (liquid
form)

Common side effects: G.I. intolerance, many others possible
Precautions/major interactions
You may want to alternate with Acetaminophen

Drug: Aspirin (Acetylsalicylic Acid)
Trade: Alka-Seltzer, Bayer, Emperin, St Joseph Childrens
Class of medication: Platelet inhibitor/Anti-inflammatory
ACTION: Blocks platelet aggregation
Indications: Chest pain suggestive of an MI Contraindications: Hypersensitivity to salicylates, active ulcer
disease, asthma
Dose: Adult: chewable baby aspirin (81mg each) PO
Pediatric: Not indicated

Common side effects: Nausea, vomiting, heartburn, bleeding.
Wheezing is possible with an allergic reaction.
Precautions/major interactions: GI bleeding and upset

Drug: Atropine (Auto Injector)
Generic:
Class of medication: Parasympatholytic
(increases heart rate)
ACTION: Atropine blocks the parasympathetic nervous system, specifically the vagal effects on the heart rate. It does
not increase contractility but may increase myocardial oxygen demand. Atropine decreases airway secretions
Dose: Adult: 2 mg IM via autoinjector Pediatric: Per medical control
only




Contraindications: None in an emergency setting

Common side effects:: Dry mouth, blurred vision, urinary
retention, tachycardia, constipation, decreased sweating
Precautions/major interactions: AMI, glaucoma.

















Drug: Pralidoxime (2-PAM)
Generic:
Class of medication: Cholinesterase reactivator

ACTION: Pralidoxime reactivates cholinesterase and
reinstitutes the degrading of acetylcholine and restores normal
neuromuscular transmission. It is used to reverse severe
organophosphate poisoning.
Indications: Organophosphate poisoning


Contraindications: Carbamate insecticides (Sevin), inorganic
phosphates, and organophosphates having no anticholinesterase activity,
asthma, peptic ulcer disease, severe cardiac disease, or
patients receiving aminophylline, theophylline, morphine,
succinylcholine, reserpine, or phenothiazines
Dose:
Adult: 600 mg IM via (Auto Injector)
Ped: Per medical control only



Common side effects: blurred or double vision, difficulty in
focusing eyes, difficulty in speaking, difficult or rapid breathing,
dizziness, fast heartbeat, muscle stiffness or weakness, pain at the place
of injection.
Precautions/major interactions
Rapid administration may result in tachycardia, laryngospasm, and
muscle rigidity. Excited or manic behavior may be noted after regaining
consciousness