Paramedic FINAL Medication Study

• Aspirin / St. Joseph's / Bayer
• Platelet Aggregation Inhibitor
• CP suggestive of MI or ACS
• Adult: 160 - 325 mg orally
• Pedi: 10 - 15 mg/kg/dose every 4 - 6 hours

Nitroglycerin / Nitro BID / Nitrostat

Nitrate

• CP suggestive of MI or ACS
• CHF

Adult: 0.4 mg SL every 3 - 5 minutes

Pedi: Not indicated

Epinephrine / Adrenalin 1:1000

Sympathomimetic

• Anaphylaxis
• Bronchial Asthma
• Exacerbation of COPD

• Adult: 0.3 - 0.5 mg IM
• Pedi: 0.01 mg/kg up to 0.3mg IM

Epinephrine / Adrenalin 1:10,000

Sympathomimetic

Cardiac Arrest

• Adult: 1.0 mg IV/IO every 3 - 5 min
• Pedi: 0.01 mg/kg IV/IO every 3 - 5 min

Vasopressin

Hormone

Cardiac Arrest

Adult: 40 units IV/IO - single dose only, can replace 1st or 2nd dose of Epinephrine

Pedi: Not Indicated

Atropine

Parasympatholytic (anticholinergic)

• Symptomatic Bradycardia
• Organophosphate Poisoning

• Adult: 0.5 mg IV/IO every 3 - 5 min to max of 3.0 mg (bradycardia)
• (2 - 5 mg or more for Organophosphate Poisoning)

Pedi: 0.02 mg/kg (minimum of 0.1 mg) Max single dose is 0.5 mg

Amiodarone / Cordarone

Potassium Channel Blocker / Antiarrhythmic

• V-Tach
• V-Fib

• Adult:
• V-Fib / Pulseless V-Tach -
• 300 mg IV/IO.  May be repeated once at 150 mg after 3 - 5 min.

• Narrow-complex tachycardias -
• 150 mg IV/IO over 10 min & repeated as needed

• Pedi:
• 5 mg/kg IV/IO over 30 min. 
• May repeat twice up to 15 mg/kg. 
• Max single dose is 300 mg

Lidocaine / Xylocaine

Sodium Channel Blocker

V-Tach / V-Fib refractory to Amiodarone or if Amio is unavailable

• Adult: 1.0 - 1.5 mg/kg IV/IO
• Additional boluses of 0.5 - 0.75 mg/kg every 5 - 10 minutes -
• until arrhythmia suppressed
• or 3.0 mg/kg administered.

• Pedi:
• 1.0 mg/kg IV/IO

Procainamide / Pronestyl

Sodium Channel Blocker

• V-Tach with a pulse
• Pre-excited A-Fib

• Adult:
• 20 - 50 mg/min until arrhythmia suppressed.
• Discontinue if:
• Arrhythmia suppressed
• Hypotension
• QRS widens by 50%
• Total of 17 mg/kg given

Pedi: Not Indicated

Sotolol / Betapace / Sotacor

Beta Blocker

• Hemodynamically stable monomorphic V-Tach
• (Stable V-Tach)

Adult: 1.5 mg/kg infused over 5 min - slower is preferred.

Pedi: Not Indicated

Metoprolol / Lopressor

Beta Blocker

• MI with HTN
• Stable, narrow-complex tachycardia refractory to vagal maneuvers/adenosine
• Control ventricular rate in A-Fib or A-Flutter

• Adult:
• 5 mg slow IV/IO
• repeat up to 3 doses (15 mg) every 2 - 5 min

Pedi: Not Indicated

Labatolol / Trandate / Normodyne

Beta Blocker

HTN emergency - elevated BP causing end-organ changes such as altered mental status, CP, renal failure

• Adult:
• 20 mg slow IV/IO over 2 min.
• Additional boluses of 40 mg every 10 min until desired supine BP is reached or max of 300 mg is given.

OR:

500 mg into 250mL of D5W (1.0 mg/mL) at a rate of 2 mg/min to max of 300 mg.

Pedi: Not Indicated

Dobutamine / Dobutrex

Sympathetic Agonist

CHF - short term management, when increased cardiac output without increased HR is desired

• Adult:
• 2 - 20 mcg/kg/min (range)
• 5 - 10 mcg/kg/min (common range)

• Pedi:
• 2 - 20 mcg/kg/min

Dopamine / Intropin

Sympathetic Agonist

• Hemodynamically significant hypotension - 70 - 100 mmHg NOT resulting from hypovolemia or cardiogenic shock.
• Symptomatic bradycardia refractory to Atropine

• Adult:
• 2 - 20 mcg/kg/min - increase until BP improves or max of 20 mcg/kg/min
• Should be piggybacked into an already established IV infusion

• Pedi:
• 2 - 20 mcg/kg/min

Norepinephrine / Levophed

Sympathetic Agonist

Hypotension - systolic <70 mmHg, NOT due to hypovolemia

• Adult:
• 0.1 - 0.5 mcg/min per AHA, however higher doses may be required.
• Should be piggybacked into existing IV with a pump
• (dilute 8 mg in 500 mL D5W - 16 mcg/mL)

• Pedi:
• 0.01 - 0.5 mcg/kg/min (rarely used)

Cardizem / Diltiazem

Calcium Channel Blocker

• Narrow-complex tachycardia only. (refractory to adenosine or if SVT is recurrent)
• To control ventricular rate in A-Fib or A-Flutter

• Adult:
• 0.25 mg/kg IV bolus over 2 minutes
• 0.35 mg/kg after 15 minutes if needed

Pedi: Rarely used

Verapamil / Isoptin / Calon

Calcium Channel Blocker

• Narrow-complex tachycardia -
• refractory to adenosine
• or if SVT is recurrent
• to control ventricular rate in A-Fib or A-Flutter

• Adult:
• 2.5 - 5.0 mg IV/IO over 2 min
• Repeat at 5.0 - 10.0 mg over 2 min in 15 - 30 min if needed

• Pedi:
• 0 - 1 yr: 0.1 - 0.2 mg/kg (max 2.0 mg)
• 1 - 15 yrs: 0.1 - 0.3 mg/kg (max 5.0 mg)
• Administered slowly

Adenosine / Adenocard

Antiarrhythmic

Tachy arrhythmias refractory to vagal maneuvers

• Adult:
• 6 mg rapid IV/IO followed by rapid flush - in closest available vein to the heart
• 12 mg rapid IV/IO w/flush after 1 - 2 min if needed

• Pedi:
• <50 kg - 0.05 - 0.1 mg/kg (max 0.3 mg/kg/dose) up to 12 mg
• >50 kg - same as adult dose

Fibrinolytic

• Acute coronary syndrome
• Acute MI

• Adult:
• 10 units IV over 2 minutes
• Repeat in 30 minutes (max 20 units)

• Pedi:
• Not indicated

Anticoagulant

• Acute coronary syndrome
• Pulmonary embolism

• Adult:
• 60 - 70 units/kg/hr IV

• Pedi:
• 50 units/kg IV

Platelet Aggregation Inhibitor

• Acute coronary syndrome
• Recent MI
• Stroke
• Peripheral Vascular Disease (PVD)

• Adult:
• ACS & NSTEMI: 300 mg loading dose, followed by 75 mg daily

• Pedi:
• Not Indicated

Morphine

Narcotic

Severe pain with MI, kidney stones, etc.

• Adult:
• 2 - 10 mg IV/IO initial dose
• Additional doses of 2 mg every few min until pain is relieved or respiratory depression occurs.

• Pedi:
• 0.1 - 0.2 mg/kg IV/IO

Fentanyl / Sublimaze

Narcotic

• Severe pain
• Adjunct to RSI
• Maintenance of analgesia

• Adult:
• 25 - 100 mcg IV/IO
• slowly over 1 - 3 minutes

• Pedi:
• 2 - 12 yrs - 1.7 - 3.3 mcg/kg/dose

Narcan / Naloxone

Narcotic Antagonist

Narcotic overdose (morphine, heroin, Percocet, demeral, methadone, fentanyl, dilaudid, oxycodone)

• Adult:
• 1 - 2 mg IV/IO
• (can also be delivered IM & Intranasal)

• Pedi:
• <5 yrs - 0.1 mg/kg
• >5 yrs - 1 - 2 mg

Calcium Chloride

Calcium Supplement

• Acute hyperkalemia
• Acute hypocalcemia
• Calcium channel blocker toxicity (verapamil, diltiazem/Cardizem)

• Adult:
• 2 - 4 mg/kg IV
• may be repeated every 10 min as needed

• Pedi:
• 5 - 7 mg/kg of a 10% solution

Magnesium Sulfate

Anticonvulsant / Antiarrhythmic

• Pregnancy: Eclampsia
• Cardiac: Torsade de pointes (irregular polymorphic V-Tach)

• Adult:
• Torsades: 1 - 2 g IV/IO
• Eclampsia: 2 - 4 g IV/IO
• dilute in 10 mL NS over 15 min

Pedi: Not Indicated

Sodium Bicarbonate

Alkalinizing Agent

• Tricyclic antidepressant OD
• Severe acidosis refractory to hyperventilation

• Adult:
• 1 mEq/kg initially IV/IO
• 0.5 mEq/kg every 10 min as indicated by blood gas studies

• Pedi:
• Same as adult dose

Etomidate / Amidate

Sedative / Hypnotic

Induction agent for RSI / Intubation

• Adult:
• 0.1 - 0.3 mg/kg IV over 15 - 30 seconds

• Pedi:
• >10 yrs - same as adult dose
• <10 yrs - Not indicated

Ketamine / Ketalar

Sedative / Hypnotic / Analgesic

Induction agent for RSI / Intubation

• Adult:
• 0.5 - 1.0 mg/kg IV/IO over 30 - 60 seconds
• OR: 2.0 - 4.0 mg/kg IM

• Pedi:
• 0.5 - 3.0 mg/kg IV/IO or IM

Propofol / Diprovan

Sedative / Hypnotic

Induction & maintenance of sedation

• Adult:
• 2 mg/kg IV/IO for induction/intubation
• followed by 25 - 75 mcg/kg/min as needed

• Pedi:
• 1 mg/kg IV/IO

Succinylcholine / Anectine

Depolarizing Paralytic

To achieve paralysis to facilitate intubation when muscle tone or seizure activity prevents it.

• Adult:
• 1.0 - 1.5 mg/kg IV/IO

• Pedi:
• 1.0 mg/kg

Rocuronium / Zemuron

Nondepolarizing Paralytic

Induction of skeletal muscle paralysis

• Adult:
• 600 mcg/kg IV/IO - initial
• 100 - 200 mcg/kg - maintenance

• Pedi:
• 600 mcg/kg IV/IO - initial
• 75 - 100 mcg/kg - maintenance infusion

Vecuronium / Norcuron

Nondepolarizing Paralytic

To achieve paralysis to facilitate intubation when muscle tone or seizure activity prevents it. (Neuromuscular blockage lasts approx. 25- 30 min)

• Adult:
• 0.08 - 0.10 mg/kg IV/IO

• Pedi:
• 0.01 mg/kg IV/IO

Osmotic Diuretic

• Acute cerebral edema
• Blood transfusion reactions

• Adult:
• 1.5 - 2.0 g/kg slow IV bolus

• Pedi:
• 0.25 - 0.5 g/kg IV over 60 min

Toradol / Ketorolac

NonSteroidal Anti-Inflammatory Agent (NSAID)

Mild to moderate pain

• Adult:
• 30 mg IV
• 30 - 60 mg IM
• Dose s/be halved in elderly Pts

• Pedi:
• 0.5 mg/kg/dose (max dose 30 mg)

Phenobarbital / Luminal

Barbituate

• Major motor seizures
• Status epilepticus
• Acute anxiety states

• Adult:
• 100 - 250 mg slow IV

• Pedi:
• 10 mg/kg slow IV

Angiotensin-Converting Enzyme (ACE) Inhibitor

• HTN
• CHF

• Adult Dose:
• 1.25 - 5.0 mg IV over 5 minutes

• Pedi:
• Not indicated prehospitally

ACE Inhibitor

• HTN
• CHF

• Adult:
• 12.5 - 25 mg SL

• Pedi:
• Not indicated prehospitally

Albuterol / Proventil / Ventolin

Sympathomimetic - B2 Selective

• Asthma
• Reversible bronchospasm assoc with COPD

• Adult:
• 2.5 - 5.0 mg in 2.5 mL NS over 5 - 15 min (small volume neb)

• Pedi:
• <1 yr: 0.05 - 0.15 mg/kg/dose
• 1 - 5 yr: 1.25 - 2.5 mg
• 5 - 12 yr: 2.5 mg
• >12 yr: same as adult

Parasympatholytic / Anticholinergic

• Bronchial asthma
• Reversible bronchospasm assoc with COPD & Emphysema

• Adult:
• 500 mcg/dose (typically with a B agonist) in a small volume Neb

• Pedi:
• 350 - 500 mcg/dose - small volume neb

Sympathetic Agonist (B2 selective)

• Pre-term labor
• Reversible bronchospasm assoc with COPD
• Bronchial asthma

• Adult:
• Pre-term labor: 0.25 mg SQ

• Pedi:
• 0.01 mg/kg SQ

Benadryl / Diphenhydramine

Antihistamine

• Allergic reaction
• Anaphylaxis

• Adult:
• 25 - 50 mg slow IV push or deep IM

• Pedi:
• 2.0 - 5.0 mg/kg

Solu-Medrol / Methylprednisolone

Corticosteroid / Anti-inflammatory

• Severe anaphylaxis
• Asthma
• COPD
• Hives

• Adult:
• 125 - 250 mg IV - single dose in prehospital setting

• Pedi:
• 30 mg/kg

Corticosteroid / Anti-inflammatory

• Anaphylaxis (after Epi & Benadryl)
• Asthma
• COPD
• Hives

• Adult:
• 4 - 10 mg IV - single dose prehospitally

• Pedi:
• 0.2 - 0.5 mg/kg

Carbohydrate

• Hypoglycemia
• Coma of unknown origin

• Adult:
• 25g slow IV

• Pedi:
• 0.5 - 1.0 g/kg slow IV - dilute 1:1 with sterile water to form a 25% solution

Hormone / Anti-Hypoglycemic Agent

• Hypoglycemia
• Beta Blocker Overdose
• Calcium Channel Blocker Overdose

• Adult:
• 0.25 - 0.5 mg IV
• OR: 1.0 mg IM
• Beta Blocker OD: 3.0 - 10.0 mg bolus

• Pedi:
• 0.03 mg/kg IV

Vitamin (B1)

• Delirium Tremens (DTs)
• Coma of unknown origin

• Adult:
• 100 mg IV or IM

• Pedi:
• Rarely indicated

Antiemetic

Nausea & Vomiting

• Adult:
• 4 - 8 mg IV

• Pedi:
• 0.15 mg/kg IV

Phenothiazine Antihistamine (H1 antagonist)

• Nausea & Vomiting
• Motion Sickness
• Sedation
• To potentiate the effects of analgesics

• Adult:
• 12.5 - 25 mg IV or IM

• Pedi:
• 0.5 mg/kg IV

Phenothiazine antiemetic

• Nausea & Vomiting
• Reflux

• Adult:
• 10 mg slow IV push over 1 - 2 min
• OR: diluted in 50 mL NS over 15 min

• Pedi:
• Rarely used

Benzodiazepine / Anticonvulsant

• Major motor seizures
• Status epilepticus
• Premed to cardioversion
• Acute anxiety states

• Adult:
• 0.5 - 2.0 mg IV
• OR: 1.0 - 4.0 mg IM

• Pedi:
• 0.05 - 0.1 mg/kg (max 4.0 mg)

Benzodiazepine

• Premed to cardioversion
• Induction agent to RSI
• Acute anxiety states

• Adult:
• 1.0 - 2.5 mg slow IV

• Pedi:
• 0.03 mg/kg IV

Benzodiazepine

• Major motor seizures
• Status epilipticus
• Premed to cardioversion
• Skeletal muscle relaxant (RSI)
• Acute anxiety states

• Adult:
• Status epilipticus: 5 - 10 mg IV
• Acute anxiety: 2 - 5 mg IV or IM
• Cardioversion: 5 - 15 mg IV
• * Do not exceed 1 mL/min when administering

• Pedi:
• 0.1 - 0.2 mg/kg

Antipsychotic / Neuroleptic

Acute psychotic episodes

• Adult:
• 2 - 5 mg IM

• Pedi:
• Rarely used

Nitrate / Cyanide Antidote

Cyanide poisoning

• Adult:
• 1 - 2 inhalants should be crushed & inhaled
• Repeat every minute or so until hospital

• Pedi:
• Same as adult, repeat as needed

Benzodiazepine Antagonist

To reverse CNS depression assoc with benzo OD (valium, versed, Ativan, Xanax, etc.)

• Adult:
• 0.2 mg IV over 30 seconds
• second dose: same after 30 sec if desired LOC isn't reached w/in 30 sec
• Additional doses: 0.5 mg IV every minute as needed to max of 3 mg

• Pedi:
• 0.01 mg/kg over 30 seconds repeated as needed to max of 1.0 mg

• Cyanide Antidote
• Cyanide poisoning

• Adult:
• 5 g IV over 15 min
• second dose if needed to total of 10 g.

• Pedi:
• Not studied

Vasodilator

HTN emergency

• Adult:
• 0.25 mcg/kg/min - can be increased to max of 3 mcg/kg/min

• Pedi:
• Not indicated prehospitally

Xanthine Bronchodilator

• Bronchial asthma
• Bronchospasms assoc with chronic bronchitis & emphysema (COPD)
• CHF & pulmonary edema (rarely)

• Adult:
• 250 mg in 90 mL over 20 -30 min

• Pedi:
• 6 mg/kg over 20 - 30 min
• Max of 12 mg/kg in 24 hours

Hormone

Postpartum vaginal bleeding

• Adult:
• 3 - 10 units IM
• OR: 10 - 20 units in 500 mL NS and titrated to effect.
• (D5W or Lactated Ringers may also be used)

• Pedi:
• Not indicated

Loop Diuretic

• CHF
• Pulmonary edema
• HTN crisis

• Adult:
• 20 - 40 mg IV (if not currently on Lasix)
• 40 - 80 mg IV (if already on Lasix)

• Pedi:
• 0.5 - 2.0 mg/kg/dose