Midterm Paramedic Meds.txt

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Plewis831
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280924
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Midterm Paramedic Meds.txt
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2014-08-19 20:16:10
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Midterm Paramedic Meds
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Midterm Paramedic Meds
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    • Amyl Nitrate (cyanide antidote kit) dosage:
    • -Amyl Nitrate: breathe 30 sec out of every minute
    • -Sodium Thiosulfate & Sodium Nitrate: IV per antidote kit directions
  1. Oxytocin (pitocon/syntocinon) dosage:
    • IV Drip= 20 units in 1,000ml NS run w/o
    • IM= 10 units
  2. Fentanyl dosage:
    2-100mcg SLOW IVP, IM, use local protocols to find appropriate dose
  3. Lidocaine (xylocaine) dosage:
    • -Ventricular ectopy: 1mg/kg SLOW IVP/IO, MR 0.5 mg/kg q 5-10 min to Max 3mg/kg
    • - V-tach: 1mg/kg SLOW IVP/IO, MR 0.5 mg/kg q 5-10 min to Max 3mg/kg
    • -V-fib: 1-1.5mg/kg IVP/IO, MR 1-1.5 mg/kg q 5-10 min to Max 3mg/kg
    • IV infusion: 2gm in 250cc D5W run @ 2-4 mg/min. 2gm/min=15 gtts, 4gm/min=30 gtts
  4. Morphine Sulfate dosage:
    • -Chest Pain= 3-5mg slow IVP, MR q 5 min to Max 10mg
    • -Pulmonary Edema= 3-5mg slow IVP, MR q 5 min to Max 10mg
    • -Ortho trauma/burns= 3-5mg slow IVP, MR q 5 min to Max 10mg (base contact required for >10mg)
  5. Nitroglycerin (nitrostat) dosage:
    0.4mg SL spray or tablet MR q 3-5 min to Max 3 doses
  6. Midazolam (Versed) dosage:
    • IV= 0.1 mg/kg SLOW IVP (Max 5mg)
    • IM= 0.2 mg/kg IM (Max 10mg)
  7. Dopamine (intropin) dosage:
    • 5-20 mcg/kg/min IV infusion, dosage ranges:
    • -5-10 mcg/kg/min= beta stimulation
    • -over 10 mcg/kg/min= alpha stimulation
  8. Epinephrine dosage:
    • -Asthma: 0.3mg-0.5mg 1:1,000 IM, MR q 5 min to Max 2 doses
    • -Anaphylaxis: 0.3mg-0.5mg 1:1,000 IM, MR q 5-15 min as needed
    • -Cardiac Arrest: 1.0mg 1:10,000 IVP, IO, MR q 3-5 min
    • -Drip: mix 1mg in 250cc NS or D5W & start at 30 gtts/min. (equivalent to 2mcg/min), titrate to effect
  9. Oxytocin (pitocon/syntocinon) action(1):
    Stimulates contraction of uterine muscles (constricts muscles and blood vessels, reducing hemorrhage)
  10. Oxytocin (pitocon/syntocinon) indication(1):
    Post-partum hemorrhage
  11. Oxytocin (pitocon/syntocinon) contraindications (2):
    • -Before delivery of infant and placenta.
    • -Allergy to oxytocin
  12. Oxytocin (pitocon/syntocinon) Adverse effects (3):
    • CV= hypotension, arrhythmias
    • GI= N/V
  13. Oxytocin (pitocon/syntocinon) Precautions (3):
    • -Monitor VS & Blood loss q 5 mins.
    • -Use other hemorrhage control methods such as: fluid replacement, uterine massage, baby to breast, shock position.
    • -Pts. w/ Hx of C-section or uterine surgery are high risk for hemorrhage
  14. Fentanyl action (5):
    • -Binds to opiate receptors in sympathetic NS
    • -Alters the perception of pain (shorter lasting than Morphine)
    • -CNS depressant
    • -Analgesia
    • -Anxiety relief
  15. Fentanyl indication (3):
    • -Anginal CP
    • -Pulmonary edema
    • -Severe pain in isolated extremity trauma and burns
  16. Fentanyl contraindications (8):
    • -Hypersensitivity to opiates
    • -Hypotension, hypovolemia, shock
    • -Severe respiratory depression
    • -Pain, unknown etiology
    • -Head trauma
    • -Diminished LOC
    • -Multi system trauma
    • -Acute abdominal pain
  17. Fentanyl adverse effects (8):
    • Euphoria, sedation, confusion, ataxia
    • CV= Hypotension, bradycardia
    • RESP= Respiratory depression
    • Gi=N/V
  18. Fentanyl precautions (6):
    • -Have Narcan and airway equipment ready to use.
    • -Monitor EKG & VS at regular intervals.
    • -Potentiates effects of ETOH/CNS depressants.
    • -For pain, obtain Pt's pain level prior to each dose
    • -Use w/ caution in very old and very young patients
    • -Has an adverse interaction w/ amiodarone, use caution
  19. Morphine Sulfate precautions (5):
    • -Have Narcan and airway equipment ready to use.
    • -Monitor EKG & VS at regular intervals.
    • -Potentiates effects of ETOH/CNS depressants.
    • -For pain, obtain Pt's pain level prior to each dose
    • -Use w/ caution in very old and very young patients
  20. Morphine Sulfate adverse effects (8):
    • Euphoria, sedation, confusion, ataxia
    • CV= Hypotension, bradycardia
    • RESP= Respiratory depression
    • Gi=N/V
  21. Morphine Sulfate contraindications (8):
    • -Hypersensitivity to opiates
    • -Hypotension, hypovolemia, shock
    • -Severe respiratory depression
    • -Pain, unknown etiology
    • -Head trauma
    • -Diminished LOC
    • -Multi system trauma
    • -Acute abdominal pain
  22. Morphine Sulfate indications (3):
    • -Anginal CP
    • -Pulmonary edema
    • -Severe pain in isolated extremity trauma and burns
  23. Morphine Sulfate action (6):
    • -Binds to opiate receptors in sympathetic NS
    • -Alters the perception of pain
    • -Systemic vasodilation (reduces afterload and preload)
    • -CNS depressant
    • -Analgesia
    • -Anxiety relief
  24. Amyl Nitrate action (3):
    • -Amyl Nitrate: affinity for cyanide ions, reacts with hemoglobin to form methemoglobin (low toxicity)
    • -Sodium Nitrate: same as Amyl Nitrate
    • -Sodium Thiosulfate: Produces thiocyanate, which is then excreted
  25. Amyl Nitrate indication (1):
    -Cyanide or Hydrocyanic acid poisoning
  26. Amyl Nitrate contraindications:
    None
  27. Amyl Nitrate adverse effects (1):
    Excessive dose of Amyl Nitrate & Sodium Nitrate can produce severe, life threatening methomoglobinemia. Use only recommended doses.
  28. Amyl Nitrate precautions (1):
    Cyanide poisoning must be recognized quickly & treated quickly: if pulse persists, even in the presence of apnea, prognosis is good with treatment. The antidote kit must be used in conjunction with administration of oxygen.
  29. Lidocaine action(3):
    • -Increases fibrillatory threshold
    • -Decreases ventricular irritability
    • -Suppresses ventricular ectopy
  30. Lidocaine indication (3):
    V-fib, V-tach, malignant PVC's
  31. Lidocaine contraindications (4):
    • -PVC's w/ bradycardia
    • -2nd or 3rd degree AV block
    • -Idioventricular rhythm
    • -Allergy to amide type local anesthetics
  32. Lidocaine s/s toxicity (13):
    • -Early s/s: restlessness, anxiety, disorientation, combativeness, twitching, numbness, euphoria
    • -Late s/s: convulsions, coma, hypotension, widening QRS complex, prolonged PRI interval, cardiac arrest.
  33. Lidocaine precautions (4):
    • -Monitor VS & EKG, ectopy, CNS toxicity.
    • -Use supplemental O2
    • -Stop infusion @ first sign of toxicity
    • -Use cautiously and 1/2 dose if patient is >65yo or has Hx of CHF or liver disease.
  34. Dopamine action (4):
    • -Stimulates dopaminergic, alpha and beta receptors of sympathetic NS
    • -Low dose stimulates dopaminergic receptors (=renal & mesenteric)
    • -Mid dose stimulates beta receptors (= +inotrope)
    • -High dose stimulates alpha receptors (= peripheral renal & mesenteric vasoconstriction)
  35. Dopamine indication (3):
    • -DOC for cardiogenic shock.
    • -Bradycardia w/ hypotension.
    • -Other shock states after fluid resuscitation
  36. Dopamine contraindication (2):
    • -Hypovolemic shock.
    • -Tachydysrhythmias
  37. Dopamine adverse effects (6):
    • CNS: h/a
    • CV: Ventricular irritability, dysrhythmias, HTN (high dose), hypotension
    • GI: n/v
  38. Dopamine precautions (5):
    • -Monitor VS & EKG continuously!
    • -Use supplemental O2
    • -If unwanted rise in diastolic pressure is seen, STOP infusion
    • -Tissue necrosis occurs on extravasion
    • -Incompatible w/ Bicarb
  39. Epinephrine action(3):
    • Stimulates adrenergic receptors:
    • -Alpha = peripheral vasoconstriction
    • -Beta 1= +inotrope & +chronotrope
    • -Beta 2= bronchodilation
  40. Epinephrine indication (7):
    • W/o pulse = asystole, V-fib, V-tach, PEA, Idioventricular rhythm
    • W/ pulse: Anaphylaxis, bronchospasms (from respiratory distress)
  41. Epinephrine contraindications (5):
    • -None in cardiac arrest.
    • -Underlying cardiovascular disease.
    • -Hypersensitivity to sympathomimetics
    • -Tachyarrhythmias, HTN
    • -Hemorrhagic or cardiogenic shock
  42. Epinephrine adverse effects (7):
    • -CNS=h/a, anxiety (skeletal muscle tremors)
    • -CV=HTN, SVT, ventricular irritability, palpitations, MI
  43. Epinephrine precautions (3):
    • -Monitor VS & EKG
    • -Use supplemental O2
    • -Potentiation may occur w/ sympathomimetics
  44. Nitroglycerin action (3):
    • -Reduces myocardial O2 demands
    • -Systemic vasodilation (reduces afterload and preload)
    • -Increases blood flow in collateral coronary vessels
  45. Nitroglycerin indication (3):
    • -Angina pectoris
    • -Pulmonary edema
    • -Hypertensive crisis
  46. Nitroglycerin contraindication (4):
    • -Hypersensitivity to nitrates
    • -Hypotension (BP<90 systolic)
    • -S/S of ICP
    • -Pt. use of viagra (or other sexual performance drugs) within 24 hrs
  47. Nitroglycerin adverse effects (7):
    • -CNS: h/a, dizziness
    • -CV: orthostatic hypotension, tachycardia, flushing, palpitations
    • -GI= n/v
  48. Nitroglycerin precautions (5):
    • -Monitor VS(BP!) & EKG.
    • -Use supplemental O2.
    • -Anticipate "throbbing" headache (indicative of Max response).
    • -Store tablets in a dark, cool, dry place. -Do not shake spray
  49. Midazolam (Versed) action (3):
    • -Anticonvulsant/CNS depressant
    • -Sedative (w/ amnesic effect)
    • -Skeletal muscle relaxant
  50. Midazolam (Versed) indication (4):
    • -Seizures
    • -Adjunct to intubation
    • -Sedation prior to cardioversion
    • -Chemical restraint
  51. Midazolam (Versed) contraindications (6):
    • -Hypersensitivity to Versed.
    • -Hypovolemia, hypotension, shock, coma.
    • -Acute narrow-angle glaucoma.
    • -Acute ETOH intoxication.
    • -Depressed vital signs.
    • -Pregnancy.
  52. Midazolam (Versed) adverse effects (7):
    • -CNS: sedation, ataxia, coma, drowsiness
    • -CV: Hypotension
    • -RESP: Respiratory depression, apnea
  53. Midazolam (Versed) precautions (5):
    • -Keep airway equipment ready (airway management)
    • -Monitor VS & assess reputations continuously
    • -IM injections: give in large muscle mass (no deltoid)
    • - Possible respiratory depression w/ rapid IVP
    • -Potentiates effects of ETOH & CNS depressants

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