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Module:
Session:
Advanced Care ParamedicineAdvanced Care Paramedicine
Pharmacology
7
2a
Electrolytes
Calcium Chloride
Class: Electrolyte
MOA: Essential component for functional integrity of
nervous and muscular systems Enhances automaticity Positive inotrope
Calcium Chloride
Indications: Hyperkalemia Hypocalcemia CCB Toxicity Hypermagnesemia Respiratory depression after MgSO4 administration To prevent Hypotension from CCB
Contraindications: Vfib Digitalis toxicity Hypercalcemia Renal or Cardiac disease
Calcium Chloride
Adverse Reactions: Bradycardia Hypotension Metallic taste Severe local necrosis (infiltration)
Calcium Chloride
Supplied: 10% solution in 10 ml
Dosage: Adult: 5 - 10 cc over 3 minutes
(8 – 16 mg/kg)
Pediatric: 5 mg/kg over 3 minutes
Magnesium Sulphate
Class: Electrolyte Anticonvulsant (toxemias) Antiarrhythmic (torsades, TCA OD) Uterine Relaxant
MOA: Reduces striated muscle contractions and
blocks peripheral neuromuscular transmission by reducing Ach release
Magnesium Sulphate
Indications: Seizure due to Eclampsia Torsades de Pointes Hypomagnesemia Refractory Vfib (not NS) Status Asthmaticus (not NS)
Contraindications: Heart block Myocardial damage
Magnesium Sulphate
Adverse Reaction: Diaphoresis Facial flushing Hypotension Depressed reflexes Hypothermia Bradycardias Circulatory collapse Respiratory depression Diarrhea
Magnesium Sulphate
Supplied: 20% solution
Dosage: Bolus:
Torsades: 1 gm IV at 1 g/min Toxemia: 4 gm IV at 1 g/min
Infusion: 2 g in 100 cc NaCL (0.9%) at 50 ml/hr (1 g/hour)
Potassium Chloride
Class: Electrolyte
MOA: Principle intracellular ion affecting
muscular contraction and nervous system transmission
Potassium Chloride
Indications: Transport medication only in doses of < 40 mEq/ml Hypokalemia Digitalis toxicity May see it Post MI (in conjunction with Dextrose and
Insulin)
Contraindications: Renal impairment Acute dehydration Heat cramps Elevated serum potassium causing diseases
Potassium Chloride
Adverse Effects: N/V Diarrhea with ABD pain K+ toxicity/hyperkalemia Hypotension Cardiac arrhythmias Heart block
Potassium Chloride
What to look for in Hyperkalemia: Paresthesis of extremities Flaccid paralysis Mental confusion Weakness and heaviness
of legs Cardiac changes
P waves flatten and may disappear
Widening and slurring of QRS
ST changes Peaked T waves
Potassium Chloride
What to do: Discontinue IV Treat hypotension as required (position and fluid
resuscitation) Arrhythmias
Consider Calcium Chloride (if CV toxicity) Consider Sodium Bicarbonate (renal failure)
Potassium Chloride
What to look for in Hypokalemia: Polyuria Muscle weakness ECG Changes
Widen QRS T waves may flatten U wave may appear
and increase in size and may pass T wave size and eventually fuse together at low levels
Sodium Bicarbonate
Class: Buffer Alkalinizing agent Electrolyte
MOA: Reacts with H+ ions to form water and
carbon dioxide
Sodium Bicarbonate
Indications: Wide complex tachycardia or arrest from TCA OD Acidosis Cardiac arrest with pre-existing hyperkalemia (renal failure) Cardiac arrest patients with suspected ASA OD
Contraindications: Alkalosis Severe pulmonary edema Abdominal pain of unknown origin Hypocalcemia Hypokalemia Hypernatremia
Sodium Bicarbonate
Adverse Effects: Metabolic alkalosis Hypoxia Increased intracellular PCO2 and increased tissue
acidosis Electrolyte imbalance (hypernatremia) Seizures
Sodium Bicarbonate
Supplied: 50 mEq/50cc
Dosage: First dose: 1 mEq/kg Subsequent dose: 0.5 mEq/kg q 10 minutes PRN
Volume Expanders
Pentaspan
Other Names: Pentastarch Hydroxyethyl Starch
Class Plasma Volume Expander
Pentaspan
MOA: Polysaccharides with water-retaining properties
and intravascular retention The colloidal properties make it a useful volume
expander. Intravascular infusion of pentaspan results in
expansion of plasma in excess of the volume of pentaspan infused.
Expansion exists for approx. 18-24 hours and is expected to improve hemodynamic status for 12-18 hours.
70% of drug eliminated in 24 hrs
Pentaspan
Indications: Plasma volume expansion in the
management of: Shock due to hemorrhage Surgery Sepsis Burns Other trauma
Pentaspan
Contraindications: Hypersensitivity to hydroxyethyl starch Bleeding disorders CHF, where volume overload is a
potential problem Should not be used in renal disease with
oliguria or anuria not related to hypovolemia.
Pentaspan
Adverse Reactions: Coagulation disorders or hemorrhage Hypersensitivity Chills Anxiety
Pentaspan
Supplied: IV infusion bags of 250 and 500 ml. (10%
solution) – which gives what concentration?
May appears translucent pale yellow to amber colored
Pentaspan
Dosage: Total dose and infusion depends on the
amount of blood or plasma lost. Typical is 500 - 2000 ml Max: 28 ml/kg/day In acute hemorrhagic shock, an
administration of 20 ml/kg/hour may be used.
Albumin
Other Names: Plasbumin- 5 % Plasbumin- 25 %
Class: Plasma Volume Expander
Albumin
MOA: Albumin is the main protein in human blood and the key to
the regulation of the osmotic pressure of blood. Chemically, albumin is soluble in water, precipitated by acid, and coagulated by heat.
Albumin 5% is oncotically equivalent volume for volume to normal human
plasma and will allow expansion of the blood volume equal to the volume infused (if patient is hydrated)
Albumin 25% has an oncotic effect in which an additional fluid is drawn
from the extra cellular tissues into circulation within 15 minutes. Blood viscosity and hemoconcentration is reduced, while total blood volume increases making Albumin 25% a key plasma volume expander (3-4 times)
Albumin
Indications: Emergency treatment of:
Hypovolemic shock, burn therapy cardiopulmonary bypass (CABG) acute liver failure
Volume deficit consider Albumin 5% Oncotic deficit consider Albumin 25% along with
appropriate crystalloid solution.
Albumin
Contraindications: Hyperhydration Pulmonary edema Severe anemia Heart failure Hypersensitivity
Albumin
Adverse Effects: Shaking Chills Uticaria Severe anemia Heart failure Hypersensitivity
Albumin
Supplied: Vial of Albumin
5% USP Vial of Albumin
25%
Albumin
Dosage: 500 ml of Albumin 5% q 30 min IV,
PRN Needs to be administered IV slowly to
prevent fluid overload No specific duration