Wilson County Emergency Management AgencyContraindications: Known Active GI Bleeding, Hypersensitivity, Known history of bleeding disorders, Hepatic impairment, Patient’s < 18 years

Wilson County Emergency Management Agency Protocol Manual Drug Reference

Drug Reference – Benzodiazepines Page 1 of 2 H - 1

Benzodiazepines

• generic

Brand equivalent

• alprazolam:

Xanax; Kalma; Apo-Alpraz; Novo-Aloprazol; Nu-Alprax; Tafil

• bromazepam:

Lexotan; Lexomil

• chloridazepoxide:

Librium; Nova-Pam; Apo-chlordiazepoxide; Corax; Medilium; Novo-Poxide; Solium

• clobazam:

Frisium

• clonazepam:

Klonopin; Rivotril

• clorazepate:

Gen-Xene; Tranxene; Apo-Clorazepate; Novo-Clopate

• diazepam:

Valium; Ducene; Antenex; D-Pam; Pro-Pam; Apo-Diazepam; Diazemuls; E Pam; Meval; Novo-Dipam; PMS-Diazepam; Vivol

• estazolam:

ProSom; Tasedan

• flunitrazepam:

Rohypnol; Hypnodorm

• flurazepam:

Dalmane; Apo-Flurazepam; Novo-Flupam; PMS-Flupam; Somnol; Som Pam

• halazepam:

Paxipam


Drug Reference – Benzodiazepines Page 2 of 2 H - 1

• ketazolam:

Anxon

• loprazolam:

Dormonoct

• lorazepam:

Ativan; Apo-Lorazepam; Novo-Lorazepam; Nu-Loraz; PMS-Lorazepam; Pro-Lorazepam

• lormetazepam:

Noctamid

• medazepam:

Nobrium

• midazolam:

Versed; Hypnovel; Dormicum

• nitrazepam:

Mogadon; Alodorm; Insoma; Nitrados

• oxazepam:

Serax; Serepax; Murelax; Alepam; Serenid; Benzotran; Apo-Oxazepam; Novo-Oxazepam; Oxpam; PMS-Oxazepam; Zapex

• prazepam:

Centrax

• quazepam:

Doral

• temazepam:

Restoril; Euhypnos; Normison; Temaze; Euhypnos; Nocturne; Normison; Temaze; Temtabs; Sompam

• triazolam:

Halcion; Apo-Triazo; Gen-Triazolam; Novo-Triolam; Nu-Triazo; Hypam; Tricam

Wilson County Emergency Management Agency Protocol Manual

Protocols

Drug Reference - Amiodarone Page 1 of 1 H - 2

Amiodarone Infusion Stable Rhythm Bolus Mix 150 mg in 100 ml. Refer to the Amiodarone Mixture Procedure I – 1. Maintenance Drip Due to the extended half-life of this medication, a Maintenance drip can be post postponed until arrival at the ER. Special Notes Utilize a gravity control device (IV Stat2) to administer this medication. VF/Pulseless VT Initial dose - 300 mg in 20 ml given over 2 minutes Secondary dose 150 mg in 20 ml given over 2 minutes

Drug Reference - Calculations

H - 4Drug Reference - Calculations





H - 4

Drug Reference - Calculations




Protocols

Drug Reference – Epi Chart (Hypotension/Brady) Page 1 of 1 H - 5

Adult Epinephrine Drip (Hypotension/Bradycardia)

2mg/500ml (4mcg/ml) Dose (mcg/minute) Infusion Rate (ml/hour)

1 15 1.5 22 2 30

2.5 37 3 45

3.5 52 4 60 5 75 6 90 7 105 8 120 9 135 10 150

Special Notes

• This medication should be administered through a gravity control device • Epinephrine should be 1:1,000 concentration


Protocols

Drug Reference – Epi Chart (Mast Cell) Page 1 of 1 H - 6

Epinephrine Drip Chart (Mast Cell Activation)

2mg/500ml (4mcg/ml) Dose (mcg/minute) Infusion Rate (ml/hour)

4 60 5 75 6 90 7 105 8 120 9 135 10 150

Special Notes

• This medication should be administered through a gravity control device • Epinephrine should be 1:1,000 concentration


Protocols

Drug Reference – Lidocaine Drip Page 1 of 1 H - 7

Lidocaine Drip Chart - Adult

1000mg/250ml (4mg/ml) Dose (mg/minute) Infusion Rate (ml/hour)

1 15 2 30 3 45 4 60

Special Notes This medication should be administered through a gravity control device (IV stat 2)

Medication References H - 8

Acetaminophen (Tylenol®)

Class: Analgesic and antipyretic agent

Packaging: 160 mg / 5 ml in oral solution

Dose: 15 mg / kg, MAX DOSE – 500 mg

Action: has been shown to inhibit the action of endogenous pyrogens on the heat-regulating centers in the brain by blocking the formation and release of prostaglandins in the central nervous system

Onset: 0.5 – 1 hour

Duration: 3 – 8 hours

Indications: A fever of 100.4 or greater, post febrile seizure Contraindications: Inability to swallow. Unconsciousness. Hepatic disease

Precautions: Use with caution by mouth if note AMS or lethargy

Adenosine (Adenocard®)

Class: Antiarrhythmic

Packaging: 12 mg / 4 ml (Vial)

Dose: 12 mg IV / IO

Max Dose: 36 mg

Action: It slows the conduction through the atrioventricular (AV) node and interrupts the reentry pathway.

Onset: Immediate

Duration: 20 – 30 seconds (Peak @ 10 seconds)

Indications: Supraventricular Tachycardia / paroxysmal supraventricular tachycardia Contraindications: AV blockages, Sinus node disease, WPW Syndrome

Precautions: Will not convert Atrial or Ventricular dysrhythmias


Albuterol

Class: A beta-2 adrenergic stimulant

Packaging: 2.5 mg / 3 ml solution (premixed)

Dose: 2.5 mg (Nebulized)

Action: Causes bronchodilation by stimulating the beta-2 receptor

Onset: 5 – 15 minutes


Indications: Bronchospasms: (Asthma / COPD)

Contraindications: Tachy-dysrhythmias

Precautions: It will cause an increase in heart rate; multiple doses in patients with a history of cardiovascular disease

Amiodarone

Class: Antidysrhythmic

Packaging: 150 mg / 3 ml in vial

Dose: Varies upon protocol

Action: Suppresses ventricular ectopy by prolonging the action potential and refractory periods. Slows the sinus rate and increases the PR and QT intervals


Duration: Variable

Indications: Life-threatening dysrhythmias

Contraindications: Patients with a known hypersensitivity to the drug. Because it may decrease automaticity, conductivity, and contractility, do not use in the presence of cardiogenic shock, severe sinus bradycardia, or advanced AV block unless a pacemaker is available

Precautions: Pregnancy. Nursing women. Use in pediatrics.


Amiodarone Drip

Class: Antidysrhythmic

Packaging: Adult: Mix 150 mg in 50 ml D5 bag, Ped: Mix 150mg in 100 ml D5 bag


Action: Suppresses ventricular ectopy by prolonging the action potential and refractory periods. Slows the sinus rate and increases the PR and QT intervals


Duration: Variable

Indications: Life-threatening dysrhythmias

Contraindications: Patients with a known hypersensitivity to the drug. Because it may decrease automaticity, conductivity, and contractility, do not use in the presence of cardiogenic shock, severe sinus bradycardia, or advanced AV block unless a pacemaker is available

Precautions: Pregnancy. Nursing women. Use in children.

Aspirin (Acetylsalicylic Acid)

Class: NSAID / Antiplatelet

Packaging: 81 mg tablets

Dose: 324 mg (PO)

Action: Impedes clotting by blocking prostaglandin synthetase action, which prevents the formation of the platelet aggregating substance thromboxane A2.



Indications: Cardiac Chest Pain

Contraindications: Known Active GI Bleeding, Hypersensitivity, Known history of bleeding disorders, Hepatic impairment, Patient’s < 18 years of age

Precautions: History of GERD, GI Bleeding, Currently taking anticoagulation medications, (Contact medical control for further advice if needed)


Atropine:

Class: Anticholinergic / Antiarrhythmic / Antimuscarinics

Packaging: 0.1 mg / ml (Prefilled Syringe)

Dose: Bradycardia: 0.5 mg IV / See protocol for other

Action: Inhibits muscarinic actions of acetylcholine at postganglionic parasympathetic neuroeffector sites.

Onset: Immediate


Indications: Bradycardia

Contraindications: None in emergency setting

Precautions: Patients with s/s of myocardial ischemia or infarction, Glaucoma

Special Notes: May not be effective in wide complex bradycardia or high degree AV blocks.

Calcium Chloride 10%

Class: Electrolyte

Packaging: 1 g / 10 ml (prefilled syringe)

Dose: 500 mg to 1000 mg IV (peds 20mg/kg)

Action: Acts as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscles. Maintains cell membrane and capillary permeability

Onset: Immediate

Duration: Depending on dose, may be up to 4 hours

Indications: KNOWN calcium channel blocker overdose / post hemodialysis arrest

Contraindications: Cardiopulmonary arrest not associated with calcium channel blocker toxicity, hypocalcemia, or hyperkalemia.

Precautions : Calcium chloride should not be administered in the same infusion with sodium bicarbonate since calcium will combine with sodium bicarbonate to form an insoluble precipitate (calcium carbonate). Calcium chloride should be given with extreme caution, and in reduced dosage, to persons taking digitalis because it increases ventricular irritability and may precipitate digitalis toxicity.


Dextrose (5%)

Class: Hypotonic solution once in the body Packaging: 5% in 50, 100, 500 ml for drug mixtures

Dose: Varies by use/protocol

Action: Provides a medium for IV medications, provides a small amount of dextrose for cellular metabolism while leaving behind water

Onset: Immediate

Duration: Remains in intravascular space for 20-40 minutes

Indications: Dilution solution for IV medications

Contraindications: None

Precautions: Diluting to the desired mixture is required.

Dextrose 50% (D50W)

Class: Carbohydrate Packaging: 25g in 50 ml (Prefilled Syringe)

Dose: Varies by protocol, can be reduced for D25 and D10.

Action: Increases blood sugar

Onset: Immediate

Duration: Dependent upon patient metabolism and degree of hypoglycemia

Indications: Hypoglycemia

Contraindications: Dextrose is contraindicated in intracranial hemorrhage, increased ICP, and known or suspected CVA in the absence of hypoglycemia.

Precautions: Diluting to the desired mixture may be required. Ensure IV patency as infiltration will cause local necrosis.


Diazepam (VALIUM)

Class: Anticonvulsant / Sedative

Packaging: 10 mg / 2 ml (Carpuject Vial) Dose: Varies by protocol

Action: Depresses the CNS by potentiating GABA; Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways; has anticonvulsant properties due to enhanced presynaptic inhibition.

Onset: IV: 1 – 5 mins // IM: Unknown (Erratic absorption rates)

Duration: IV/IM: 15 – 60 mins

Indications: Seizure

Contraindications: Known hypersensitivity, drug abuse, coma, shock, or head injury

Precautions: Use caution if the patient has ingested CNS depressants, May cause a decrease in respiratory drive and apnea.

Diltiazem (CARDIZEM)

Class: Calcium Channel Blocker // Antiarrhythmic

Packaging: 100 mg (ADD-Vantage® vial)

Dose: 0.25 mg/kg (max of 25mg), mixed in 100ml ADD-Vantage® soft saline bag

Action: Produces relaxation of coronary vascular smooth muscle and dilation of both large and small coronary arteries at drug levels which cause little or no negative inotropic effect


Duration: Unknown

Indications: Supra Ventricular Tachydysrrythmias: Atrial fibrillation / flutter with RVR

Contraindications: Sick sinus syndrome, high degree AV blocks, Recent MI, pulmonary congestion, hypersensitivity, or hypotension

Precautions: Hepatic or renal impairment, decreased cardiac function, geriatrics should receive a lower dose and a slower infusion, hepatic or renal failure.


Diphenhydramine (Benadryl)

Class: Antihistamine


Dose: Adult: IV/IO: 25 mg, IM: 50 mg. Peds: IV/IM: 1 mg / kg

Action: Reverses histamine-induced bronchospasm, vasodilation, and increased capillary membrane permeability.

Onset : Immediate IV/IO, 20 – 30 minutes IM


Indications: Anaphylaxis. Acute allergic reaction. Extrapyramidal/dystonic reactions

Contraindications: Narrow-angle glaucoma. Asthma. Pregnancy

Precautions: May cause significant sedation or paradoxical excitation/akethesia. Patients with a history of bronchial asthma, increased intraocular pressure, hyperthyroidism, cardiovascular disease or hypertension.

Dopamine

Class: Sympathomimetic


Dose: 2 – 20 mcg/kg/min (refer to right dose manual) IV, mixed in 250 ml D5% soft bag.

Action: Chemical precursor of norepinephrine that stimulates dopaminergic, beta-2-adrenergic, and alpha-adrenergic receptors


Duration: <10 minutes

Indications: Cardiogenic, neurogenic, septic, or anaphylactic shock. Bradycardia with hypotension refractory to Atropine. Hypotension (SBP < 90 mmHg) not secondary to hypovolemia

Contraindications: Hypovolemia, Tachydysrhythmias

Precautions: Local tissue necrosis can occur with extravasation from peripheral IV


Epinephrine 1:1000


Packaging: 1 mg / 1 ml (Ampule), 30 mg / 30 ml (Multi-dose Vial)

Dose: Varies on protocol

Action: Sympathomimetic, which stimulates both alpha and beta-adrenergic receptors causing immediate bronchodilation, an increase in heart rate and an increase in the force of cardiac contraction.

Onset: IM/SC: 3 – 10 minutes

Duration: IM/SC: 5 – 10 minutes

Indications: Allergic reaction, MAST cell activation, Croup

Contraindications: Known hypersensitivity

Precautions: Patients with a history of cardiovascular disease

Epinephrine 1:10,000


Packaging: 1 mg / 10 ml (Prefilled Syringe)

Dose: Varies upon protocol (Cardiac arrest & Anaphylaxis)

Action: Sympathomimetic, which stimulates both alpha and beta-adrenergic receptors causing immediate bronchodilation, increase in heart rate and an increase in the force of cardiac contraction

Onset: Less than 2 min IV/IO. Less than 1 min ETT.

Duration: 5 – 10 minutes IV/IO/ETT

Indications: To restore cardiac rhythm in cardiac arrest.

Contraindications: None in cardiac arrest and anaphylaxis

Precautions: None in cardiac arrest and anaphylaxis


Epinephrine Drip


Packaging: 2 mg Epinephrine 1:1000 added to 500 ml 5% Dextrose soft bag


Action: Sympathomimetic, which stimulates both alpha and beta-adrenergic receptors causing immediate bronchodilation, increase in heart rate and an increase in the force of cardiac contraction

Onset: Immediate

Duration: Varies upon infusion

Indications: Post-arrest hypotension, bradycardia, MAST Cell activation

Contraindications: None in life-threatening events

Precautions: None in life-threatening events

Fentanyl

Class: Opioid analgesic

Packaging: 100 mcg / 2 ml (Carpujet Vial)

Dose: Varies by protocol

Action: Narcotic agonist-analgesic of opiate receptors: Inhibits ascending pain pathways thus altering the response to pain; increases pain threshold; produces analgesia, respiratory depression, and sedation

Onset: IV : Immediate // IM: 7-15 min // IN: Unknown

Duration: IV : 30-60 mins // IM: 1-2 hr // IN: Unknown

Indications: Pain from an acute traumatic injury / Cardiac Chest Pain

Contraindications: Hypersensitivity to drug, Within two weeks of MAOI use

Precautions: Patients currently taking or recent use of CNS depressant, use caution when administering in conjunction with benzodiazepines, elderly patients, patients with hepatic or renal impairment


Ipratropium Bromide (Atrovent)

Class: Parasympatholytic bronchodilator

Packaging: 0.5 mg / 2.5 ml solution (premixed) Dose: 0.5 mg / 2.5 ml solution via nebulizer (Adult and peds the same)

Action: Causes bronchodilation, dries respiratory tract secretions



Indications: Bronchospasm in patients with reversible obstructive airway disease (asthma, chronic bronchitis, emphysema) and acute attacks of bronchospasm

Contraindications: Hypersensitivity to atropine or its derivatives or to soy lecithin or related food products (peanuts)

Precautions: Pregnant and nursing mothers

Ketamine

Class: Analgesic, Dissociative Analgesic, Anesthetic Dose: Varies on protocol


Action: Ketamine is a rapid-acting general anesthetic producing an anesthetic state characterized by profound analgesia, disassociation, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression

Onset: IV/IO: 30 seconds // IM: 3 – 4 minutes // IN: 5 – 15 minutes

Duration: Varies upon dose and protocol used

Indications: Severe pain / Injury / Burns & Extremity extrication

Contraindications: Any possibility of an acute MI, CVA, TIA, or any other ischemia. Hypertensive crisis, signs of herniation, Cushing’s Syndrome. Relative Hypertension: Systolic of 180 or Diastolic of 130

Precautions: Patients with a history of coronary artery disease, CHF, and possible increased ICP. Emergence reactions have been shown to occur in approximately 12% of patients.


This medication SHALL not be used to assist and / or facilitate intubation outside the RSI protocol!!!


Ketorolac (TORADOL)

Class: Nonsteroidal anti-inflammatory drug (NSAID)

Packaging: 30 mg / 1 ml (Carpujet Vial)

Dose: Adult 30 mg IV (15 mg if patient is older than 65 yr, or weighs less than 50 kg), 30−60 mg IM

Action: Exhibits analgesic, anti-inflammatory, and antipyretic activity

Onset: 30 minutes

Duration: 45 – 60 minutes

Indications: Mild or moderate pain

Contraindications: Patients with asthma. Hypersensitivity to Ketorolac, aspirin, or other NSAIDs

Precautions: Patients with a history of peptic ulcers; impaired renal or hepatic function; elderly

Lactated Ringers

Class: Electrolyte

Packaging: 1000 ml in soft bag

Dose: Adult 20 ml / kg bolus, Ped 20 ml / kg bolus – IV/IO

Action: Assist in fluid replacement due to blood loss or dehydration

Onset: Immediate

Duration: Individualized

Indications: Hypovolemia due to blood loss, burns, dehydration

Contraindications: Can’t be used with blood tubing

Precautions: CVA, Diabetics, Mixing with blood sets


Lidocaine 2%

Class: Antiarrhythmic, anesthetic

Packaging: 100 mg / 5 ml (Prefilled Syringe)


Action: Local anesthetic. Exerts antidysrhythmic action (class Ib) by suppressing automaticity in the His-Purkinje system and by elevating electrical stimulation threshold of the ventricle during diastole.

Onset: IV: Immediate // IO:


Indications: For responsive patients, slow infusion over 60 seconds prior to intraosseous fluid/medication administration. To convert ventricular dysrhythmias (ventricular fibrillation, ventricular tachycardia) in cardiac arrest to sinus rhythm

Contraindications: Known hypersensitivity, Stokes-Adams syndrome, and in second- or third-degree heart block in the absence of a pacemaker, WPW (Wolff-Parkinson-White syndrome). Allergy to -caine related anesthetics

Precautions: Patients with liver or renal disease, CHF, marked hypoxia, respiratory depression, hypovolemia, shock; myasthenia gravis; debilitated patients, the elderly; family history of malignant hyperthermia (fulminant hypermetabolism). Pregnancy


Lidocaine Drip

Class: Antiarrhythmic

Packaging: 2 g per 500 ml soft bag

Dose: Adult: 1 – 4 mg / min // Ped: 20 – 50 mcg / kg / min, IV/IO

Action: Exerts antidysrhythmic action (class Ib) by suppressing automaticity in the His-Purkinje system and by elevating electrical stimulation threshold of the ventricle during diastole.

Onset: Immediate


Indications: If maintenance infusion is needed following VT/VF conversion

Contraindication: Known hypersensitivity, Stokes-Adams syndrome, and in second- or third-degree heart block in the absence of a pacemaker, WPW (Wolff-Parkinson-White syndrome). Allergy to -caine related anesthetics

Precautions: Patients with liver or renal disease, CHF, marked hypoxia, respiratory depression, hypovolemia, shock; myasthenia gravis; debilitated patients, the elderly; family history of malignant hyperthermia (fulminant hypermetabolism)

Magnesium Sulfate 10%

Class: Electrolyte

Packaging: 1 g / 2 ml in vial


Action: Essential for the activity of many enzymes. Plays an important role in neurotransmission and muscular excitability. Acts as a physiological calcium channel blocker and blocks neuromuscular transmission of calcium. Smooth muscle relaxant.

Onset: IV: 3 – 5 minutes

Duration: 30 minutes

Indications: Severe asthma attack / Eclampsia

Contraindications: Patients with myocardial damage, heart block, shock, persistent hypertension, hypocalcemia

Precautions: Impaired renal function, digitalized patients, concomitant use of other CNS depressants or neuromuscular blocking agents


Methylprednisolone

Class: Steroid

Packaging: 125 mg / 2 ml (Act-O-Vial®)


Action: Reduces inflammation by multiple mechanisms. As a steroid, it replaces the steroids that are lacking in adrenal insufficiency

Onset: Onset of action is 1 to 2 hours following intravenous administration

Duration: 8 to 24 hours

Indications: Exacerbation of asthma and COPD, anaphylaxis/acute allergic reactions

Contraindications: Known hypersensitivity, Cushing’s Syndrome

Precautions: Use caution when administering to patients with diabetes mellitus, pregnancy, liver disease, or signs of systemic infection. Do not administer methylprednisolone preserved with benzyl alcohol to pregnant women, breastfeeding women, or neonates - benzyl alcohol is associated with serious adverse events in this population

Midazolam (VERSED)

Class: Benzodiazepine, sedative hypnotic

Packaging: 10 mg / 2 ml in (Vial)


Action: Midazolam is a shorter-acting benzodiazepine central nervous system depressant that produces sedation and lack of recall

Onset: IV: 3-5 min // IM: 15-20 min // IN: Unknown

Duration: IV: 20-40 min // IM: 1-6 hr // IN: Unknown

Indications: Procedural sedation (Cardio version etc.), Combative patients that require chemical sedation, Seizures, Secondary induction agent for RSI,

Contraindications: Known benzodiazepine sensitivity, narrow-angle glaucoma

Precautions: Pronounce respiratory depression in the elderly


Morphine

Class: Opiate, narcotic analgesic

Packaging: 4mg / 1 ml (Carpuject Vial)


Action: Narcotic analgesic, which depresses the central nervous system and sensitivity to pain. Increases venous capacitance, decreases venous return and produces mild peripheral vasodilation. Morphine also decreases myocardial oxygen demand.

Onset: IV: Immediate // IM/SC: 15-30 min

Duration: IV: Peak effect in 20 minutes // IM/SC: 30-60 min

Indications: Pain from an acute traumatic injury, chest pain associated with ACS

Contraindications: Known hypersensitivity, hypovolemia, hypotension, head injury, and asthma

Precautions: May result in respiratory depression and hypotension (especially in patients who are volume depleted or those with increased systemic vascular resistance)

Naloxone (NARCAN)

Class: Narcotic antagonist

Packaging: 2mg/2ml (Prefilled Syringe)

Dose: Adult 0.4 – 2 mg IV/IO/IM/IN, Peds 0.1 mg/kg

Action: Binds the opioid receptor and blocks the effect of narcotics

Onset: IV/IO: Less than 2 min // IM/IN: 2 – 10 min

Duration: IV/IO: 45 min // IM/IN: >45 min

Indications: Respiratory depression associated with narcotic overdose

Contraindications: Hypersensitivity to the drug, patients whose respiratory depression is due to non-opioid drugs

Precautions: May induce opiate withdrawal in patients who are physically dependent


Normal Saline

Class: Isotonic solution

Packaging: Prefilled syringe, soft bags


Action: Replacement of fluid and electrolytes lost from the intravascular and intracellular spaces

Onset: Immediate

Duration: Remains in intravascular space for less than an hour

Indications: Fluid replacement for hypovolemia, IV access line for drug administration, infusion into saline locks to ensure patency

Contraindications: Use caution in patients with rales

Precautions: Circulatory fluid volume overload

Nitro-Bid (Nitro Paste)

Class: Nitrate, Vasodilator

Packaging: 1 g in Folipac®

Dose: ½ - 1 inches (1 g /1 in)

Action: Direct vasodilator, which acts principally on the venous system although it also produces direct coronary artery vasodilation as a result. There is a decrease in venous return, which decreases the workload on the heart and thus, decreases myocardial oxygen demand



Indications: Symptomatic hypertensive crisis

Contraindications: Known hypersensitivity, hypotension, and cerebral hemorrhage or head injury. Withhold if the patient has taken Viagra/Levitra within 24 hours and Cialis/Revatio within 48 hours


Precautions: Alcohol will accentuate vasodilating and hypotensive effects. In the event that the patient requires cardioversion or pacing, avoid placing paddles or defibrillator or pacing pads near Nitro patch. It may be necessary to remove Nitro patch and wipe off skin prior to placing paddles or patches before cardioversion or pacing.

Nitroglycerin

Class: Nitrate, vasodilator

Packaging: Tablet in Amber vial

Dose: 0.4 mg tablet sublingual

Action: Direct vasodilator, which acts principally on the venous system although it also produces direct coronary artery vasodilation as a result. There is a decrease in venous return, which decreases the workload on the heart and thus, decreases myocardial oxygen demand



Indications: Chest pain or discomfort associated with suspected AMI or Angina Pectoris and acute pulmonary edema with hypertension.

Contraindications: Known hypersensitivity, hypotension, and cerebral hemorrhage or head injury. Withhold if the patient has taken Viagra/Levitra within 24 hours and Cialis/Revatio within 48 hours

Precautions: Use with caution in acute inferior wall MI or right ventricular infarct. Nitro tablets are inactivated by light, air and moisture and must be kept in amber glass containers with tight-fitting lids. Alcohol will accentuate vasodilating and hypotensive effects

Ondansetron (ZOFRAN)

Class: Antiemetic

Packaging: 4mg / 2ml (Vial)

Dose: Adult 4mg IV/IM, Peds 0.1mg/kg max 4mg (must be at least 6 months old)

Action: Blocks the effects of serotonin (5HT3) receptor sites peripherally, centrally and its release in the small intestine. Reduces the activity of the vagus nerve from activating the vomiting center in the medulla oblongata

Onset: 30 min

Duration: 3 – 6 hrs


Indications: Patients experiencing nausea and vomiting

Contraindications: Hypersensitivity to Ondansetron or to other similar drugs.

Precautions: Liver disorders, Long QT syndrome (heart problems), and Phenylketonuria

Promethazine (Phenergan®)

Class: Antiemetic

Packaging: 25 mg / ml (Vial)

Dose: Adult 12.5 mg IV, 25 mg IM. Ped: 0.25 mg / kg IV (max 25 mg), 0.5 mg IM (max 25 mg)

Action: Administered to prevent and control nausea, vomiting, and motion sickness. It is also used as a sedative and to potentiate the effects of analgesics

Onset: IV: 5 minutes // IM: 20 minutes


Indications: Nausea, vomiting, and motion sickness. To potentiate the effects of analgesics; to induce sedation.

Contraindications: Hypersensitivity to phenothiazines, nursing mothers, newborn or premature infants, acutely ill or dehydrated children.

Precautions: Patients with impaired hepatic function, cardiovascular disease, asthma, acute or chronic respiratory impairment (particularly in children), hypertension; elderly or debilitated patients

Quelicin (Succinylcholine)

Class: Depolarizing Neuromuscular Blocker


Dose: 1.5 mg / kg – (Max of 200 mg) IV/IO

Action: Depolarizing skeletal muscle relaxant; no effect on consciousness or pain

Onset: 30 – 60 seconds


Indications: RSI

Contraindications: Hypersensitivity to the drug. Hyperkalemia. Malignant hyperthermia. Narrow-angle glaucoma. Major burns greater than 16 hours and up to 6


months. Penetrating eye injuries. Chronic paralysis. Neuromuscular disorders such as Multiple Sclerosis and Muscular Dystrophy

Precautions: Increased ocular pressure. Burn patients. Organophosphate poisoning. Hyperthermia. Allergic reactions / Anaphylaxis may occur


Racemic Epinephrine


Packaging: (made by combining 1 mg of Epinephrine 1:1000 with 2.5 – 3 cc normal saline)

Dose: Adult/Ped 1 mg Epinephrine 1:1000 in 2.5 – 3 ccs normal saline Nebulized

Action: Racemic epinephrine stimulates both alpha- and beta-adrenergic receptors, with a slight preference for the beta2 receptors in the lungs. This results in bronchodilation and a decrease in mucus secretion. It also has some effect in relieving the subglottic edema

Onset: Within 5 min

Duration: 30 minutes – 2 hours (Peak: 5 – 20 minutes)

Indications: Subglottic edema in croup (laryngotracheobronchitis)

Contraindications: Known hypersensitivity, epiglottitis.

Precautions: Tachycardia and dysrhythmias may develop

Rocuronium (Zemuron)

Class: Non-depolarizing Neuromuscular Blocker


Dose: 1 mg / kg – (Max of 100 mg) IV/IO

Action: Non-depolarizing skeletal muscle relaxant; cholinergic receptor antagonist, inhibits depolarization


Duration: 30 - 60 minutes

Indications: Intubated patients that require a long-acting skeletal muscle relaxant

Contraindications: Hypersensitivity. Neuromuscular disease. Lack of waveform ETCO2

Precautions: Allergic reactions / Anaphylaxis may occur. Increased ocular pressure. Hepatic disease. Patients with ascites may require larger dose to assure complete block


Sodium Bicarbonate

Class: Electrolyte

Packaging: 50 mEq per 50 ml (Prefilled Syringe)

Dose: 1 mEq/kg IV/IO for Adults and Peds

Action: An alkalizing agent used to buffer acids present in the body during and after severe hypoxia. Bicarbonate combines with excess acids (usually lactic acid) present in the body to form a weak, volatile acid. This acid is broken down into CO2 and H2O. Sodium bicarbonate is effective only when administered with adequate ventilation and oxygenation

Onset: Immediate

Duration: Dependent upon degree of acid/base imbalance

Indications: Metabolic acidosis due to salicylate (Aspirin) overdose, barbiturate overdose, tricyclic antidepressant overdose, hyperkalemia, severe ketoacidosis, cardiac arrest, shock, physostigmine toxicity, methanol toxicity, ethylene glycol toxicity.

Contraindications: Congestive heart failure, alkalotic states

Precautions: Can cause metabolic alkalosis

Thiamine

Class: Vitamin (B1)


Dose: Adult 50 − 100 mg given slow IV/IM. Ped 10 − 25 mg given slow IV/IM

Action: Required for the conversion of glucose into energy and for the conversion of pyruvic acid to acetyl-coenzyme-A

Onset: Immediate

Duration: Dependent upon degree of deficiency

Indications: Coma of unknown origin especially if alcohol involved, delirium tremors

Contraindications: Known hypersensitivity

Precautions: Hypotension, burning at IV site


Vecuronium (Norcuron)

Class: Non-depolarizing Neuromuscular Blocker


Dose: 0.1 mg / kg – (Max 10 mg) IV/IO

Action: Non-depolarizing skeletal muscle relaxant; cholinergic receptor antagonist, inhibits depolarization



Indications: Intubated patients that require a long-acting skeletal muscle relaxant

Contraindications: Hypersensitivity. Neuromuscular disease. Lack of waveform ETCO2

Precautions: Allergic reactions / Anaphylaxis may occur

Wilson County Emergency Management Agency Protocol Manual Drug References

Drug Reference - Narcotics Page 1 of 1 H - 9

Narcotics

Alenta Alfentanil hcl Astramorph.PF Buprenex Buprenorphine.hcl Butorphanol.Tartrate Codeine.Phosphate Codeine.Sulfate Codoxy Dalgan Darvon.pulvules Demerol Dezocine Dilaudid Dilaudid HP Diprivan Dolene Dolophine.hcl Duramorph Fenoprofen Fentanyl Fentanyl.Citrate Fentanyl.Transdermal Hydromorphone.hcl Ingumorph 200, 500 Innovar Levo-dromoran Levorphanol Tartrate Meperidine.hcl Methadone hcl Methadone hcl Intensol Morphine Sulfate MS Contin MSIR Nalbuphine hcl Nalfon Nubain OMS Concentrate Oramorph SR Oxycondone Oxymorphone hcl Pentazocine hcl Pentazocine Lactate Propoxyphene hcl Percodan Propoxyphene hcl Propoxyphene Napsylate RMS Roxanol Roxanol Rescudose Roxanol SR Roxicodone Stadol Sublimaze Talwin Tylox

Wilson County Emergency Management Agency Emergency Pediatric Drug Dosages

GRAY GRAY GRAY GRAY GRAY GRAY PINK PINK RED RED PURPLE PURPLE

Weight guidelines 3 kg 3 kg 4 kg 4 kg 5 kg 5 kg 6 & 7 kg 6 & 7 kg 8 & 9 kg 8 & 9 kg 10 & 11 kg10 & 11 kg

Age guidelines Newborn Newborn Newborn Newborn Newborn Newborn up to 6 m/o up to 6 m/o ~ 9 mo ~ 9 mo ~ 1 y/o ~ 1 y/o

Adenocard (3mg/ml) (1st) 0.3 mg 0.1 ml 0.4 mg 0.13 ml 0.5 mg 0.17 ml 0.6 mg 0.2 ml 0.8 mg 0.27 ml 1 mg 0.33 ml

Adenocard (3mg/ml) (2nd) 0.6 mg 0.2 ml 0.8 mg 0.27 ml 1 mg 0.34 ml 1.2 mg 0.4 ml 1.6 mg 0.53 ml 2 mg 0.67 ml

Amiodarone (150mg/3ml) 15 mg 0.3 ml 20 mg 0.4 ml 25 mg 0.5 ml 30 mg 0.6 ml 40 mg 0.8 ml 50 mg 1 ml

Atropine (1mg/10ml) 0.1 mg 1 ml 0.1 mg 1 ml 0.1 mg 1 ml 0.12 mg 1.2 ml 0.16 mg 1.6 ml 0.2 mg 2 ml

Calcium Chloride 10% 60 mg 0.6 ml 80 mg 0.8 ml 100 mg 1 ml 120 mg 1.2 ml 160 mg 1.6 ml 200 mg 2 ml

Dextrose 10% 0.6 Gm 6 ml 0.8 Gm 8 ml 1 Gm 10 ml

Dextrose 25% 1.5 Gm 6 ml 2 Gm 8 ml 2.5 Gm 10 ml 3 Gm 12 ml 4 Gm 16 ml 5 Gm 20 ml

Epi 1:10,000 (1mg/10ml) 0.03 mg 0.3 ml 0.04 mg 0.4 ml 0.05 mg 0.5 ml 0.06 mg 0.6 ml 0.08 mg 0.8 ml 0.1 mg 1 ml

Epi 1:1,000 (1mg/ml) ETT 0.3 mg 0.3 ml 0.4 mg 0.4 ml 0.5 mg 0.5 ml 0.6 mg 0.6 ml 0.8 mg 0.8 ml 1 mg 1 ml

Lidocaine (100mg/5ml) 3 mg 0.15 ml 4 mg 0.2 ml 5 mg 0.25 ml 6 mg 0.3 ml 8 mg 0.4 ml 10 mg 0.5 ml

Magnesium (1Gm/2ml) 150 mg 0.3 ml 200 mg 0.4 ml 250 mg 0.5 ml 300 mg 0.7 ml 400 mg 0.8 ml 500 mg 1 ml

Soduim Bi Carb (4.2%) 1.5 mEq 3 ml 2 mEq 4 ml 2.5 mEq 5 ml 3 mEq 6 ml 4 mEq 8 ml 5 mEq 10 ml

Valium (10mg/2ml) IV 0.3 mg 0.06 mg 0.4 mg 0.08 ml 0.5 mg 0.1 ml 1.2 mg 0.24 ml 1.6 mg 0.3 ml 2 mg 0.4 ml

Valium (10mg/2ml)RECTAL 1.5 mg 0.3 ml 2 mg 0.4 ml 2.5 mg 0.5 ml 3 mg 0.6 ml 4 mg 0.8 ml 5 mg 1.0 ml

Versed (10mg/2ml) IV/IO 0.3 mg 0.06 ml 0.4 mg 0.08 ml 0.5 mg 0.1 ml 0.6 mg 0.12 ml 0.8 mg 0.16 ml 1 mg 0.2 ml

Versed (10mg/2ml) IN 0.6 mg 0.3 ml 0.8 mg 0.16 ml 1 mg 0.2 ml 1.2 mg 0.25 ml 1.6 mg 0.32 ml 2 mg 0.4 ml

Color (Broselow tape) YELLOW YELLOW WHITE WHITE BLUE BLUE ORANGE ORANGE GREEN GREEN

Weight guidelines 12 - 14 kg 12 - 14 kg 15 - 18 kg 15 - 18 kg 19 - 22 kg 19 - 22 kg 24 - 28 kg 24 - 28 kg 30 - 36 kg 30 - 36 kg

Age guidelines ~ 2 y/o ~ 2 y/o 4 y/o 4 y/o 6 y/o 6 y/o 8 y/o 8 y/o 10 y/o 10 y/o

Adenocard (3mg/ml) (1st) 1.2 mg 0.4 ml 1.5 mg 0.5 ml 1.9 mg 0.63 ml 2.4 mg 0.8 ml 3 mg 1 ml

Adenocard (3mg/ml) (2nd) 2.4 mg 0.8 ml 3 mg 1 ml 3.8 mg 1.3 ml 5.4 mg 1.8 ml 6 mg 2 ml

Amiodarone (150mg/3ml) 60 mg 1.2 ml 75 mg 1.5 ml 95 mg 1.9 ml 120 mg 2.4 ml 150 mg 3 ml

Atropine (1mg/10ml) 0.24 mg 2.4 ml 0.3 mg 3 ml 0.38 mg 3.8 ml 0.48 mg 4.8 ml 0.5 mg 5 ml

Calcium Chloride 10% 240 mg 2.4 ml 300 mg 3 ml 380 mg 3.8 ml 480 mg 4.8 ml 600 mg 6 ml

Dextrose 25% 6 Gm 24 ml 7.5 Gm 30 ml 9.5 Gm 38 ml 12 Gm 48 ml NA NA

Dextrose 50% NA NA NA NA NA NA NA NA 16.5 Gm 33 ml

Epi 1:10,000 (1mg/10ml) 0.12 mg 1.2 ml 0.15 mg 1.5 ml 0.19 mg 1.9 ml 0.27 mg 2.7 ml 0.3 mg 3 ml

Epi 1:1,000 (1mg/ml) ETT 1.2 mg 1.2 ml 1.5 mg 1.5 ml 1.9 mg 1.9 ml 2.4 mg 2.4 ml 2.5 mg 2.5 ml

Lidocaine (100mg/5ml) 12 mg 0.6 ml 15 mg 0.75 ml 19 mg 0.95 ml 24 mg 1.2 ml 30 mg 1.5 ml

Magnesium (1Gm/2ml) 600 mg 1.2 ml 750 mg 1.5 ml 950 mg 1.9 ml 1200 mg 2.4 ml 1500 mg 3.1 ml

Soduim Bi Carb (8.4%) 12 mEq 12 ml 15 mEq 15 ml 19 mEq 19 ml 24 mEq 24 ml 30 mEq 30 ml

Valium (10mg/2ml) IV 2.5 mg 0.5 ml 3.0 mg 0.6 ml 4 mg 0.8 ml 4 mg 0.8 ml 4 mg 0.8 ml

Valium (10mg/2ml)RECTAL 5 mg 1.0 ml 5 mg 1.0 ml 5 mg 1.0 ml 5 mg 1.0 ml 5 mg 1.0 ml

Versed (10mg/2ml) IV/IO 1.2 mg 0.24 ml 1.5 mg 0.3 ml 2 mg 0.4 ml 2.5 mg 0.5 ml 3.5 mg 0.7 ml

Versed (10mg/2ml) IN 2.5 mg 0.5 ml 3 mg 0.6 ml 4 mg 0.8 ml 4 mg 0.8 ml 4 mg 0.8

Adenocard (3mg/ml) regardless of 6mg/2ml or 12 mg/4ml prefilled syringes

The drug dosages are based on the setup of Wilson County EMA. Version 4 Revised: 9/22/2016Drug Reference - WEMA Chart Page 1 of 1 H - 13


Drug Reference - Tricyclics Page 1 of 1 H - 14

Tricyclics

Amitriptyline hcl Amoxapine Anafranil Asendin Aventyl hcl Clomipramine hcl Desipramine hcl Doxepin hcl Elavil Endep Enovil Imipramine hcl Janimine Norpramine Nortriptyline hcl Pamelor Pertofrane Protriptyline hcl Sinequan Surmontil Tofranil Trimipramine Maleate Trisoralen Vivactil

This document serves as a reference for medications included in the 2015 WEMA

Protocols. Utilize the individual protocols and standardized medication guides for all dosing.

Drug Adult Pediatric

Drug Guide

Acetaminophen (Tylenol) 32 mg / ml

WEMA Protocol:Fever / Infection (C-6.1)Pediatric Seizure (C-13)

Indications /Contraindications:Fever > 100.4Post Febrile SeizureAvoid in PT's with severe liver disease

15 mg / kg POMax Dose: 500 mg

One time dose

Adenosine 3 mg / ml

(Adenocard)

WEMA Protocol:SVT, PSVT (B-9)

Indications/Contraindications:SVT, PSVTAvoid in high degree blocks,VT, and Sick Sinus

Albuterol 2.5 mg / 3 ml

Beta-Agonist

WEMA Protocol:Respiratory Distress (C-12)

Indications/Contraindications:Bronchospasm, COPD, AsthmaAvoid in tachydysrhythmias

2.5 mg in 3 cc's NSNebulized

May repeat twice as long as HR is < 150

2.5 mg in 3 cc's NSNebulized

May repeat twice as long as HR is < 200

WEMA Drug Guide 2016 H-15




Drug Guide

Amiodirone 50 mg / ml

(Cordarone)

WEMA Protocol:V-Fib (B-11)V-Tach (B-12)PVC (B-7)

Indications/Contraindications:V-FibWide Complex Tachycardia'sPVC's (as defined in protocol)Avoid in heart block's and profound bradycardia's

V-fib / Pulseless V-Tach300 mg Bolus IV / IO

A second dose of 150 mg for recurrent events

V-Tach with a Pulse150 mg over 10 minutes

PVC's150 mg over 10 minutes

V-fib / Pulseless V-Tach

5 mg / kg slow IV push

V-Tach with a Pulse

5 mg / kg infused over 30 minutes

Use the "Right Dose" Book or WEMA infusion sheet to

Aspirin (ASA) 81mg / tab

WEMA Protocol:Chest Pain / STEMI (C-4)

Indications/Contraindications:Chest pain

81 mg chewable tabletPO

Desired dose: 324 mg

Atropine 0.1 mg / ml

WEMA Protocol:Bradycardia (B-4)Organophosphate poisoning(D-11)

Symptomatic bradycardia or to reduce the effects of

Bradycardia

0.5-1 mg IV/IO every 3-5 mins up to 0.04 mg/kg or 3 mg total dose

Organophosphate poisoning

2 mg IV / IO every 5 mins for moderate SLUDGE

Reflexive Bradycardia0.02 mg/kg IV / IO

Minimum of 0.1 mg

Organophosphate poisoning0.05 mg/kg IV / IO until vital

signs improve

See Color Coded Chart

Calcium Chloride 10%

WEMA Protocol: 100 mg / mlPEA / AsystoleDrug ingestionCrush

Indications/Contraindications:Known CCB OD, Crush injuriesSevere HyperkalemiaDigitalis toxicity

Cardiac Arrest500 - 1000 mg bolus IV / IO

This is diagnostic specific as described in the protocols

Cardiac Arrest 20 mg / kg bolus IV / IO

This is diagnostic specific as described in the protocols






Drug Guide

Dextrose - IV / IO Only10%, 25%, 50%

WEMA Protocol:Hypoglycemia (D-9)

Indications/Contraindications:HypoglycemiaTitrate to a blood glucose of 70 mg/dl in patients with increased ICP

IV / IO Only

Dextrose 50%

Blood sugar 40-80: 12.5g

Blood sugar < 40: 25g

Dextrose 10%Neonate - 2 months

Blood sugar 40-80: 2 ml / kg

Blood sugar < 40: 4 ml / kg

Dextrose 25%2 months - 8 years

Blood Sugar 40-80: 1 ml / kg

Dextrose 5%IV solution

WEMA Protocol:Various drug mixturesNot for use as fluid replacement or volume expansion

Not for use as fluid replacement or volume

expansion

Various amount needed for different drug mixtures

Possible maintenance infusion for hypoglycemic neonates.

Contact Vanderbilt Pediatric ED for orders and dosing.

Diazepam 5 mg / ml

(Valium)

WEMA Protocol:Seizures (C-13)

Indications/Contraindications:SeizuresHead Injury, Hypotension, Acute glaucoma

IV / IO ONLY

5 mg slow pushMay repeat onceMax total dose: 10 mg

Neonate < 1 month - (IV/IO)0.1 mg/kg (Up to 1 mg)

May repeat once

1 month - 5 years - (IV/IO)0.2 mg/kg (Up to 2.5 mg)

May repeat once

5 - 12 years - (IV/IO)0.3 mg/kg (Up to 4 mg)

May Repeat Once

Diltiazem 1 mg / ml

(Cardizem)

WEMA Protocol:A-Fib & A-flutter (B-2)

Indications/Contraindications:A-fib with RVR or A-flutterUse EXTREME caution in patients taking beta blockers

BP, Heart block or failure

Initial Rx0.25 mg/kg slow IV bolus

If No Change0.25 mg/kg slow IV bolus

Refer to procedure I-5.1 for instructions on delivery

Can not be given in the same line as Lasix





Drug Guide

Morphine 4 mg / ml

WEMA ProtocolChest Pain (C-4)Pain management (E-13)CHF (C-4.1)Sickle Cell Anemia (C-14)

Indications/ContraindicationsIschemic chest painModerate to severe painCHFPulmonary edemaHypotensionRespiratory depression

2 - 4 mg IV / IO / IM

< 6 months - 0.1 mg/kg

> 6 months - 0.2 mg/kg

Max single dose: 4 mg

IV / IO / IM

Naloxone 1 mg / ml

(Narcan)

WEMA ProtocolVarious

Contraindications/IndicationsSuspected opioid or other narcotic overdose

0.5 mg increments

Up to 2 mg

IV / IO / IN / IM

Absolute Maximum dose 4 mg

0.1 mg / kg

Max single dose: 2 mg

IV / IO / IN / IM

Absolute Maximum dose 4 mg

Normal Saline

Standard isotonic fluid for volume replacementFor use when a bolus, flush, mix is needed

Nitroglycerin (NTG)0.4 mg / tab & PasteWEMA Protocol

Chest pain (C-4)CHF (C-4.1)HTN Crisis (C-8)

Indications ContraindicationChest pain Pulmonary edemaHTN crisisHypotensionUse of ED drugsSuspect stroke

Varies

Normal bolus - 20 ml / kg

0.4 mg tablet SLFor Chest Px & CHF

May repeat twiceDepending on BP

Use Extreme caution if an Inferior MI is suspected

Varies

Normal bolus - 20 ml / kg





Drug Guide

Diphenhydramine(Benadryl) 50 mg / ml

WEMA Protocol:Allergic reaction (C-2)Anaphylaxis (C-2.1)Mast cell activation (C-10)

Indications/ContraindicationsUticaria and / or itchingAnaphylaxis Mast cell activation Acute Asthma

25 mg IV / IO 50 mg IM

Mast Cell Activation

50 mg IV / IO / IM

0.1 mg / kg IV / IO / IM

Dopamine800:1 solution

WEMA Protocol:Bradycardia (B-4)Septic Shock (E-18)Neurogenic shock (E-17)Post resuscitation (B-6)

Indications/ContraindicationsHypotension due to decreased cardiac output, septic shock, post resuscitation, & symptomatic bradycardia Ventricular arrhythmias, sulfite

2-20 mcg / kg per min IV or IO - Titrate to affect

Use the "Right Dose" Book

Starting dose: 5 mcg / kg / min

Cardiac Dose

5-10 mcg / kg / min

Vasopressor Dose

10-20 mcg / kg / min

2-20 mcg / kg per min IV or IO - Titrate to affect


Epi drip is preferred for pediatrics in refractory

bradycardia

Starting dose: 5 mcg / kg / min

Epinephrine 1 mg / ml

1:1000 solution

WEMA Protocol:Anaphylaxis (C-2.1)Asthma (C-12)Croup (C-5)Mast Cell (C-10)

Indications/ContraindicationsBronchospasmAnaphylactic reactionsMast Cell activation (systemic)

Anaphylaxis0.01 mg/kg IM - Max .5 mg

Asthma0.3 mg IM

Mast Cell Activation0.3 mg IM every 5 mins as needed

Anaphylaxis0.01 mg/kg IM Max 0.3 mg

Asthma0.01 mg/kg IM Max 0.3 mg

Croup

1 mg in 3 cc's NSIf severe first dose can be 3 mgNebulized



Protocols. Utilize the individual protocols and standardized medication guides for all dosing

Drug Adult PediatricEpinephrine 0.1 mg / ml

1:10,000 solution

WEMA Protocol:Cardiac Arrest (Section B)Anaphylaxis (C-2.1)Bradycardia (Pediatric) (B-4)

Indications/ContraindicationsCardiac ArrestLife Threatening AnaphylaxisPediatric symptomatic bradycardia (despite O2)None during life threatening events

Cardiac Arrest

1 mg bolus IV / IOEvery 3-5 mins

Life Threatening Anaphylaxis

0.3 - 0.5 mg slow bolus IV/IO

Cardiac Arrest

0.01 mg/kg IV / IOEvery 3-5 mins

Life Threatening Anaphylaxis

0.01 mg/kg IV / IOUp to 0.3 mg

Drug Guide

EpinephrineDrip

WEMA Protocol:Bradycardia (B-4)Mast Cell (C-10)

Indications/ContraindicationsSymptomatic BradycardiaMast Cell ActivationPost Arrest Hypotension

Bradycardia2-10 mcg / minTitrate to effect

Mast Cell Activation4-10 mcg / min Titrate to effect


Bradycardia2-10 mcg / minTitrate to effect

Post Arrest Hypotension2-10 mcg / minTitrate to effect

Fentanyl 50 mcg / ml

(Sublimaze)

WEMA Protocol:Various trauma protocols (E)Sickle Cell (C-10)Chest Pain (C-4)

Indications/ContraindicationsTraumatic injurySevere painChest pain with morphine allergy

Moderate Pain1 mcg / kg - IV / IO1 mcg / kg - IN / IM100 mcg max single dose

Severe Pain Protocol Specific2 mcg / kg - IV / IO2 mcg / kg - IN / IM200 mcg max single dose

< 12 y/o

Moderate Pain0.5 mcg / kg - IV / IO0.5 mcg / kg - IN / IM50 mcg max single dose

Severe PainProtocol Specific1 mcg / kg - IV / IO1 mcg / kg - IN / IM100 mcg max single dose





Drug Guide

Glucose (Oral)15 grams / pack

WEMA ProtocolHypoglycemia (C-9)

Indications/ContraindicationsHypoglycemiaUnable to swallowUnable to follow commandsAbsent gag reflex

1 pack / (15 grams)

< 2 y/oCarefully massage a small amount of the gel onto the gums of the child; be cautious of biting. Repeat as needed

> 3 y/o1 pack (15g) while closely monitoring the child

Ipratropium .02%(Atrovent) 0.5 mg / 2.5 ml

WEMA ProtocolRespiratory Distress (C-12)

Indications/ContraindicationsAsthma & COPDBronchospasmGlaucoma

0.5 mg in 2.5 cc's NS

Nebulized

0.5 mg in 2.5 cc's NS

Nebulized





Drug Guide

Ondansetron 2 mg / ml

(Zofran)


Indications/ContraindicationsNausea (C-11)Vomiting

Promethazine 25 mg / ml

(Phenergan)


Indications/ContraindicationsNausea (C-11)VomitingUse cautiously with pediatrics and the elderlyBe cautious of the sedative effect< 2 y/o

4 mg IV / IM

May repeat once

0.1 mg/kg IV / IM

May repeat once

Sodium Bicarbonate(NaHCO3) 1 MeQ / ml

WEMA ProtocolCardiac arrest (Section B)Poisoning / Ingestion (D-10)

Indications/ContraindicationsMetabolic acidosis due to cardiac arrestTricyclic ODCan not mix with various medications in tubingInadequate ventilation

12.5 mg IV or

25 mg IM

If given IV, it must be diluted in 5-10 cc's NS flush and given very

slowly

0.25 mg/kg IV (Max 12.5 mg)

or

0.5 mg/kg IM(Max 25 mg)

If given IV, it must be diluted in 5-10 cc's NS flush and given very

slowly

Cardiac Arrest1-1.5 mEq / kg IV / IO

Tricyclic ODContact medical control for orders

< 1 month use 4.2%

> 1 month use 8.4%

Cardiac Arrest1 mEq / kg IV / IO

Tricyclic ODContact Vanderbilt pediatrics for orders






Drug Guide

Ketamine (50mg/ml)

(Ketalar)

WEMA Protocol:Severe pain management (Various) (E-13)Thermal Burn's (E-5)Amputation's (E-3)Extremity extrication (E-6.1)

Indications/ContraindicationsSevere painProcedural Sedation neededMust Have access to airwayMust be able to suction patientHx of CHFHx of CADUse caution if TBI presentHypertensive crisisRelative HypertensionSystolic > 180Diastolic > 130Any Acute Ischemic eventHerniation SyndromeCushings Syndrome

Severe PainAs described by protocol0.5 mg / kg - IV / IOUp to 100 mgMay repeat twiceNot to exceed 300 mg

OR

1 mg / kg - IN / IMUp to 150 mgMay repeat twiceNot to exceed 450 mg

Extremity Extrication1 mg / kg - IV / IOUp to 200 mg

1.5 mg / kg - IN / IMUp to 225 mg

Can not be used to

Severe Pain

Extremity extrication1 mg / kg - IV / IOUp to 40 mg

1.5 mg / kg - IN / IMUp to 60 mg

Can not be used to

Ketorolac 30 mg / ml

(Toradol)

WEMA ProtocolPain Management - General (G-8)

Indications/ContraindicationsPain due to kidney stonesBack painMuscle Sprain / StrainMigraine PregnancyRenal insufficiencyHypovolemia

30 mg IV

OR

60 mg IM





20 ml/kg Bolus 20 ml/kg Bolus

Lactated RingersIV solution


Indications/ContraindicationsHypovolemia due to blood lossVolume replacement

Drug Guide

Lidocaine 2%Single Dose (20 mg / ml)

WEMA ProtocolCardiac (Section B)IO procedure (I-21)

Indications/ContraindicationsVentricular dysrhythmias V-fib / Pulseless VTLocal anesthetic for IO inf.1/2 dose for patients > 701/2 dose for patient w/ history of hepatic diseaseAV blockBradycardia

Lidocaine Drip4 mg / ml solution

WEMA ProtocolCardiac (B-7) & (B-12)

Indications/ContraindicationsMaintenance drip post dysrhythmia conversionSame as single dose

Ventricular dysrhythmias1 - 1.5 mg / kg

PVC's1 - 1.5 mg / kg

V-fib / Pulseless VT1 - 1.5 mg / kg

Anesthetic for IO infusionSee I-21 for procedure 40 mg Initially20 mg subsequently

Max dose as an antiarrhythmic

3 mg / kg

Ventricular dysrhythmias1 mg / kg

PVC's1 mg / kg

V-fib / Pulseless VT1 mg / kg

Anesthetic for IO infusionSee I-21 for procedure0.5 mg/kg Initially (Max 40)half initial dose subsequently

Max dose as an antiarrhythmic

3 mg / kg


1 - 4 mg / min

maintenance infusion


20-50 mcg / kg / min





Drug Guide

Magnesium Sulfate10% 500 mg / ml

WEMA ProtocolRespiratory Distress (C-12)Cardiac (Section B)Eclampsia w/ seizures (F-4)

Indications/ContraindicationsSevere AsthmaCOPDTorsade's de pointesHypokalemia (Arrest)HypomagnesemiaEclampsia w/ seizuresAV Block

Asthma / COPD1-2 grams over 10 mins

Torsade's de pointes1-2 grams IV / IOInfuse over 10 mins

Cardiac Arrest1-2 grams IV / IOSlow push over 2 mins

Eclampsia w/ seizures1-2 grams over 10 mins

Asthma25 - 50 mg/kg over 20 minsSee drip procedure

Torsade's de pointes25 - 50 mg/kg IV / IOInfuse over 20 mins

Cardiac Arrest25 - 50 mg/kg IV / IOSlow push over 2 mins

Max dose of 2 grams

Methylprednisolone(Solu-Medrol) 62.5 mg / ml

WEMA ProtocolAnaphylaxis (C-2.1)Asthma (C-12)

Indications/ContraindicationsAcute asthma attackAcute anaphylactic reactionUse w/ caution in patients with active infections

One time dose

125 mg IV / IM

If small in stature, sensitive to steroids, on chronic

steroid therapy or diabetic

62.5 mg

Contact Medical control

Midazolam(Versed) 5 mg / ml

WEMA ProtocolSedation in various protocolsSeizure (C-13)

Indications/ContraindicationsSeizure ActivityRequired sedationBe cautious w/ hypotensionWill cause significant Resp. depression in elderly< 1 month oldPregnancy

Seizure5 mg IV / IO / IN / IM

General Sedation2-5 mg IV / IO / IN / IM

Mind Altering Drugs5-10 mg IV / IN / IM

The max dose varies by protocol.

All Pediatrics - (IV/IO/IM)0.1 mg/kg IV / IO / IMMax Dose 6 mgDO NOT REPEAT

1 - 5 Months - (IN)0.2 mg/kg INMax dose: 3 mgDO NOT REPEAT

5 months - 12 years - (IN)0.2 mg/kg INMax dose: 4 mgMay Repeat OnceMax Total dose: 8 mg





Drug Guide

Thiamine 100 mg / ml

WEMA ProtocolAMS / Unconscious (C-3)Hypoglycemia (C-9)Seizure (C-13)

Indications/ContraindicationsWernicke-Korsakoff syndromeMalnourished Chronic alcoholism

One time dose

100 mg IV / IO


Drugs: Generic Name Drugs: Trade Name

Acetaminophen TYLENOL

Adenosine ADENOCARD

Albuterol VENTOLIN

Amiodirone CORDARONE

Aspirin (ASA) ASA

Atropine N/A

Calcium chloride 10% N/A

Dextrose 10%, 25%, 50% N/A

Dextrose 5% IV solution N/A

Diazepam VALIUM

Diltiazem CARDIZEM

Diphenhydramine BENADRYL

Dopamine Drip 800 mcg / ml INTROPIN

Epi 1:1000 ADRENALIN

Epi 1:10000 ADRENALIN

Fentanyl SUBLIMAZE

Glucose (oral) N/A

Ipatropium Bromide 0.02% ATROVENT

Ketamine KETALAR

Ketorolac TORADOL

Lactated Ringers N/A

Lidocaine 2% XYLOCAINE

Lidocaine Drip 4 mg / ml XYLOCAINE

Magnesium Sulfate 10% N/A

Methylprednisolone SOLU-MEDROL

Midazolam VERSED

Morphine Sulfate N/A

Naloxone NARCAN

Normal Saline N/A

Nitro-paste (NTG) (TD Paste) NITRO-BID

Ntroglycern (NTG) (SL Tab) N/A

Ondansetron N/A

Promethizine PHENERGEN

Sodium Bicarb N/A

Thiamine VITAMIN B1

WEMA Drug List - 2016


Documents

Wilson County Emergency Management AgencyContraindications: Known Active GI Bleeding, Hypersensitivity, Known history of bleeding disorders, Hepatic impairment, Patient’s < 18 years