ADENOSINE (Adenocard) ADULT- 1ST dose 6 mg IVP, 2ND dose 12 mg IVP PED- 1ST DOSE 0.1 mg/kg up to 6 mg 2ND DOSE 0.2 mg/kg up to 6 mg **Contact base after 2nd dose if no improvement ALBUTEROL SULFATE ADULT- 2.5 mg/3ml PED- 0.15 mg/kg up to 10 mg in NS
Continuous nebulizer 0.5 mg/kg/hr max 15 mg/hr
A. Cardiac Arrest, VF/Pulseless VT: 1st dose 300 mg IV/IO
bolus, May repeat once 150 mg IV/IO bolus
B. Hemodynamically unstable wide complex tachycardia
with pulse: 150 mg IV bolus infusion over 10 min
C. ROSC: 150 mg bolus infusion over 10 min-base contact recommended PED- A. Pulseless VF/VT: 5 mg/kg IV/IO over 5 min (300 mg max dose) B. Perfusing supraventricular & ventricular arrhythmias 5 mg/kg IV/IO over 20 min bolus infusion (300 mg max dose) ADULT- Chew four 81 mg tablets (324MG)
Basic Intermediate Paramedic ATROPINE SULFATE
A. Hemodynamically Unstable Bradycardia- 0.5 mg IV/IO
every 3-5min. Max 3mg or 0.04mg/kg. Titrate to LOC
and BP. Contact base after persistant bradycardia after 2
doses B. Symptomatic Insecticide/Organophosphate poisoning/exposure- contact base for orders (usually 2mg IVP q 5min until secretions dried) doses may be massive PED- A. Symptomatic Bradycardia: 0.02 mg/kg IV/IO, max single dose for child 0.5 mg and for adolescent 1 mg. May repeat once for max total dose for child 1 mg and adolescent 3 mg. CALCIUM CHLORIDE 10%
A. Magnesium sulfate overdose: 10 ml of 10% solution (100 mg/ml) SIVP over 5min. B. Calcium channel blocker/beta blocker toxicity- 500-1000 mg
slow IV (no faster than 200 mg in a minute)
(over 1min per 200mg) C. Hyperkalemia: 500-1000 mg slow IV
Contact base for additional dosages and notify base physician of usage.
PED- 0.2-0.3 ml/kg of 10% solution, may repeat in 10 min. Do not exceed adult dosage. DEXTROSE 50% ADULT- ½ to 1 amp of D50W, IVP (12.5-25 gm) PED- Newborn to 1month of age- 2-4ml/kg D10W solution
Greater than 1 month- 2 ml/kg of D25W solution IV
***To make D10W – 10 ml of D50W and 40 ml of NS
***To make D5W – Remove 100 ml of NS from 1000 ml bag, add 2 amps of D50W in 1000 ml of NS
DIAZEPAM (Valium) ADULT- 1-10 mg slow IV push or deep IM PED- 0.1-0.3 mg/kg slow IV push (max dose 5 mg) or 0.5 mg/kg DIPHENHYDRAMINE ADULT- 25-50mg SIVP, deep IM (Benadryl) PED- Children 8yrs and younger- 1 mg/kg Slow IV/IM
Paramedic DOPAMINE (Inotropin)
Attempt to contact base for all doses and indications
ADULT/PED- 2-20 mcg/kg/min **should put drip on a pump EPINEPHRINE
A. Cardiac arrest- 1.0 mg (10 ml of 1:10,000) IV/IO q 3-
B. Bradycardia (contact base for direct physician order)
Epinephrine drip: In 1000 ml NS, add 4 mg of Epinephrine =
Epi Concentration: 4 mcg/ml in 1000 ml of NS Begin at 1 mcg/min, titrate to SBP 90 mmHg, to max of 10 mcg/min on IV pump. C. Moderate/severe allergic reactions- 0.3-0.5 mg (0.3 ml – 0.5 ml of 1:1000) SQ/IM or Epi-pen.(EMT-B, BIV use EPI-PEN only) D. Anaphylaxis- 0.3-0.5 mg IV/IO 1:10,000 (3-5 ml of 1:10,000) E. Asthma- 0.3 mg (0.3 ml of 1:1,000) SQ/IM PED- A. Cardiac arrest- 1st dose- 0.01 mg/kg (0.1 ml/kg) of 1:10,000 every 3-5 min B. Bradycardia (unresponsive to O2/ventilation) 0.01 mg/kg (0.1 ml/kg 1:10,000) IV/IO or Epi drip (contact base)
Epinephrine Drip: In a 100 ml bag NS, Add 1 ml (0.1 mg) of Epi 1:10,000 = Epi Concentration 1 mcg/1ml in 100 ml of NS. Begin at 0.1 mcg/kg/min on IV pump (may titrate to effect to 1 mcg/kg/min). C. Anaphylaxis- Racemic Epinephrine for inhalation
0.001 mg/kg (0.01ml/kg 1:1,000) SQ/IM (max single dose 0.5
May give every 15 min up to 3 doses. D. Asthma/Croup/Epiglottitis/Reactive Airway/Bronchiolitis- Racemic Epinephrine for inhalation E. Life threatening airway obstruction secondary to croup, epiglottitis, asthma, reactive airway disease- if no racemeic epi- plain epi can be used. (0.01ml/kg 1:1,000 in 3ml NS nebulized).
Loading dose- 1-2 mcg/kg SIVP/atomized IN/IM last resort
Maintenance dose- 1-2 mcg/kg SIVP/ IN/IM PED- 0.5 – 1.0 mcg/kg SIVP/IN/IM DRIP ADULT/PEDI- To make Fentanyl infusion, remove 10 ml of NS from 50 ml bag. Add 500 mcg Fentanyl to the 50 ml bag of NS. Begin infusion at 0.25 ml/kg/hr. Treat any break through pain/agitation with small boluses of Fentanyl and/orVersed. GLUCAGON
Beta Blocker/Ca++ channel Blocker OD- 2mg IV/IN
PED- Hypoglycemia- 0.1 mg/kg IM/IN (>8y/o, max dose 1 mg) Beta Blocker/Ca++ channel Blocker OD- 0.1 mg/kg IV/IN (max dose 1mg) HALOPERIDOL (Haldol)
5-10mg IM (may follow w/ Benedryl 25-50mg IV/IM for dystonic
Intermediate-follow written ordersPED- Contact base for all orders for 13-15y/o HYDROMORPHONE (Dilaudid)
0.5 mg-1.0 mg IV/IM q 15min until pain is managed (or 2 mg IV/IM
IPRATROPIUM BROMIDE ADULT- 250-500 mcg nebulized 1 time dose (Atrovent) PED- 250 mcg nebulized 1 time dose for children < 12 years IV SOLUTIONS ADULT/PED- NS, LR or D5W
TKO- 30 ml/hr (unless otherwise ordered by physician)
Fluid Bolus/Challenge- 20 ml/kg NS rapid IVP (250-500 ml
increments as appropriate than reassess)
A. Cardiac- Contact base except in VFIB, Pulseless VTACH, and
post arrest dosing 1 - 1.5 mg/kg IV/IO bolus
B. Brain Trauma- pre-intubation single dose- 1.5 mg/kg IV
PED- Pediatric ventricular dysrhythmias- 1 mg/kg IV/IO (over 1-2 min if pt has pulse) LORAZEPAM (Ativan)
0.5-2 mg IV/IM/IO (diluted with D5W/NS prior to IV
0.1 mg/kg IV/PR with max dose 2 mg (diluted with D5W/NS prior to
A. Adult Cardiac Arrest - Torsade de pointes: 1-2 Gm slow IV push,
B. Torsade de Pointe with Pulse – 1-2 Gm diluted in 50-100 ml of
C. Acute bronchospasm: 2 Gm slow bolus infusion IV, diluted in 50-
D. In OB associated seizures, 4 Gm in 50-100 ml NS, very slow IV
bolus infusion (over 10-20 minutes), consider
consulting base physician for order E. For high-risk OB patients during intra-facility transport: This
should be mixed 20 grams in 1000 ml NS (Discard same amount of ml from base fluid as added from Magnesium Sulfate). Infuse as piggyback to NS main line.
Magnesium Sulfate is infused via IV/medication pump. Total
mainline should total 125 ml/hr. 0.5 grams = 25 ml/hour 1.0 grams = 50 ml/hour 1.5 grams = 75 ml/hour 2.0 grams = 100 ml/hour 2.5 grams = 125 ml/hour F. Monitor vital signs, contractions, and fetal heart tones every 15
G. For all pregnancy related Magnesium Sulfate administration: Monitor deep tendon reflexes (+1 to +4) every 30 minutes, contact base medical control for decreased
H. A foley catheter is required to be in place for a patient on a
Magnesium Sulfate drip. Notify base physician for urine
output < 30 ml/hr PED- A. Pediatric pulseless torsades de pointe: 25 to 50 mg/kg in 10 ml NS
IV/IO bolus infusion over 10 to 20 minutes, max dose 2 Gm.
B. Torsade de Pointe w/pulse – 25-50 mg/kg diluted in 50-100 ml of
NS IV/IO bolus infusion over 10-20 min, max dose 2 Gm.
C. Pediatric severe asthma: 25-50 mg/kg in 50-100 ml NS over 20
METERED DOSE INHALERS ADULT/PED-
B. Ascertain how many times the patient has used the inhaler.
C. If needed, contact Base Physician for an order to administer. D. Up to 2 puffs E. Contact Base Physician for additional orders if needed.
A. 250 mg slow IV, may mix in 50-100 ml of NS and give IV over
A. 2 mg/kg to max of 250 mg slow IV, may mix in 50-100 ml of NS
A. Cardioversion premedication: up to 2.5 mg slow IV/IN
B. Status seizures, pacing agitation and post intubation agitation: 1
mg every min IV, titrate to seizure cessation or
decreased agitation (max single dose= 0.1 mg/kg or 10 mg)
C. Combative behavior compromising patient care: up to 0.1 mg/kg IV or IM (maximum single dose = 10 mg) D. Notify base physician that Midazolam has been given E. Patients being paced may tolerate procedure without sedation, administer only if indicated PED- A. Analgesics/Sedative: 0.1 mg/kg IV/atomized IN max single dose 10 mg. B. Second dose or any other indication for children contact base physician for order. MORPHINE SULFATE
A. STEMI: 2-4 mg IV every 5-15 min to relieve chest
discomfort. B. NSTEMI/Pain control 2-10 mg IV/IM, the goal is to decrease
C. Repeat as needed to effect. PED- A. Pain Control: 0.05 mg - 0.1 mg/kg IV slowly B. Repeat as needed to effect. NALOXONE (Narcan)
A. 2 mg (2 ml) IV/IO/atomized IN, or IM if IV not available
B. If no response is observed, this dose may be repeated
after 5 min., if narcotic overdose is suspected.
PED- A. 0.1 mg/kg/dose IV/IO/atomized IN/IM with single max dose 2 mg. NITROGYCERIN (NITRO, NTG)
A. Basic/Basic-IV contact base physician to assist with patient
B. 0.4 mg (1/150 grain) tablet sublingually, may repeat every 5
minutes as needed for effect. Maximum 3 doses in 15 min.
C. Blood pressure to be checked prior to each dose.
ONDANSETRON ADULT (4 yrs and up)- 4 mg slow IV with max dose 12 mg (Zofran) PED (under 4 years)- 2 mg slow IV ,(May give ODT tablets if no
Paramedic ORAL GLUCOSE
A. 1gm/kg up to 15gm total one time dose.
A. 12.5 mg slow IV, dose may be repeated once for max
B. Dose adjustment for elderly: 6.25 mg-12.5 mg IV. PED- 0.5 -1 mg/kg slow IV, up to 6.25 mg single dose. RACEMIC EPINEPHRINE ADULT/PED- 0.5 ML OF 2.25% solution in 3 ml of NS via
If no improvement after 2 doses contact medical control
A. 1 mEq/kg (1 ml/kg) IV/IO of 8.4% solution
B. Contact base for direct physician order for tricyclic overdose.
A. 1 mEq/kg (1 ml/kg) IV/IO of 8.4% solution B. 4.2% solution should be used for newborns, 2 mEq/kg (4 ml/kg) IV/IO C. Contact base for direct physician order for tricyclic overdose.
A. 0.25 mg SQ/IH. Dose can be repeated every 15-30 minutes as
B. MDI- dose is two inhalations, 1 minute apart
INTERFACILITY TRANSPORT FORMULARY LABETALOL
BOLUS- 2-20 mg IVP over 2min (per .physician). Do not exceed a
total dose of 300 mg INFUSION-2-8 mg/kg per physician orders Normal Infusion Concentration- 200 mg/250 ml = 2 mg/3ml **Medication must be put on Medication IV pump
INSULIN DRIP ADULT- 0.1 units/kg/hour. PED- 0.1 units/kg/hour BGL checks are mandatory q 30min during transport or more often if ordered by the physician. A decrease in blood sugar of 30-50 dl/hr is anticipated. If the blood sugar decreases more than 30dl during a 30 minute recheck, contact the base physician for further orders. **Medication must be put on Medication IV pump NITROGYCLERIN
Nitroglycerin is a concentrated medication that is administered after
dilution. Usual mixtures include 25 mg in 250 ml of D5w or NS. This
**Medication must be put on Medication IV pump
VECURONIUM ADULT/PEDI- 0.1 mg/kg IV (NORCURON) ALTEPLASE ADULT-0.9mg/kg (max 90mg) (ACTIVASE, tPA)
10% total dose administered as an initial IV bolus over 1min and
Medication drips for interfacility transport rate is correct prior to transport.
Available online at www.sciencedirect.comCognitive and Behavioral Practice 17 (2010) 290–300Current Treatment Practices for Children and Adults With Trichotillomania:Christopher A. Flessner, Bradley/Hasbro Child Research Center/Warren Alpert School of Medicine at Brown UniversityFred Penzel, Western Suffolk Psychological Services, Huntington, NYTrichotillomania Learning Center–Scienti
The Virginia Dermatological Society Volume 6 Number 5 B U L L E T I N Summer 2007 I have enjoyed serving as president of thefortunate to have Virginia dermatologists asVirginia Dermatological Society this pastleaders in the American Academy of Dermatol-ogy: David Pariser, MD is President-Elect anddermatologists in Virginia. In the fall, IEvan Farmer, MD is Vice President. We are