Microsoft word - medication cards 2011.doc

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 AMIODARONE
(Cordarone)
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). FENTANYL CITRATE
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 orders PED- 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) LIDOCAINE
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 MAGNESIUM SULFATE
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. METHYLPREDNISOLONE
(Solu-medrol)
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 MIDAZOLAM
(Versed)
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. PROMETHAZINE
(Phenergan)
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 SODIUM BICARBINATE
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. TERBUTALINE
(Brethine)
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 Paramedic waiver
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.

Source: http://www.grandcountyems.com/Education/Resources/GCEMS_Medication_Cards_2011.pdf