Med Directives

Moderate - Severe Allergic Reaction INDICATIONS

Exposure to probable allergen

AND

signs and symptoms of a moderate - severe allergic reaction

Moderate - Severe Allergic Reaction CONDITIONS

Epi

• For anaphylaxis only

Diphenhydramine

• >=25kg

Moderate - Severe Allergic Reaction CONTRAINDICATIONS

Epi

• Allergy

Diphenhydramine

• Allergy

Moderate - Severe Allergic Reaction EPINEPHRINE

Route - IM

Concen - 1:1000

Dose - 0.01mg/kg

Max dose - 0.5mg

Dosing interval → 5 minutes

max dose of 2

Moderate - Severe Allergic Reaction DIPHENHYDRAMINE

>=25kg - <50kg

IM

25mg

only 1 dose

>50kg

IM

50mg

Bronchoconstriction INDICATIONS

respiratory distress

AND

suspected bronchoconstriction

Bronchoconstriction CONDITIONS

EPi

• Bvm ventilations required

• Hx of asthma

Salbutamol

• N/a

Dexamethasone

• Hx of asthma OR COPD OR 20 pack year hx smoking

Bronchoconstriction CONTRAINDICATIONS

Epinephrine

• Allergy

Salbutamol

• Allergy

Dexamethasone

• Allergy

• Currently on PO steroids

Bronchoconstriction TREATMENT

Epinephrine

IM

1:1000

0.01mg/kg

max 0.5mg

only 1 dose

Salbutamol

<25kg

MDI = 6puffs

5-15PRN

max 3 dose

NEB

2.5mg

5-15PRN

max 3 dose

>=25kg

MDI = 8 puffs

5-15PRN

max 3 puffs

NEB

5mg

5-15min

max 3

Dexamethasone

PO

0.5mg/kg

max 8mg

only 1 dose

Croup INDICATIONS

Current history of URTI

AND

Barking cough or recent history of

Croup CONDITIONS

Epinephrine

>= 6months to <8yrs

<200bpm

Stridor at rest

Dexamethasone

>=6months to <8 years

unaltered

Mild - moderate severe croup

Croup CONTRAINDICATIONS

Epinephrine

• Allergy

Dexamethasone

• Allergy to steroids

• Steroids received in the past 48 hours

• Unable to tolerate oral medication

Croup TREATMENT

Epinephrine

<10kg

NEB

1:1000

2.5mg

only 1 dose

>=10kg

NEB

1:1000

5mg

only 1 dose

Dexamethasone

>=6 months to <8yrs

PO

0.5mg/kg

8mg

only 1 dose

Cardiac Ischemia INDICATIONS

Suspected cardiac ischemia

Cardiac Ischemia CONDITIONS

ASA

>=18yrs old

Unaltered

able to chew & swallow

Nitroglycerin

>=18yrs old

Unaltered

60-159 bpm

Normotensive

Prior history of nitro use or IV access

Cardiac Ischemia CONTRAINDICATIONS

ASA

• allergy to NSAIDS

• if asthmatic no pior use of ASA

• current active bleed

• CVA or TBI in past 24hrs

Nitro

• Allergy to nitrates

• Phosphodiasterase inhibitor use in past 48 hrs

• SBP drops by one third or more of its inital value

• 12 lead RVMI

Cardiac Ischemia TREATMENT

ASA

PO

160-162mg

only 1 dose

Nitro

NO STEMI

>100mmHg

SL

0.4mg

5mins

6 doses

YES STEMI

>100mmHg

SL

0.4mg

5min

3 doses

Acute Cardiogenic Pulmonary Edema INDICATIONS

Moderate - severe respiratory distress

AND
suspected acute cardiogenic pulmonary edema

Acute Cardiogenic Pulmonary Edema CONDITIONS

Nitro

>=18yrs

60-159bpm

Normotensive

Acute Cardiogenic Pulmonary Edema CONTRAINDICATIONS

Nitro

• Allergy or sensitivity to nitrates

• Phosphodiasterase inhibitor use in past 48hrs

• SBP drops by one third or more of initial value

Acute Cardiogenic Pulmonary Edema TREATMENT

Nitro

>=100 -<140mmHg

IV Or hx YES
SL

0.4

5min

6 doses

>=140mmHg

IV or Hx NO

SL

0.4mg

5min

6 doses

>=140mmHg

IV or Hx YES

SL

0.8mg

5min

6 doses

Hypoglycemia INDICATIONS

Suspected hypoglycemia

Hypoglycemia CONDITIONS

Dextrose

>= 2 years

Hypoglycemia

Glucagon

>=4 yrs for IN

Altered

Hypoglycemia

Hypoglycemia CONTRAINDICATIONS

Dextrose

• allergy

Glucagon

• allergy

• Pheochromocytoma

Hypoglycemia TREATMENT

IM

<25kg

0.5mg

dosing interval 20mins

can do twice

>=25kg

1mg

20mins

can do twice

IN

>=4years

3mg

20min

can do twice

Opioid Toxicity and Withdrawal INDICATIONS

Suspected opioid toxicity

Opioid Toxicity and Withdrawal Conditions

Naloxone

>= 24hours

Altered

<10 breaths/min

Inability to adequately ventilate OR, persistent need to assist ventilations, persistent

Buprenorphine/naloxone

>=16

Unaltered

Received naloxone for current opioid toxicity AND the patient is exhibiting acute withdrawal with a COWS score >=8

Opioid Toxicity and Withdrawal TREATMENT

NALOXONE

IV

Dose: 0.4 mg max = 0.4 mg

Dosing interval: 5 mins

Max #dose: 3

IM

Dose: 0.4 mg max = 0.4 mg

Dosing interval: 5 mins

Max #dose: 3

IN

Dose: 2-4 mg max = 2-4 mg

Dosing interval: 5 mins

Max # dose: 3

SC

Dose: 0.8 mg max = 0.8 mg

Dosing interval: 5 mins

Max #dose: 3

BUPRENORPHINE/NALOXONE

BUC/SL

Initial dose: 16 mg

Subsequent dose: 8 mg

Dosing interval: 10 mins

Max cumulative dose: 24 mg