Drug Monogram EMR 2024

Acetylsalicylic Acid (ASA) Indications

Cardio suggestive chest pain or MI (Myocardial infrarction)

Chest pain..

Acetylsalicylic Acid (ASA) Contraindications and cautions

-Known Hypersensitivity or allergy to ASA

-inability to swallow

-Bronchospasm (asthma) caused by salicylates or non steroid anti-inflammatory drugs

-Active peptic ulcer or GI bleeding

-Pediatric patients with signs of viral illnesses

-Taken ASA dose before arrival

Cautions
Recent internal bleeding
known bleeding diesases
currently taking anticoagulants
recent surgery
possibility of pregnancy

Acetylsalicylic Acid (ASA) Cautions

Possibility of pregnancy

Currently taking other anti-coagulants (call cinicall)

Recent Surgeries

Recent internal bleeding

Known bleeding diseases

ASA Dose

81 mg x 2 chewed

Entonox (50% Nitrous 50% Oxygen) Indications

Relief of low to moderate pain

givine if Nitro is ineffective or contradicted

Entonox (50% Nitrous 50% Oxygen) Contradictions PAINDIEA

Pneumothorax - Auscultation

Air Embolism - Recent IV therapy or drug use

Inhalation Injury

Nitroglycerin in the last 5 Mins

Decompression sickness

inability to comply with medication administration

Enclosed Space

Altered level of consciousness

Entonox (50% Nitrous 50% Oxygen) Cautions SADFC

signs of shock

abdominal distension

depressant drug

facial injuries

COPD

Epinephrine Indications

Anaphylaxis

Respiratory

abdominal

Skin

Hypotension

Epinephrine Contraindications

Absolutly no contranindications

Epinephrine Dosages

0.5 IM every 5mins

may repeat up to 3 times

0.01mg/kg paediatric

Epinephrine caution

Hypotension if administered too quickly

What is hypokalemia in glucagon

Person has low potassium condition and add glucagon person may have heart arrhythmia

Glucagon Indications

hypoglycaemic patients that can’t safely take oral glucose gel

Glucagon contraindications

Allergy of hypersensitivity to glucagon

Glucagon dose

0.5 mg to 1 mg IM

3 mg IN can repeat after 15 mins if no clinical response

Glucagon cautions

Nausea

Vomiting

Hypokalemia (potassium loss)

Urticaria (hives)

Respiratory distresss

Hypotension

Naloxone (Narcan) Indications

Respiratory depression or arrest with low mental status

suspectected opioid use

Naloxone (Narcan) contraindications

know allergy or hypersensitivity

Naloxone (Narcan) dose

IM

every 3 mins if SpO2 is <94% and ventilation >10 not achieved

1st dose 0.4mg

2nd dose 0.4mg

3rd dose 0.8mg

4th dose 2.0mg

call clinicall if need more doses

Naloxone cautions

Patient combativeness
may precipitate withdrawal symptoms

Nitroglycerin Indications

Chest pain discomfort that appears in cardiac nature

Nitroglycerin Contraindications

Systolic BP <110

Heart rate <50 or >150

Known allergy or hypersensitive to nitrates

patient used ED meds like Viagra or levitra <24 hours

ED Cialis <48 hours

Patient doesnt have a prescription (call clinicall)

Nitroglycerin Dosage

Sublingual 0.4mg (one spray) primed

Or prescription dose

every 3-5 mins

max 3 doses within 30 mins

Repeat protocol if chest pains come back after 5 mins

Nitroglycerin cautions

Ensure patient not at risk of fall

Viagra past 24 hours monitor BP

If decreased LOC after nitro and drop in BP substantially

-Discontinue nitro

-supine position

-Reassess ABC

-Apply high flow O2

Oral Glucose Gel indications

Decreased or altered leve of consciousness and blood glucose <4.0

Oral Glucose Gel Contraindications

unable to manage own airway

unable to follow directions

Oral Glucose Gel dose

administer ½ of package (15g)

every 5 mins if GCS <15 and BGL <4

Oral glucose gel caution

Patient must maintain their airway

salbutamol (Ventolin) indications

Bronchospasm

salbutamol (Ventolin) Contraindications

known hypersensitivity

Tachyarrhytgmias >120 HR

salbutamol (Ventolin) doseages

5 mg nebulized

meter dose 4 × 100 mcg

Salbutamol (ventolin) cautions

Coronary disease

Diabetes

COPD with degenerative heart disease

salbutamol (Ventolin) Pediatric considerations and dosing

Nebulizer

Age <1 year: 2.5mg

Metered dose

<10 KG: not indicated

10-20 kg: 5 × 100 mcg may repeat 3 times

20 kg: 10 × 100 mcg may repeat 10 times

Spinal MOI No multi trauma

Candi

C-spine tenderness

Altered mental status - RTC

New neuro focal deficits - RTC

Distracting injury

Intoxicated

Spinal MOI No multi trauma and no CANDI

High Risk patients

1. 65 or Older

2. osteroperosis

3. exsisting spinal condition or spinal injury

FULL SMR (spinal motion restriction)

1. 30 Degrees stretcher

2. Collar

3. foam roller

4. clam shell

5. pelvin binder

6. tied feet

7. blanket

8. O2

Acetaminophen (Tylenol) Indication

Mild to Moderate pain

Pyrexia (fever)

Acetaminophen (Tylenol) Contradictions

Hypersensitivity or any

Severe hepatic impairment

Severe active liver disease

taken acetaminophen in the last four hrs

Suspected acetaminophen overdose Like nausea, vomiting, pain upper right quadrant

Total maximum acetaminophen intake in last 24 hrs (4,000mg) or 2,000mg if known liver disfunction

Acetaminophen (tylenol) doseage

500-1000 mg

May repeat once after 4 hours

24 hour max 4,000mg

If suspected liver dysfunction 24 hour max lowered 2000mg

Acetaminophen cautions

Hepatic impairment

Heavy alcohol use

Hypovolemia

Chronic malnutrition

4 signs of shock

Low blood pressure

Cool clammy

Altered mental state

Weak and rapid pulse

Ibuprofen indication

Mild to moderate pain

Ibuprofen (advil) contraindications

Hyper sensitivity or other NSAID drugs non-steroidal anti inflammatory drugs

active gi bleed

Pregnancy (first second or third trimester)

Ibuprofen dose

300-400mg

May repeat every 4-6 hours

Maximum dose 1200mg

Ibuprofen cautions

Adverse effects on

Gastrointestinal

Renal

Cardiovascular disease

Consider alternative treatments in high risk patients

Six rights of administration

Right person

Right medication

Right time

Right route

Right amount

Right documentation

Hip fracture CI

3 straps

Blanket

No toe ties

Spinal MOI reasons

High speed impact 100 kph

Blunt force trauma head

Penetrating chest

Roll over ATV

High voltage electrocution

Diving off a diving board

Motorcycle MVI

Death of a passenger

Explosion and thrown 10 ft

Penthorx contraindications

Patient less then 18 years

Pregnant, intended or breastfeeding

Head injury

Decrease LOC

Lack of cooperation

History of renal impairment. Reduceed renal output

Liver dysfunction induced by halogenated anesthetics

Use of tetracycline antibotics

Genetic or personal history of malignant hypothermia

Muscular dystrophy

Penthorx dose

3ml inhaler

Repeat after 20 mins

Max dose 6 ml

Penthorx cautions

Cardiac instability or respiratory depression

Hypersensitivity

consciousness altered

Kidneys signs of kidney failure

Adult dosage

Respiratory distress checks

SOS

Auscultate

Seizures status seizures

More then 5 mins of seizing

multiple seizures without returning to your normal level of consciousness in between

Cardiac chest pain

Expose chest

Semi fowlers

What is congestive heart failure

Heart can’t pump blood well in system

CHF causes respiratory failure called?

Pulmonary edema

COPD

Chronic obstructive pulmonary disease

Causes by smoking

Damaged air sacs

Inflamed airway with mucus

Amputated part

Rinse

Wrap in cool moist salinr gauze

Place part in plastic bag and keep it cool

Transport with patient

Vitals

LOC GCS

HR

BP

RR

SKIN

SPo2

TEMP

PUPILS

GCS EYES

4 - spontaneous

3 - To verbal

2 - To pain

1 - No eyes opening

GCS verbal

5 - oriented x 4

4 - confused

3 - inappropriate answers

2 - inarticulate sounds

1 - No verbal response

GCS Motor

6 - follow directions

5 - localized to pain (extension)

4 - withdrawals from pain (flexion)

3 - decorticate posturing core

2 - decerebrate posturing celebrates

1 - no movement to pain simultaneous

Oxygen administration indication

Low flow

-SPo2 90% - 93%

No signs of hypoxia

High flow

SPo2 <90%

Signs of hypoxia

-SOB

-increase work of breathing

-evidence of shock

-inhalation injury

-carbon monoxide poisoning

Tachycardia/ tachyarrhythmia

Hr >100

Tachypnea

Fast and shallow breathing

Pallor

Pale result from lack of blood flow

Cyanosis

Purple around finger tips because of lack of oxygen

Cervical spine injury

Manual C- spine

Nexus

Obstructed airway

Conscious

• 5 Initiate abs trust

• 5 Back blows

Unconscious

• Chest compression

• Ventilate every 30 compressions

Cardiac arrest

Look for DNR or NO CPR ORDERS

30 comp

1 breath

20 mins of cpr call clini call

Aed

Hypothermia

1 min check ABC if unresponsive

High flow o2 or ventilate

Check temp

Handle carefully

Remove from cold

Remove wet clothing

Hypowrap

Heat pack wrapped with triangular bandages at groin, arm pits and neck

Heat stroke

Wrapped cold packs at neck, groin and arm pits

High flow o2

Active cool

open pneumothorax

Seal with gloved hand

HF o2

Semi fowlers

Chest seal

Torso hemorrhage

Dress with abdo pad and lots of tape

Hemorrhage to the neck

Occlusive with tape on all sides

Fractures

stabiliz

Expose

Distal pulse

Anatomical splint if rtc

Realign limb if grossly angulated or impaired circulation

Keep warm

Burns

Cool with saline 20 mins (30 if chem)

High flow o2

Flail chest

Manual stabilization

High flow o2

Semifowlers

Dressing and tape

Abs eviceration

Supine knees bent

Corral from behind

High flow o2

Saline moist gause abdo pad and plasitc

Abs internal bleeding

Bruising or guarding

Supine knees bent

High flow O2

Pelvic binding if 

HR > 100 or SBP <90 mmHG
pelvic pain or instability 
altered LOC
major injury distracting from pelvic exam

Pulmonary Edema

Fluid in lungs
Tri pod, ineffective will be ventilation

Cardiogenic Shock

heart cannot pump enough oxygenated blood to tissues

Chest pains 
SOB
PCC
LOW BP
rapid or low hr

confused

Hypovolemic shock

loss signifcant amout of blood

SOB 

PCC
LOW BP
RAPID OR LOW HR
CONFUSED

Seizure

Clear head

¾ 
NPA
if resp ineffective then bvm
suction
Time and document

cardiac chest pain

expose chest
postion of comfort
high flow o2
OPQRST
ASA.
BLANKET
NITRO if stretcher not rdy
Entonox if contraindicated for Nitro

anaphylaxis

RASH
early vitals
supine or ¾
bvm if needed
high flow o2


Verify exposure
epi
blanket
remove allergen

SOB WITH HISTORY OF ASTHMA /COPD

Tri pod
highflow oxygen
auscultate
administer salbultamol

sepsis

HR >90
RR >20
TEMP >37 OR <36
SBP <90

abdominal aortic aneurysm

pulsating mass in abs

high flow o2
supine knees bent
gentle movement
blanket

HEMATEMESIS

blood in vomit coffee grounds

HEMATOCHEZIA

FRANK RED BLOOD IN STOOL

MELENA

BLACK STOOL

FULL SMR indications

mulitiple large or prox

TBI

30 deg
loose collar
MOI

TBI scale

GCS > 13 MILD TBI
GCS 9 - 12 moderate tbi
GCS >8 severe tbi

Musculoskeletal injuries RTC

shock
pulseless limb after realignment
multiple long or proximal injuries
pelvic injury
hip fractures
cold therapy if circulation not impaired

Breathing emergency

High flow O2
AUSCULTATE

Hypothermia Cardiac arrest

45 secs to determine pulselessness
AED max of 3 times