EMT Medications

- preferable use as flashcards

Indication for Oxygen

hypoxia (SpO2 < 94%), respiratory distress, chest pain, altered mental status, shock, carbon monoxide poisoning

Contraindication for Oxygen

SpO2 over 94%

• use continuously in COPD, but never withhold if hypoxic

Route for Oxygen in Nasal Cannula

2-6 lpm

Route for Oxygen in CPAP

10 lpm

Route for Oxygen in BVM

15 lpm

Route for Oxygen in Nonrebreather Mask

15 lpm

Adult Dose for Oxygen

Titrate to SpO2 ≥94%

PEDS Dose for Oxygen

Same as adult; Titrate to SpO2 ≥94%

Class and Mechanism for Oxygen

rapidly makes more O2 available

Side Effects for Oxygen

Oxygen toxicity with prolonged high-flow use

Indication for Albuterol

Bronchospasm, asthma attack, COPD exacerbation, patient has own prescription

Class for Albuterol

Bronchodilator

Contraindications for Albuterol

Hypersensitivity to albuterol; tachycardia >150 use with caution

Route for Albuterol

Inhalation (MDI or nebulizer)

Adult Dose for Albuterol

2.5mg via nebulizer or 1–2 puffs MDI

PEDS Dose for Albuterol

2.5mg via nebulizer

Side Effects for Albuterol

• Tachycardia

• tremors

• nervousness

• headache

• hypokalemia with repeated doses

Class and Mechanism for Albuterol

Bronchial dilator that allows easier air passage to alveoli

Class for Atrovent

Anticholinergic / Bronchodilator

Indications for Atrovent

• Bronchospasm

• COPD exacerbation

• asthma (adjunct to albuterol)

Contraindications for Atrovent

Hypersensitivity to ipratropium or atropine, hypersensitivity to peanuts or soy (some formulations)

Route for Atrovent

Inhalation (nebulizer or MDI)

Adult Dose for Atrovent

0.5mg via nebulizer

PEDs Dose for Atrovent

0.25mg via nebulizer

Side Effects for Atrovent

• Dry mouth

• blurred vision

• urinary retention

• tachycardia

• paradoxical bronchospasm

Mechanism for Atrovent

An anticholinergic that blocks broncoonstriction & helps dry secretions in lung

Class for Aspirin

Antiplatelet

Indications for Aspirin

Chest pain suggestive of cardiac origin, suspected AMI

Contraindications for Aspirin

• Allergy to aspirin

• active GI bleeding

• recent GI ulcer

• already taken aspirin today

• unable to swallow

Route for Aspirin

PO (chewed)

Adult Dose for Aspirin

324mg (four 81mg tablets)

PEDs dose for Aspirin

Not indicated at EMT level

Side Effects of Aspirin

• GI upset

• bleeding risk

• bronchospasm in aspirin-sensitive asthmatics

Mechanism for Aspirin

NSAID & antithrombic that lubricates blood allowing blood cells to pass clots in coronary arteries with greater ease

Class for Nitroglycerin

Nitrate

Indications for Nitroglycerin

• Chest pain suggestive of cardiac origin

• patient has own prescription

• systolic BP >90 mmHg

Contraindications for Nitroglycerin

• Systolic BP <90 mmHg

• ED medications within 24–48 hours

• head injury

• right-sided MI suspected

• already taken 3 doses

Route for Nitroglycerin

SL (sublingual)

Adult Dose for Nitroglycerin

0.4mg, repeat every 5 minutes x3 max

PEDs Dose for Nitroglycerin

Not indicated

Side Effects of Nitroglycerin

Hypotension, headache, dizziness, reflex tachycardia

Class for Oral Glucose

Antihypoglycemic

Indications for Oral Glucose

• Altered mental status with known diabetes

• suspected hypoglycemia

• patient able to swallow

Contraindications for Oral Glucose

• Unresponsive patient

• unable to follow commands or swallow

• no gag reflex

Route for Oral Glucose

PO

Adult Dose for Oral Glucose

15-25g

PEDs Dose for Oral Glucose

15g

Side Effects of Oral Glucose

• Nausea

• aspiration risk if swallowing impaired

Class for Glucagon

Antihypoglycemic

Indications for Glucagon

Hypoglycemia when patient is unable to take oral glucose

Contraindications for Glucagon

Blood glucose level is normal

Route for Glucagon

IM

Adult Dose for Glucagon

1 mg

PEDS dose for Glucagon

0.5mg (or 0.1mg/kg for <20kg)

Side Effects of Glucagon

Nausea, vomiting, tachycardia, hypertension — delayed onset 10–15 minutes

Mechanism for Glucagon

causes glucose to be released from liver stored as glycogen

Class for Activated Charcoal

Adsorbent

Indications for Activated Charcoal

• Ingestion of certain poisons or overdoses within 1 hour

• patient alert and able to swallow

Contraindications for Activated Charcoal

• Altered mental status

• unable to swallow

• ingestion of acids/alkalis/petroleum products

Route for Activated Charcoal

PO

Adult Dose for Activated Charcoal

1g/kg (25–100g)

PEDS dose for Activated Charcoal

1g/kg (12.5–25g)

Side Effects of Activated Charcoal

• Black stools

• nausea

• vomiting

• aspiration risk

Mechanism for Activated Charcoal

Pseudo poison antidote that blocks toxic absorbants through the GI tract

Class of Naloxone (Narcan)

Opioid Antagonist

Indications for Naloxone (Narcan)

• Suspected opioid overdose

• respiratory depression

• unresponsive patient with pinpoint pupils

Contraindications for Naloxone (Narcan)

Hypersensitivity to naloxone — use cautiously in opioid-dependent patients

Route for Naloxone (Narcan)

IN (intranasal), IM

Adult Dose for Naloxone (Narcan)

0.4–2mg, may repeat every 2–3 minutes

PEDS Dose for Naloxone (Narcan)

0.1mg/kg

Side Effects of Naloxone (Narcan)

• Acute withdrawal symptoms

• re-sedation if opioid half-life exceeds naloxone

Class for Epinephrine (EpiPen)

Sympathomimetic

Indications for Epinephrine (EpiPen)

Anaphylaxis with signs of shock or severe allergic reaction, severe bronchospasm unresponsive to albuterol

Contraindications for Epinephrine (EpiPen)

No absolute contraindications in life-threatening anaphylaxis — use cautiously in patients with cardiac history

Route for Epinephrine (EpiPen)

IM (auto-injector outer mid-thigh)

Adult Dose for Epinephrine (EpiPen)

0.3mg (1:1000)

PEDS Dose for Epinephrine (EpiPen)

0.15mg (EpiPen Jr.)

Side Effects of Epinephrine (EpiPen)

• Tachycardia

• hypertensionanxiety

• pallor

• headache

• dysrhythmias

Class for Ondansetron (Zofran)

Antiemetic

Indications for Ondansetron (Zofran)

• Nausea and vomiting

• motion sickness

• post-medication nausea

Contraindications for Ondansetron (Zofran)

Hypersensitivity to ondansetronuse cautiously with QT-prolonging medications

Route for Ondansetron (Zofran)

PO (ODT)

Adult Dose for Ondansetron (Zofran)

4mg

PEDS Dose for Ondansetron (Zofran)

Not indicated

Side Effects of Ondansetron (Zofran)

Headache, constipation, dizziness, QT prolongation with high doses

Class of Benadryl

Antihistamine

Indications for Benadryl

• Allergic reactions

• anaphylaxis (adjunct to epinephrine)

• mild to moderate allergic response

Contraindications for Benadryl

• Hypersensitivity to diphenhydramine

• narrow-angle glaucoma

• inability to swallow

• newborns

Route for Benadryl

PO

Adult Dose for Benadryl

50mg

PEDS Dose for Benadryl

Not indicated

Side Effects of Benadryl

Sedation, dry mouth, urinary retention, blurred vision, hypotension

Narcan

Before administering this medication, check for all 3 of these:

1. unconscious

2. not ventilating adequately (snoring / shallow)

3. pinpoint pupils