NC EMT Basic Drug Cards and Formulary

Medication Cards for Basic Emergency Medical Technicians in the state of North Carolina. Information obtained from the North Carolina Office of Emergency Medical Services (NCOEMS).

Acetaminophen (Tylenol, Anacin-3)

Class: Analgesic and antipyretic agent

Description: Acetaminophen is a clinically proven analgesic/ antipyretic with little effect on platelet functionality

Indications: Pain and fever control

Contraindications: Hypersensitivity (allergy), children under the age of 3

Precautions: Patients with hepatic (liver) disease, children under the age of 12 with arthritic conditions, alcoholism, malnutrition, and thrombocytopenia (low platlet counts)

Side Effects: When used appropriately, side effects are rare, with the most serious being liver damage do to large doses or extended use.

Dosage and Administration

Adults 325 to 1000 mg orally (PO)

Pediatrics: 15mg per kilogram of body weigh orally (PO)

Activated Charcoal (Actidose)

Class: Absorbant (Binding agent)

Description: Activated charcoal is a specially prepared charcoal that will absorb and bind toxins from the gastrointestinal (GI) tract. Combined with Sorbitol to promote GI motility (autonomous movement)

Indications: Acute ingested poisoning

Contraindications: An uncontrolled airway, ingestion of cyanide, mineral acids, caustic alkalis, organic solvents, irons, ethanol, methanol

Precautions: Administer only after emesis (vomiting) or in cases where emesis is contraindicated

Side Effects: Constipation, Diarrhea, temporary darkening of the stool, vomiting

Dosage and Administration

Adults: 50g orally if ingestion is less then 1 hour prior

Pediatrics: 1g per kg orally with a max of 25g if ingestion is less then 1 hour prior

Albuterol (Proventil, Ventolin)

Class: Sympathomimetic bronchodilator (Mimics effects of the sympathetic nervous system)

Description: synthetic sympathomimetic that causes bronodialation with less cardiac effect then epinephrine and reduces mucus secretion, pulmonary capilary leaking and edema in the lungs during allergic reactions

Indications: Bronchospasm and asthma in COPD (Chronic Obstructive Pulmonary Disease)

Contraindications: hypersensitivity, history of cardiac disease, heart rate higher then 150 in adults, heart rate higher then 200 in pediatrics.

Precautions: Vital signs and breath sounds must be monitored, use caution is elderly, cardiac, or hypertensive patients

Side Effects: Increased pulse rate (tachycardia), anxiety, nausea, cough, wheezing, tremors, and or dizziness.

Dosage and Administration:

Adults: 2.5 to 5mg via nebulizer continuously with a max of three doses (15mg) as long as there is not medical history of cardiac disease and heart rate remains below 150bpm

Pediatrics: 2.5mg via nebulizer continuously with a max of three doses (7.5mg) as long as no medical history of cardiac disease and heart rate remains below 200 bpm

Note: EMT- Basic administration is limited to patients who are under a physician’s orders with a prescription (check local policies, as standing orders count as a physician order as well as contacting medical control to request online orders)

Aspirin (Acetylsalicylic Acid, Alka-Seltzer, Bayer, Empirin, St Joseph Children’s

Class: Analgesic, antipyretic, platelet inhibitor, anti-inflammatory

Description: Inhibits agents that cause the production of inflammation, pain, and fever. It relives mild to moderate pain by working on the peripheral nervous system, it lowers body temperature in. fever, and powerfully inhibits platelet aggregation (Clotting).

Indications: Chest pain suggestive of a myocardial infarction (MI)

Contraindications: Hypersensitivity to salicylates, active ulcer disease, asthma

Precautions: Allergies to other NSAIDs (Non Steroidal Anti Inflammatory Drugs), bleeding disorders, children or teenagers with varicella (Chicken Pox) or influenza like symptoms.

Side Effects: Nausea, vomiting, heartburn, bleeding.

Bronchospasm and wheezing if patient is allergic to medication

Dosage and Administration

Adults: 4 chewable low dose asprin (81mg each) orally for a total of 324mg

Pediatrics: Not indicated

Atropine

Parasympatholytic (increases heart rate)

Description: Blocks the parasympathetic nervous system, specifically the vagal effects of the heart rate . It does not increase contractility (the heart’s ability to contract and generate force) but may increase the oxygen demand of the heart.

Indications: Organophosphate poisoning (Insecticides, pesticides, cyanide, mustard gas, Sarin)

Contraindications: None in the emergency setting

Precautions: Acute Myocardial Infarction, Glaucoma

Side Effects: Dry mouth, blurred vision, urinary retention, tachycardia, constipation, decreased perspiration

Dosage and Administration

Adults: One auto-injector intramuscularly (IM) then as per medical control

Pediatrics: One pediatric auto-injector IM then as per medical control

Note: All EMS personnel may self-administer or administer to a patient, by protocol and under medical direction, nerve agent kits containing Atropine and Pralidoxime through an auto injector system.

Diphenhydramine (Benadryl)

Class: Antihistamine

Description: Blocks histamine release, thereby reducing broncoconstriction, vasodilation, and edema

Indications: Anaphylaxis and allergic reactions

Contraindications: Asthma and other lower respiratory disorders

Precautions: Can cause hypotension, headache, palpitations, tachycardia, sedation, drowsiness, and or disturbed coordination

Side Effects: Commonly causes sedation, tiredness, sleepiness, dizziness, disturbed coordination, drying and thickening of oral and other respiratory secretions, and stomach distress

Dosage and Administration

Adults: 25-50mg PO

Pediatrics: 1mg per kg PO. Do not administer to infants under 3 months

Note: EMT Basics can administer in oral, over-the counter form as allowed by protocol and medical control

Epinephrine (Adrenalin)

Class: Sympathomimetic

Description: A naturally occurring catecholamine that increases heart rate, cardiac contractile force, myocardial electrical activity, systemic vascular resistance, and systolic blood pressure, and decreases overall airway resistance and automaticity. It also, through bronchial artery constriction, may reduce pulmonary congestion and increase tidal volume and vital capacity.

Indications: Severe allergic reactions (anaphylaxis)

Contraindications: Hypersensitivity to sympathomimetic amines, narrow angle glaucoma, hemorrhagic, traumatic, or cardiac shocks, coronary insufficiency, dysrhythmias, organic heart or brain disease, or during labor

Precautions: Elderly, debilitated patients, hypertension, diabetes, hyperthyroidism, Parkinson’s disease, tuberculosis, asthma, emphysema, and in children less then 6 years of age

Side Effects: Increased heart rate, pallor (paleness of the skin) dizziness, chest pain, headache, nausea, vomiting, excitability, anxiety

Dosage and Administration

Adults: 0.3 to 0.5mg of 1:1000 IM

Pediatrics:

Greater then or equal to 30kg: Same as adult dosage IM

Less then 30kg: 0.15mg 1:1000 IM

Glucagon

Class: anti-hypoglycemic agent and glycogenolytic

Description: Induces liver glycogen breakdown to release glucose into the blood

Indications: Blood glucose level less then 69 and patient is symptomatic

Contraindications: Hyperglycemia

Precautions: Malnutrition and children, especially infants

Side Effects: Nausea, vomiting, dizziness, tachycardia, hypertension, hyperglycemia

Dosage and Administration

Adults: 1-2 grams IM; repeatable after 15 minutes

Pediatrics: 0.1mg per kg with a max of 1mg; can be repeated every 15 minutes to keep BGL above 60

Note: Infants and malnourished individuals either do not have or have already used up their glycogen reserves and it may be ineffective. Must be reconstituted.

Oral Glucose (Glucose, Insta-glucose)

Class: Carbohydrate

Description: Increases blood sugar

Indications: Patients with altered mental status and a known history of diabetes mellitus

Contraindications: Unconsciousness, known diabetic who has not taken insulin for days, patient who is unable to swallow

Precautions: Assure patient has control of swallowing and airway

Side Effects: None when given properly, may be aspirated by a patient with a negative gag reflex

Dosage and Administration:

Adults: 1 tube or packet PO, repeat as needed based on BGL

Pediatrics: ½ to 1 rube, repeat as needed based on BGL, Minimum age is 3 years old due to choking risk.

Ibuprofen (Advil, Motrin, Exedrin IB)

Class: Non-steroidal anti-inflammatory drug (NSAID)

Description: Prototype NSAID with significant analgesic and antipyretic properties. It also inhibits platelet aggregation and increases bleeding time.

Indications: Reduce fever and relieve minor to moderate pain

Contraindications: Hypersensitivity to aspirin or other NSAIDs, patients with history of GI bleeding, renal insufficiency, patients currently on anticoagulants (blood thinners)

Precautions: Hypertension, cardiac decompensation

Side Effects: The most common side effects from ibuprofen are rash, ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation, and heart burn. NSAIDs reduce the ability for blood to clot and therefor increases bleeding after an injury

Dosage and Administration:

Adults: 400 to 800mg PO

Pediatrics: 10mg per kg PO, do not use in infants 6 months of age or younger

Naloxone (Narcan)

Class: Narcotic antagonist

Description: A pure narcotic antagonist that blocks the effects of both natural and synthetic narcotics and may reverse respiratory depression

Indications: Narcotic and synthetic narcotic overdose, coma of unknown orgin

Contraindications: Hypersensitivity to the drug, non-narcotic induced respiratory depression

Precautions: Possible dependency including newborns. Also has a shorter half life then most narcotics, meaning that patient may return into an overdose

Side Effects: Abrupt reversal of narcotic depression may result in nausea, vomiting, sweating, tachycardia, increased blood pressure, tremulousness, seizures, and cardiac arrest

Dosage and Administration

Adults 0.4-2 mg nasally via atomizer

Pediatrics: 0.1 mg per kg with a max of 2 mg; repeated in 5 minutes if no effect

Note: Used to restore respirations not regain consciousness. EMT basic administration is limited to IM or IN routes

Nasal Spray (Afrin)

Class: Vasoconstrictor

Description: Constricts the blood vessels in the nose

Indications: Epistaxis (Nosebleed), preparation for nasal intubation

Contraindications: Significant hypertension

Precautions: None

Side Effects: Sneezing or burning, stinging, dryness, or irritation of the nose. These side effects are usually mild and temporary

Dosage and administration:

Adult: 2 sprays in the affected nostril

Pediatrics: 1-2 sprays in the affected nostril

Nitroglycerin (Nitrostat)

Class: Nitrate; Vasodilator

Description: Relaxes blood vessels, decreases the workload of the heart

Indications: Chest pain associated with angina and acute myocardial infarction

Contraindications: Hypersensitivity, tolerance to nitrates, severe anemia, head trauma, hypotension, increased intracranial pressure (ICP), male patients with usage of erectile dysfunction medications within the past 72 hours.,glaucoma, and shock

Precautions: May induce a headache that can be severe. Is light sensitive and will degrade when exposed to air.

Side Effects: Hypotension (lowers blood pressure), headache, pulse rate changes

Dosage and administration

Adults: One tablet or spray sublingually (SL) (under the tongue) every 5 minutes until pain free, a max of 3 doses, or a systolic blood pressure of less then 100

Pediatrics: Not indicated

Note: EMT- Basic administration is limited to patients who have a physicians orders with a prescription for the drug. Be sure to check agency policy or contact medical control for potential standing or online orders.

Nitrous Oxide (Laughing Gas)

Class: Anesthetic Gas

Indications: Pain management

Contraindications: Patients in respiratory distress, unable to follow commands, unable to self administer

Precautions: High concentrations can cause hypoxia and asphyxiation, those with a Vitamin B12 deficiency

Side Effects: Dizziness, hypotension, headache, nausea, vomiting

Dosage and Administration

Adults and Pediatrics

Self administered via inhalation with either 70:30 or 50:50 mix with oxygen

Oxygen

Class: Oxidizing Agent (Gas)

Description: A odorless, colorless, tasteless gas that is essential for life. One of the most important emergency drugs.

Indications: Hypoxia or anticipated hypoxia, or in any medical or trauma patient to improve respiratory efficiency

Contraindications: None

Precautions: Chronic obstructive pulmonary disease and very prolonged administration of high concentrations in newborns

Dosage and Administration:

Adults and Pediatrics

1-4 LPM via Nasal Canula

6-15 LPM via Non-Rebreather Mask

15 LPM via Bag-Valve Mask

Pralidoxime (2-Pam)

Class: Cholinesterase Reactivator

Description: Reactivates cholinesterase and reinstitute the degrading of acetylcholine and restores normal neuromuscular transmission. Used to reverse severe organophosphate poisonings

Indications: Organophosphate poisoning

Contraindications: Carbamate insecticide poisoning, inorganic phosphates and organophosphates having no anti-cholinesterase activity, asthma, peptic ulcer disease, severe cardiac disease, or patients receiving aminophylline, theophylline, morphine, succinylcholine, reserpine, or phenothiazines.

Precautions: Rapid administration may result in tachycardia, laryngospasm, and muscle rigidity. Excited or manic behavior may be noted after regaining consciousness.

Side Effects: Blurred or double vision, difficulty in focusing eyes, difficulty speaking, difficult or rapid breathing, dizziness, fast heartbeat, stiffness or weakness of muscles, pain at injection site

Dosage and Administration

Adults and Pediatrics

Begin with 1 nerve agent kit for children under 7

2 nerve agent kits from 8-14 years of age

3 nerve agent kits for patients 15 years old and older