EMS cardiac medication

Epinephrine 1mg/ml

Formerly 1:1000, a non-selective beta agonist indicated for severe anaphylaxis and asthma needing medical command.

Class of Epinephrine 1mg/ml

Non-Selective Beta Agonist.

Indications for Epinephrine 1mg/ml

Severe Anaphylaxis; Asthma (bronchospasm) needs medical command.

Mechanism of Action for Epinephrine 1mg/ml

Catecholamine with strong alpha adrenergic, strong Beta1, and moderate beta 2 effects.

Effects of alpha stimulation in Epinephrine 1mg/ml

Systemic vasoconstriction, increasing peripheral vascular resistance.

Effects of beta 1 stimulation in Epinephrine 1mg/ml

Increase in heart rate, myocardial contractility, cardiac output, and oxygen demand.

Effects of beta 2 stimulation in Epinephrine 1mg/ml

Bronchial smooth muscle dilation.

Dosage for Adult Epinephrine 1mg/ml

0.3mL IM every 5-15 minutes as needed.

Dosage for Pediatric Epinephrine 1mg/ml

0.01 mg/kg, max 0.3 mg IM.

Epinephrine infusion concentration

1mg/250ml, run until hypotension resolves.

Side Effects of Epinephrine 1mg/ml

Tachydysrhythmias, V-Tach, V-Fib, HTN, Angina.

Contraindications for Epinephrine 1mg/ml

Caution in patients with known cardiovascular disease or >45 years of age; also hypertensive, cerebrovascular disease, shock from non-anaphylactic causes, closed-angle glaucoma, diabetes, pregnant women in active labor, known sensitivity to epinephrine or sulfites.

Epinephrine 0.1mg/ml

Formerly 1:10,000, a vasopressor indicated for cardiac arrest.

Dosage for Cardiac Arrest using Epinephrine 0.1mg/ml

1mg IV/IO repeated every 3-5 minutes until circulation is restored.

Nebulized dosage for Epinephrine 0.1mg/ml (Adult)

0.3 mg (3ml) at 6 lpm.

Contraindications for Epinephrine 0.1mg/ml

Arrhythmias other than VF, asystole, PEA, cardiovascular disease, hypertension, cerebrovascular disease, shock from non-anaphylactic causes, closed-angle glaucoma, diabetes, pregnant women in active labor, known sensitivity to epinephrine or sulfites.

Amiodarone Class

Antiarrhythmic.

Amiodarone Indications

Cardiac arrest (V-fib/V-tach); Stable wide complex tachycardias.

Amiodarone Mechanism of Action

Prolongs myocardial cell-action potential duration and refractory period, acting as a noncompetitive a- and b-adrenergic inhibitor.

Dose for VF/VT using Amiodarone

300mg IV/IO, may repeat 150mg in 10 minutes.

Side Effects of Amiodarone

Vasodilation; Low BP; Low HR; AV Block; Hepatotoxicity; Torsades, CHF.

Contraindications for Amiodarone

Known hypersensitivity, Iodine hypersensitivity, Bradycardia, AV block >1 degree without pacemaker, Hypotension (SBP <100 mmHg).

Aspirin Class

Antiplatelet/ NSAID.

Aspirin Indications

Chest pain; Acute Myocardial Infarctions, Mild to moderate pain in adults.

Dosage for Aspirin

324mg (4 pills) PO chewed.

Side Effects of Aspirin

GI Bleeding.

Contraindications for Aspirin

GI bleeding, active ulcer disease, hemorrhagic stroke, bleeding disorders, children with chickenpox or flu-like symptoms, known hypersensitivity.

Adenosine Class

Antiarrhythmic.

Adenosine Indications

Narrow complex REGULAR supraventricular tachycardia refractory to vagal maneuvers.

Mechanism of Action for Adenosine

Slows conduction through AV node, interrupts re-entrant pathways.

Adult Dosage for Adenosine

6mg IV rapidly, may repeat 12mg after 2 minutes.

Contraindications for Adenosine

Sick sinus syndrome, second/third-degree heart block, hypersensitivity, drug-induced tachycardia, and asthma.

Atropine Sulfate Class

Antiarrhythmic; antimuscarinic; Parasympatholytic.

Indications for Atropine Sulfate

Hemodynamically significant bradycardia; Organophosphate Poisoning.

Atropine Sulfate Mechanism of Action

Competes reversibly with acetylcholine at muscarinic receptors, blocks parasympathetic effects.

Dose of Atropine Sulfate for Bradycardia

1 mg IVP every 3-5 minutes up to 3mg total.

Side Effects of Atropine Sulfate

Dilated Pupils; Increased heart rate; VT; VF; Headache; Dry mouth.

Contraindications for Atropine Sulfate

AMI, myasthenia gravis, GI obstruction, known sensitivity to atropine.

Nitroglycerin Class

Nitrate.

Nitroglycerin Indications

CHF and suspected acute coronary syndrome.

Mechanism of Action for Nitroglycerin

Smooth muscle relaxant acting on vasculature, reducing preload in acute pulmonary edema.

Contraindications for Nitroglycerin

Hypotension, severe bradycardia, right-sided MI, intracranial bleeding, known sensitivity to nitrates.