emt medications

Medication

Indications

Contraindications

Route of Administration

Specific Assessment Needed to Confirm it Should be Administered to the Patient 

Dosage

Mechanism of Action

Narcan

Opioid OD with respiratory depression/unconcsioucness 

Not opioid OD, conscious, or no respiratory depression

Intranasal (~2-4 mg); 

Verify narcotic overdose (confirm pinpoint pupils with respiratory depression)

0.4-4 mg 

MDI (specifically fast acting inhaler---how do you know which are "fast acting?"/ALBUTEROL

Respiratory distress from bronchial constriction 

CHF and wet lung sounds 

One dose (usually 2 puffs) or 3 mg nebulizer treatment OR via nebulizer (equivalent to 5 puffs)

Verify the patient takes/has the medication. Assess lung sounds.

2 puffs

ASA

Cardiac chest pain

Bleeding, Allergy (Major) 

Chewed

Rule-out chest pain caused by trauma through physical examination, ensure no allergy to ASA and no active bleeding.

4 x 81 mg = 324 mg or 1 adult dose (325mg) tablet

NTG

Cardiac chest pain 

BP below 100 mgHg systolic. Cannot be given within 24 hours of taking Viagra
/Revatio (sildenafil) or Levitra (vardenafil) or within 48 hours of taking Cialis (tadalafil).

Sublingual 

Ensure the patient has the medication. Rule-out chest pain caused by trauma through physical examination, ensure pt has not taken ED drugs within past 24-48 hours. Check BP to ensure systolic >100mmHg.

0.4 mg, up to 3 doses (can only administer 1 dose without medical command authorization)

O2

Difficulty breathing; pulse-ox < 95%; hypoperfusion; significan MOI/NOI

None [if giving high-flow oxygen to patient with COPD, watch for need to assist ventilations with BVM due to elimination of hypoxic drive.] Patients with ischemic conditions )ST-elevation MI, suspected stroke, or post-cardiac arrest with ROSC) may be harmed by high plasma oxygen concentrations. Avoid routine use of NRB oxygen in these patients. Unless indicated by other complications, apply oxygen only if room air SpO2 is <95% and titrate oxygen to attain SpO2 in range of 95-99%:

Low-flow = nasal cannula; high-flow = non-rebreather mask; BVM if ventilations are not adequate; CPAP as indicated.

Check pulse-ox. Identify need for oxygen based on MOI/NOI and/or patient presentation. 

Depends on route

Glucose

Hypoglycemia 

No gag reflex.

Oral if patient is able to swallow. If still has gag reflex but unable to follow commands, can place small amount between cheek and gum (buccal).

Identify signs/symptoms of hypoglycemia. Check BG.

Half to full tube

Glucagon 

Per PA Protocol - given for hypoglycemia in patient with no gag reflex.

Conscious patient with BG > 60.

Intranasal spray

Assess ability to swallow and check BG level.

Baqsimi - 3 mg intranasal [PA ONLY].

Activated Charcoal 

Oral poisoning 

Greater than 30 minutes after the poisoning; Unable to maintain an open airway or swallow. Injestion of acid.

Oral 

SAMPLE; Must contact medical command for authorization to give. Need to know what the patient took, how much they took, patient presentation and vitals. 

1 g/kg---up to 50 grams [need authorization from medical command]

Epinephrine 

Anaphalaxis 

Lack of the signs of anaphalaxis 

Intramuscular (into vastus lateralis) 

Confirm allergy. Assess airway, skin, and lung sounds. Confirm moderate to severe anaphylaxis.

0.3 mg---adult; 0.15 mg---pediatric