EMS cardiac medication

Epinephrine 1mg/ml (Formerly 1:1000)

Class: Non-SelectiveBeta Angonist

Indications: Severe Anaphylaxis; Asthma (bronchospasm) needs medical command

Mechanism of Action: Catecholamine with strong alpha adrenergic, Strong Beta1, and moderate beta 2

effects Effects of alpha simulation result in systemic Vasoconstriction, increasing peripheral vascular

resistance. Effects of beta 1 stimulation results in increase in heart rate Myocardial contractility, cardiac

output and oxygen Demand Effects of beta 2 stimulation results in Bronchial smooth Muscle dilation

REMEMBER: Med is given IM, not IV

Dose: Adult - 0.3mL IM every 5-15 minutes as needed. Peds- 0.01 mg/kg max 0.3 mg IM

Epi infusion may be ordered (1mg/250ml) run until hypotension resolves

Side Effects: Tachydysrhythmias, V-Tach, V-Fib, HTN, Angina

Contraindications:, Caution in patients with known cardiovascular disease or pts > 45; hypertension,

cerebrovascular disease; shock secondary to cause other than anaphylactic shock; closed angle

glaucoma; diabetes; pregnant women in active labor; known sensitivity to epinephrine or sulfites.

Associated Protocols: 4011, 4022, 4023

Epinephrine 0.1mg/ml (formerly 1:10,000)

Class: Vasopressor

Indications: Cardiac Arrest

Mechanism of Action: Catecholamine with strong alpha adrenergic, Strong Beta1, and moderate beta 2

effects Effects of alpha simulation result in systemic Vasoconstriction, increasing peripheral vascular

resistance. Effects of beta 1 stimulation results in increase in heart rate Myocardial contractility, cardiac

output and oxygen Demand Effects of beta 2 stimulation results in Bronchial smooth Muscle dilation

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

EPINEPHrine by push dose (dilute boluses) or infusion. Pulse dose boluses = prepare 1:100,000

10 mcg/mL concentration by adding 1 mL (of 0.1 mg/mL concentration1:10,000) EPINEPHrine in

9 mL NSS, then administer 1-2 mL every 2 minutes and titrate to SBP target. Infusion = must

administer by electronic pump at 0.1-0.5 mcg/kg/min titrated to SBP target

NEBULIZED- Adult- 0.3 mg (3ml) @ 6lpm. Peds- 0.5mg (5mls) @6 lpm

Side Effects: Tachydysrhythmias, V-Tach, V-Fib, HTN, Angina

Contraindications: Arrhythmias other than VF, asystole, PEA, cardiovascular disease, hypertension,

cerebrovascular disease; shock secondary to cause other than anaphylactic shock; closed angle

glaucoma; diabetes; pregnant women in active labor; known sensitivity to epinephrine or sulfites;

Caution in patients with known cardiovascular disease or pts > 45

Associated Protocols: 3000A, 3031, 3032, 3033, 3080, 5021, 6002, 7005

Amiodarone

Class: Antiarrhythmic

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

Mechanism of Action: It prolongs the myocardial cell-action potential (phase 3) duration and

refractory period and acts as a noncompetitive a- and b-adrenergic inhibitor Acts directly on the

myocardium to delay repolarization and increase the duration of the action potential

Dose: VF/VT (pulseless): 300mg IV/IO. May repeat 150mg IV/IO in 10 minutes

Stable Irregular Narrow Complex Tachycardia or Stable VT/ Wide complex with a pulse: 150 mg in 50-

100 ml NS over 10 minutes

Recurrent VT or Runs of VT post ROSC- 1mg/min infusion (Max 2.2 gm in 24hrs)

Pediatric : VT (Pulsed) and SVT: 5mg/kg in 50 ml NS 20-60 minutes (5022P) (5023P)

VF/VT (Pulseless): 5mg/kg IV/IO Max 300 mg

Side Effects: Vasodilation; Low BP; Low HR; AV Block; Hepatoxicity; Torsades, CHF

Contraindications: Known hypersensitivity, Iodine hypersensitivity, Bradycardia, AV block >1

degree in the absence of a pacemaker, Hypotension (SBP <100 mmHg)

Associated Protocols: 3031A/P, 3080, 5022P , 5023A & P

Aspirin

Class: Antiplatelet/ NSAID

Indications: Chest pain; Acute Myocardial Infarctions, Mild to moderate pain in an adult patient

Mechanism of Action: blocks formation of the substance thromboxane A2, limiting platelet aggregation

and arterial constriction. Also decreases levels of PGE2, Decreasing pain and inflammation.

Dose: 324mg (4pills) PO chewed

650 mg PO (>14 years old)

Side Effects: GI Bleeding

Contraindications: Gastrointestinal (GI) bleeding, active ulcer disease, hemorrhagic stroke, bleeding

disorders, children with chickenpox or flu-like symptoms, known hypersensitivity.

Associated Protocols: 5001, 6003, 7003

Adenosine

Class: Antiarrhythmic

Indications: Narrow complex REGULAR supraventricular tachycardia refractory to vagal maneuvers

Mechanism of Action: slows conduction through AV node; interrupts re-entrant pathways; works on

pacemaker cells; chemically cardioverts. A naturally occurring nucleoside found in all cells of the

body. It is a byproduct of the breakdown of adenosine triphosphate (ATP). Adenosine specific

receptors are in the lungs and cardiomyocytes. Stimulation of these receptors results in decreased

electrical conduction. As a result, SA node automaticity is decreased and conduction velocity is

slowed and AV nodal refractoriness is increased

Dose: Adult: Attempt vagal maneuvers first. 6mg(2cc) IV rapidly over 1-3 seconds. Flush with 20cc NS

bolus. May repeat 12mg bolus one more time in 2 minutes. 3rd dose 12mg needs medical command

before administration.

Pediatric: First dose - 0.1mg/kg (Max 6mg). After 2 minutes: 0.2mg/kg (max 12 mg)

Side Effects: Asystole; Transient dysrhythmias; bronchospasm; chest pressure; facial flushing;

hypotension; headache; nausea

Contraindications: Sick sinus syndrome, second degree or third degree heart block, hypersensitivity,

poison-drug induced tachycardia, asthma, or bronchospasm; V tach

Associated Protocols: 5022A & P, 5023A & P

Atropine Sulfate

Class: Antiarrhythmic; antimuscarinic; Parasympatholytic; Antivagolytic

Indications: Hemodynamically significant bradycardia; Organophosphate Poisoning

Mechanism of Action: competes reversibly with acetylcholine at the site of the muscarinic receptor.

Blocks parasympathetic nervous system effects

Dose: Adult: Symptomatic Bradycardia: 1 mg IVP every 3-5minutes up to 3mg total dose

Organophosphate Poisoning: 2-6mg IV every 15-30 minutes, until vitals improve

Peds: Symptomatic Bradycardia (with increased vagal tone)- 0.02 mg/kg (minimum 0.1mg; max dose

0.5mg) repeat to a total of 1mg.

**May be given endotracheally (Not preferred) dose is 0.03mg/kg with

5ml NSS**

Side Effects: Dilated Pupils; Increased heart rate; VT; VF; Headache; Dry mouth

Contraindications: AMI, myasthenia gravis, GI obstruction; closed-angle glaucoma; known sensitivity to

atropine, belladonna alkaloids, or sulfites, Will not be effective for intranodal (type II) AV block and new

third- degree block with wide QRS complex; Tachycardia

Associated Protocols: 5021A & P, 8083

Nitroglycerin

Class: Nitrate

Indications: CHF decrease pulmonary venous congestion and improves cardiac output; Suspected acute

coronary syndrome (Chest Pain)

Mechanism of Action: Smooth muscle relaxant acting on vasculature, bronchial, uterine, intestinal

smooth muscle; Reduces preload in acute pulmonary edema

Dose: CP: 1 tablet or spray sublingually every 5 minutes(max of 3) Systolic BP must be over 100mmHg

CHF Dosage: May be repeated every 3-5 minutes as long as BP >100mmHg After initial dose give

following based on SBP: 3SL tablets or spray if SBP>180; 2SL tablets or sprays if SBP 140-180; 1SL tablet

or spray if SBP 100-140

IV: (Drip or Push Dose): Optional: 200 mcg slow IV push over 2 mins; Repeat up to 3 doses: OR

With IV Pump- 5- 200 mcg/min titrated to systolic greater than 100

Side Effects: Headache; Hypotension; Syncope; Tachycardia; Flushing; Burning under tongue

Contraindications: Hypotension, severe bradycardia, or tachycardia, right-sided MI, increased

intracranial pressure, intracranial bleeding, patients taking any medications for erectile dysfunction

(Viagra, Cialis, and Levitra), known sensitivity to nitrates. Use caution in anemia, closed- angle glaucoma,

hypotension, postural hypotension, uncorrected hypovolemia.

Associated Protocols: 5001, 5002, 9001