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ALS Meds
Statewide Protocols
| Term | Definition |
|---|---|
| Adenosine (Adenocard) | Indications: Specifically for tx or diagnosis of supraventricular tachycardia Consider for regular or wide complex tachycardia |
| Adenosine (Adenocard) Dosing | Tachycardia: 6 mg rapid IV/IO push over 1-3 seconds May repeat 12 mg after 1-2 mins x 2, if no conversion |
| Albuterol - Beta Agonist | Indications: Nebulized treatment for use in respiratory distress with bronchospasm |
| Albuterol - Beta Agonist Dosing | Allx Rx/Anaphylaxis: 2.5mg via nebulizer - May repeat 2.5mg Asthma/COPD/RAD: 2 puffs per dose of MDI - May repeat every 5 mins Albuterol is 2nd line drug, initial tx should be 2.5mg albuterol and 0.5mg ipratropium (Duoneb)- may repeat every 5 mins |
| Amiodarone (Cordarone) | Indications/Contraindications -Antiarrhythmic used mainly in wide complex tachycardia and ventricular fibrillation -Avoid in patients with heart block or profound bradycardia -Contra: in pts with iodine hypersensitivity |
| Amiodarone (Cordarone) Dosing | Cardiac Arrest - V-Fib/Pulseless V-Tach 300 mg IV push - repeat dose of 150 mg IV/IO push for recurrent episodes PostArrest: 150mg in 10mL normal saline slow IV/IO over 8-10 mins. If successful maintenance infusion of 1 mg/min Tachy:Wide complex Tachy-150 mg in 50-100mL normal saline infused over 10 mins. if successful, consider maintenance infusion of 1mg/min |
| Aspirin | Indications/Contra: -An antiplatelet drug for use in cardiac chest pain -Hx of anaphylaxis to aspirin or NSAIDs -Not used in presence of active GI bleeding |
| Aspirin Dosing | Acute Coronary Syndrome -324 mg chewed PO |
| Atropine | Indications: -Anticholinergic drug used in bradycardia and organophosphate poisonings |
| Atropine Dosing | Bradycardia: 0.5 - 1mg IV/IO every 3-5 mins up to max of 3mg Organophosphate Poisoning and Nerve Agent 2-6mg IM/IV/IO every 5 mins as needed |
| Atropine and Pralidoxime Auto-Injector (DuoDote) Nerve Agent Kit | Indications: Antidote for nerve agents or organophosphate overdose |
| Atropine and Pralidoxime Auto-Injector (DuoDote) Nerve Agent Kit Dosing | Nerve agents: -Pts experiencing: apnea, convulsions, unconsciousness, flaccid paralysis administer 3 DuoDote and 1 Atropine (10mg) auto injectors -Pts experiencing: dyspnea, twitching, nausea, vomiting, sweating, anxiety, confusion, constricted pupils, restlessness, weakness administer 1 DuoDote |
| Calcium Chloride 10% solution | Indications: For calcium channel blockers overdose |
| Calcium Chloride 10% solution Dosing | Bradycardia: -2-4mg/kg slow IV over 5 mins, max 1g -Avoid use if pt is taking digoxin |
| Cyanide Antidote Kit (Amyl Nitrite, Sodium Nitrite and Sodium Thiosulfate) | Indications: Antidote for Cyanide Poisoning |
| Cyanide Antidote Kit (Amyl Nitrite, Sodium Nitrite and Sodium Thiosulfate) Dosing | Poisoning: -Amyl Nitrite 2 Inhalants -Sodium Nitrite: 3%, 10mL slow IV/IO over 2-4 mins -Sodium Thiosulfate: 25% 50mL IV/IO bolus |
| Cyanokit (Hydroxocobalamin) | Indications: Antidote for Cyanide Poisoning |
| Cyanokit (Hydroxocobalamin) Dosing | Poisoning: 5gm IV/IO over 15 mins |
| Dextrose (Glucose solutions) | Indications: Symptomatic hypoglycemia |
| Dextrose (Glucose solutions) Dosing | Diabetic Emergencies: - 12.5g to 25g IV/IO Name Concentration Volume (25g) D50 0.5g/mL. 25g/50mL D25. 0.25g/mL. 25g/100mL D10. 0.1g/mL. 25g/250mL |
| Diazepam (Valium) Benzodiazepine | Indications: -Seizure control -Sedation -Anti-anxiety (anxiolytic) |
| Diazepam (Valium) Benzodiazepine Dosing | Sedation for Electrical Therapy - 2.5-5mg IV/IO/IM/IN/PR Nerve Agent -10mg IV/IN/IO/IM/PR. OR - 10mg IM via auto-injector Seizure/Poisoning/Substance abuse/OD -5-10mg IV/IO/IM/PR Induced Therapeutic Hypothermia - 5-10mg IV/IO/IM/PR (for shivering) |
| Diltiazem (Cardizem) | Indications/Contraindications: -Calcium channel blocker used to treat narrow complex SVT -Contra: in pts with heart block, ventricular tachycardia, WPW and/or acute MI |
| Diltiazem (Cardizem) Dosing | Tachycardia- Narrow Complex Tachycardia: 0.25 mg/kg slow IV/IO push; may repeat dose in 15 mins at 0.35mg/kg if necessary |
| Diphenhydramine (Benadryl) | Indications: Antihistamine used as an adjective treatment in allergic reactions |
| Diphenhydramine (Benadryl) Dosing | Allergic Reaction/Anaphylaxis: 25-50 mg IV/IO/IM |
| Dopamine | Indications: -A vasopressor used in shock or hypotension -Used when infusion pump/norepinephrine not available |
| Dopamine Dosing | Bradycardia, Post-Resuscitation and Shock - Infusion 2-20 mcg/kg/min IV/IO |
| Epinephrine 1:1,000 (Auto-Injector ONLY) | Indications: Bronchodilation in asthma and COPD exacerbation. primary tx for anaphylaxis |
| Epinephrine 1:1,000 (Auto-Injector ONLY) Dosing | Allergic Rx/Anaphylaxis - 0.3mg IM, repeat every 5 mins to a total of 3 doses Asthma/COPD/RAD - 0.3mg IM (no repeat) If authorized by service, Advanced EMTs and Medics may administer Epinephrine 1:1,000 IM if using a kit that has following criteria: - Supplies in separate container from all other meds - Medication provided as 1mg/mL in glass vial - Kit case and med vial labeled with "NOT FOR IV USE"/ adult/pedi dose - Kit has 2 sterile 1 cc graduated syringes and 21 to 25 gauge attached |
| Epinephrine 1:1,000 (by Infusion ONLY) | Indications: Vasopressor Post-Resuscitation, Bradycardia, allergic reaction |
| Epinephrine 1:1,000 (by Infusion ONLY) Dosing | Allx Rx 2-10 mcg/min IV/IO infusion (maintenance) Bradycardia 2-10 mpg/min IV/IO Infusion Post-Resuscitation 2-10mcg/min IV/IO infusion Shock-Adult 2-10 mcg/min IV/IO infusion-by pump |
| Epinephrine 1:10,000 | Indications: Vasopressor used in cardiac arrest |
| Epinephrine 1:10,000 Dosing | Cardiac Arrest 1 mg IV/IO, repeat every 3-5 mins per AHA guidelines |
| Epinephrine (Racemic, for inhalation) | Indications: Croup |
| Epinephrine (Racemic, for inhalation) Dosing | Croup: 11.25 mg in 2.5mL solution |
| Fentanyl (Sublimaze) | Indications: Opioid analgesic |
| Fentanyl (Sublimaze) Dosing | Pain 1mcg/kg up to 150 mpg slow IV/IO/IM/IN Therapeutic Hypothermia, Shivering 50 mpg every 5 mins, max 200mcg IV/IO/IM/IN |
| Furosemide (Lasix) | Indications: CHF, Pulmonary Edema, Hypertensive Emergencies, Toxicology |
| Furosemide (Lasix) Dosing | CHF, Pulmonary Edema 20-40mg IV/IO Hypertensive Emergencies 0.5-1mg/kg IV/IO Toxicology 40mg IV/IO |
| Glucagon | Indications: -Hypoglycemia -Beta Blocker or Calcium channel blocker overdose |
| Examples of Calcium Channel Blockers | Amlodipine (Norvasc) Diltiazem (Cardizem, Tiazac,) Felodipine. Isradipine. Nicardipine. Nifedipine (Adalat CC, Afeditab CR, Procardia) Nisoldipine (Sular) Verapamil (Calan, Verelan) |
| Examples of Beta Blockers | acebutolol (Sectral) atenolol (Tenormin) betaxolol (Kerlone) betaxolol (Betoptic S) bisoprolol fumarate (Zebeta) carvedilol (Coreg) esmolol (Brevibloc) labetalol (Trandate [Normodyne - discontinued]) metoprolol (Lopressor, Toprol XL) nadolol (Corgard) nebivolol (Bystolic) penbutolol (Levatol) propranolol (Hemangeol, Inderal LA, Inderal XL, InnoPran XL) sotalol (Betapace, Sorine) timolol timolol ophthalmic solution (Timoptic, Betimol, Istalol) |
| Glucagon Dosing | Diabetic Emergencies 1mg IV/IO/IM/IN/SC Beta Blocker/Calcium Channel Blocker Overdose 1-5mg IV/IO/IM/IN/SC Bradycardia 1-5mg IV/IO/IM/IN/SC |
| Glucose Oral | Indications: Use in conscious hypoglycemic patients |
| Glucose Oral Dosing | Diabetic Emergencies Administer 1-2 tubes of commercially prepared glucose gel or equivalent |
| Haloperidol (Haldol) Phenothiazine Preparation | Indications/Contra Medication to assist with sedation of agitated patients |
| Haloperidol (Haldol) Phenothiazine Preparation Dosing | Behavioral Emergencies 5 mg IM |
| Hydrocortisone (Solu-Cortef) | Indications/Contra -Adrenal Insufficiency/Crisis -Other inflammatory processes (COPD/Asthma) |
| Hydrocortisone (Solu-Cortef) Dosing | Adrenal Insufficiency/Crisis 100mg IV/IO/IM Respiratory Distress (COPD/Asthma) 100mg IV/IO/IM |
| Ipratropium Bromide (Atrovent) | Indications/Contra -Anticholinergic bronchodilator. Blocks the muscarinic receptors of acetylcholine -Relief of bronchospasm in patients with reversible obstructive airway disease and bronchospasm |
| Ipratropium Bromide (Atrovent) Dosing | Asthma/COPD/RAD -2-3 puffs per dose of MDI combo of albuterol/ipratropium bromide. may repeat as necessary every 5 mins OR -0.5mg ipratropium and 2.5mg albuterol (DuoNeb) May repeat as necessary every 5 mins 0.5mg ipratropium nebulizer may repeat as necessary every 5 mins |
| Ketamine | Indications: Agitated patient |
| Ketamine Dosing | Behavioral: 4mg/kg IM only, to a max dose of 400mg IM only as a single dose |
| Lidocaine | -Antiarrhythmic used for control of ventricular dysrhythmias -Used prior to intubation of pts c suspected increased intracranial pressure (ex. TBI, ICH) to reduce increases in intracranial pressure -Anesthetic for nasotracheal intubation and intraosseous procedures |
| Lidocaine Dosing | Cardiac Arrest: 1-1.5mg/kg IV/IO; repeat dose 0.75mg/kg up to max 3mg/kg follow by 2-4mg/min maint. infusion V. Tachycardia c pulses: 1-1.5mg.kg IV/IO (consider 2nd therapy to amiodarone) repeat dose of 0.5-0.75mg/kg every 3-5 mins - total of 3 mg/kg follow by 2-4 mg/min maint. infusion Post-Resus.: 1-1.5mg/kg IV/IO follow by 2-4mg/min maint infus Nasotracheal intub.: 2% lidocaine jelly Intraosseous: 40mg 2% lidocaine slow bolus over 2 mins follow 10mL normal saline flush, then use IO access for meds |
| Lorazepam (Ativan) Benzodiazepine | Indications: Seizure control Sedation Anti-anxiety (anxiolytic) |
| What does anxiolytic mean? | Used to reduce anxiety |
| Lorazepam (Ativan) Benzodiazepine Dosing | Behavioral: 2-4mg IV/IO/IM Nerve Agent/Seizures 2-4mg slow IV/IO/IM |
| Magnesium Sulfate | Indications: -Elemental electrolyte used to treat eclampsia during the third trimester of pregnancy -A smooth muscle relaxer used in refractory respiratory distress resistant to beta-agonists -Torsades de Pointes |
| Magnesium Sulfate Dosing | Asthma/RAD 2 grams in 100mL NS given IV over 10 mins Seizures 4 grams IV over 10 mins in the presence of a sz in 3rd trimester of pregnancy or post party Cardiac Arrest/Tachycardia-Torsades de Pointes 1-2 grams IV over 5 mins |
| Methylprednisolone (Solu-Medrol) | Indications: Steroid used in respiratory distress to reverse inflammatory and allergic reactions |
| Methylprednisolone (Solu-Medrol) Dosing | Asthma/COPD/RAD 125mg IV/IO/IM |
| Metoprolol (Lopressor) | Rate control for adult patients who are already prescribed a beta blocker NOTE: do not use IV Beta Blockers with IV Calcium channel blockers |
| Metoprolol (Lopressor) Dosing | Tachycardia 2.5mg to 5 mg slow IV over 2-5 mins May repeat every 5 mins to a max of 15mg |
| MIdalozam (Versed) Benzodiazepine | Seizure control sedation anxiolytic |
| MIdalozam (Versed) Benzodiazepine Dosing | Behavioral/Sz/Induced Therapeutic Hypothermia 2-6mg IV/IO/IM/IN Nerve Agent/Organophosphate Poisonin 2mg IV/IO/IN every 5 mins or 6mg IM every 10 mins as needed Sedation for Electrical Therapy 0.5mg -2mg IV/IO/IM/IN Difficult Airway 2mg slow IV/IO/IM/IN, repeat if needed up to total dose of 6mg |
| Morphine Sulfate | Opioid analgesic Avoid use if BP < 100mmHg |
| Morphine Sulfate Dosing | Pain 0.1mg/kg every 5 mins IV/IO/IM/SC up to 10mg max |
| Naloxone (Narcan) Opioid Antagonist | Opioid overdose |
| Naloxone (Narcan) Opioid Antagonist Dosing | Pain: Antidote: for hypoventilation from opioid admin by EMS, admin naloxone 0.4mg - 4.0mg IV/IM/IN as needed Poisoning/Substance Abuse/Opioid OD 0.4mg - 4mg IV/IM/IN if no response, may be repeated as needed First responders and EMTs may administer by auto-injector or nasal atomizer |
| Nitroglycerin | Indications/Contra Vasodilator used in the tx of cp secondary to acute coronary syndrome and CHF Hypertensive emergencies Contra: not used in the presence of hypotension or recent use of phosphodiesterase-type-5 inhibitor within last 48 hours |
| Nitroglycerin Dosing | Cardiac conditions/Hypertensive emergencies -0.4mg SL tabs or 1 spray every 3-5 mins while symptoms persist and if systolic BP remains > 120mmHg -1 inch paste to chest wall, transdermal |
| Norepinephrine (Levophed) | Alpha and Beta 1 receptor adrenergic receptor agonist vasopressor Infusion pump REQUIRED |
| Norepinephrine (Levophed) Dosing | Hypotension 0.1mcg/kg/min IV/IO titrate to goal SBP of 90mmHg - generally to a max dose of 30 mcg/min - 4 mg mixed in 250mL of D5 diluent packaged with medication; max dose: generally to a max dose |
| How many epinephrine and norepinephrine are there? | 4 epis and 1 nor |
| Ondansetron (Zofran) Anti-emetic | used to control nausea and/or vomiting |
| Ondansetron (Zofran) Anti-emetic Dosing | Nausea/Vomiting 4mg IV/IO/IM/ODT |
| Oxygen | -Any condition with increased cardiac work load, respiratory distress, or illness/injury resulting in altered ventilation and/or perfusion. Goal oxygen sat > or = 94% -Used for pre-oxygenation whenever possible prior to endotracheal intubation. Goal oxygen sat 100% |
| Oxygen Dosing | -1-6 liters/min via nasal cannula -10-15 liters/min via NRB mask -15 liters/min via BVM |
| Pralidoxime (2-PAM) | -Antidote for nerve agents or organophosphate overdose -administered as part of Mark I kit |
| Pradidoxime (2-PAM) Dosing | Nerve Agent/Organophosphate Poisoning 600mg via Auto-Injector IM per kit, 1-3 kits |
| Sodium Bicarbonate | A buffer used in acidosis to increase the pH in cardiac arrest, hyperkalemia, or tricyclic overdose |
| Sodium Bicarbonate Dosing | Poisoning/Substance Abuse/OD/Toxicology 0.5 - 1 mEq/kg IV/IO Cardiac Arrest/Known Hyperkalemia/Acidosis/TCA Overdose 1 mEq/kg IV/IO |
| What is an organophosphate overdose? | Organophosphate are used as insecticides, medications, and nerve agents. Symptoms include increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle tremors, and confusion. Carbamate poisoning can present similarly. |
| What is a tricyclic overdose? | Antidepressant overdose Examples: Amitriptyline Amoxapine Doxepin Nortriptyline (Pamelor) Protriptyline (Vivactil) Trimipramine (Surmontil) |
| What is hyperkalemia and some symptoms> | Potassium level in your blood that's higher than normal. Potassium is a nutrient that is critical to the function of nerve and muscle cells, including those in your heart. Your blood potassium level is normally 3.6 to 5.2 millimoles per liter (mmol/L). Symptoms: asymptomatic, nausea,fatigue,muscle weakness, tingling sensations, slow heartbeat or weak pulse |
| Tetracaine 0.5% | Topical anesthetic for eye injuries |
| Tetracaine 0.5% Dosing | Eye injuries 1-2 drops to affected eye; repeat every 5 mins as needed |
| Vasopressin | Used in Cardiac Arrest |
| Vasopressin Dosing | Cardiac Arrest; Asystole, Pulseless Electrical Activity, Ventricular Fibrillation, Ventricular Tachycardia (without pulses) 40 units IV/IO in place of first or second dose of epinephrine |
Created by:
Jess2008
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