Activated Charcoal-

Class: * Absorbent
Actions: * Absorbs poisons in the stomach, prevents absorption by the body and enhances their elimination from the
Body
Indications: * Utilized for patients who have ingested poisons or overdosed medications by mouth
Contraindications:
* Altered mental status
* Patients that have ingested acids of alkalis.
* Patients unable to swallow.
Precautions: * Do not give the patient milk, ice cream or sherbet as they decrease the effectiveness of the charcoal.
Adverse Reactions:
* Blackening of the stools.
* Vomiting
Adult dose:
Administer 1-2 g/kg (25-50)
Pediatric dose:
Administer 1-2 g/kg (12.5-25 grams)
Adenosine/Adenocard-
Class: antidysrhythmic.
Action: *natural nucleoside that slows conduction through the AV node without negative
inotropic effects.
*Decreases chronotroic effect from direct activity of sinus pacemaker cells and vagal
nerve terminals.
Indication: *Superventricular tachycardia, except for atrial fibrillation and flutter.
Contraindications: * Adenosine hypersensitivity
*Bradycardia
* Second-or third –degree block
*Sick sinus syndrome
Side effects/Precaution: *Transient dysrhythmias including second or third degree AV Blocks,
asystole, sinus Bradycardia, premature atrial contractions, or
premature ventricular contractions.
*facial flushing
*Headache
*Shortness of breath
*Dizziness
*Nausea
*Chest Discomfort
*Bronchoconstriction
*Methylxanthines may decrease effectiveness, may require larger
dose.
*Dipyridamole may potentiate effect, may need to reduce dose.
Dosage: 6mg rapid IV push followed by a 20 ml saline flush, repeated in 1 to 2 minutes at 12 mg to a total cumulative
dose of 30 mg.
Albuterol (Proventil, Ventolin, Salbutaol)-

Class: * beta 2 specific sympathomimetic.

Action: * Primarily a beta 2 agonist that dilates bronchial smooth muscle
* Relaxes vascular smooth muscle.
Indications:
* Reverse Bronchoconstriction associated with asthma, emphysema, chronic bronchitis,
and other conditions that cause bronchospasm.
Contraindications:
* Hypersensitivity to drug
* Symptomatic tachycardia
* Hypertension
* Tachycardia greater than 150 BPM
* Acute myocardial infarction
Side Effects/Precautions:
*Tachycardia
* Hypertension
*Chest pain
*Anxiety
* Headache
Side Effects/Precautions:
* Dizziness
* Sweating
* Nausea and Vomiting
*Tremors
* Dysrhythmias
* Antidepressants may potentiate vasodilation
Dosage:
* 2.5 mg to 5.0 mg in 2.5 to 3 ml of normal saline via nebulizer over 5 to 10 minutes
* Repeat if severe bronchospasm persists.
Amyl Nitrate-
Class: * Antidote for cyanide Poisoning
Actions: Forms methemoglobin, which combines with the cyanide forming a nontoxic compound (cyanmethemoglobin)
which is excreted when sodium thiosulfate is administered.

Indications: Used initially in the management of cyanide poisoning.

Contraindications: Non when used for cyanide poisoning.

Precautions: * stop administration once sodium nitrate infusion is started

* Do not administer to patients improving on their own
* Oxygenation is critical in these patients

Adverse Reactions:
* Headache
* Hypotension
* Tachycardia
* Nausea/Vomiting
Adult dose:
Vapor inhaled every 10-20 minutes until sodium nitrate iv solution is available. Crush capsule inside oxygen mask
and patient inhales vapor.

Pediatric dose:
Same as adult.
Aspirin-

Class: * Platelet aggregation inhibitor

* Anti-inflammatory agent
Action: * Inhibits platelet aggregation and reduces clot formation

Indications: * Acute Myocardial infarction

* Acute ischemic stroke

Contraindications:
*Hypersensitivity
* Hemorrhagic stroke
* Bleeding disorder
* GI Bleed

Side Effects/ Precautions:

* GI Bleeding
* Nausea and vomiting
* May cause wheezing
* Heartburn
Dosage: * 160 or 325 mg tablet chewed or swallowed.
Atropine Sulfate-

Class: * Parasympatholytic (Anticholinergic, Vagolytic)

Action: * Anticholinergic agent that blocks acetylcholine receptors blocking the parasympathetic
nervous system influence on the heart, smooth muscle, and glands.

Indications: * Hemodynamically significant Bradycardia

* Asystole
* Organophosphate poisoning or nerve gas exposure
* PEA with slow complex rate
Contraindications: * Asymptomatic Bradycardia
* Tachycardia
* Hypersensitivity
* Thyrotoxicosis
Side Effects/Precautions:
* Tachycardia
* Palpitations
* Seizures
* Hypertension
* Respiratory Distress
* Dizziness
*Anxiety
Side Effects/ Precautions:
* Dry mouth
* Pupillary Dilation
* Blurred Vision
* Urinary Retention
Dosage: * Symptomatic Bradycardia: 0.5 to 1.0 mg IV repeated in 3 to 5 minutes at dose of 0.5
to 1.0 mg to a total maximum cumulative dose of 0.04 mg/kg.
Calcium Chloride-

Class: Calcium Salt (electrolyte)

Action: * Increases calcium levels (calcium is necessary for normal function of nerves, muscles,
skeletal system, and for cell membrane and capillary permeability.
* Has a role in the release of neurotransmitters and hormones
* Increases cardiac contractile state
* May increase ventricular automaticity
Indications: * Acute hypocalcemia
* Acute hyperkalemia
* Calcium channel blocker overdose
* Hypermagnesemia
Contraindications: * Hypercalcemia
* Digitalis toxicity
* Renal or cardiac disease
Side Effects/Precautions:
* Extravasation may cause tissue damage and necrosis
* Will precipitate of mixed with sodium bicarbonate
* Rapid injection may cause vasodilation, Hypotension, Bradycardia, cardiac
dysrhythmias, syncope, and cardiac arrest.
Dosage: * 2-4 mg/kg of a 10% solution repeated at 10 minute intervals
Dextrose 50 %-

Class: * Carbohydrate

Action: * Increases blood glucose level

Indications: * Hypoglycemia

Contraindications: * Do not use for altered mental status due to stroke, head injury, or other
intracranial pathology unless hypoglycemia is documented.

Side Effects/Precautions:
* Local venous irritation
* Infiltration may cause tissue necrosis
* Collect a blood sample before administration
* Consider thiamine administration in suspected thiamine-deficient patients

Dosage: 25 g (50 ml) intravenous injection

Diazepam (Valium)-

Class: * Benzodiazepine
Action: * CNS depressant
* Anticonvulsant
* Anxiolytic
* Sedative
* Skeletal Muscle relaxant
Indications: * Status epilepticus or actively seizing patient
* Skeletal muscle relaxant
* Sedation prior to cardioversion
* Reduction of extreme anxiety

Contraindications: *Hypersensitivity
Side Effects/Precautions:
* Local venous irritation and burning at the intravenous injection site
* CNS depression
* Respiratory depression
* Hypotension when injected too rapidly
* Use with caution in patients with narrow angle glaucoma and those with
increased intraocular pressure.
Dosage: * Seizures: 5-10 mg over a three minute period repeat every 5 minutes to a total of 20
mg.
* Acute anxiety: 2-5 mg IV or IM
* Premedication prior to cardioversion: 5-15 mg
Diphenhydramine (Benadryl)-

Class: * Antihistamines (H1 histamine blocker)

Action: * Blocks histamine 1 receptor sites

* Anticholinergic effects
* Reduces vasodilation, Hypotension, Tachycardia associated with histamine release in
anaphylaxis.

Indications: * Severe allergic reaction

* Anaphylaxis
* Dystonic (extrapyramidal) reaction as a result of phenothiazines and
antipsychotic drug.

Contraindications: * Hypersensitivity
* Asthma
* Narrow-angle glaucoma
Side Effects/Precautions:
* Hypotension
* Drowsiness * Wheezing
* Nausea and vomiting * Thickened bronchial secretions
* Disturbed coordination
* Epigastric distress
* Dry mouth
* Dry nose
 * Tachycardia
* Urinary retention
Dosage: * 25-50 mg IV or Deep IM
Dobutamine (Dobutrex)

Class: * Synthetic catecholamine (sympathomimetic) with primary beta adrenergic reception

stimulation.

Action: * Positive inotrope (increases myocardial contractility)

* Increases stroke volume and cardiac output
* Minimal chronotrope (increased heart rate)

Indications: * Cardiogenic shock from left ventricular dysfunction

* Acute congestive heart failure

Contraindications: *Atrial fibrillation, atrial flutter

* Bradycardia-induced hypotension

Side effects/Precautions:
* May increase myocardial infarction size
* May cause ventricular
* May be deactivated by alkaline solutions
* Headache
* Hypertension
Side Effects/Precautions- cont.
* Palpitations

Dosage: 2-20 ug/kg/minute intravenous infusion

Dopamine (Intropin)-

Class: * sympathomimetic

Action: * Precursor to noreinehrine

* Dose-dependent action may include increased renal and mesentery blood flow, beta
adrenergic effects including increased heart rate in myocardial contractility, and
increased systemic vascular resistance from vasoconstriction
* Acts on alpha, beta and dopaminergic adrenergic receptors

Indications: * Cardiogenic shock with hemodynamically significant hypotension (systolic BP

of 70 to 100 mmHg)

Contraindications: * Hypotension due to hypovolemia prior to fluid resuscitation efforts

* Pheochromocytoma (tumor of adrenal gland)

Side Effect/Precautions:
* Tachydysrhythmias
* Hypertension
* Palpitations
* Nausea and vomiting
* Chest pain
* Nervousness
* Headache
* Dyspnea
Side Effects/Precaustions cont:

* May be deactivated by alkaline solution

* Reduce the dose of patient is taking MAO inhibitor (antidepressant)
* May cause hypotension if administered concomitantly with phenytoin
(dilantin)

Dosage: * 2 to 5 ug/kg/minute will increase renal and mesentery blood flow

* 2 to 10 ug/kg/minute for predominant beta adrenergic effects for increasing heart rate
and myocardial contractility
* 10 to 20 ug/kg/minute for predominant alpha adrenergic effects for vasoconstriction
and an increase in systemic vascular resistance
Epinephrine (Adrenalin)-

Class: * Sympathomimetic

Action: *Alpha and beta agonist

* Alpha effects are vasoconstriction and an increase in peripheral vascular resistance
(PVR)
* Beta 1 is a positive inotrope that increases myocardial contractility and a positive
chronotrope that increases heart rate
* Beta 2 dilates bronchial smooth muscle and skeletal vasculature
* Increases myocardial automaticity
* Increases myocardial electrical activity
* Vasoconstriction of arterioles in the skin, muscle, and splanchic (visceral) areas

Indications: * Cardiac arrest

* Anaphylaxis
* Status asthmaticus
* Reactive airway disease

Contraindications:
* None in cardiac arrest
* Hypertension
* Pregnant Patient
* Cardiovascular or hyperthyroid disease
Side Effects/Precautions:
* Protect drug from light
* Tachycardia
* Palpitations
* Hypertension
* Dysrhythmia due to myocardial irritability
* Increased myocardial oxygen demand
* Headache
* Tremors
* Anxiety
* Nausea and vomiting
* Use with caution in males > 40 years of age or females> 50 years of age

Dosage:
* Cardiac arrest: 1 mg of 1:10,000 IV every 3 to 5 minutes
* Anaphylaxis: 0.3 to 0.5 mg 1:1,000 SQ or 0.3 to 0.5 mg IV (1:10,000) if hypotension
and poor perfusion
* Asthma with severe bronchochonstriction: 0.3 to 0.5 mg 1:1,000 SQ
* Infusion: 1 mg in 500 ml D5W --- infuse at 1 to 2 ug/min and titrate to desired
response to 10 ug/min
* Endotracheal dose: 2.0 to 2.5 mg
Flumazenil (Romazicon)

Class: * Benzodiazepine Antagonist

Action: * Reverses the effects of benzodiazepines

Indications: * Reversal of respiratory depression associated with administration of

Benzodiazepines
Contraindications:
* Hypersensitivity to drug
* Cocaine or other stimulant intoxication
* Should not be used to rule out benzodiazepine overdose in the same manner
as naloxone

Side Effect/Precautions:
* Headache
* Nervousness and agitation
* Dizziness
* Fatigue
* Cutaneous vasodilation
*Careful administration in patients with known benzodiazepine dependency
Dosage:

* 0.2 mg IV over 30 seconds with additional doses of 0.3 to 0.5 mg to a maximum dose
of 3.0 mg
Furosemide (Lasix)-

Class: * Loop diuretic

Action: * Inhibits reabsorption of sodium and chloride in loop of Henle, promoting diuresis
* Vasodilation increases venous capacitance and decreases preload

Indications: * Congestive heart failure

* Pulmonary edema associated with left ventricular failure

Contraindications:
* Anuria
* Hypovolemia
* Dehydration
* Pregnancy
* Hypersensitivity

Side Effects/Precautions:
* Protect drug from light
* Dehydration
* Hypokalemia
Side Effects/Precautions: cont.
* Hyperglycemia
* Hypercalcemia
* Hyponatremia
* Hypochloremia

Dosage:

* 40 mg (0.5 to 1.0 mg/kg) slow IV push over 1-2 minutes not exceed 20 mg/min.
Glucagon-

Class: * Antihypoglycemic counter-regulatory hormone

* Beta blocker overdose antidote

Action: * Causes glycogenolysis ( conversion of glycogen to glucose

* Increases blood glucose level (only if liver glycogen is available)
* Positive inotrope (increased myocardial contractility) and positive chronotrope
(increased heart rate)
* Increases AV Conduction
* Inhibits glycogenesis (syntheses of glycogen from glucose)

Indication: * Hypoglycemia
* Beta-blocker overdose

Contraindications:
* Hypersensitivity
* Hyperglycemia
Side Effects/Precaution:

* Nausea
* Vomiting
* Headache
* Tachycardia
* Hypotension
* Use with caution in patients with cardiovascular or renal disease
Dosage:

* Hypoglycemia: 0.5 to 1 mg IM or IV
* Beta-blocker overdose: 3 to 10 mg IV Bolus followed by a 2 to 5 mg/hr infusion
Glucose (Oral)-

Class: Carbohydrate

Action: Increases blood Glucose Level

Indications: Altered mental statues secondary to hypoglycemia

Contraindications:
*Patients unable to protect their own airway,
*Patients unable to swallow.

Precautions: Assure that the patient has a gage reflex.

Adverse reaction:
Aspiration
Nausea and vomiting
Adult dose:
25-50 gm PO or one single dose tube, and may repeat once

Pediatric dose:
0.5 gm/kg PO if the child is < 8 years of age (ALS ONLY)
Haloperidol (Haldol)-

Class: Tranquilizer
Anti-psychotic

Actions: Strong anti-emetic effect and impairs central thermoregulation. Produces weak central anticholinergic effects
and transient orthostatic hypotension due to blockade of dopamine activity.

Indications: Management of the manifestations of the psychotic disorders and for treatment of agitated states in acute
and chronic psychoses.

Contraindications:
Patients wit known hypersensitivity
Coma
Parkinson’s disease
Alcoholism
CNS depression
Cocaine Overdose

Precaution: *Severe cardiovascular disorders (may cause transient hypotension or precipitate angina pectoris).
* Receiving anticonvulsant medication (may lower convulsive threshold.
Adverse Reactions: Extra-pyramidal syndrome (EPS)
Headache
Lethargy
Tachycardia
Hypotension

Adult dose:
5 mg IM> Patients over the age of 655 y/o, 2.5 mg IM

Pediatric:
5 mg IM (>12 yrs) and 2 mg IM (6-12yrs) MEDICAL DIRECTION REQUIRED.
HYDROXYCOBALAMIN (CYANOKIT)-

Class: Antidote
Precursor of vitamin B12

Actins: Binds with cyanide ions to form cyanocobalamin, which is excreted in the urine.

Indications: Treatment of cyanide poisoning with significant signs and symptoms of circulatory compromise.

Contraindications: Patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin.

Precautions: Administer slowly over 15 minutes

Transient hypertension

Adverse reactions: Hypertension

Headache
Red-colored urine
Nausea

Adult dose:
Initial dose is 5 g administered over 15 minutes slow IV. (Each 2.5 g vial of hydroxocobalamin for injections is
to be reconstituted with 100 mL of N.S. and administered at 10-15 mL/Min) An additional 5 g dose may be
administered with medical control order.
Pediatric dose:
70 mg/kg (reconstitute concentration is 25 mg/mL) Each 2.5 g vial of hydroxocobalamin for injection is to be
reconstituted with 100 mL/Minute. Maximum single dose 5 grams.
Ipratropium Bromide (Atrovent)-

Class: Anticholinergic
Bronchodilator

Actions: Bronchodilation
Dries respirator tract secretions.
Is most effective in combination with a beta-adrenergic bronchodilator.

Indications: Bronchospasm related to asthma, chronic bronchitis and emphysema.

Contraindications: Sensitivity to soybeans or peanuts

Sensitivity to Atropine
Tachydysrhythmias

Precautions: Administer Cautiously to patients with narrow-angle glaucoma.

Adverse Reactions: Tachycardia

Palpitations
Dizziness
Headache
Dry Mouth
Adult dose:
2.5 mL (500 mcg) mixed with 2.5 mg albuterol via nebulizer
Pediatric dose:
< 2 y/o 1.25 mL (250 mcg) mixed with 2.5 mg Albuterol via nebulizer
> 2 y/o 2.5 ml (500 mcg) mixed with 2.5 mg Albuterol via nebulizer.
Lidocaine (Xylocine)-

Class: * Antidysrhythmic

Action: * Decreases automaticity by slowing rate of phase for depolarization

* Reduces re-entry by converting unidirectional block to bidirectional block in ischemic
tissue
* Increases the ventricular fibrillation threshold

Indications: * Prevents a rise in intracranial pressure associated with administration of

succinylcholine and the intubation procedure
* Suppression of ventricular dysrhythmia

Contraindications: * Hypersensitivity
* Second- or third-degree block
* PVC’s with a heart rate less than 60 bmp
Side Effects/Precautions:
* Hypotension
* Drowsiness
* Confusion
* Anxiety
* Seizures at high doses
* Muscle twitching
* Agitation
* Blurred vision
* Lightheadedness
* Reduced conduction velocity at large doses
Dosage:
* 1 to 1.5 mg/kg IV repeat at 0.5 to 0.75 mg/kg every 3-5 minutes to a total cumulative
dose of 3 g/kg
* 2 to 2.5 mg/kg ET
* After suppression of ectopy or dysrhthmia, initiate an infusion at 2 to 4 mg/minute
Magnesium Sulfate-

Class: * Anticonvulsant
* Electrolyte
* Antidysrhythmic

Action:
* Magnesium depresses central nervous system and blocks neuromuscular transmission

Indications:
* Seizures associated with eclampsia
* Hypomagnesemia
* Tosades de pointes
* Severe asthma
* Refractory ventricular fibrillation
* Refractory pulseless ventricular tachycardia
Side Effects/Precautions:
* CNS depression
* Flushing
* Hypotension
* Myocardial depression
* Diaphoresis
* Respiratory depression
* Hypothermia
* Decreased heart rate
* Use with caution in patient with renal failure or taking digitalis

Adult Dosage:
Torsades de pointes (Pulseless)
2 gm slow IV/IO. Mix 2 gm in 10 mL of N.S. and administer over 2 minutes.
With Pulses-
2 gm slow infusion. Mix 2 gm in 100 mL of N.S. Utilize a 10 gtts set and run at 50 gtts/min.
Eclampsia-
4 gm slow infusion. Mix 4 gm in 100 mL of N.S. Utilize a 10 gtts set and run at 50 gtts/min
Asthma=
2 gm slow infusion. Mix 2 gm in 100 mL of N.S. Utilize a 10 gtts set and run at 50 gtts/min.
Pediatric dosage:
Tosades de pointes (Pulseless)
25-50 mg/kg IV over 20 minutes, up to maximum single dose of 2 gm.
Torsades de pointes with pulse:
25-50 mg/kg IV over 20 minutes up to a maximum single dose of 2 gm
Asthma-
25-50 mg/kg IV over 20 minutes up to a maximum single dose of 2 gm
Methylprednisolone ( Solu-Medrol)-

Class: * Corticosteroid

Action: * Anti-inflammatory
* Immunosuppression

Indications: * Anaphylaxis
* Asthma
* Chronic obstructive pulmonary disease
* Spinal cord injury

Contraindications: * None in the emergency setting

Side Effects/Precautions:
* Headache
* Hypertension
* Hyperglycemia
* Hypocalcemia
* Nausea and vomiting
* Use with caution in patients with renal disease, CHF and diabetes mellitus
Adult Dosage:

* 125 mg IV/IM

Pediatric dose:

* 2 mg/kg IV/IM up to a maximum single dose of 125.

Midazolam HCL (Versed)-

Class: Benzodiazepine

Actions: A short acting central nervous system depressant that causes amnesia, sedation and muscle relaxation,

Indications: Active seizures/status epilepticus.

A sedation prior to cardioversion or Transcutaneous pacing in conscious patients.
Chest pain or tachycardia due to overdose on ingestion of cocaine, amphetamine, ecstasy, LSD, PCP,
or ketamine.
Contraindications: Known Hypersensitivity
Hypotension

Precautions: Monitor respirations

Avoid mixing with other medications, flush IV line after administration
Titrate in small doses.
Adverse reactions: respiratory depression
Apnea
Hypotension
Amnesia
Nausea
Adult Dose:
2-5 mg IN/IN, up to a maximum dose of 5 mg. For combative patients the dosages is 5 mg IN/IM.

2-5 mg IV/IN, up to a maximum dose of 10 mg for patients requiring drug-assisted intubation.

Pediatric dose:
0,1 mg/kg IV/IN, up to a maximum single dose of 5 mg
Morphine Sulfate-

Class: Narcotic
Analgesic
Actions: Potent analgesic
Decreases peripheral vascular resistance-vasodilatation.
Decreases cardiac workload and oxygen demand on the heart.

Indications: Chest pain not relived by nitroglycerin

Pain management
Contraindications: Known hypersensitivity.
Head injury
Hypotension
Respiratory depression.
Precautions: Monitor respirator status and blood pressure. Have naloxone readily available.

Adverse reactions: Hypotension

Respiratory Depression
Syncope
Bronchospasm
Adult dose:
Pain management:
2 mg IV until pain is relieved or maximum of 10 mg is reached.

CHF:
2 mg IV, up to a maximum of 10 mg as long as the patients systolic BP is > 140 mmHg.

Cardiac Chest Pain:

2 mg IV, up to a maximum of 6 mg.

Pediatric dose:
Pain management:
0.1 mg/kg IV, until pain is relieved or a maximum of 5 mg is reached.
CHF:
0.1 mg/kg IV up to a maximum of 5 mg.
Naloxone (Narcan)-

Class: * Narcotic antagonist

Action: * Competes for narcotic receptor sites

Indications: * Known or suspected narcotic overdose

Contraindications: * Hypersensitivity

Side Effects/Precautions:
* Hypertension
* Nausea and vomiting
* Dysrhythmia
* Use with caution in patients who are depending on narcotics since it may
cause withdrawal

Dosage: * 0.4 mg to 2.0 mg IV, IM, or SQ

* Endotracheal dose: 2 to 2.5 times IV dose
Nitroglycerin (Nitostat)-

Class: * Vasodilator
* Antianginal analgesic

Action: * Vascular smooth muscle dilation

* Reduction in myocardial workload
* Coronary artery dilation
* Reduction of systemic vascular resistance

Indications: * Angina pectoris

* Chest pain associated with myocardial infarction
* Hypertensive emergency
* Congestive heart failure
* Cerebral hemorrhage

Contraindications: * Hypersensitivity
* Hypotension
* Increased intracranial pressure
Side Effects/Precaution:
* Hypotension
* Reflex tachycardia
* Headache
* Syncope
* Burning sensation in mouth
* Dizziness
* Nausea and vomiting
Dosage:
* 1/150 g (0.4 mg) sublingual repeated every 3-5 minutes up to 3 doses
* 1 to 2 metered dose sprays (0.4 mg/spray) repeat every 3 to 5 minutes up to 3 doses
* 10 to 100 ug/min for IV infusion
Ondansetron (Zofran)-

Class: Anti-emetic.

Action: Potent anti-emetic

Indications: Persistent vomiting due to gastrointestinal

Contraindications: History of allergic reaction

Pregnancy – MEDICAL CONTROL OPTION ONLY

Precautions: Avoid intra-arterial or subcutaneous administration.

Adverse reactions: Allergic reaction.

Adult dose:
4 mg IV.

Pediatric dose:
Rarely used. 2-4 mg IV MEDICAL DIRECTION REQUIRED.
OXYGEN

Class: Gas

Action: Odorless, colorless, tasteless gas that is essential for life.

Indications: Cardiopulmonary arrest

Trauma
Dyspnea
Suspected hypoxemia
Cardiac related chest pain.

Contraindications: None

Precautions: Utilize the prescribed dose of the COPD patient unless the patient is in severe respiratory distress then 100
% is required.

Adverse reactions: May induce respiratory drive in some COPD patients.

Adult dose:
> 15 lpm via BVM, 12-15b lpm via NRB, or 2-6 lpm via nasal cannula.
Pediatric dose:
>15 lpm via BVM, 12-15 lpm vial NRB mask or blow by, 2-6 lpm via nasal cannula
Pralidoxime Chloride / 2-Pam CL (WMD)

Class: Cholinesterase Reactivator

Actions: * Reactivates cholinesterase which has been deactivated by chemical nerve agents and organophosphate
poisons.
* Relieves paralysis of the respiratory muscles following chemical nerve agent or organophosphate exposure.
Indications: *Second drug given for the treatment of poisoning due to organophosphate pesticides and chemical nerve
agents. (First drug of choice is atropine).
* Primary indication for Pralidoxime administration is muscle weakness or respiratory depression in these
patients.
Contraindications: Known hypersensitivity

Precautions: not indicated for poisonings with carbonate pesticides.

Effects during pregnancy are unknown.
Safety and efficacy in children is unknown.
Do not administer more than 3 Auto-injectors due to its hypertensive effects.
Adverse Reactions: Tachycardia, laryngospasm, muscle rigidity if IV and infused to quickly
Mild to moderate pain at the injection site.
Blurred or double vision, dizziness, loss of coordination, headache drowsiness, hypertension,
tachycardia.
Adult dose:
600 mg IM, uup to 1800 mg or 3 auto-injectors.
Pediatric dose:
Not indicated.
Sodium Bicarbonate-

Class: * Alkalinizing agent, electrolyte

Action: * Sodium bicarbonate combines with hydrogen ions to for water and carbon dioxide
* buffers metabolic acidosis
* Forces and intracellular shift of excess potassium in hyperkalemia
* Increases pH

Indications: * Severe metabolic acidosis in cardiac arrest refractory to ventilation

* Tricyclic antidepressant overdose
* Hyperkalemia
* Alkalinization agent for specific toxins

Contraindications:
* Metabolic or respiratory alkalosis
* Hypocalcemia
* Hypokalemia
* Hypernatremia
Side Effect/Precautions:
* Metabolic alkalosis may occur
* Precipitates when mixed with calcium chloride
* May increase intracellular acidosis
* May cause electrolyte imbalance
* May deactivate catecholamine
* Large solute load may lead to fluid overload

Dosage:
* 1 mEq/kg IV Repeated at 0.5 mEg/kg every 10 minutes
Sodium Thiosulfate-

Class: Antidote for cyanide poisoning.

Actions: converts cyanide to less toxic thiocyanate which is excreted in the urine

Indications: Acute cyanide toxicity.

Contraindications: None in acute cyanide toxicity

Precautions: Not useful in hydrogen sulfide toxicity.

Should be used after administration of nitrates.

Adverse reactions: No significant side effects in the setting of acute cyanide toxicity following the administration of
nitrates.

Adult dose:
12.5 grams (50 mL of 25 % solution) Slow IV push over 10 minutes.
Pediatric dose:
MEDICAL CONTROL!!!
TETRACAINE HCL-

Class: Local anesthetic for the eye

Actions: Blocks the initiation and conduction of nerve impulse.

Indications: Topically applied local anesthetic for eye examination.

Contraindications: Hypersensitivity to ester anesthetics.

Not to be applied in large amounts or to infants less than 1 year of age.
Do not use in the presence of penetrating trauma

Precautions: Advise patient that the drops may burn for a few seconds.

Adverse reactions: Stinging in affected eye.

Adult dose:
1-2 drops per eye

Pediatric dose:
1-2 drops per eye.
Thiamine (bendizine)

Class: * Vitamin B1

Action: * Combines with ATP to form a co-enzyme in glucose metabolism

Indications: * Known or suspected thiamine deficiency

* Alcoholism
* Coma of unknown origin
* Wernicke’s encephalopathy
* Korsakoff’s syndrome

Contraindications:
* None in emergency settings

Side Effects/Precautions:
* May cause allergic reaction
* Hypotension in rapid push
* Nausea and vomiting

Dosage:
* 100 mg slow IV or IM
* Ideally, 50 mg IV and 50 mg IM