Activated Charcoal
Class: Adsorbent
Actions: Adsorbs toxins by chemical binding and prevents
gastrointestinal adsorption.
Indications: Poisoning following emesis or when emesis is
contraindicated.
Contraindications: None in severe poisoning.
Precautions: Should only be administered following emesis, in
cases in which it is so indicated. Use with caution in patients with altered
mental status. May adsorb Ipecac before emesis; If Ipecac is administered, wait
at least 10 minutes to administer activated charcoal.
Side Effects: Nausea, vomiting, and constipation.
Dosage: 1 g/kg (typically 50-75 grams) mixed with a glass of
water to form a slurry.
Routes: Oral
Pediatric Dosage: 1 g/kg mixed with a glass of water to form a
slurry
Adenosine (Adenocard)
Class: Antiarrhythmic
Actions: slows AV conduction
Indications: symptomatic
PSVT
Contraindications: second- or third-degree heart block,
sick-sinus syndrome, known hypersensitivity to the drug.
Precautions: Arrhythmias, including blocks, are common at the
time of cardioversion. Use with caution in patients with asthma.
Side Effects: Facial flushing, headache, shortness of breath,
dizziness, and nausea.
Dosage: 6 mg given as a rapid IV bolus over a 1-2 second
period; if, after 1-2 minutes, cardioversion does not occur, administer a 12-mg
dose over 1-2 seconds.
Routes: IV; should be administered directly into a vein or into
the medication administration port closest to the patient and followed by
flushing of the line with IV fluid.
Pediatric Dosage: Safety in children has not been established.
Albuterol (Proventil) (Ventolin)
Class: Sympathomimetic (ß2 selective)
Actions: Bronchodilation
Indications: Asthma reversible bronchospasm associated with
COPD
Contraindications: Known hypersensitivity to the drug,
symptomatic tachycardia
Precautions: Blood pressure, pulse, and EKG should be monitored
use caution in patients with known heart disease
Side Effects: Palpitations, anxiety, headache, dizziness, and
sweating
Dosage: Metered Dose Inhaler: 1-2 sprays (90
micrograms per spray)
Small-Volume Nebulizer: 0.5 ml (2.5 mg) in 2.5 ml normal saline over
5-15 minutes
Rotohaler: one 200-microgram rotocap should be placed in the inhaler
and breathed by the patient
Routes: Inhalation
Pediatric Dosage: 0.15 mg (0.03 ml)/kg in 2.5 ml normal saline
by small volume nebulizer
Aspirin (Bayer)
Class: Platelet inhibitor/anti-inflammatory.
Actions: Blocks platelet aggregation.
Indications: New-onset chest pain suggestive of MI signs and
symptoms suggestive or recent CVA.
Contraindications: Patients with history of hypersensitivity to
the drug.
Precautions: GI bleeding and upset.
Side Effects: Heartburn, nausea and vomiting, wheezing.
Dosage: 150-325 mg PO or chewed.
Routes: PO.
Pediatric Dosage: not recommended.
Atropine
Class: Parasympatholytic (anticholinergic).
Actions: Blocks acetylcholine receptors, increases heart rate,
decreases gastrointestinal secretions.
Indications: Hemodynamically-significant bradycardia,
hypotension secondary to bradycardia, asystole, organophosphate poisoning.
Contraindications: None when used in emergency situations.
Precautions: Dose of 0.04 mg/kg should not be exceeded except
in cases of organophosphate poisonings, tachycardia, hypertension.
Side Effects: Palpitations and tachycardia, headache,
dizziness, and anxiety, dry mouth, pupillary dilation, and blurred vision,
urinary retention (especially older males).
Dosage: Bradycardia: 0.5 mg every 5 minutes to maximum of 0.04
mg/kg.
Asystole: 1 mg.
Organophosphate poisoning: 2-5 mg.
Routes: IV, ET (ET dose is 2 - 2.5 times IV dose).
Pediatric Dosage: Bradycardia: 0.02 mg/kg
Maximum single dose (child 0.5 mg) (adolescent 1.0 mg)
Maximum total dose (child 1.0 mg) (adolescent 2.0 mg)
Calcium Chloride (CaCl)
Class: Electrolyte.
Actions: Increases cardiac contractility.
Indications: Acute hyperkalemia (elevated potassium), acute
hypocalcemia (decreased calcium), calcium channel blocker (Nifedipine, Verapamil,
etc.), overdose, abdominal muscle spasm associated with spider bite and
portuguese man-o-war stings, antidote for
magnesium sulfate.
Contraindications: Patients receiving digitalis.
Precautions: IV line should be flushed between calcium chloride
and sodium bicarbonate
administration. Extravasation may cause tissue necrosis.
Side Effects: Arrhythmias (bradycardia and asystole),
hypotension.
Dosage: 2-4 mg/kg of a 10% solution; may be repeated at
10-minute intervals.
Routes: IV.
Pediatric Dosage: 5-7 mg/kg of a 10% solution.
Dextrose 50%
Class: Carbohydrate.
Actions: Elevates blood glucose level rapidly.
Indications: Hypoglycemia.
Contraindications: None in the emergency setting.
Precautions: A blood sample should be drawn before
administering 50% dextrose.
Side Effects: Local venous irritation.
Dosage: 25 grams (50 ml).
Routes: IV.
Pediatric Dosage: 0.5 g/kg slow IV; should be diluted 1:1 with
sterile water to form a 25% solution.
Diazepam (Valium)
Class: tranquilizer (Benzodiazepine).
Actions: Anticonvulsant, skeletal muscle relaxant, sedative.
Indications: Generalized seizures, status epilepticus,
premedication before cardioversion, skeletal muscle relaxant, acute anxiety
states.
Contraindications: Patients with a history of hypersensitivity
to the drug.
Precautions: Can cause local venous irritation. Has short
duration of effect. Do not mix with other drugs because of possible
precipitation problems.
Side Effects: Drowsiness, hypotension, respiratory depression,
apnea.
Dosage: Status epilepticus: 5-10 mg IV.
Acute anxiety: 2-5 mg IM or IV.
Premedication before cardioversion: 5-15 mg IV.
Routes: IV (care must be taken not to administer faster than 1
ml/min)
IM rectal.
Pediatric Dosage: Status epilepticus: 0.1 - 0.2 mg/kg
Diltiazem (Cardizem)
Class: Calcium channel blocker.
Actions: Slows conduction through the AV node, causes
vasodilation, decreases rate of ventricular response, decreases myocardial
oxygen demand.
Indications: To control rapid ventricular response associated
with atrial fibrillation and flutter.
Contraindications: Hypotension, wide complex tachycardia,
conduction system disturbances.
Precautions: Should not be used in patients receiving
intravenous ß blockers. Hypotension. Must be kept refrigerated or discarded one
month after removal from refrigeration.
Side Effects: Nausea, vomiting, hypotension, and dizziness.
Dosage: 0.25 mg/kg bolus (typically 20 mg) IV over 2 minutes.
This should be followed by a maintenance infusion of 5-15 mg/hour.
Routes: IV, IV drip.
Pediatric Dosage: Rarely used.
Diphenhydramine (Benadryl)
Class: Antihistamine.
Actions: Blocks histamine receptors, has some sedative effects.
Indications: Anaphylaxis, allergic reactions, dystonic
reactions due to phenothiazines.
Contraindications: Asthma, nursing mothers.
Precautions: Hypotension.
Side Effects: Sedation, dries bronchial secretions, blurred
vision, headache, palpitations.
Dosage: 25-50 mg.
Routes: Slow IV push deep IM.
Pediatric Dosage: 2-5 mg/kg.
Dopamine (Intropin)
Class: Sympathomimetic.
Actions: Increases cardiac contractility, causes peripheral
vasoconstriction.
Indications: Hemodynamically significant hypotension (systolic
BP of 70-100 mmhg) not resulting from hypovolemia, cardiogenic shock.
Contraindications: Hypovolemic shock where complete fluid
resuscitation has not occurred.
Precautions: Should not be administered in the presence of
severe tachyarrhythmias. Should not be administered in the presence of
ventricular fibrillation, ventricular irritability. Beneficial effects lost when
dose exceeds 20 µg/kg/min.
Side Effects: Ventricular tachyarrhythmias, hypertension,
palpitations.
Dosage: 2-20 µg/kg/minute. Start low and increase as needed.
Method: 800 mg should be placed in 500 ml of D5W giving a concentration of 1600
µg/ml.
Routes: IV drip only.
Pediatric Dosage: 2-20 µg/kg/minute.
Epinephrine 1:1,000
Class: Sympathomimetic.
Actions: Bronchodilation.
Indications: Bronchial asthma, exacerbation of COPD, allergic
reactions.
Contraindications: Patients with underlying cardiovascular
disease, hypertension, pregnancy, patients with tachyarrhythmias.
Precautions: Should be protected from light. Blood pressure,
pulse, and EKG must be constantly monitored.
Side Effects: Palpitations and tachycardia, anxiousness,
headache, tremor.
Dosage: 0.3-0.5 mg.
Routes: Subcutaneous (IV and ET for pediatric cardiac arrest).
Pediatric Dosage: 0.01 mg/kg up to 0.3 mg.
Epinephrine 1:10,000
Class: Sympathomimetic.
Actions: Increases heart rate and automaticity.
Increases cardiac contractile force.
Increases myocardial electrical activity.
Increases systemic vascular resistance.
Increases blood pressure.
Causes bronchodilation.
Indications: Cardiac arrest, anaphylactic shock severe reactive
airway disease.
Contraindications: Epinephrine 1:10,000 is for intravenous or
endotracheal use; it should not be used in patients who do not require extensive
resuscitative efforts.
Precautions: Should be protected from light. Can be deactivated
by alkaline solutions.
Side Effects:Palpitations, anxiety, tremulousness, nausea and
vomiting.
Dosage: cardiac arrest: 0.5-1.0 mg repeated every 3-5 minutes.
severe anaphylaxis: 0.3-0.5 mg (3-5 ml); occasionally and Epinephrine drip is
required.
Routes: IV, IV drip, ET.
Pediatric Dosage: 0.01 mg/kg initially. with subsequent doses,
Epinephrine 1:1,000 should be used at a dose of 0.1 mg/kg.
Furosemide (Lasix)
Class: Potent diuretic.
Actions: Inhibits reabsorption of sodium chloride, promotes
prompt diuresis, vasodilation.
Indications: Congestive heart failure, pulmonary edema.
Contraindications: Pregnancy, dehydration.
Precautions: Should be protected from light, dehydration.
Side Effects: Few in emergency usage.
Dosage: 40-80 mg.
Routes: IV.
Pediatric Dosage: 1 mg/kg.
Glucagon
Class: Hormone (antihypoglycemic agent).
Actions: Causes breakdown of glycogen to glucose.
Inhibits glycogen synthesis.
Elevates blood glucose level.
Increases cardiac contractile force.
Increases heart rate.
Indications: Hypoglycemia.
Contraindications: Hypersensitivity to the drug.
Precautions: Only effective if there are sufficient stores of
Glycogen within the liver. Use with caution in patients with cardiovascular or
renal disease. Draw blood glucose before administration.
Side Effects: Few in emergency situations.
Dosage: 0.25-0,50 mg (unit) IV 1.0 mg, IM.
Routes: IV, IM.
Pediatric Dosage: 0.03 mg/kg.
Lidocaine (Xylocaine)
Class: Antiarrhythmic.
Actions: Suppresses ventricular ectopic activity, increases
ventricular fibrillation threshold, reduces velocity of electrical impulse
through conductive system.
Indications: Malignant PVCs, ventricular tachycardia,
ventricular fibrillation, prophylaxis of arrhythmias associated with acute
myocardial infarction and thrombolytic therapy, premedication prior to rapid
sequence induction.
Contraindications: High-degree heart blocks, PVCs in
conjunction with bradycardia.
Precautions: Dosage should not exceed 300 mg/hr. Monitor for
CNS toxicity. Dosage should be reduced by 50% in patients older than 70 years of
age or who have liver disease in cardiac arrest, use only bolus therapy.
Side Effects: Anxiety, drowsiness, dizziness, and confusion,
nausea and vomiting, convulsions, widening of QRS.
Dosage: Bolus: Initial bolus of 1.5 mg/kg; additional boluses
of 0.5 - 0.75 mg/kg can be repeated at 8-10-minute intervals until the
arrhythmia has been suppressed or until 3 mg/kg of the drug has been
administered; reduce dosage by 50% in patients older than 70 years of age.
Drip: after the arrhythmia has been suppressed a 2-4 mg/minute infusion may be
started to maintain adequate blood levels.
Routes: IV bolus, IV infusion.
Pediatric Dosage: 1 mg/kg.
Magnesium Sulfate
Class: Anticonvulsant/antiarrhythmic.
Actions: CNS depressant, anticonvulsant, antiarrhyhmic.
Indications: Obstetrical eclampsia (toxemia of pregnancy), pre-eclampsia/PIH,
cardiovascular severe refractory ventricular fibrillation, pulseless ventricular
tachycardia, post-MI as prophylaxis for arrhythmias, torsades de pointes
(multi-axial ventricular tachycardia).
Contraindications: Shock, heart block.
Precautions: Caution should be used in patients receiving
digitalis. Hypotension. Calcium Chloride
should be readily available as an antidote if respiratory depression ensues. Use
with caution in patients in renal failure.
Side Effects: Respiratory depression, drowsiness.
Dosage: 1-4 g.
Routes: IV, IM.
Pediatric Dosage: Not indicated.
Methylprednisolone (Solu-Medrol)
Class: Steroid.
Actions: Anti-inflammatory, suppresses immune response
(especially in allergic reactions).
Indications: Severe anaphylaxis, asthma/COPD, possibly
effective as an adjunctive agent in the management of spinal cord injury.
Contraindications: None in the emergency setting.
Precautions: Must be reconstituted and used promptly. Onset of
action may be 2-6 hours and thus should not be expected to be of use in the
critical first hour following an anaphylactic reaction.
Side Effects: GI bleeding, prolonged wound healing, suppression
of natural steroids.
Dosage: General usage: 125-250 mg.
Spinal cord injury: Initial bolus of 30 mg/kg administered over 15 minutes,
followed by a maintenance infusion of 5.4 mg/kg/hr.
Routes: IV, IM.
Pediatric Dosage: 30 µg/kg.
Midazolam (Versed)
Class: Benzodiazepine tranquilizer.
Actions: Hypnotic, sedative.
Indications: Premedication prior to cardioversion/RSI, acute
anxiety states.
Contraindications: Patients with known hypersensitivity to the
drug, narrow-angle glaucoma, shock.
Precautions: Emergency resuscitation equipment should be
available. Flumazenil (Romazicon)
should be available. Dilute with normal saline or D5W prior to intravenous
administration. Respiratory depression more common with Midazolam than with
other Benzodiazepines.
Side Effects: Drowsiness, hypotension, amnesia, respiratory
depression, apnea.
Dosage: 1.0- 2.5 mg IV.
Routes: IV, IM, intranasal.
Pediatric Dosage: 0.03 mg/kg.
Morphine
Class: Narcotic.
Actions: CNS depressant, causes peripheral vasodilation,
decreases sensitivity to pain.
Indications: Severe pain, pulmonary edema.
Contraindications: Head injury, volume depletion undiagnosed
abdominal pain, patients with history of hypersensitivity to the drug.
Precautions: Respiratory depression (narcan should be
available), hypotension, nausea.
Side Effects: Dizziness, altered level of consciousness.
Dosage: IV: 2-5 mg followed by 2 mg every few minutes until the
pain is relieved or until respiratory depression ensues.
IM: 5-15 mg based on patient weight.
Routes: IV, IM.
Pediatric Dosage: 0.1-0.2 mg/kg IV.
Naloxone (Narcan)
Class: Narcotic antagonist.
Actions: Reverses effects of narcotics.
Indications:
Narcotic overdoses including the following: Codeine, Demerol, Dilaudid, Fentanyl,
Heroin, Lortabs, Methadone, Morphine, Paregoric, Percodan, Tylox, Vicodin and
synthetic analgesics.
Overdoses including the following: Darvon, Nubain, Stadol, Talwin and alcoholic
coma.
Contraindications: Patients with a history of hypersensitivity
to the drug.
Precautions: Should be administered with caution to patients
dependent on narcotics as it may cause withdrawal effects. Short-acting, should
be augmented every 5 minutes.
Side Effects: none.
Dosage: 1-2 mg.
Routes: IV, IM.
ET (ET dose is 2.0-2.5 times IV dose).
Pediatric Dosage: < 5 years old > 5 years old 0.1 mg/kg 2.0 mg.
Nitroglycerin Spray (Nitrolingual Spray)
Class: Antianginal.
Actions: Smooth-muscle relaxant, decreases cardiac work,
dilates coronary arteries, dilates systemic arteries.
Indications: Angina pectoris, chest pain associated with
myocardial infarction.
Contraindications: Hypotension.
Precautions: Constantly monitor vital signs. Syncope can occur.
Side Effects: Dizziness, hypotension, headache.
Dosage: One spray administered under the tongue; may be
repeated in 10-15 minutes; no more than three sprays in a 15-minute period;
spray should not be inhaled.
Routes: Sprayed under tongue on mucous membrane.
Pediatric Dosage: Not indicated.
Procainamide (Pronestyl)
Class: Antiarrhythmic.
Actions: Slows conduction through myocardium, elevates
ventricular fibrillation threshold, suppresses ventricular ectopic activity.
Indications: Persistent cardiac arrest due to ventricular
fibrillation and refractory to lidocaine,
PVCs refractory to lidocaine,
ventricular tachycardia refractory to lidocaine.
Contraindications: High-degree heart blocks, PVCs in
conjunction with bradycardia.
Precautions: Dosage should not exceed 17 mg/kg. Monitor for
central nervous system toxicity.
Side Effects: Anxiety, nausea, convulsions, widening of QRS.
Dosage: Initial: 20 mg/minute until arrhythmia abolished,
hypotension ensues, QRS widened by 50% of original width total of 17 mg/kg has
been given.
maintenance: 1-4 mg/minute.
Routes: slow IV bolus, IV drip.
Pediatric Dosage: Rarely used.
Promethazine (Phenergan)
Class: Antihistamine (h1 antagonist).
Actions: Mild anticholinergic activity, antiemetic, potentiates
actions of analgesics.
Indications: Nausea and vomiting, motion sickness, to
potentiate the effects of analgesics, sedation.
Contraindications: Comatose states, patients who have received
a large amount of depressants (including alcohol).
Precautions: Avoid accidental intra-arterial injection.
Side Effects: May impair mental and physical ability,
drowsiness.
Dosage: 25 mg.
Routes: IV.
Pediatric Dosage: 0.5 mg/kg.
Sodium Bicarbonate
Class: Alkalinizing agent.
Actions: Combines with excessive acids to form a weak volatile
acid, increases ph.
Indications: Late in the management of cardiac arrest, if at
all, tricyclic antidepressant overdose, severe acidosis refractory to
hyperventilation.
Contraindication: Alkalotic states.
Precautions: Correct dosage is essential to avoid
overcompensation of ph. Can deactivate catecholamines. Can precipitate with
calcium preparations. Delivers large sodium load.
Side Effects: Alkalosis.
Dosage: 1 mEq/kg initially followed by 0.5 mEq/kg every 10
minutes as indicated by blood gas studies.
Routes: IV.
Pediatric Dosage: 1 mEq/kg initially followed by 0.5 mEq/kg
every 10 minutes.
Terbutaline (Brethine)
Class: Sympathomimetic.
Actions: Bronchodilator, increases heart rate.
Indications: Bronchial asthma, reversible bronchospasm
associated with COPD, preterm labor.
Contraindications: Batients with known hypersensitivity to the
drug.
Precautions: Blood pressure, pulse, and EKG must be constantly
monitored.
Side Effects: Palpitations, tachycardia, and PVCs, anxiety,
tremor, and headache.
Dosage: Metered-dose inhaler: two inhalations, 1 minute apart.
Subcutaneous injection: 0.25 mg; may be repeated in 15-30 minutes.
Preterm labor: 0.25 mg IM or IV. may be repeated in 15-30 minutes as needed.
Routes: Inhalation, subcutaneous injection, IV (preterm labor
only).
Pediatric Dosage: 0.01 mg/kg subcutaneously.