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San Diego EMS Protocols 2019 > Medications > Flashcards

Flashcards in Medications Deck (227)
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1

Acetaminophen (Ofirmev) Class/Action/Onset/Peak/Duration

Class:
-Analgesic/Antipyretic

Action:
-Inhibits the synthesis of prostaglandins which transmit pain signals and produce fever.
-Reduces pain by blocking signals produced by prostaglandins.

Onset = 15 minutes
Peak = 1 hour
Duration = up to 4 to 6 hours

2

Acetaminophen (Ofirmev) Indications

For treatment of pain as needed: (S-141, S-173)
-Abdominal pain (S-120) (S-174)
-Burns (S-124) (S-170)
-Envenomation Injury (S-129) (S-164)
-Trauma (S-139) (S-169)

3

Acetaminophen (Ofirmev) Dosage/Route (Adult/Ped)

Adult:
1,000mg IV x1 SO infuse over 15"
Peds:
>2 y/o PDC x1 SO infuse over 15"

BHPO required for:
-Isolated head injury
-Acute onset severe headache
-Drug/ETOH intoxication
-Multiple trauma with GCS <15
-Suspected active labor

Maximum total daily dose:
4,000mg in 24 hours

4

Acetaminophen (Ofirmev) Contraindications

-<2 years of age
-Severe hepatic impairment
-Sever active liver disease
-If known or suspected total dose exceeding 4,000mg in a 24-hour period

5

Acetaminophen (Ofirmev) Side Effects

-Nausea, vomiting
-Headache, sleep problems
-Constipation
-Itching, agitation
-Partial or total lung collapse in pediatric patients

6

Acetaminophen (Ofirmev) Packaging

1,000mg/100ml (10mg/ml)

7

Acetaminophen (Ofirmev) Administration (Adult/Ped)

Adult:
-Must use VENTED tubing for IV drip directly from medication vial.
-Place vial on flat surface and insert vented IV set. Open vent, hang vial, and fill IV tubing.
-Administer as piggyback into a port on the main IV line, closing main line as needed.
-Adjust flow rate to administer medication over 15".

Peds:
-Identify patients dose from the PDC. Draw patients dose from the medication vial using a syringe.
-Inject this dose into a 50ml or 100ml normal saline bag and label it.
-Insert IV tubing into medication bag and fill IV tubing.
-Administer as IV piggyback into a port on the main IV line, closing main line as needed.
-Adjust flow rate to administer medication over 15".

8

Acetaminophen (Ofirmev) Cautions&Considerations

-Use with caution on patients with history of alcoholism, chronic malnutrition, severe hypovolemia, renal impairment, and hepatic impairment/disease.
-Rare side effect of skin reaction - discontinue use if skin rash develops, this reaction could be fatal.
-Dosing errors of IV Tylenol could result in hepatic injury, risk of liver favor, overdose, and death.

9

Acetaminophen (Ofirmev) Special Info

-Daily max dose is 4,000mg in 24 hours.

10

Adenosine (Adenocard) Class/Action/Onset/Duration

Class:
-Antiarrhythmic

Action:
-Slows electrical conduction through the AV node, and interrupts re-entry pathway, converting SVT to NSR.

Onset = within 30 seconds
Duration = 1-2 minutes

11

Adenosine (Adenocard) Indications (Adult/Ped)

Indications:

Adult: Dysrhythmias (S-127)
-SVT
If patient has history of bronchospasm or COPD:
Dosing as above per BHO

Peds: Dysrrhythmias (S-163)
-Unstable SVT

12

Adenosine (Adenocard) Dosage/Route (Adult/Ped)

Adult:
-6mg rapid IV/IO; follow with rapid 20ml NS
-12mg rapid IV/IO; follow with rapid 20ml NS
If no sustained rhythm changes MR x1 in 1-2"

Peds:
-1st dose per drug chart rapid IV BHPO
follow with NS 20ml rapid IV
-2nd dose per drug chart rapid IV BHPO
follow with NS 20ml rapid IV
If no sustained rhythm change, MR x1 BHPO

13

Adenosine (Adenocard) Contraindications

-2nd and 3rd degree AV heart blocks
-Sick sinus syndrome (without pacemaker)

14

Adenosine (Adenocard) Side Effects

-SOB/Dyspnea; may cause bronchospasms in COPD patients (BHO)
-Chest pressure/palpitations
-Facial flushing/headache
-Dizzy/lightheadedness
-Nausea
-Transient arrhythmias (PVC's, PAC's, sinus bradycardia, AV block, sinus tach, or asystole) These are generally not treated and are quickly self-limiting

15

Adenosine (Adenocard) Packaging

6mg/2ml

16

Adenosine (Adenocard) Administration

-Use large bore IV in large proximal vein to assist administration of rapid (within 1 to 2 seconds) IV push.
-Pinch IV tubing, inject in port closest to patient and immediately follow with NS flush using 20-ml syringe.
-Obtain ECG documentation before, during, and after administration.

17

Adenosine (Adenocard) Cautions&Considerations

-Adenosine does not convert AFib/AFlutter; a transient modest slowing of ventricular response may occur. Obtain a 12 lead EKG prior to administration if AFib/AFlutter is suspected.
-Antagonized by caffeine and theophylline. Adenosine may be ineffective of larger doses may be required.

18

Adenosine (Adenocard) Special Info

-Half life of Adenosine is <10 seconds.

19

Albuterol (Proventil, Ventolin) Class/Action/Onset/Peak/Duration

Class:
-Bronchodilator: Sympathomimetic (beta-2 specific)

Action:
-Relaxes bronchial smooth muscle by stimulating beta-2 adrenergic receptors.
-Produces bronchodilation, relieves bronchospasm, and reduces airway resistance.

Onset = 5 minutes
Peak = 1 hour
Duration = up to 5 hours

20

Albuterol (Proventil, Ventolin) Indications (Adult/Ped)

Respiratory Distress (S-136, S-167) [Adult/Peds] Suspected Non Cardiac

Allergic Reaction/Anaphylaxis (S-122, S-162) [Adult/Peds]
-acute allergic reactions or anaphylaxis

Burns (S-124, S-170) [Adult/Peds]
-respiratory distress with bronchospasm

Hemodialysis Patient (S-131) [Adult Only]
-symptomatic, suspected hyperkalemia if >72 hours since last dialysis

21

Albuterol (Proventil, Ventolin) Dosage/Route (Adult/Ped)

Adult:
-6ml (0.083%) via nebulizer MR
Peds:
-PDC via nebulizer MR

Adult: (Hemodialysis)
-Continuous 6ml (0.083%) via nebulizer MR

22

Albuterol (Proventil, Ventolin) Contraindications

-None in adults
-PEDS: for croup/stridor (nebulized saline/epinephrine is indicated)

23

Albuterol (Proventil, Ventolin) Side Effects

-Tachycardia/palpitations
-Dizziness/headache
-Tremors, nervousness

24

Albuterol (Proventil, Ventolin) Packaging

-2.5ml/3ml or 0.083%

25

Albuterol (Proventil, Ventolin) Administration

-Use with 4-6 liters of O2 for handheld mouthpiece.
-Use with 6-10 liters of O2 for aerosol mask, CPAP, and ET tube.

26

Albuterol (Proventil, Ventolin) Cautions&Considerations

-Consider anaphylaxis if wheezing in the patient with distress, especially if no history of asthma.

27

Albuterol (Proventil, Ventolin) Special Info

-Continuous nebulized Albuterol is the goal for hyperkalemia and patients in respiratory distress.
-Decreases hyperkalemia associated with dialysis patients by facilitating the movement of potassium back into cells.
-Fireline Paramedics (FEMP) without access to oxygen may use MDI delivery for Albuterol in place of nebulizer. (2.5mg inhaler = 2 puffs)

28

Amiodarone Hydrochloride (Cordarone, Pacerone, Nexterone) Class/Action/Onset/Duration

Class:
-Antiarrhythmic

Action:
-Blocks sodium, potassium, and calcium channels in cardiac cells slowing conduction and prolongs repolarization.
-Has alpha and beta adrenergic blocking properties causing negative inotropic effects and reduces peripheral vascular resistance (afterload).

Onset = minutes
Duration = days

29

Amiodarone Hydrochloride (Cordarone, Pacerone, Nexterone) Indications (Adult/Peds)

Dysrhythmias (S-127) [Adult only]
-Stable Ventricular Tachycardia

Dysrhythmias (S-172) [Adult only]
-reported/witnessed >2 AICD firing, or >1 AED shock delivered with pulse >60

Dysrhythmias (S-127)(S-163) [Adult/Peds]
-VF/Pulseless VT: After 1st shock if still refractory

30

Amiodarone Hydrochloride (Cordarone, Pacerone, Nexterone) Dosage/Route (Adult/Ped)

Adult Only: (Stable Ventricular Tachycardia)
-150mg in 100ml of NS over 10" IV/IO SO
MR x1 in 10" SO

Adult Only: (>2 AICD firing/>1 AED shock w/ pulse >60)
-150mg in 100ml of NS over 10" IV/IO SO

Adult: (VF/Pulseless VT)
-300mg IV/IO SO, MR 150mg (max of 450mg) SO

Peds: (VF/Pulseless VT)
-PDC IV/IO SO, MR x1 in 3-5" SO