Actions: Absorbs toxins by binding to them to prevent GI absorption.
Indications: Adsorbent used in overdoses and poisonings, if emesis is not indicated.
1. Acetaminophen [Tylenol] ingestion
2. Petroleum product ingestion
3. Corrosive (mineral acids, strong bases) ingestion
4. Alcohol (ethanol, methanol, isopropanol, ethylene glycol) ingestion
5. Lithium ingestion
6. Metals (iron, lead, mercury, etc.) ingestion
Comments: 1. Activated Charcoal interferes with Ipecac and many antidotes.
2. Patient must be alert to avoid aspiration.
3. Shake vigorously before using.
Adenosine, (Adenocard)
[Paramedic]
Class: Antiarrhythmic
Actions: Slows conduction through the AV node.
Indications:
Unstable Narrow-QRS Tachycardia refractory to vagal maneuvers
1. Chest pain, systolic BP < 90, decreased LOC, or CHF
2. Rate 150/min. (adult), 220 (children)
3. Regular rhythm
4. QRS < 0.12 seconds
Contraindications:
Wide QRS (> 0.12 seconds) Tachycardia
Second or Third degree H.B.
Sick Sinus Syndrome
Hypersensitivity to the drug
Side Effects: Transient asystole, AV block, PVCs, hypotension
Dosage:
Adults:
Peds:
6 mg (2 ml) IV/IO over 1-2 sec.
If not effective after 2 min., administer 12 mg [4 ml] IV/IO.
Free-flowing IV. Use injection port closest to body. Follow with
a 10 ml IV flush from a separate syringe.
0.1 mg/kg IV/IO over 1-2 sec.
If not effective after 2 min., give 0.2 mg/kg. MAX dose: 12 mg.
Free-flowing IV. Use injection port closest to body. Follow with
a 5 ml IV flush from a separate syringe.
Supply: 6mg/2ml Prefilled syringe
12mg/4ml Prefilled syringe
Comments:
1. Does not convert atrial flutter, atrial fibrillation, or ventricular
tachycardia. May cause temporary slowing.
2. Adenosine antagonized by Methylxanthines, such as caffine,
Theophylin. May require larger dose to treat.
3. Adenosine effects are potentiated by dipryidomole and will require
smaller doses to treat.
4. Presence of carbamazepine (Tegretol), may produce higher degrees
of HB. or may develop asystole (1%) and can last for 3 days.
[3]
ALBUTEROL
Albuterol, (Proventil, Ventolin)
[Intermediate / RN/ Paramedic]
Class: Sympathomimetic (2 selective)
Actions: Bronchodilation
Indications: Asthma, Emphysema, COPD, Anaphylactic respiratory distress
Contraindications:
Avoid in the following unless symptoms are severe:
1. Chest pain
2. Pulse > 140/min. (adults) or > 180/min. (children)
3. Systolic BP > 180
Side Effects: Tachycardia, hypertension, arrhythmias, tremor, anxiety, headache
Dosage:
< 4 yrs old: nebulizer held under the face
4 yrs old: nebulizer with mouth piece or face mask
Set oxygen at 6-10 LPM [until nebulizer mists]
May repeat every 10 minutes
Supply: Bottle of 0.083% solution contains 2.5 mg in 3 ml.
Comments: EMT-B’s may assist with use of patient’s own prescribed inhaler
[4]
AMIODARONE
Amiodarone
[Intermediate / RN/ Paramedic]
Class: Antiarrhythmic
Actions: Depresses automaticity of SA node. Slows conduction & increases
refractoriness of the AV node. Increases Atrial & Ventricular
refractoriness
Indications: Pulseless VF / VT, V-tach with pulse, Wide complex Tachycardia
Contraindications: None in the face of pulseless VF / VT
Side Effects: May produce vasodilation, hypotension, a prolonged QT interval, and a
negative inotropic effect
Dosage:
1. V-fib / Pulseless V-tach. 300 mg IV/IO may repeat once in 3 – 5 min.
at 150 mg IV/IO. If pt converts administer drip at rate of 1mg/min
2. V-tach with pulse / Wide complex Tachycardia. 150 mg in 100 ml LR
or NS. Rapid infusion of 15 mg/min over 10 min., may repeat 150mg
rapid infusion in 10 min. If pt converts administer drip at rate of
1mg/min
Supply: 150mg in 3 ml preload
150mg in 3 ml vial
Comments:
Maintenance drip: May mix drip 150 mg in 100ml LR or NS and
administer at 45 gtts to give 1mg/min on Micro drip set.
Rapid Infusion: Mix in macro solu-set, or 150 mg in 100 ml LR or NS
and administer at 150 gtts/min. over 10 min. for 15 mg/min infusion.
(Approx. 37 gtts/15 sec.)
[5]
AMYL NITRITE
Amyl Nitrite
[Paramedic]
Class: Inhalant
Actions: Amyl Nitrate has affinity for cyanide ions; reacts with hemoglobin to form
methemoglobin.
Indications: Cyanide or hydrocyanic poisoning
Contraindications:
Side Effects: Headache
Dosage: Adults & Pediatric: Breathe Amyl Nitrate vapors for 30 seconds, then
breathe Oxygen for 30 seconds repeat this procedure continuously
Supply:
Comments: Protect yourself from exposure to cyanide sources. DO NOT BECOME
A VICTIM YOURSELF.
[6]
ACETYLSALICYLIC ACID
, Aspirin
Acetylsalicylic Acid , Aspirin
[Basic / Intermediate / RN / Paramedic]
Class: Analgesic, antipyretic
Actions: Blocks platelet aggregation
Indications: Chest pain suggestive of new AMI
Contraindications: Hypersensitivity, intolerance, Allergy
Side Effects: Urticaria, angioedema, bronchospasm, anaphylactic shock, nausea,
vomiting, heartburn, GI bleed and prolonged bleeding
Dosage: 4 chewable baby aspirin (81 mg each) PO
Supply: 81 mg tablets
Comments: Avoid in pediatric
[7]
ATIVAN (Lorazepam)
Ativan (Lorazepam)
[Paramedic]
Class: Tranquilizer, Anti-convulsant and Skeletal muscle relaxant.
Actions: Binds specifically to sites in the brain acting to inhibit the chaotic
neurotransmission seen in seizures.
Indications: 1. Status seizures
2. As an amnesic / anxiolytic prior to cardioversion
3. Chemical restraint
Contraindications: Hypersensitivity to the drug, acute narrow-angle glaucoma
Side Effects:
1. Drowsiness, dizziness, fatigue and ataxia.
2. Most likely to produce respiratory depression in patients who have
taken other depressant drugs, especially alcohol and barbiturates, or
when given rapidly.
Dosage:
1. Generalized convulsive status epilepticus (GCSE)
1 Adult 0.5-2.0 mg IV/IO/IM Pediatric 0.1mg/kg IV/IO/IM
2. Cardioversion premedication Adult 0.5-2.0 mg IV/IO/IM
3. Chemical Restraint 0.5-2.0 mg IV/IO/IM slow push to a maximum
dose of 4.0 mg. If given IM, do not dilute. Dilute 1 – 1 for IV/IO.
4. For pain management with MS, 0.5 -1 mg IV/IO/IM.
Supply: 2 mg/ml Carpuject / Vial
2 mg/ml – 2 ml Vial
Comments:
1. Lorazepam’s advantage over Diazepam is that it is shorter acting and
does not markedly suppress respirations as does Diazepam.
2. Consider rectal administration (if unable to administer IV) in seizing
children. Contact Medical Control hospital prior to doing so.
[8]
ATROPINE SULFATE
Atropine Sulfate
[Intermediate / RN / Paramedic]
Class: Parasympatholytic (anticholinergic)
Actions: Blocks acetylcholine receptors (decreases vagal tone thus increasing
heart rate)
Indications:
1. Narrow-QRS (< 0.12 sec) Bradycardia with systolic BP < 90,
decreased LOC, chest pain, or PVC’s
2. Asystole
3. Narrow-QRS (< 0.12 sec) PEA with rate < 60/min.
4. Severe organophosphate (insecticide) poisoning
Contraindications: 1. Wide-QRS ( 0.12 sec) Bradycardia in (adults only)
2. Glaucoma
Side Effects: Tachycardia, chest pain, blurred vision, headache, dry mouth, flushing,
urinary retention
Dosage:
Bradycardia: 0.5 mg IV/IO. Repeat in 5 min. if needed. Total Max dose
= 0.04mg/kg.
Asystole: 1 mg IV/IO or 2 mg ET. Repeat in 5 min. if needed. Max
Dose = 0.04 mg/kg
Children: 0.02 mg/kg IV/IO or 0.04 mg/kg ET (Avoid age < 1 month).
Repeat dose in 5 min. if the heart rate is < 80/min.
MINIMUM DOSE: 0.1 mg
MAXIMUM TOTAL DOSE (child): 1.0 mg
0.04 mg/kg
MAXIMUM TOTAL DOSE (adolescent): 2.0 mg 0.04 mg/kg
Organophosphate Poisoning: 1 – 2 mg IV, IO, IM repeated q. 20 to 30
min. until muscarinic symptoms disappear or atropine toxicity appears.
Supply: Prefilled syringe contains 1 mg (10 ml)
Vial: 20 ml – 0.4 mg/ml
Comments:
1. Use cautiously in patients with chest pain
2. Severe organophosphate poisoning requires double doses if:
Systolic BP < 90
Decreased LOC
Respiratory distress
Excessive oral secretions
Pulse < 60
[9]
ATROVENT (Ipratropium Bromide)
Atrovent (ipratropium Bromide)
[Intermediate / RN / Paramedic]
Class: Anticholinergic
Actions: Inhibits interaction of acetylcholine at receptor sites of the bronchial
smooth muscle resulting in bronchial dilation.
Indications: For Relief of Bronchospasms in those with COPD
Contraindications: Glaucoma,
Side Effects: N/V, Dry mouth, cramps, anxiety, dizziness, H/A, cough , worsening of
Bronchospasms
Dosage: Adult and pediatric 0.5 mg nebulized mixed with albuterol dose.
Supply: 2.5 ml of solution per preloaded dose for nebulization
Comments: Mix with Albuterol to form “Duoneb” – Administer once, all subsequent
Neb treatments are to be Albuterol. Duoneb will be second treatment
for pediatric patients if Albuterol treatment does not break asthma.
NOTE: Atrovent (meter dose inhaler, auto inhaler only) should not be
administered to individuals allergic to soya lecithin or related food
products, e.g. soya beans or peanuts. Current formulations of
NEBULIZED Atrovent do not contain these agents and can be
administered to individuals allergic to soya lecithin.
[10]
CALCIUM GLUCONATE
[ RN / Paramedic]
Class: Membrane stabilizer and antidote
Actions: Calcium is the most common cation in the human body and
the majority of the body stores are located in bone. It is
critical in many different cellular processes and is essential
for the functional integrity of muscle (skeletal, smooth and
cardiac) and nervous tissues.
Indications: 1. As a membrane stabilizer in suspected hyperkalemia.
Reverses EKG changes pending correction of the
extracellular potassium concentration.
2. As a potential antidote in suspected calcium channel
blocker overdoses, hydrofluoric acid poisoning and
iatrogenic magnesium intoxication.
Contraindications: 1. Digoxin Poisoning.
2. Hypercalcemia
Side Effects: Rapid IV administration can cause bradycardia,
vasodilatation, hypotension, syncope and local burning.
Dosage: 10 – 20 mL calcium gluconate (0.2 – 0.3 mL/kg children) over
10 – 20 minutes
Supply: 10 mL of 10% solution contains 93 mg (4.65 mEq) of
calcium.
Comments:
Administer slowly (no faster then 2.0 ml/min) and stop if
the patient complains of pain.
Inject using a small needle in large vein and do not mix
with bicarbonate.
Avoid use with patients who are on Digoxin since
calcium can augment the positive inotropic and negative
chronotropic effects of digitalis preparations.
Suspect hyperkalemia in patient with wide complex
arrhythmia or tall peaked T-waves and Hx of renal
failure.
[11]
CAPTOPRIL (Capoten)
Captopril (Capoten)
Class: Ace Inhibitor
[Paramedic]
Actions:
Prevents conversion of agiotensin I to agiotensin II, a potent
vasoconstrictor. Decreases peripheral arterial resistance so there is
reduced sodium and water retention and lowers blood pressure.
Onset occurs in 15-30 minutes. Persist for 6-12 hours.
Indications:
1. Flash pulmonary Edema
2. CHF
Contraindications:
1. Pts. Hypersensitive to the drug
2. Pts. Sensitive to any other ACE inhibitor
Precautions:
1. Use with caution in Pts. With impaired renal function
2. Pts. with serious auto-immune disease (Lupus, etc.)
3. Elderly may be more sensitive to drug’s hypotensive effects.
Side Effects:
1. May cause tachycardia, hypotension, angina.
2. Nausea, vomiting, abdominal pain.
3. Severe Reaction may be rash, swelling of tongue, angioedema
of the face and extremities.
Dosage: 12.5 mg Sub lingual 1 time. (May dampen with small amount of sterile
water or normal saline to help tablet to dissolve.)
Supplied: 12.5 mg white tab
[12]
DEXAMETHASONE (Decadron)
Dexamethasone (Decadron)
[ Paramedic]
Class: Corticosteroid
Actions: Dexamethasone is a synthetic steroid that suppresses acute
and chronic inflammation. In addition, it potentiates vaxcular
smooth muscle relaxation by beta-adrenergic agonists and
may alter airway hyperactivity.
Indications: Moderate to severe asthma/COPD.
Severe allergic reactions.
Croup
Precautions: May cause hypertension and hyperglycemia.
Dosage: Adult (>40): 10mg IV, IO, IM, PO.
Pediatric (<40): 0.3mg/kg, up to 10 mg, IV, IO, IM, PO.
Comments: May cause nausea, vomiting, headache or dizziness
[THESE ALL IMERGENCY DRUGS ARE USE IN COMENELY AND MORE DRUGS ARE
COMING SOON…
THANKS FOR READING]
Pradeep Kumar 
