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H-1 Benzodiazepines V4

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H-1 Benzodiazepines V4 Wilson County Emergency Management Agency Protocol Manual Drug Reference Benzodiazepines • generic Brand equivalent • alprazolam: Xanax; Kalma; Apo-Alpraz; Novo-Aloprazol; Nu-Alprax; Tafil • bromazepam: Lexotan; Lexomil • chloridazepoxide: Librium; Nova-Pam; Apo-chlordiazepoxide; Corax; Medilium; Novo-Poxide; Solium • clobazam: Frisium • clonazepam: Klonopin; Rivotril • clorazepate: Gen-Xene; Tranxene; Apo-Clorazepate; Novo-Clopate • diazepam: Valium; Ducene; Antenex; D-Pam; Pro-Pam; Apo-Diazepam; Diazemuls; E Pam; Meval; Novo-Dipam; PMS-Diazepam; Vivol • estazolam: ProSom; Tasedan • flunitrazepam: Rohypnol; Hypnodorm • flurazepam: Dalmane; Apo-Flurazepam; Novo-Flupam; PMS-Flupam; Somnol; Som Pam • halazepam: Paxipam Drug Reference – Benzodiazepines Page 1 of 2 H - 1 Wilson County Emergency Management Agency Protocol Manual Drug Reference • ketazolam: Anxon • loprazolam: Dormonoct • lorazepam: Ativan; Apo-Lorazepam; Novo-Lorazepam; Nu-Loraz; PMS-Lorazepam; Pro-Lorazepam • lormetazepam: Noctamid • medazepam: Nobrium • midazolam: Versed; Hypnovel; Dormicum • nitrazepam: Mogadon; Alodorm; Insoma; Nitrados • oxazepam: Serax; Serepax; Murelax; Alepam; Serenid; Benzotran; Apo-Oxazepam; Novo-Oxazepam; Oxpam; PMS- Oxazepam; Zapex • prazepam: Centrax • quazepam: Doral • temazepam: Restoril; Euhypnos; Normison; Temaze; Euhypnos; Nocturne; Normison; Temaze; Temtabs; Sompam • triazolam: Halcion; Apo-Triazo; Gen-Triazolam; Novo-Triolam; Nu-Triazo; Hypam; Tricam Drug Reference – Benzodiazepines Page 2 of 2 H - 1 Wilson County Emergency Management Agency Protocol Manual Protocols Amiodarone Infusion Stable Rhythm Bolus Mix 150 mg in 100 ml. Refer to the Amiodarone Mixture Procedure I – 1. Maintenance Drip Due to the extended half-life of this medication, a Maintenance drip can be post postponed until arrival at the ER. Special Notes Utilize a gravity control device (IV Stat2) to administer this medication. VF/Pulseless VT Initial dose - 300 mg in 20 ml given over 2 minutes Secondary dose 150 mg in 20 ml given over 2 minutes Drug Reference - Amiodarone Page 1 of 1 H - 2 Drug Reference - Calculations H - 4 Drug Reference - Calculations Drug Reference - Calculations H - 4 Drug Reference - Calculations H - 4 Drug Reference - Calculations H - 4 Drug Reference - Calculations H - 4 H - 4 Drug Reference - Calculations Drug Reference - Calculations H - 4 Drug Reference - Calculations H - 4 Wilson County Emergency Management Agency Protocol Manual Protocols Adult Epinephrine Drip (Hypotension/Bradycardia) 2mg/500ml (4mcg/ml) Dose (mcg/minute) Infusion Rate (ml/hour) 1 15 1.5 22 2 30 2.5 37 3 45 3.5 52 4 60 5 75 6 90 7 105 8 120 9 135 10 150 Special Notes • This medication should be administered through a gravity control device • Epinephrine should be 1:1,000 concentration Drug Reference – Epi Chart (Hypotension/Brady) Page 1 of 1 H - 5 Wilson County Emergency Management Agency Protocol Manual Protocols Epinephrine Drip Chart (Mast Cell Activation) 2mg/500ml (4mcg/ml) Dose (mcg/minute) Infusion Rate (ml/hour) 4 60 5 75 6 90 7 105 8 120 9 135 10 150 Special Notes • This medication should be administered through a gravity control device • Epinephrine should be 1:1,000 concentration Drug Reference – Epi Chart (Mast Cell) Page 1 of 1 H - 6 Wilson County Emergency Management Agency Protocol Manual Protocols Lidocaine Drip Chart - Adult 1000mg/250ml (4mg/ml) Dose (mg/minute) Infusion Rate (ml/hour) 1 15 2 30 3 45 4 60 Special Notes This medication should be administered through a gravity control device (IV stat 2) Drug Reference – Lidocaine Drip Page 1 of 1 H - 7 Acetaminophen (Tylenol®) Class: Analgesic and antipyretic agent Packaging: 160 mg / 5 ml in oral solution Dose: 15 mg / kg, MAX DOSE – 500 mg Action: has been shown to inhibit the action of endogenous pyrogens on the heat- regulating centers in the brain by blocking the formation and release of prostaglandins in the central nervous system Onset: 0.5 – 1 hour Duration: 3 – 8 hours Indications: A fever of 100.4 or greater, post febrile seizure Contraindications: Inability to swallow. Unconsciousness. Hepatic disease Precautions: Use with caution by mouth if note AMS or lethargy Adenosine (Adenocard®) Class: Antiarrhythmic Packaging: 12 mg / 4 ml (Vial) Dose: 12 mg IV / IO Max Dose: 36 mg Action: It slows the conduction through the atrioventricular (AV) node and interrupts the reentry pathway. Onset: Immediate Duration: 20 – 30 seconds (Peak @ 10 seconds) Indications: Supraventricular Tachycardia / paroxysmal supraventricular tachycardia Contraindications: AV blockages, Sinus node disease, WPW Syndrome Precautions: Will not convert Atrial or Ventricular dysrhythmias Medication References H - 8 Albuterol Class: A beta-2 adrenergic stimulant Packaging: 2.5 mg / 3 ml solution (premixed) Dose: 2.5 mg (Nebulized) Action: Causes bronchodilation by stimulating the beta-2 receptor Onset: 5 – 15 minutes Duration: 3 – 4 hours Indications: Bronchospasms: (Asthma / COPD) Contraindications: Tachy-dysrhythmias Precautions: It will cause an increase in heart rate; multiple doses in patients with a history of cardiovascular disease Amiodarone Class: Antidysrhythmic Packaging: 150 mg / 3 ml in vial Dose: Varies upon protocol Action: Suppresses ventricular ectopy by prolonging the action potential and refractory periods. Slows the sinus rate and increases the PR and QT intervals Onset: 2 – 5 minutes Duration: Variable Indications: Life-threatening dysrhythmias Contraindications: Patients with a known hypersensitivity to the drug. Because it may decrease automaticity, conductivity, and contractility, do not use in the presence of cardiogenic shock, severe sinus bradycardia, or advanced AV block unless a pacemaker is available Precautions: Pregnancy. Nursing women. Use in pediatrics. Medication References H - 8 Amiodarone Drip Class: Antidysrhythmic Packaging: Adult: Mix 150 mg in 50 ml D5 bag, Ped: Mix 150mg in 100 ml D5 bag Dose: Varies upon protocol Action: Suppresses ventricular ectopy by prolonging the action potential and refractory periods. Slows the sinus rate and increases the PR and QT intervals Onset: 2 – 5 minutes Duration: Variable Indications: Life-threatening dysrhythmias Contraindications: Patients with a known hypersensitivity to the drug. Because it may decrease automaticity, conductivity, and contractility, do not use in the presence of cardiogenic shock, severe sinus bradycardia, or advanced AV block unless a pacemaker is available Precautions: Pregnancy. Nursing women. Use in children. Aspirin (Acetylsalicylic Acid) Class: NSAID / Antiplatelet Packaging: 81 mg tablets Dose: 324 mg (PO) Action: Impedes clotting by blocking prostaglandin synthetase action, which prevents the formation of the platelet aggregating substance thromboxane A2. Onset: 5 – 30 minutes Duration: 1 – 4 hours Indications: Cardiac Chest Pain Contraindications: Known Active GI Bleeding, Hypersensitivity, Known history of bleeding disorders, Hepatic impairment, Patient’s < 18 years of age Precautions: History of GERD, GI Bleeding, Currently taking anticoagulation medications, (Contact medical control for further advice if needed) Medication References H - 8 Atropine: Class: Anticholinergic / Antiarrhythmic / Antimuscarinics Packaging: 0.1 mg / ml (Prefilled Syringe) Dose: Bradycardia: 0 .5 mg IV / See protocol for other Action: Inhibits muscarinic actions of acetylcholine at postganglionic parasympathetic neuroeffector sites. Onset: Immediate Duration: 4 – 6 hours Indications: Bradycardia Contraindications: None in emergency setting Precautions: Patients with s/s of myocardial ischemia or infarction, Glaucoma Special Notes: May not be effective in wide complex bradycardia or high degree AV blocks. Calcium Chloride 10% Class: Electrolyte Packaging: 1 g / 10 ml (prefilled syringe) Dose: 500 mg to 1000 mg IV (peds 20mg/kg) Action: Acts as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscles. Maintains cell membrane and capillary permeability Onset: Immediate Duration: Depending on dose, may be up to 4 hours Indications: KNOWN calcium channel blocker overdose / post hemodialysis arrest Contraindications: Cardiopulmonary arrest not associated with calcium channel blocker toxicity, hypocalcemia, or hyperkalemia. Precautions : Calcium chloride should not be administered in the same infusion with sodium bicarbonate since calcium will combine with sodium bicarbonate to form an insoluble precipitate (calcium carbonate). Calcium chloride should be given with extreme caution, and in reduced dosage, to persons taking digitalis because it increases ventricular irritability and may precipitate digitalis toxicity. Medication References H - 8 Dextrose (5%) Class: Hypotonic solution once in the body Packaging: 5% in 50, 100, 500 ml for drug mixtures Dose: Varies by use/protocol Action: Provides a medium for IV medications, provides a small amount of dextrose for cellular metabolism while leaving behind water Onset: Immediate Duration: Remains in intravascular space for 20-40 minutes Indications: Dilution solution for IV medications Contraindications: None Precautions: Diluting to the desired mixture is required. Dextrose 50% (D50W) Class: Carbohydrate Packaging: 25g in 50 ml (Prefilled Syringe) Dose: Varies by protocol, can be reduced for D25 and D10. Action: Increases blood sugar Onset: Immediate Duration: Dependent upon patient metabolism and degree of hypoglycemia Indications: Hypoglycemia Contraindications: Dextrose is contraindicated in intracranial hemorrhage, increased ICP, and known
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