Acetaminophen & Ibuprofen Dextrose 50%  Mechanism: analgesic, antipyretic  Mechanism: Nutrient  Indication: fever  Indication: Hypoglycemia (Adults <80mg/dL, Peds <40,  Dose: If temperature >101ºF and pt has not taken in last full term newborns <30, low birth weight infants <20) hour, give Acetaminophen 1000mg PO or Ibuprofen and AMS or other signs such as 400mg-800mg PO tremors/weakness/nausea/intense hunger. Oral glucose  Peds: See dosing chart (pg 27 of Protocols). Give not tolerated/possible. Acetaminophen or Ibuprofen if pt has a fever and has not  Dose: 25g (50mL) IV; repeat once in 15 mins if BGL taken within last 4 hrs; if temperature >102ºF, remains <80mg/dL; do NOT administer within 5 minutes Acetaminophen and Ibuprofen may be given together of glucagon admin  Peds: Infants <10kg – D 25% at 0.5g/kg (2ml/kg) IV; Children >10kg – D50 at 0.5g/kg (1ml/kg) IV Albuterol  Contraindication: no patent IV established, try to avoid  Mechanism: Bronchodilator use in suspected CVA (stroke) pt unless BGL and  Indication: Bronchospasm, COPD, asthma, dyspnea symptoms indicate hypoglycemia during allergic reaction  Side effect: tissue necrosis if IV not patent  Dose: 2.5mg/3ml saline nebulized (6 lpm) – for allergic  Remember to: administer thiamine before if suspicions reaction, can repeat once after 15 mins if BP is stable; for of alcohol abuse or malnutrition; check IV patency respiratory distress due to asthma/COPD/pneumonia, can repeat once in 5 mins if dyspnea continues  Peds: for respiratory distress, give 2.5mg via nebulizer Epinephrine (for anaphylaxis)  Contraindication: hypersensitivity, caution with  Mechanism: Sympathomimetic – vasoconstricts and tachydysrhythmias bronchodilates  Side effect: tachycardia, chest pain, anxiety, nausea, and  Indication: Allergic reaction (anaphylaxis) – Systolic BP vomiting <100 with dyspnea and hives/generalized edema  Dose: 0.3mg Epipen IM (Conc: 1:1000) – if without Rx, IC admin only Aspirin  Peds 0.15mg Epipen-Jr (Conc: 1:1000) – if without Rx,  Mechanism: Antiplatelet IC admin only  Indication: cardiac ischemia (non-traumatic chest pain).  Side effect: palpitations, tachycardia, N/V, dizziness, Associated symptoms include SOB, nausea, diaphoresis weakness, anxiety, tremor, headache WITH systolic BP ≥110mmHg or within 30% of baseline systolic  Dose: 324mg PO Epinephrine (for cardiac arrest) – IC admin only  Contraindication: Allergy, taken recently  Mechanism: vasoconstrictor, bronchodilator  Side effect: GI bleeding  Indication: Cardiac arrest (pulseless and apneic)  make sure you cover all the basics first (i.e. airway, CPR, etc)!  Dose: 1mg IV/IO (Conc 1:10,000); repeat 3-5 mins if Diphenhydramine (Benadryl) still pulseless for a max of 2 doses. Use IO if IV fails in 2  Mechanism: Antihistamine attempts or 90 secs  Indication: Allergic reaction  Dose: Mild: 25 mg IV or IM; Mod/Severe: 50 mg IV.  Peds: 1mg/kg IM for mild; 1mg/kg IV or IM for Glucagon moderate; 1mg/kg IV or IO for severe (Single max dose  Mechanism: hormone that causes body to release sugar 25mg)  Indication: Hypoglycemia where IV access unobtainable  Contraindication: nursing mothers, neonates/premies, and no gag reflex/oral glucose not tolerated allergy to drug  Dose: 1mg reconstituted with 1 ml sterile water, IM or  Side effect: hypotension, sedation, blurred vision, SQ epigastric distress, restlessness  Peds Less than 6 y/o – 0.5mg SQ/IM; Greater than 6 y/o – 1mg SQ/IM

IV Normal Saline (for dehydration) Naloxone  Mechanism: fluid replacement  Mechanism: Narcotic antagonist (blocks opiate receptors)  Indication: hypovolemia and other S/S of dehydration e.g.  Indication: opiate overdose (heroin, codeine, methadone, poor skin turgor, dry/cracked mucous membranes, morphine, fentanyl, vicodin); AMS of unknown etiology orthostatic hypotension, little or no urine output with respiratory compromise (e.g. can be used for  Dose: IV large bore then bolus at 20ml/kg; if pt remains extended AMS in seizure or postictal pts) symptomatic and breath sounds remain clear, administer  Dose: 0.4-2mg slow IV push or IN titrated to respiratory 10ml/kg bolus increments thereafter every 15 mins. compromise; may repeat every 2-5 min if pt responds to Between boluses, maintain the IV at 200ml/hr. initial dose; maximum total dosage of 4mg  Peds: Fluid bolus 20ml/kg, may repeat every 5 mins if  Peds: 0.1 mg/kg slow IV push; may repeat every 10-15 still symptomatic and breath sounds are clear min if pt responds to initial dose, max single dose of 2mg  Infants: bolus 10ml/kg  Newborns: if persistently obtunded and suspicion of  Contraindication: wet lung sounds evidence of maternal narcotic use, give 0.1mg/kg IV/IO  Side effect: electrolyte imbalance, fluid overload  with a max single dose of 2mg and can repeat every 2-3 hypertension, heart failure, pulmonary edema min as needed  Remember to: assess VS before and after each bolus;  Contraindication: intubated pt, use caution with assess breath sounds often; stop fluid admin when a pregnancy systolic BP of ≥ 90 mmHg with HR of ≤ 100 is reached  Side effect: vomiting, withdrawal symptoms  or pulmonary edema is suspected combative pt

IV Normal Saline (for heat related emergencies) Nitroglycerin  Indication: Heat cramps - environmental evidence and  Mechanism: Vasodilator cramps in extremities without heat exhaustion  Indication: non traumatic chest pain; BP systolic ≥110 signs/symptoms; Heat exhaustion – environmental mmHg; prescription (IC can give to over 40 y/o without evidence and weakness/vertigo/nausea/syncope, profuse prescription) sweating, tachycardia, temperature normal or 1-2 degrees  Dose: 0.4 mg SL; repeat up to 3 doses total every 3-5 elevated; Heat stroke – temperature of ≥ 105ºF and AMS minutes if systolic BP remains ≥110 mmHg or seizure or neurological dysfunction  Contraindication: Viagra (past 24hrs), Levitra or Cialis  Dose: IV large bore - bolus at 20ml/kg then TKO (past 48 hrs); BP systolic lower than 110 mmHg; no prescription  Side effect: hypotension IV Normal Saline (for hyperglycemia)  Remember to: use extreme caution prior to  Indication: BGL > 180 with one of the following: AMS, administration  have IV established TKO NS, get HFD, tachypnea, abdominal pain, hypotension, tachycardia, evaluate BP in both arms, monitor vitals headache  Dose: IV large bore - bolus at 20ml/kg. May repeat twice every 10 mins. Ondansetron (Zofran)  Mechanism: Antiemetic – works on vagus nerve to decrease N/V IV Normal Saline (for hypotension)  Indication: Nausea /Vomiting  Indication: Systolic BP <90 – usually associated with  Contraindication: long QT segment, hypokalemia, other conditions, make sure to treat those (e.g. hypersensitivity / contact MD for pregnant female trauma/bleeding, allergic reaction)  Dose: 4-8 mg slow IVP over 2-5 min  Dose: IV large bore - bolus at 20ml/kg and titrate to a  Peds: = Adult for >8 yrs, for <8 y/o call MD systolic BP of > 90mmHg (shoot for 100mmHg)  Newborns: if there are S/S of hypoperfusion, hypovolemia, or dehydration, give an initial bolus of Oral glucose 10ml/kg within 10 mins. Repeat if needed.  Mechanism: glucose absorbed in GI tract and increases BGL  Indication: Hypoglycemia (Adults <80mg/dL, Peds Methylprednisolone (Solu-Medrol) <40mg/dL) and AMS or other signs such as  Mechanism: anti - inflammatory glucocorticoid (steroid) tremors/weakness/nausea/intense hunger  Indication: For Asthma or COPD after 2 breathing  Dose: 15g PO (pt must be conscious with a gag reflex); treatments still significant difficulty breathing (wheezing repeat once in 15 mins if BGL remains <80mg/dL and SpO2 < 95%).  Contraindication: unconscious patent, no patent airway,  Other Indication: Severe anaphylaxis no gag reflex  Dose: 125mg adult IV (follow by flush); 1mg/kg  Side effect: nausea Pediatric (Max 125mg).  Contraindication: sensitivity/allergy