Medication List Acetaminophen Glucose Adenosine Hydroxocobalamin Albuterol/Ipratropium Ketamine – Analgesia Amiodarone Ketamine – Post Airway Aspirin Ketamine – Pt Restraint Atropine Ketorolac Calcium Gluconate Lidocaine Dexamethasone Midazolam Dextrose 5% Naloxone Medication List Dextrose 10% Nitroglycerin Diltiazem Norepinephrine Diphenhydramine Normal Saline Epinephrine Ondansetron Fentanyl Sodium Bicarbonate Glucagon Medical Director: Benjamin Weston, MD, MPH Revision Date: April 2021 MedicationGuideline List 1 ALBUTEROL/IPRATROPIUM ALBUTEROL / ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS NOTES IPRATROPRIUM DOSE DOSE GUIDELINE Respiratory 5 mg 2.5 mg Respiratory Distress (2 nebules) (1 nebule) Distress Nebulized Bronchospasm Heart Rate > 180 Concentration: Allergic Reaction 2.5 mg Albuterol and 0.5 mg NEB Ipratropium Bromide in 3 mL AMIODARONE SPECIAL CONSIDERATION: In cases where home albuterol metered dose inhaler ‐ MDI ‐ is prioritized over nebulizer treatments, administer five puffs of home albuterol inhaler every 20 minutes up to 3 doses. This should be entered into the ePCR as such. ASPIRIN ASPIRIN ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS NOTES DOSE DOSE GUIDELINE Chest Pain 324 mg N/A Chest Discomfort PO Acute Coronary Concentration: Syndrome PO 81 mg / tablet ATROPINE ATROPINE ATROPINE ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS NOTES DOSE DOSE GUIDELINE Bradycardia 1 mg 0.2 mUkg IV/1O Bolus given Bradycardia Max Total 3 mg Max dose 0.5 mg LI IV/10 over 10 seconds BOLUS Concentration: 1 mg in 10 ml Weight (kg) 5 10 15 20 25 30 35 40 45 >50 Dose (mg) 0.1 0.2 0.3 0.4 0.5 0.5 0.5 0.5 0.5 1 Bradycardia (0.2ml/kg) 1ml 2m l 3 ml 4ml 5ml 5ml 5ml 5ml 5ml 10ml Cholinergic IV/1O Bolus given Anticholinergic May require frequent and Toxidrome 2mg 0.5 mUkg Max dose: 2 mQ over 10 seconds Toxidrome high doses to reverse agent Concentration: IV/10 1 mg in 10 ml BOLUS LI Weight (kg) 5 10 15 20 25 30 35 40 45 >50 Dose (mg) 0.25 0.5 0.75 1 1.25 1.5 1.75 2 2 2 Cholinergic Toxidrome (0.5ml/kg) 2.5ml 5ml 7.5ml 10ml 12.5 ml 15ml 17.5ml 20ml 20ml 20ml DEXTROSE 5% DEXTROSE 5% ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS NOTES DOSE DOSE GUIDELINE Diluent Variable Variable Diluent for Concentration: IV/IO Amiodarone and IV/IO 100 mL Bag Ketamine DEXTROSE 10% DILTIAZEM DILTIAZEM ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS NOTES DOSE DOSE GUIDELINE A-Fib w/ RVR *Online Medical Control* IV/10 slow push over 2 minutes 0.25 mg/kg Draw the dose Atrial Fibrillation Bradycardia Requires 12 lead transmitted le N/A volume from the bag with RVR Hypotension OLMC via EMSCOMM_ IV/10 with a syringe. Wolff-Parkinson-White SLOW PUSH! Do not infuse Syndrome medicated bag directly into patient. LI Concentration: 25 mgin 5 ml -OR- 100 l11Qi n 100 ml 25mg/ 5ml Weight (kg) <40 so 60 70 80 90 100 Dose (mg) N/A 12.5 15 17.5 20 22.5 25 A-Fib w/ RVR (0.25 mg/kg) N/A 2.5 ml 3 ml 3.5 ml 4ml 4.5 ml 5 ml 100mg/100ml Weight (kg) <40 so 60 70 80 90 100 Dose (mg) N/A 12.5 15 17.5 20 22.5 25 A-Fib w/ RVR (0.25 mg/kg} N/A 12.5 ml 15 ml 17.5 ml 20ml 22.5 ml 25 ml II EPINEPHRINE EPINEPHRINE ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS NOTES DOSE DOSE GUIDELINE Anaphylaxis Vastus lateralis Anaphylaxis Severe 0.3 mg 0.15 mg preferred site Severe No absolute contraindications Never give this Bronchospasm {less than 30 kg) IM Bronchospasm in a life-threatening situation concentration IV or 10 Concentration: IM 1 mg (1 :1,000) in 1 ml Do NOT exceed 0.3 ml LI Bronchiolitis Severe bronchiolitis 5mg 2.5mg Nebulized Caution with heart Never give this Croup Moderate croup rate over 180 concentration Anaphylaxis IV or lO Concentration: NEB 1 mg (1 :1,000) in 1 ml LI Cardiac Arrest 1 mg 0.1 mUkg Max dose 10 ml IV or 10 bolus given Cardiac arrest over 10 seconds IV/10 Concentration: BOLUS 1 mg (1:10,000) in 10 ml LI Weight (kg) 5 10 15 20 25 30 35 40 >45 Dose (mg) 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 1 Cardiac Arrest (0.1 ml/kg) 0.5 ml 1ml 1.5ml 2ml 2.5ml 3ml 3.5 ml 4ml 10ml GLUCAGON GLUCAGON ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS NOTES DOSE DOSE GUIDELINE Hypoglycemia <20kg: 0.5mg Anaphylaxis 1 mg >20kg: 1 mg Reconstitute Hypoglycemia 1 mg/mL Anaphylaxis Concentration: IM/IN 1mg reconstituted in 1mL IM/IN GLUCOSE GLUCOSE GLUCOSE ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS NOTES DOSE DOSE GUIDELINE Hypoglycemia 15g q 5 min 1g/kg q 5 min Max 15g/dose Max Total: 45g Max Total: 45g PO Hypoglycemia Impaired Swallowing PO Concentration: 15 g/tube HYDROXOCOBALAMIN (CYANOKIT) KETAMINE - ANALGESIA KET AMINE - ANALGESIA Analgesia 0.5 mg/kg Max Dose 50 mg Do not dilute Pain Control LI Concentration: IM 500 mg in 5 ml Weight (kg} 5 10 15 20 25 30 35 40 50 60 70 80 90 100 Dose(mg) 0 5 g 10 13 15 18 20 25 30 35 40 45 50 Analgesia (0.Smg/kg) 0ml 0.1ml 0.1ml 0.1ml 0.1ml 0.2ml 0.2ml 0.2ml 0.3ml 0.3ml 0.4ml 0.4ml 0.5ml 0.5ml Analgesia 0.1 mg/kg Dilute 100 mg into Max Dose 1 0 mg 100 ml bag. Concentration: **Draw offweight- Pain Control LI IV/10 Dilute: 100 mg in 100 ml based dose** SLOW PUSH Slow push given over 2 minutes Weight (kg} 5 10 15 20 25 30 35 40 50 60 70 80 90 100 Dose (mg) 0.5 l 1.5 2 2.5 3 3.5 4 5 6 7 8 9 10 Analgesia (0.1mg/kg) 0.5ml 1ml 1.5ml 2ml 2.5ml 3ml 3.5ml 4m 5ml 6ml 7ml 8ml 9ml 10ml KETAMINE - POST AIRWAY SEDATION KETAMINE- POST AIRWAY SEDATION KETAMINE ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS DOSE DOSE GUIDELINE Post Airway 0.3 mg/kg Sedation Max Dose 30 mg Dilute 100 mg into Initial event I 100 ml bag Sedation following Agitation after suspected/known to be **Draw off weight- Airway Insertion advanced airway cardiac in origin Concentration: placement IV/10 Dilute: 100 mg in 100 ml based dose** SLOW PUSH Slow push given over 2 minutes LI I Weight (kg) 5 10 15 20 25 30 35 40 50 60 70 80 90 100 Dose( mg) l.S 3 4.S 6 7.S 9 10.S 12 15 18 21 24 27 30 Post Airway Sedation (0.3mg/kg) 1.5ml 3ml 4.5 ml 6ml 7.5ml 9ml 10.5ml 12 ml 15ml 18 ml 21ml 24ml 27ml 30ml KETAMINE - PATIENT RESTRAINT KETAMINE - PATIENT RESTRAINT KETAMINE ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS NOTES DOSE DOSE GUIDELINE Patient Restraint 1st Dose: 3 mg/kg (300 mg max) Excited Delirium 2nd Dose: 1 mg/kg (100 mg max) Do not dilute Immediate threat This dosing is not to be used Concentration: of harm to self or for Post Airway Sedation LI IM 500 mg in 5 ml others Initial Dose Weight (kg) 5 10 15 20 25 30 35 40 50 60 70 80 90 100 Dose(mg) 15 30 45 60 75 90 105 120 150 180 210 240 270 300 Patient Restraint (3.0mg/kg) 0.2ml 0.3ml 0.5ml 0.6ml 0.8ml 0.9ml 1.1ml 1.2ml 1.5ml 1.8ml 2.1ml 2.4ml 2.7ml 3ml Second Dose (Contact OLMC for additional dosing beyond second dose) MIDAZOLAM MIDAZOLAM ADULT PEDIATRIC ADMINISTRATION INDICATIONS CONTRAINDICATIONS NOTES DOSE DOSE GUIDELINE Seizure Will need more than 1 injection 10 mg 0.25 mg/kg site due to large adult volume IM Seizure H ypotension IM Concentration: 2 mg in 2 mL -or- 5 mg in 5 ml LI Weight (kg) 5 10 15 20 25 30 35 40 >45 Dose (mg) 1.25 2.5 3.75 5 5 5 5 5 10 Seizure IM (0.25mg/kg) 1.3 ml 2.5ml 3.8 ml 5ml 5 ml 5 ml 5ml 5ml 10ml Seizure 4mg 0.1 mg/kg IV/10 bolus given over 10 seconds IV/10/IN Concentration: IN BOLUS 2 mg in 2 mL -or- 5 mg in 5 ml LI Weight (kg) 5 10 15 20 25 30 35 40 >45 Dose (mg) 0.5 1 1.5 2 2.5 3 3.5 4 4 Seizure IV/10/IN (0.1 mg/kg) 0.5ml 1 ml 1.5ml 2 ml 2.5ml 3ml 3.5ml 4ml 4ml Procedural IV/10 bolus given Cardioversion Sedation 2mg 0.1 mg/kg over 10 seconds Pacing Hypotension IM/IN LI IV/10/IM/IN Concentration: BOLUS 2 mg in 2 mL -or- 5 mg in 5 ml Weight (kg) 5 10 15 20 25 30 35 40 > 45 Dose (mg) 0.5 1 1.5 2 2 2 2 2 2 Procedural Sedation (0.1 mg/kg) 0.5 1ml 1.5 ml 2 ml 2ml 2ml 2ml 2 ml 2ml Post AirwaySedation 2 mg 0.1 mg/kg IV/10 IV/10 bolus given Advanced Airway Hypotension Concentration: over 10 seconds Placement LI BOLUS 2 mg in 2 mL -or- 5 mg in 5 ml Weight (kg) 5 10 15 20 25 30 35 40 >45 Dose (mg) 0.5 1 1.5 2 2 2 2 2 2 Post AirwaySedation (0.1mg/kg) 0.5ml 1ml 1.5ml 2ml 2ml 2ml 2ml.