Medications

  • acetaminophen
  • adenosine
  • albuterol
  • amiodarone
  • aspirin
  • atropine
  • calcium choloride
  • dextrose
  • diphenhydramine
  • epinephrine
  • epinephrine
    racemic
  • fentanyl
  • glucagon
  • glucose
  • ipratopium
  • ketorolac
  • ketamine
  • lidocaine
  • magnesium sulfate
  • methylprednisolone
  • midazolam
  • naloxone
  • nitroglycerin
  • norepinephrine
  • ondansetron
  • prednisone
  • sodium bicarbonate

acetaminophen

Indication

 

  • Pain
  • Fever

 

Side Effects

 

  • Minimal

 

Considerations

 

    DO NOT GIVE if known sensitvity

adenosine

Indication

 

  • PSVT
  • Monomorphic (regular) VT

 

Side Effects

 

  • Dypsnea
  • Chest pain
  • Atrial tachy-dysrhytmias
  • Nausea
  • Throat tightness
  • AV block
  • Asystole

 

Considerations

 

    DO NOT GIVE

     

  • AV block
  • Sick sinus syndrome
  • Atrial flutter
  • Atrial fib
  • VT
  • Known Wolff-Parkinson-White

albuterol

Indication

 

  • Asthma
  • Hyperkalemia

 

Side Effects

 

  • Tremors
  • Anxiety

 

Rare:

 

  • Tachycardia
  • Hypertension
  • Dysrhythmias

 

Considerations

 

    USE WITH CAUTION

     

  • Cardiac disorder
  • Hyperthyroidism
  • Hypertension

amiodarone

Indication

 

  • Tachy-dysrhythmias especially VT or VF

 

Side Effects

 

  • Hypotension
  • Bradycardia

 

Considerations

 

  • In the non-arrest situaion, 150 mg must be administered slowly over 10 minutes.

aspirin

Indication

 

  • Chest pain/discomfort supected to be of cardiac origin

 

Side Effects

 

  • Tinnitus
  • Nausea
  • Vomiting
  • GI bleeding

 

Considerations

 

DO NOT GIVE:

 

  • If known hypersensitivity to aspirin.

atropine

Indication

 

  • Brady-dysrhytmias
  • Organophosphate poisoning
  • Nerve agent poisoning

 

Side Effects

 

  • Dilated pupils
  • Headache
  • Dry mouth
  • Tachycardia
  • PVC's

 

Considerations

 

DO NOT GIVE:

 

  • Tachydysrhythmias

 

USE WITH CAUTION:

 

  • Pregnancy
  • CHF
  • Hyperthyroidism
  • COPD
  • Hepatic disease

calcium chloride

Indication

 

  • Hypocalcemia
  • Calcium channel blocker overdose
  • Hyperkalemia

 

Side Effects

 

  • Possible heart block
  • VF

 

Considerations

 

USE WITH CAUTION:

 

  •  Patient is on digitalis
  • Renal failure

 

DO NOT MIX WITH:

 

  • Sodium bicarbonate

destrsose 10%
dextrose 25%
dextrose 50%

Indication

 

  • Hypoglycemia

 

Side Effects

 

  • Impaired neurologic recovery following stroke or cardiac arrest

 

Considerations

 

  • Tissue necrosis if infiltrates
  • Should not be used in cardiac arrest or in ischemic CVA unless documented hypoglycemia.

diphenhydramine

Indication

 

  • Allergic reaction

 

Side Effects

 

  • Dizzy
  • Drowsy
  • Hypotension
  • Dry mouth
  • Tachycardia
  • Dilated pupils
  • Blurred vision

 

Considerations

 

DO NOT USE:

 

  • Acute asthma

 

USE WITH CAUTION:

 

  • Renal disease
  • Cardiac disease
  • Hypertension
  • Asthma
  • Seizure

epinephrine 1:10,000 (1 mg in 10 ml)
epinephrine 1:1,000 (1 mg in 1 ml)

Indication

 

  • Cardiac arrest
  • Anaphylaxis
  • Asthma
  • Can be made into a vasopressor drip.

 

Side Effects

 

  • Tremors
  • Tachycardia
  • Dysrhythmias
  • Hypertension

 

Considerations

 

USE WITH CAUTION:

 

  • Angina
  • Hypertension
  • Hyperthyroidism

 

NO CONTRA-INDICATIONS IN CARDIAC ARREST

racemic epinephrine

Indication

 

  • Croup

 

Side Effects

 

  • Tremors
  • Tachycardia
  • Palpitations
  • Nausea
  • Vomiting
  • Hypertension

 

Considerations

 

USE WITH CAUTION:

 

  • Known cardiac problems
  • Hypertension

fentanyl

Indication

 

  • Pain

 

Side Effects

 

  • Hypotension
  • Sedation
  • Vomiting
  • Bradycardia
  • Respiratory depression

 

Considerations

 

USE CAUTION IF:

 

  • Hypotensive
  • Signficant head injury
  • Depressant use (e.g. EtOH)

glucagon

Indication

 

  • Hypoglycemia
  • Beta blocker overdose

 

Side Effects

 

  • Nauseau
  • Vomiting
  • Hypersensitivity

 

Considerations

 

  • Additonal carbohydrates needed for patient after awakening.

oral glucose

Indication

 

  • Hypoglycemia

 

Side Effects

 

  • Nauseau
  • Vomiting
  • Hypersensitivity

 

Considerations

 

  • Additonal carbohydrates needed for patient after awakening.

ipratroprium

Indication

 

  • Respiratory distress
  • Wheezing

 

Side Effects

 

  • Cough
  • Headache
  • Dizziness
  • Palpitations

 

Considerations

 

  • Always administered with albuterol.
  • Do not give more than three (3) 0.5 mg doses

ketorolac

Indication

 

  • Pain

 

Side Effects

 

  • Headache
  • Dizziness
  • Nausea

 

Considerations

 

DO NOT USE:

 

  • Renal insufficiency
  • PUD
  • GI bleed
  • 1st trimester pregnancy
  • Allergy to NSAIDS
  • Head bleed

ketamine

Indication

 

  • Excited delirium
  • Agitation
  • Post intubation sedation
  • breakthrough pain

 

Side Effects

 

  • Apnea
  • Laryngospasm
  • Vomiting
  • Tachycardia
  • Hypertension

 

Considerations

 

  • Relative contraindication with known coronary artery disease.
  • Head injury is not a contraindication.

lidocaine

Indication

 

  • Pain from IO infusion

 

Side Effects

 

  • Drowsiness
  • Confusion
  • Seizures
  • Hypotension
  • Heart blocks

 

Considerations

 

DO NOT USE:

 

  • Heart rate < 60
  • Heart block

 

USE WITH CAUTION:

 

  • Renal disease
  • Liver disease
  • CHF
  • Patients > 60 years old

magnesium sulfate 50%

Indication

 

  • Pregnant pts. experiencing severe pre-eclampsia or eclampsia
  • Alcoholic patient with prolonged seizures
  • Refractory VF/VT

 

Side Effects

 

  • Decreased muscle strength which may lead to hypoventilation, esp. if patient is also taking depressant medications.

 

Considerations

 

  • May occasionally lead to A-V block &/or respiratory arrest.
  • Calcium chloride may reverse these effects.

 

NOT INDICATED IN:

 

  • Patients with heart block
  • patients with significant heart disease

methylprednisolone

Indication

 

  • Difficulty breathing
  • Asthma
  • COPD
  • Allergic reaction

 

Side Effects

 

  • Nausea
  • Sweating
  • Dizziness
  • Sleep problems

 

Considerations

 

  • Hypersensitvity
  • Caution in patients with GI bleeding

midazolam

Indication

 

  • Seizures
  • Chemical restraint

 

Side Effects

 

  • Respiratory depression
  • Respiratory arrest

 

Considerations

 

  • Hypersensitivity
  • Acute narrow angle glaucoma
  • Shock
  • Hypotension
  • Head injury
  • Drug use
  • Alcohol use

naloxone

Indication

 

  • Narcotic overdose

 

Side Effects

 

  • Vomiting
  • Acute withdrawal
  • Ventricular dysrhythmias

 

Considerations

 

  • Titrate to improve respirations only.
  • Do not fully arouse addicted patient.

nitroglycerin

Indication

 

  • Angina
  • Chest pain of suspected cardiac origin
  • Pulmonary edema

 

Side Effects

 

  • Hypotension
  • Headache
  • Dizziness
  • Flushing

 

Considerations

 

DO NOT USE:

 

  • Systolic BP < 90
  • Increased ICP

 

USE WITH CAUTION:

 

  • Acute MI

norephinephrine

Indication

 

  • Hypotension unresponsive to fluid resuscitation

 

Side Effects

 

  • Tachycardia
  • Hypertension
  • Extravasation can cause tissue necrosis

 

Considerations

 

  • Can cause prolonged hypertension
  •  

    USE EXTREME CAUTION IN PATIENTS RECEIVING:

     

    • Monoamine oxidase inhibitors (MAOI)
    • TCA medications

ondansetron

Indication

 

  • Nausea
  • Vomiting

 

Side Effects

 

  • Constipation
  • Headache
  • Lightheadedness

 

Considerations

 

  • Minimal sedation, if at all

prednisone

Indication

 

  • Difficulty breathing
  • Asthma
  • COPD
  • Allergic reaction

 

Side Effects

 

  • Nausea
  • Sweating
  • Dizziness
  • Sleep problems

 

Considerations

 

  • Hypersensitvity
  • Caution in patients with GI bleeding

sodium bicarbonate

Indication

 

  • Metabolic acidosis in cardiac arrest
  • Ventricular arrythmias secondary to tricyclic overdose
  • Hyperkalemia

 

Side Effects

 

  • Alkalosis
  • Hypervolemia
  • Hypokalemia
  • Tetany

 

Considerations

 

Hyperventilate patient after administration.

 

 

DO NOT USE:

 

  • During first 10 minutes of cardiac arrest.

 

USE WITH CAUTION:

 

  • CHF
  • Renal disease
  • Toxemia
  • Cirrhosis

 

DO NOT MIX WITH:

 

  • Epinephrine
  • Calcium