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 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
tremors/weakness/nausea/intense hunger. Oral glucose  Peds: See dosing chart (pg 27 of Protocols). Give 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  Peds: Infants <10kg – D 25% at 0.5g/kg (2ml/kg) IV; Children >10kg – D50 at 0.5g/kg (1ml/kg) IV  Contraindication: no patent IV established, try to avoid use in suspected CVA (stroke) pt unless BGL and
 Indication: Bronchospasm, COPD, asthma, dyspnea  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  Contraindication: hypersensitivity, caution with  Mechanism: Sympathomimetic – vasoconstricts and  Side effect: tachycardia, chest pain, anxiety, nausea, and  Indication: Allergic reaction (anaphylaxis) – Systolic BP <100 with dyspnea and hives/generalized edema
 Dose: 0.3mg Epipen IM (Conc: 1:1000) – if without Rx,  Peds 0.15mg Epipen-Jr (Conc: 1:1000) – if without Rx,  Indication: cardiac ischemia (non-traumatic chest pain).  Side effect: palpitations, tachycardia, N/V, dizziness, Associated symptoms include SOB, nausea, diaphoresis WITH systolic BP ≥110mmHg or within 30% of Epinephrine (for cardiac arrest) – IC admin only  Contraindication: Allergy, taken recently  Mechanism: vasoconstrictor, bronchodilator  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 still pulseless for a max of 2 doses. Use IO if IV fails in 2  Dose: Mild: 25 mg IV or IM; Mod/Severe: 50 mg IV.
 Peds: 1mg/kg IM for mild; 1mg/kg IV or IM for moderate; 1mg/kg IV or IO for severe (Single max dose  Mechanism: hormone that causes body to release sugar  Indication: Hypoglycemia where IV access unobtainable  Contraindication: nursing mothers, neonates/premies, and no gag reflex/oral glucose not tolerated
 Dose: 1mg reconstituted with 1 ml sterile water, IM or  Side effect: hypotension, sedation, blurred vision,  Peds Less than 6 y/o – 0.5mg SQ/IM; Greater than 6 y/o  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  Newborns: if persistently obtunded and suspicion of
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  Remember to: assess VS before and after each bolus;  Contraindication: intubated pt, use caution with assess breath sounds often; stop fluid admin when a systolic BP of ≥ 90 mmHg with HR of ≤ 100 is reached
 Side effect: vomiting, withdrawal symptoms  IV Normal Saline (for heat related emergencies)  Indication: Heat cramps - environmental evidence and
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
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  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  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  Dose: IV large bore - bolus at 20ml/kg. May repeat twice  Mechanism: Antiemetic – works on vagus nerve to  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  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 10ml/kg within 10 mins. Repeat if needed.  Mechanism: glucose absorbed in GI tract and increases  Indication: Hypoglycemia (Adults <80mg/dL, Peds <40mg/dL) and AMS or other signs such as
 Mechanism: anti - inflammatory glucocorticoid (steroid)  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  Contraindication: unconscious patent, no patent airway,  Other Indication: Severe anaphylaxis  Dose: 125mg adult IV (follow by flush); 1mg/kg  Contraindication: sensitivity/allergy

Source: http://rems.blogs.rice.edu/files/2013/11/REMS.Drugs_.pdf