Lisbon Fire Department Standard Operating Guidelines and Policies

Hypotension

Nausea, vomiting

Use with caution in patients receiving digitalis

Calcium chloride can be used as an antidote if respiratory depression occurs

Pregnancy Class A

1-4 grams IV given at a rate of 1 gram/minute

Vitals signs, respiratory, cardiovascular and neurologic status within 5 minutes of administration and every 15 minutes thereafter.

The following is the basic information and guideline for use of:

Approved for use by:	EMT	Advanced EMT	EMT-Intermediate	Paramedic
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Adrenal corticosteroid

Decrease inflammation

Suppress immune reactions (e.g. anaphylaxis)

Spinal cord injuries (new)

Allergy

Tuberculosis or AIDS

Use with caution in patients with a history of peptic ulcer, congestive heart failure, liver or kidney disease, diabetes mellitus
SIDE EFFECTS

Insomnia

Mood swings

Delayed wound healing

Increased susceptibility to infection

Hypertension
SPECIAL NOTES:

Provided in a Mix-O-Vial. Follow manufacturer’s recommendations to reconstitute

Pregnancy category C
USUAL DOSE

125 mg (adult)

2 mg/kg (pediatric), maximum dose 125 mg

30 mg/kg over 2-3 minutes for spinal cord injuries

Continuous ECG

Vital signs before and within 5 minutes after administration
END

DRUG PROFILE

The following is the basic information and guideline for use of:

Approved for use by:	EMT	Advanced EMT	EMT-Intermediate	Paramedic
				XX

Antiemetic, GI stimulant (increases peristalsis)

Nausea and vomiting (adults)

Allergy to metoclopromide or procaine/procainamide

History of pheochromocytoma, seizure disorder, kidney or liver failure, Parkinson’s disease, GI bleeding, bowel obstruction
SIDE EFFECTS

Fatigue

Dystonic reactions (muscle spasm, fixed postures, strange movement patterns

Diphenhydramine (Benadryl) can be used to treat dystonic reactions

Pregnancy category B
USUAL DOSE

10 mg over 1-2 minutes IV bolus (adults)

Continuous ECG

Vital signs before and within 5 minutes after administration
END

DRUG PROFILE

Initial Date: 1/5/05	Last Review/Revision: 12/08	Profile Number: 029
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The following is the basic information and guideline for use of:

Approved for use by	EMT	Advanced EMT	EMT-Intermediate	Paramedic
	XX	XX	XX	XX

Absorbs ingested toxins and toxicants

Suspected orally ingested overdose in patients with normal level of consciousness

Depressed level of consciousness

Active vomiting
SIDE EFFECTS

Constipation

Nausea, vomiting

Bowel obstruction

Pulmonary aspiration

Corneal abrasions may occur if charcoal inadvertently gets into the eyes

Consider contact with Poison Control Center

Rapid ingestions may invoke vomiting. Be prepared to clear and monitor the patient’s airway

Container must be shaken thoroughly and frequently during administration.

Continue to assess patient and be prepared to manage airway difficulties.

Pregnancy category D

Adults and children: 1 gram activated charcoal/kg of body weight, administered orally

Usual adult dose: 25-50 grams

Usual child dose: 12.5-25 grams

Vital signs within 5 minutes after administration

The following is the basic information and guideline for use of:

Approved for use by:	EMT	Advanced EMT	EMT-Intermediate	Paramedic
				XX

Synthetic narcotic analgesic, central nervous system depressant

Moderate to severe pain

Head, chest, abdominal trauma

Allergy to the drug

Undiagnosed abdominal pain

CHF, Myocardial infarction
SIDE EFFECTS

May precipitate withdrawal in addicts

Can be reversed with naloxone (Narcan)

Pregnancy category C

0.5-2 mg slow IV bolus over 2-3 minutes (adults)

Vital signs, response to medication

Approved for use by:	EMT	Advanced EMT	EMT-Intermediate	Paramedic
				XX

Calcium Channel Blocker, Calcium Channel Antagonist

Atrial Fibrillation with rapid ventricular rate (greater than 160/minute)

Atrial Flutter with rapid ventricular rate (greater than 160/minute)

Multifocal Atrial Tachycardia with rapid ventricular rate (greater than 160/minute)

Paroxysmal Supraventricular Tachycardia (PSVT) with rapid ventricular rate (greater than 160/minute)
CONTRAINDICATIONS:

Sick Sinus Syndrome

Second or Third- Degree AV block

Severe Hypotension

Cardiogenic Shock

Atrial Fibrillation or Atrial Flutter associated with WPW syndrome

Use of IV Beta Blockers

Ventricular Tachycardia

Wide-Complex Tachycardia of unknown origin
SIDE EFFECTS

Chest Pain Ventricular Dysrhythmias

Bradycardia First and Second- Degree AV blocks

Congestive Heart Failure Nausea and Vomiting

Syncope Atrial Flutter
SPECIAL NOTES:

For use with on-line medical control order only (no standing orders)

Pregnancy Safety- Category C (generally considered safe for use during labor)

Use with caution in patients with impaired renal or hepatic function

Hypotension may occasionally result – usually related to rate of delivery

PVC’s may be present on conversion of PSVT to sinus rhythm

Treatment of resultant hypotension: Calcium Chloride (100mg/ml) 2mg/kg IVP (usually 2ml)

Adult: Start with 10mg dose IVP over 2 min. Re-evaluate, Repeat if needed

Maximum initial dose = 0.25mg/kg (usual concentration = 25mg/5ml)

Pediatric: Not recommended

Rhythm strip/12 Lead EKG before administration and after administration

Vital signs within 5 min of administration

Watch for Bradycardia and Hypotension, and any Heart Blocks

DRUG PROFILE

The following is the basic information and guideline for use of:

Approved for use by:	EMT	Advanced EMT	EMT-Intermediate	Paramedic
				XX

Non-barbiturate hypnotic, sedative

Onset of action within 60 seconds, duration of action 3-5 minutes
INDICATIONS FOR USE

Short acting anesthesia as premedication for endotracheal intubation, cardioversion or pacing

Labor, delivery

Allergy to the drug
SIDE EFFECTS

Nausea, vomiting

Hypo- or hypertension

Tachy- or bradycardia, arrhythmias

Respiratory depression

Involuntary muscle movements

Use with caution is elderly patients

Not recommended for pediatric patients

Pregnancy category C, unknown excretion in breast milk

0.2-0.3 mg/kg IV bolus into a free-flowing IV line

Not recommended for children under age 10
MONITOR, REPORT, DOCUMENT

Continuous ECG

Vital signs before and within 5 minutes after administration
END
DRUG PROFILE

The following is the basic information and guideline for use of:

Approved for use by:	EMT	Advanced EMT	EMT-Intermediate	Paramedic
				XX

Short acting narcotic analgesic

Central Nervous System depressant
INDICATIONS FOR USE

Moderate to Severe pain

Adjunct to rapid sequence intubation (RSI)

CONTRAINDICATIONS

Hypotension (if less than 90mm Hg or greater than 60mm Hg below baseline consider contacting medical control)

Allergy to the drug
SIDE EFFECTS

Can be reversed with naloxone

Use with caution in patients with respiratory, liver or kidney disease, seizure disorder

Protect from light

Titrate to effect

25-100 micrograms slow IV over 2-3 minutes (adult)

1 mcg/kg slow IV over 2-3 minutes (pediatric moderate to severe pain)

Contact medical control for additional dosing

Intranasal dosing same as IV dosing

Vital signs, response to medication

The following is the basic information and guideline for use of:

Approved for use by:	EMT	Advanced EMT	EMT-Intermediate	Paramedic
				XX

Long acting narcotic analgesic, central nervous system depressant

Moderate to severe pain

Allergy to the drug

Head, chest, abdominal trauma

Undiagnosed abdominal pain

Addictive

Can be reversed with naloxone

Can precipitate seizures in patients with convulsive disorders

Use with caution in patients with respiratory disease/depression

Pregnancy category C

0.5 - 1 mg slow IV bolus over 2-3 minutes (1 mg hydromorphone is equivalent to 7.5 mg morphine)

Not recommended for pediatric patients
MONITOR, REPORT, DOCUMENT

Vital signs, response to medication

The following is the basic information and guideline for use of:

Approved for use by:	EMT	Advanced EMT	EMT-Intermediate	Paramedic
				XX