OLMC Required: A. ASA and Acetaminophen with time of ingestion > two hours. B. All other poisons or ingestions regardless of time from ingestion.

 Supplied: 25 grams/120 ml bottle.

 Pharmacology and Actions: Activated charcoal absorbs toxic substances ingested and inhibits GI absorption by forming an effective barrier between the particulate material and the gastrointestinal mucosa. the effect is greatest if used within one hour of ingestion.

Indications: Mangement of poisoning or overdose of many substances.

Contraindications: A. pt's with altered mental status or the inability to maintain their own airway. B. pt's who have aspirated or with a potential for aspiration. Precautions: A. Activated charcoal may be ineffective in some ingestions. B. Milk, ice cream and other dairy products will decrease the absorption capacity substantially.

Side effects and notes: May cause nausea, vomiting and constipation.

 Adult dosing: Poisoning and overdose 1 gram/kg PO or NG

 Pediatric dosing: same as adult

Adenosine

(Adenocard)

OLCM: no

Supplied: 6mg/2ml and 12mg/4ml pre-filled syringes.

Pharmacology and actions: Adenosine is a naturally occurring nucleoside that has the ability to slow conduction through the AV node. Since most cases of PSVT involve AV nodal re-entry, adenosine is capable of interrupting the AV nodal circuit and stopping the tachycardia, restoring NSR. It is eleminated from the circulation rapidly and has a half-life in the blood of less then ten seconds.

Indications: To convert PSVT to a NSR, including PSVT that is associated with accessory bypass tracts( e.g. Wolff-Parkinson-White syndrome)>

Contraindications: A. Second or Third degree heart block. B. Sick sinus syndrome. C. Known hypersensitivity. D. Atrial fibrillation.

Precautions: A. When doses larger than 12mg are given by injection there may be a decrease in blood pressure secondary to a decrease in vascular resistance. B. The effects of adenosine are antagonized by methylxanthines such as theophylline and caffeine. Larger doses of adenosine may be required. C. Adenosine effects are protentiated by dipridamole (Persantine) resulting in prolonged asystole. D. In the pressence of carbamazepine (tegretol), high degree heart block may occour. E. Adenosine is not effective in converting atrial fibrillation, atrial flutter or ventricular tachycardia. F. All doses of adenosine should be reduced to one-half(50%) in the following clinical settings. 1. history of cardiac transplantation. 2. pt's who are on carbamazepine (tegretol) and dipyridamole (persantine).

Side effects and notes: may cause facial flushing, shortness of breath, chest pressure, nausea, headache and light headedness.

Adult dosing: PSVT- 6mg rapid IV. May repeat with 12mg IV x2 if pt fails to convert after 6mg dose. Use a large proximal IV site with fluid bolus flush.

Pediatric dosing: PSVT- 0.1 mg/kg IV. May repeat with 0.2 mg/kg once if pt fails to convert after first dose. Use a large proximal IV site with fluid bolus flush.

Albuterol

(Ventolin)

OLMC Requried: for use in hyperkalemia pt's including crush injury.

Supplied: 2.5mg/3ml vial.

Pharmacology and actions: Albuterol is a potent, relatively selective beta-2 adrenergi bronchodilator and is associated with relaxtion of bronchial smooth muscle and inhibition of release of mediators of immediate sensitivity from cells, epecially MAST cells. The onset of improvement in pulmonary function is within 2-15 mins after the initiation of treatment and the duration of action is from 4-6 hours. Albuterol has occasional beta-1 overlap with clinically significant cardiac effects.

Indications: A. To treat bronchial asthma and reversible bronchial spasm that occurs with chronic obstructive pulmonary disease. B. To treat hyperkalemia.

Contraindications: None in the prehospital setting.

Precautions: A. the pt's rhythm should be observed for arrhythmias. Stop treatment if frequent PVC's develop or any tachyarrhythmias other than sinus tachycardia appear or if heart rate increases by more than 20 beats/minute.  B. Paradoxical bronchspasm may occur with excessive administration.

Side effects and notes: Clinically significant arrythmias may occur, especially in pt's with underlying cardiovascular disorders such as coronary insuffciency and htn.

Adult dosing: Respiratory distress- 2.5mg via nebulizer. Repeat as needed. Hyperkalemia- 10mg via nebulizer.OLMC contact required. Hyperkalemia secondary to crush injury- OLMC contact required.

Pediatric dosing: Same as adult.

Amiodraone

(Cordarone)

OLMC Required: No

Supplied: 150mg/3ml pre-filled syringe or vial.

Pharmacology and actions: Amiodarone depresses automaticity of the SA node. it slows conduction and increases refractoriness of the AV node. Amiodarone increases atrial and ventricular refractory period and prolongs the QT interval. When given IV it is rapidly distributed. no dosage adjustments are needed for pt's with renal, liver or heart failure, or advanced age.

Indications: A. Ventricular fibrillation. B. Ventricular tachycardia with pulses.

Contraindications: None in cardiac arrest.

Precautions: A. In high concentrations(>3mg/ml) Amiodarone can cause phlebitis. Infusion concentrations should not exceed 2mg/ml. B. Amiodarone will precipitate if administered in the same IV as sodium bicarbonate or heparin.

Side effects and notes: A. In prefusing pt's, amiodarone may cause hypotension, prolonged QT interval, proarrhythmic effects(torsades and ventricular fibrillation), severe bradycardia and atrioventricular block. B. Non-cardiac toxicities are usually related to chronic administration and include pulmonary infiltrates, hepatic and/or thyroid disfunction and perhiperal neuropathy.

Adult dosing: V fib, pulseless V tach- 300 mg IV/IO. May repeat once with 150 mg. V tach with a pulse- 150 mg IV/IO. Mix with 100 ml of NS in buretrol and infuse over 10 mins.

Pediatric dosing: V fib, pulseless V tach- 5mg/kg IV/IO. May repeat once with 2.5 mg/kg. V tach with a pulse- 2.5 mg/kg IV/IO. mix with 2 ml/kg of ns in buretrol and infuse over 10 mins.

OLMC Required: No

Supplied: 81mg chewable tablets (children's aspirin)

Pharmacology and actions: Aspirin inhibits prostaglandins and disrupts platelet function for the life of the platelet. it is also a mild analgesic and anti-inflammatory agent.

Indications: In unstable angina and acute myocardial infarction, aspirin has been shown to lower mortality and is indicated in pt's with suspected ischemic chest pain.

Contraindications: A. Allergy to ASA or ASA induced asthma. B. History of bleeding disorder (i.e. hemophilia). C. Current ulcer or GI bleeding. D. Suspected aortic dissection.

Side effects and notes: A. high doses of ASA can cause ringing in the ears. B. May cause heartburn, nausea and vomiting.

Adult dosing: Chest pain (acute myocardial infarction) 324 mg po.

Pediatric dosing: Not indicated for pediatric pt's.