ASA
ASA Indications
Suspected ACS
Dextrose therapeutic Actions
1. Increases blood sugar levels to normal cases in hypoglycemia
2. Hypertonic solution producing a transient movement of water from interstitial spaces into the venous system (osmotic diuretic)
Dimenhydrinate Classifications
Antiemetic
Naloxone indications
1. Respiratory and neurologic depression induced by opiate intoxication unresponsive to oxygen and hyperventilation
2. Decreased LOC or coma of unknown etiology believed to be induced by narcotics
Diphenhydramine classifications
Antihistamine
Epinephrine classifications
Sympathomimetic; endogenous catecholamine
Glucagon trade name
Glucagon
IB Trade name
Atrovent
Nitroglycerine trade name
Nitrostat
Nitrous oxide trade name
entonox
Oral Glucose Action
A simple monosaccharide used to increase circulating blood glucose levels
Salbutamol Indications
Treatment of bronchospasm due to asthma, COPD, anaphylaxis or associated with airway burn injury
ASA Trade Name
Asprin
Dextrose Indications
1. Severe, symptomatic hypoglycemia from any cause 2. Head injury with symptomatic hypoglycemia
3. Stroke with symptomatic hypoglycemia
Dimenhydrinate therapeutic actions
Depresses vestibular (equilibrium) function
2. Sedative effects due to inhibition of histamine
Naloxone pharmacokinetics
Onset: Within two minutes (IV/IO)
Duration of action: Dependent on route, dose and amount of pre-existing opioid present in patient
Diphenhydramine Actions
1. Competes with histamine for H1 receptor sites on effector cells. They thereby prevent, but do not reverse responses mediated by histamine alone
2. Does not inhibit histamine release
Epinephrine trade name
Adrenalin
500mcg q 5 min via neb, max 1500mcg (AHS) OR
MDI with spacer 1 puff (20mcg/puff) q 30-60 sec prn, max 15 puffs (AHS)
Nitroglycerine actions
Causes relaxation of vascular smooth muscle; dilation of both arterial and venous blood vessels, decreasing both preload and afterload. Myocardial perfusion is increased through coronary and collateral blood vessel dilation.
Nitrous oxide classification
Gaseous Analgesic
Oral glucose classification
Caloric Agent
Salbutamol Contraindications
1. Hypersensitivity
2. Uncorrected tachydysrhythmias
Side effects of ASA
1. GI irritation
2. NV
3. Tinnitus
4. Increased risk of bleeding
Dextrose dosage adult
Hypoglycemia
25g D50W SIVP/IO q 5min prn, titrate to BGL >/= 4.0mmol/L or patient improvement to max 50g
Stroke
12.5 g D50W SIVP/IO, repeat 12.5g D50W only if BGL remains < 3.0mmol/L
Head Injury
12.5g D50W SIVP/IO; repeat 12.5g D50W if BGL remains less than 4.0mmol/
Dimenhydrinate Trade name
Benedryl
1. Displaces previously administered opioid analgesics from all three opioid receptor sites and competitively inhibits their actions.
2. Naloxone is metabolized more quickly than most narcotics.
Diphenhydramine Contraindication
Hypersensitivity to either diphenhydramine or dimenhydrinate
Epinephrine indications
Anaphylaxis
Glucagon indications
Confirmed hypoglycemia in which an IV cannot be established
IB indications
1. Bronchospasm
2. Anaphylaxis
Antianginal, Vasodilator
Nitrous oxide dosage
Self-administered prn via specialized demand valve and mask (AHS); Note PSI before use and after for amount taken by patient
Oral glucose contraindications
Unconscious
Hyperglycemic
Salbutamol Classification
Bronchodilator (sympathomimetic)
Contraindications of ASA
1. Hypersensitivity to salicylates/NSAIDS
2. Asthma (relative contraindication)
3. Patients with active ulcer disease (active GI hemorrhage)
4. Bleeding disorders
5. Pregnancy (especially third trimester)
6. Children under 15 years old
7. Unconscious
Dextrose side effects
1. May aggravate hypertension and CHF
2. May cause neurological symptoms in the alcoholic patient
3. Wernicke’s encephalopathy/Korsakoff’s Syndrome
Dimenhydrinate Dosage adult
ADULT: 50mg SIVP/IM q 4 hours
25 mg SIVP/IM for patients over 65 years old prn q 15 mins max 50 mg
Naloxone side effects
1. Restlessness
2. Seizures
3. Narcotic withdrawal
4. Combative
Diphenhydramine Trade name
Benedryl
Epinephrine contraindications
None in emergent situations
2. Hypersensitivity to epinephrine
3. Uncorrected tachydysrhythmias
4. Shock (non-anaphylactic)
Glucagon contraindications
1. Hypersensitivity to glucagon, beef, or pork proteins
2. Pheochromocytoma
IB pharmacokinetics
Onset of action: 5-15 min
Peak: 1-2 hours
Nitroglycerine contraindications
1. Systolic BP less than 100 mmHg
2. Right ventricular infarction
3. Patients taking phosphodiesterase inhibitors
Nitrous oxide pharmacokinetics
Onset: within 1 minute
Duration of action: elimination half-life is approximately five minutes, effect of the gas is usually not noticeable within a few minutes of discontinuing use
Oral Glucose indications
Conscious patients with suspected hypoglycemia
Salbutamol Trade name
Ventolin
Dosage ASA Adult
160mg PO chewed do not repeat
Dextrose trade name
Trick question its dextrose
Dimenhydrinate indications
Nausea and Vomiting associated with motion sickness and vertigo
Narcotic Antagonist
Diphenhydramine Pharmacokinetics
Onset of action: a. PO - 15min
b. IV / IM 5 – 10 mins
Peak effects: 1-4 hours
Epinephrine pharmacokinetics
Onset of Action: 5-10min (IM)
Peak effects: 20 min
Glucagon actions
Causes an increase in blood glucose by stimulating glycogen breakdown in the liver, converting glycogen to glucose.
IB actions
1. Derivative of atropine
2. Exerts anticholinergic action in the bronchioles thereby inhibiting bronchoconstriction
3. Blocks increased mucus secretions
Nitroglycerine indications
Suspected ACS
1. Inability to follow verbal instructions.
2. ALOC and /or Intoxication with drugs or alcohol
3. Head Injury
4. Respiratory compromise where 100% O2 is needed
5. Thoracic trauma with potential or actual pneumothorax (N2O collects in dead air spaces and may increase pneumothorax)
6. Abdominal pain and distension suspicious of bowel obstruction 7. Abdominal Trauma
8. Pregnant (not including active labour)
Oral Glucose Trade name
Dex 4
Salbutamol Pharmacokinetics
Onset: Less than 15 mins 2. Duration of action: 2 – 6 hours
Pharmacokinetics ASA
Onset: 1-2 hrs
Duration 4-5 hrs
Contraindications Dextrose
1. Allergy to corn or corn products
2. Hypersensitivity to dextrose solution
3. Intracranial hemorrhage (half the dose)
4. Hyperglycemia
Dimenhydrinate side effects
1. Drowsiness 2. Sedative effect
Naloxone trade name
Narcan
H1 receptor reactions
Increased bronchial and nasal secretions
• Constriction of bronchioles • Stimulation of sensory nerve endings
(itching)
Epinephrine dosage
0.3mg 1:1,000 IM q 5 min prn, max 0.9mg
Glucagon dosage
1mg IM q 15min prn, total max 2mg (AHS)
IB Classification
Anticholinergic Bronchodilator
Nitroglycerine side effects
1. Headache
2. Hypotension
3. Dizziness/Lightheadedness
4. Nausea/Vomiting
5. Flushing
Nitrous oxide indications
1. Fracture/dislocation management
2. Active Labour
3. Burns
4. Kidney Stones
Oral glucose dosage adult
25 g PO q 5 min prn, max 50 g (AHS)
Salbutamol Actions
1. Selective Beta2 stimulation
2. Bronchodilation, some peripheral vasodilation, slight tachycardia
3. Beta2 selectively lost with high doses (Beta1 effects more common)
ASA classifications
Antiplatelet; analgesic; antipyretic; anti-inflammatory (Nonsteroidal Anti-Inflammatory Drug (NSAID)
Pharmacokinetics Dextrose
Onset: < 1 minute
Duration: varies
Dimenhydrinate contraindications
1. Hypersensitivity to dimenhydrinate and diphenhydramine
2. Narrow angle glaucoma
3. Patients that are intoxicated
Naloxone contraindications
None significant.
*Use with caution in the setting of mixed opioid / stimulant (methamphetamine, cocaine PMMA, MDMA) overdose, since the narcotic may be exerting a mediating effect on sympathomimetic symptoms.
Diphenhydramine Indications
1. Allergic reactions
2. Adjunct to epinephrine (used after epinephrine deployed) in the management of anaphylaxis
3. Management of drug induced extrapyramidal symptoms
Epinephrine side effects
1. Palpitation
2. Tremors
3. Hypertension
4. Tachycardia
5. Nervousness
Glucagon side effects
1. Dizziness
2. Headache
3. Hypertension
4. Tachycardia
IB side effects
1. Dry mouth/throat
2. Headache
3. Cough
4. Palpitations
5. Dizziness
Nitroglycerine dosage
0.4 mg SL spray q 5 min prn or until systolic BP less than 100 mmHg (AHS)
0.8 mg/hr patch (AHS)
Nitrous oxide side effects
1. Dizziness/Lightheaded
2. Drowsiness
3. Headache
4. Nausea/Vomiting
Oral glucose pharmacokinetics
Onset: 5-15 min
Duration of action: varies
Salbutamol Dosages (both MDI and Neb)
1 Puff MDI (100mcg/puff) with spacer q 30-60 secs prn, max 30 puffs Or 5 mg nebulized continuously
ASA Therapeutic Actions
1.Blocks the formation of thromboxane A2, which is responsible for platelets aggregating and arteries constricting
2. Produces analgesia and has anti-inflammatory, and antipyretic effects by inhibiting the
production of prostaglandins.
Dextrose Classifications
Caloric agent
Dimenhydrinate Pharmacokinetics
Onset: IV immediate; IM 20-30 min Duration of action: 3-6 hours
0.4 mg IV/IO push q 2 minutes to total max of 1.6 mg
Or 0.8 mg IM q 5 min prn, total max 3.2mg
Or 2mg intranasal (1mg per nostril) q 3-5 minutes prn, total max 4mg
Diphenhydramine Dosage
ALLERGIC REACTION/ANAPHYLAXIS Adult:
(ELIXIR) 50mg PO Or 1mg / kg IM / SIVP, single max dose 50mg, do not repeat
Epinephrine actions
1. Alpha 1 agonista. Peripheral vasoconstriction improving coronary and cerebral perfusion
2. Beta 1 agonista. Positive chronotropic, inotropic, and dromotropic properties b. Increases automaticity in the heart
3. Beta 2 agonist-
a. Bronchodilation
Glucagon pharmacokinetics
Onset of action: 5-15 minutes (IM)
IB contraindications
Hypersensitivity
Hypersensitivity to atropine
Nitroglycerine pharmacokinetics
Onset: 1-3 min (SL), Patch 40-60 min
Duration of Action: SL - 3-60 min, Patch – 8- 24 hours
Nitrous oxide actions
1. Rapidly reversible CNS depression and analgesia.
2. Inhaled anesthetics act on the lipid matrix of neuronal membranes or other lipophilic sites. This changes the membrane thickness, which in turn affects the gating properties of ion
channels in neurons
Oral glucose side effects
Nausea/Vomiting
Salbutamol Side effects
1. Tremors
2. Palpitations
3. Headache
4. Tachycardia
5. Dizziness
6. Nervousness