Pharmacology
- Acetaminophen (APAP)
- Acetylsalicylic Acid
- Adenosine
- Albuterol
- Amiodarone
- Atropine Sulfate
- Calcium Chloride
- Dextrose
- Diphenhydramine
- Droperidol
- Epinephrine
- Fentanyl Citrate
- Glucagon Hydrochloride
- Glucose
- Hydroxycobalamin (Cyanokit)
- Ipratropium
- Labetalol
- Lidocaine
- Magnesium Sulfate
- Methylprednisolone
- Midazolam
- Morphine Sulfate
- Naloxone Hydrochloride
- Nitroglycerin
- Ondansetron
- Sodium Bicarbonate
- Terbutaline
- Tranexamic Acid (TXA)
Acetaminophen (APAP)
GENERIC NAME
Acetaminophen (APAP)
TRADE NAME
Tylenol
DESCRIPTION
Non-opioid analgesic and antipyretic.
HOW SUPPLIED
Oral Suspension: 160 mg / 5 mL strength
INDICATIONS
- Pain management – mild pain levels
- Fever
CONTRAINDICATIONS
- Active and severe liver disease
- Severe liver impairment
- Allergy or hypersensitivity to acetaminophen
- Do not dose if acetaminophen has been taken within the last 4 hours
PRECAUTIONS
- Monitor for signs of liver toxicity, especially in patients with existing liver conditions.
- Be cautious with dosing in patients who are also taking other medications containing acetaminophen.
- Ensure proper dosage based on weight, particularly in pediatric patients.
MECHANISM OF ACTION
Inhibits specific parts of the cyclooxygenase (COX) pathway in the central nervous system, likely inhibiting the synthesis of prostaglandins involved in pain sensation. Affects the hypothalamus to reduce body temperature.
SIDE EFFECTS
- Skin rash
- Kidney toxicity
- Liver failure in large doses
AUTHORIZATION
EMT: Standing Order
EMT-I: Standing Order
Paramedic: Standing Order
DOSAGE
- Adult: 20 mL of PO liquid medication
- Pediatric:
- Under 2 years: Not recommended
- 2-3 years (24-35 lbs): 5 mL
- 4-5 years (36-47 lbs): 7.5 mL
- 6-8 years (48-59 lbs): 10 mL
- 9-10 years (60-71 lbs): 12.5 mL
- 11 years (72-95 lbs): 15 mL
- 12 years and above (96 lbs and above): 20 mL
Acetylsalicylic Acid
GENERIC NAME
Aspirin
TRADE NAME
Acetylsalicylic Acid
DESCRIPTION
Aspirin works by inhibiting platelet aggregation, which reduces the formation of blood clots. It makes platelets less sticky, helping to prevent clots that can lead to myocardial infarction (MI) or cardiac ischemia.
HOW SUPPLIED
Tablets: 81 mg
INDICATIONS
- Chest pain or discomfort suggestive of myocardial infarction (MI) or cardiac ischemia.
CONTRAINDICATIONS
- Hypersensitivity or allergy to aspirin.
PRECAUTIONS
- Emergency Medical Dispatch (EMD) protocol allows patients to self-administer aspirin. Verify the amount taken before administering additional doses.
- Aspirin may be taken in conjunction with anticoagulants like Coumadin.
- Do not administer if there is evidence of active bleeding.
MECHANISM OF ACTION
Aspirin decreases platelet aggregation and reduces inflammation, which helps prevent blood clot formation in the cardiovascular system.
SIDE EFFECTS
- Gastritis
- Nausea and vomiting
AUTHORIZATION
EMT: Standing Order
AEMT: Standing Order
Paramedic: Standing Order
DOSAGE
- Adult: 324 mg, chewed and swallowed (use baby aspirin if available).
- Pediatric: Not authorized
Adenosine
GENERIC NAME
Adenosine
TRADE NAME
Adenocard
DESCRIPTION
Adenosine is a naturally occurring substance present in all cells that slows conduction through the AV node of the heart. Due to its rapid onset of action and short half-life, the administration of Adenosine is sometimes referred to as "chemical cardioversion."
HOW SUPPLIED
Vial and pre-filled syringe: 6 mg/2 mL
INDICATIONS
- Paroxysmal Supraventricular Tachycardia (PSVT) refractory to common vagal maneuvers
- Wide Complex Tachycardia with a pulse
CONTRAINDICATIONS
- Hypersensitivity or allergy to adenosine
- Second- or third-degree heart block
- Sick sinus syndrome
MECHANISM OF ACTION
Adenosine decreases conduction of the electrical impulse through the AV node, which can terminate rapid supraventricular arrhythmias such as PSVT. The half-life of Adenosine is approximately 5 seconds.
SPECIAL CONSIDERATIONS
The preferred IV site is the antecubital fossa with an 18 gauge or larger catheter. Administer via the port closest to the IV catheter for rapid delivery.
SIDE EFFECTS
- Facial flushing
- Headache
- Shortness of breath
- Chest pain or tightness
- Dizziness
- Nausea
- Other transient symptoms due to the brief half-life of adenosine
AUTHORIZATION
Paramedic: Standing Order and Medical Control
DOSAGE
- Adult:
- 1st dose: 6 mg Rapid IV/IO push, followed immediately by a 10 – 20 mL saline bolus
- 2nd dose: 12 mg Rapid IV/IO push, followed immediately by a 10 – 20 mL saline bolus
- 3rd dose: 12 mg Rapid IV/IO push, followed immediately by a 10 – 20 mL saline bolus
- Pediatric:
- 1st dose: 0.1 mg/kg (max 6 mg) Rapid IV/IO push, followed immediately by a 10 mL saline bolus
- 2nd dose: 0.2 mg/kg (max 12 mg) Rapid IV/IO push, followed immediately by a 10 mL saline bolus
- 3rd dose: 0.2 mg/kg (max 12 mg) Rapid IV/IO push, followed immediately by a 10 mL saline bolus
Albuterol
GENERIC NAME
Albuterol
TRADE NAME
Proventil, Ventolin
CLASS
Sympathetic Agonist
HOW SUPPLIED
Pre-mixed vial: 2.5 mg in 3 mL saline
INDICATIONS
- Based on patient condition, paramedics may consider any of the dosing regimens listed below.
- Wheezing or diminished breath sounds due to acute bronchospasm (Asthma, COPD)
- Bronchospasm associated with chronic bronchitis, emphysema, allergic reaction, or toxic inhalation
CONTRAINDICATIONS
- Hypersensitivity or allergy to Albuterol
MECHANISM OF ACTION
Albuterol causes bronchodilation with minimal side effects. The duration of action is approximately 5 hours.
SIDE EFFECTS
- Palpitations
- Anxiety
- Dizziness
- Headache
- Nervousness
- Tremor
- Hypertension
- Arrhythmias
- Chest pain
- Nausea and vomiting
AUTHORIZATION
EMT: Standing Order
AEMT: Standing Order
Paramedic: Standing Order
DOSAGE
- All Patients:
- 1st Dose: Albuterol 2.5 mg via nebulizer
- 2nd Dose: Albuterol 2.5 mg and Atrovent 500 mcg via nebulizer
- 3rd Dose: Albuterol 7.5 mg and Atrovent 500 mcg via nebulizer or BVM with in-line nebulizer
Amiodarone
GENERIC NAME
Amiodarone
TRADE NAME
Cordarone
DESCRIPTION
An antiarrhythmic medication indicated for the treatment of documented, recurrent, life-threatening ventricular arrhythmias.
HOW SUPPLIED
150 mg/3 mL pre-filled syringe
INDICATIONS
- Ventricular Fibrillation (VF)
- Ventricular Tachycardia (VT)
- Supraventricular Tachycardia (SVT) with aberrancy
- Indicated only for patients with life-threatening arrhythmias
CONTRAINDICATIONS
- Hypersensitivity or allergy to Amiodarone
- Iodine allergy
- Cardiogenic shock
- Pregnancy, except in life-threatening situations
MECHANISM OF ACTION
Amiodarone prolongs the duration of the action potential of all cardiac fibers, which helps reduce arrhythmias.
SIDE EFFECTS
- Heart blocks
- Cardiac arrest
AUTHORIZATION
Paramedic: Standing Order
DOSAGE
- Cardiac Arrest (VT/VF):
- Adult: 300 mg IV/IO push during the third set of 200 compressions. Repeat once with 150 mg IV/IO (maximum dose: 450 mg).
- Pediatric: 5 mg/kg IV/IO push
- Tachycardia (Wide Complex with Pulse):
- Adult: 150 mg drip over 10 minutes (mix 150 mg in 100 mL D5W; run wide open with 60 gtts tubing)
- Pediatric: Not given
Atropine Sulfate
GENERIC NAME
Atropine Sulfate
TRADE NAME
None
DESCRIPTION
Atropine is used to increase slow heart rates and to treat organophosphate and nerve agent poisoning.
HOW SUPPLIED
- Prefilled syringe: 1.0 mg / 10 mL
- DuoDote: One auto-injector containing both 600 mg Pralidoxime chloride and 2.1 mg Atropine
- Mark I Kit: One auto-injector containing 600 mg Pralidoxime chloride and one auto-injector containing 2 mg Atropine
INDICATIONS
- Hemodynamically significant bradycardia
- Organophosphate poisoning
- WMD Nerve Agent poisoning
CONTRAINDICATIONS
- Hypersensitivity or allergy to Atropine
MECHANISM OF ACTION
Atropine sulfate increases heart rate by blocking the parasympathetic nervous system and its inhibitory effects on heart rate. It is used when a slow heart rate is accompanied by hypotension, shortness of breath, chest pain, altered mental status, congestive heart failure, or shock. It also reverses the effects of parasympathetic overstimulation seen in organophosphate poisoning.
SIDE EFFECTS
- Blurred vision
- Dilated pupils
- Dry mouth
- Palpitations
- Tachycardia
- Drowsiness
- Confusion
- Paradoxical bradycardia if less than 0.5 mg is given to adults
AUTHORIZATION
EMT: Standing order when DuoDote or Mark I Kit is necessary for WMD Nerve Agents; all other usages not authorized
AEMT: Standing order when DuoDote or Mark I Kit is necessary for WMD Nerve Agents; all other usages not authorized
Paramedic: Standing Order
DOSAGE
- Bradycardia:
- Adult: 0.5 mg IV/IO every 3–5 minutes, with a maximum total dose of 3 mg
- Infant & Child: 0.02 mg/kg IV/IO every 3–5 minutes, with a maximum total dose of 3 mg (single dose minimum 0.1 mg; maximum 0.5 mg)
- Overdose / Poisoning (Organophosphate Poisoning) / WMD:
- Adult: 2–4 mg IV/IO every 5 minutes until secretions dry (No total maximum dose)
- Pediatric: 0.05 mg/kg IV/IO every 5 minutes until secretions dry (single dose minimum 0.1 mg; maximum 0.5 mg; No total maximum dose)
Calcium Chloride
GENERIC NAME
Calcium Chloride
TRADE NAME
None
DESCRIPTION
Calcium chloride provides elemental calcium in the form of the cation (Ca++). Calcium is essential for many physiological activities, including muscle contraction and neurotransmitter release.
HOW SUPPLIED
Prefilled syringe: 1 gm/10 ml
INDICATIONS
- Calcium channel blocker toxicity (e.g., overdose of drugs such as Nifedipine, Verapamil).
- Hyperkalemia
CONTRAINDICATIONS
- Hypersensitivity or allergy
PRECAUTIONS
- Calcium chloride can cause severe local necrosis if IV infiltration occurs.
- Calcium chloride can precipitate when mixed with certain drugs, notably Sodium bicarbonate. Always flush the IV line with 10–20 ml of IV fluid after administering Calcium chloride and before administering any other medication.
MECHANISM OF ACTION
- Increases myocardial contractility significantly and may enhance ventricular automaticity.
- Mitigates the hypotensive effects of calcium channel blocker drugs.
- Pediatric patients require a higher dose due to faster calcium metabolism.
SIDE EFFECTS
- Bradycardia
- Arrhythmias
AUTHORIZATION
Paramedic: Standing order
DOSAGE
- Adult: 10 mg/kg (0.1 ml/kg) IV/IO push
- Pediatric: 20 mg/kg (0.2 ml/kg) IV/IO push
Dextrose
GENERIC NAME
Dextrose
TRADE NAME
Dextrose 10
DESCRIPTION
Dextrose is a simple sugar that is rapidly metabolized by the body, providing quick restoration of blood glucose levels.
HOW SUPPLIED
Prefilled bag: 25 grams/250 ml (10% solution)
INDICATIONS
- Hypoglycemia
CONTRAINDICATIONS
- No major contraindications for IV administration of Dextrose.
- Known or suspected CVA (stroke) in the absence of hypoglycemia.
MECHANISM OF ACTION
Rapidly restores blood glucose levels in cases of hypoglycemia.
SIDE EFFECTS
- Local venous irritation and potential tissue necrosis if IV infiltration occurs.
AUTHORIZATION
AEMT: Standing order
Paramedic: Standing order
DOSAGE
- Adult: 250 ml IV/IO wide open, may repeat once if blood glucose remains < 60 mg/dL.
- Pediatric: 5 ml/kg (0.5 g/kg) IV/IO, may repeat once if blood glucose remains < 60 mg/dL.
ADMINISTRATION NOTES
- If desired dose is ≤ 100 ml, draw the required amount of D10 into a syringe and administer via slow IV/IO push using the port closest to the patient.
- If the desired dose is > 100 ml, administer by running wide open as a piggy-back to Normal Saline.
Diphenhydramine
GENERIC NAME
Diphenhydramine
TRADE NAME
Benadryl
DESCRIPTION
Diphenhydramine is a potent antihistamine with both antihistamine and mild sedative properties.
HOW SUPPLIED
Ampule and pre-filled syringe: 50 mg/mL
INDICATIONS
- Anaphylaxis
- Allergic reactions
CONTRAINDICATIONS
- Allergy or hypersensitivity to diphenhydramine
MECHANISM OF ACTION
- Blocks the effects of histamine, preventing bronchoconstriction and vasodilation.
- Produces mild sedative effects.
SIDE EFFECTS
- Hypotension
- Headache
- Palpitations
- Tachycardia
- Sedation and drowsiness
- Disturbed coordination
AUTHORIZATION
AEMT: Standing order (IM only)
Paramedic: Standing order
DOSAGE
- Adult:
- 25 mg, slow IV/IO push or IM for mild allergic reaction
- 50 mg, slow IV/IO push or IM for severe allergic reaction
- Pediatric:
- 1 mg/kg, slow IV/IO push or IM (max dose 25 mg) for mild or moderate reaction
- 1 mg/kg, slow IV/IO push or IM (max dose 50 mg) for severe reaction
Droperidol
GENERIC NAME
Droperidol
TRADE NAME
Inapsine
DESCRIPTION
Droperidol (Inapsine) is a potent antiemetic and antipsychotic medication used for nausea, vomiting, and chemical restraint in agitated or violent patients.
HOW SUPPLIED
Intramuscular injection solution: 2.5 mg/1 mL
INDICATIONS
- Nausea and vomiting
- Sedation of acutely agitated and/or violent patients (chemical restraint)
CONTRAINDICATIONS
- Known hypersensitivity to Droperidol
MECHANISM OF ACTION
Droperidol is a butyrophenone neuroleptic (antipsychotic) that acts by antagonizing dopamine receptors in the central nervous system, similar to haloperidol.
SIDE EFFECTS
- Sinus tachycardia
- Hypotension
- Dystonic reactions
- Hallucinations
- Drowsiness
- Dizziness
- Chills
- Anxiety
AUTHORIZATION
Paramedic: Standing order
DOSAGE
- Adult:
- Active vomiting: 1.25 mg IV; may repeat once after 10 minutes with Medical Control approval (max dose 2.5 mg).
- Agitated/Psychosis (RASS Score +2): 5 mg IM.
- Violent Patient (RASS Score ≥ +3): 10 mg IM; may repeat once after 20 minutes with Medical Control approval.
- Pediatric: Not given
Epinephrine
GENERIC NAME
Epinephrine 1:1,000 and Epinephrine 1:10,000
TRADE NAME
None
DESCRIPTION
Epinephrine is a naturally occurring potent stimulant with rapid onset of action. Its effects usually occur within seconds and are typically of short duration.
HOW SUPPLIED
- 1:1,000 - Ampule: 1 mg/ml
- 1:10,000 - Prefilled syringe: 1 mg/10 ml
INDICATIONS
- Cardiac arrest
- Severe anaphylaxis
- Severe bronchospasm
- Severe symptoms of croup (e.g., sternal retractions, agitation, fatigue)
- Hypotension post-resuscitation
CONTRAINDICATIONS
- Allergy or hypersensitivity to Epinephrine
PRECAUTIONS
- Consider risk/benefit in patients with allergic reactions and history of coronary artery disease, as Epinephrine may precipitate acute myocardial infarction (MI).
- Use caution in patients with tachycardia, especially if heart rate > 200/min.
- Use with caution in patients with diabetes mellitus.
- Use with caution in patients with hyperthyroidism.
MECHANISM OF ACTION
- Increases heart rate and contractile force.
- Increases electrical activity in the myocardium.
- Increases systemic vascular resistance and blood pressure.
- Induces bronchodilation.
SIDE EFFECTS
- Tachycardia
- Hypertension
- Palpitations
- Anxiety
- Tremors
- Headache
- Dizziness
- Nausea and vomiting
- Increased myocardial oxygen demand
AUTHORIZATION
AEMT: Standing order for patients in cardiac arrest (all doses except push dose and nebulized); standing order for 1st dose in non-cardiac arrest situations
Paramedic: Standing order for all doses, including push dose and nebulized
DOSAGE
Allergic Reaction / Anaphylaxis
- Adult:
- 1st dose: 1:1,000 - 0.3 mg SQ/IM
- Additional doses: 1:10,000 - 0.3 mg IV/IO push
- Pediatric:
- 1st dose: 1:1,000 - 0.01 mg/kg SQ/IM (max 0.3 mg)
- Additional doses: 1:10,000 - 0.01 mg/kg IV/IO push (max 0.3 mg)
Bradycardia
- Child: 1:10,000 - 0.01 mg/kg IV/IO push every 3–5 minutes (Paramedic only)
- Infant: 1:10,000 - 0.01 mg/kg IV/IO push every 3–5 minutes (Paramedic only)
Cardiac Arrest
- Adult:
- 1st dose: 1:10,000 - 1 mg IV/IO push
- Additional doses: 1:10,000 - 1 mg IV/IO push every 3–5 minutes (max of 3 doses)
- Pediatric:
- 1st dose: 1:10,000 - 0.01 mg/kg IV/IO (max 1 mg)
- Additional doses: 1:10,000 - 0.01 mg/kg IV/IO every 3–5 minutes (max of 3 doses)
Newborn Care and Resuscitation
- Newborn: 1:10,000 - 0.01 mg/kg IV/IO push (max of 3 doses)
Push Dose Epinephrine
- Using 1:10,000: Waste 1 ml of a 10 ml Normal Saline flush and draw up 1 ml of Epinephrine 1:10,000. Dose is 0.5–2 ml (5–20 mcg) IV/IO push.
- Using 1:1,000: Inject 1 mg/1 ml of Epinephrine 1:1,000 into a 100 ml Normal Saline bag. Dose is 0.5–2 ml (5–20 mcg) IV/IO push.
Croup
- Adult/Pediatric: 0.3 mg (1:10,000) mixed with 3 ml Normal Saline, nebulized; may repeat once as needed.
Fentanyl Citrate
GENERIC NAME
Fentanyl Citrate
TRADE NAME
Fentanyl
DESCRIPTION
Fentanyl is a potent narcotic analgesic used for pain management. It acts quickly and has a short duration of action, making it suitable for trauma patients experiencing pain.
HOW SUPPLIED
Prefilled Syringe: 100 mcg/2 ml
INDICATIONS
- All trauma patients with pain
CONTRAINDICATIONS
- Allergy or hypersensitivity to Fentanyl
- Acute respiratory compromise or bradycardia
MECHANISM OF ACTION
Fentanyl Citrate binds with opiate receptors in the central nervous system, altering the perception of and emotional response to pain.
SIDE EFFECTS
- Nausea
- Vomiting
- Abdominal cramps
- Headache
- Anxiety
- Respiratory depression
AUTHORIZATION
Paramedic: Standing order
DOSAGE
- Adult:
- IV/IO/IM: 100 mcg, may repeat once after 10 minutes (max 200 mcg total)
- IN: 200 mcg (administer half in each nostril), may repeat once after 10 minutes (max 400 mcg total)
- For patients ≥ 65 years: 25 mcg per dose, titrate to effect
- Pediatric:
- IV/IO/IM: 1 mcg/kg, may repeat once after 10 minutes (max 72 mcg total)
- IN: 2 mcg/kg (administer half in each nostril), may repeat once after 10 minutes (max 144 mcg total)
Glucagon Hydrochloride
GENERIC NAME
Glucagon Hydrochloride
TRADE NAME
None
DESCRIPTION
Glucagon is used to increase blood glucose levels, particularly in cases where an IV line cannot be immediately established. Intramuscular (IM) administration results in a quicker onset than subcutaneous (SQ) and is therefore the preferred route.
HOW SUPPLIED
Vial: 1 mg powder (activated by injection of 1 cc sterile water)
INDICATIONS
- Hypoglycemia
CONTRAINDICATIONS
- Allergy or hypersensitivity to Glucagon
MECHANISM OF ACTION
Glucagon increases circulating blood glucose levels by promoting the breakdown of stored glycogen to glucose. Return to consciousness typically occurs within 5–20 minutes after administration. However, Glucagon may lose its effectiveness if given within the previous 48 hours.
SIDE EFFECTS
- Hypotension
- Dizziness
- Headache
- Nausea and vomiting
ADDITIONAL INFORMATION
After administration of Glucagon, the patient should eat a carbohydrate-rich meal as soon as possible to prevent recurrent hypoglycemia.
AUTHORIZATION
Paramedic: Standing order
DOSAGE
- Adult: 1 mg IM/SQ
- Pediatric < 20 kg: Refer to specific dosages listed in the 402 – Drug Dosage Chart – Pediatric
- Pediatric > 20 kg: 1 mg IM/SQ
Glucose
GENERIC NAME
Glucose
TRADE NAME
Glutose, Insta-Glucose
DESCRIPTION
Oral glucose is used to provide supplemental glucose in cases of hypoglycemia. It is administered when the patient is conscious and able to swallow.
HOW SUPPLIED
Tube: 15 gm
INDICATIONS
- Hypoglycemia
CONTRAINDICATIONS
- Allergy or hypersensitivity to glucose
- Patient is not awake or unable to swallow
MECHANISM OF ACTION
Oral glucose restores blood sugar levels in patients experiencing hypoglycemia.
SIDE EFFECTS
- None
AUTHORIZATION
EMT: Standing order
AEMT: Standing order
Paramedic: Standing order
DOSAGE
- Adult: 15 gm (1 tube) orally
- Pediatric: 15 gm (1 tube) orally
Hydroxycobalamin (Cyanokit)
GENERIC NAME
Hydroxycobalamin
TRADE NAME
Cyanokit
DESCRIPTION
Cyanokit is an antidote for cyanide poisoning.
HOW SUPPLIED
5 gram single-dose vial of dark red crystalline powder
PREPARATION
Without removing the vial from the box, transfer 200 ml of Normal Saline from an IV bag to the 5 gram Cyanokit vial using the transfer spike, filling to the line on the vial. Rock or invert the vial repeatedly (do not shake) for at least 60 seconds. Verify that no particulate matter is present and the solution is dark red. Attach the included IV tubing to the Cyanokit vial. For adults, administer the entire vial by running the IV wide open. For pediatric patients, use the dosing chart below and administer over 15 minutes.
INDICATIONS
- Patients with known or suspected exposure to both carbon monoxide and cyanide, with moderate or severe symptoms (e.g., confusion, altered mental status, coma, hypotension, cardiac dysrhythmias, respiratory or cardiac arrest).
- Patients at high risk include victims of closed-space fires with smoke inhalation.
CONTRAINDICATIONS
- No contraindications in emergency situations for patients exposed to both carbon monoxide and cyanide.
- Patients exposed only to cyanide should not be treated with Cyanokit; they should receive the traditional cyanide antidote kit at a hospital.
MECHANISM OF ACTION
Hydroxycobalamin has a higher affinity for cyanide than hemoglobin, preventing cyanide from binding to hemoglobin. When cyanide binds to hydroxycobalamin, it is converted into a form of Vitamin B12, which is then excreted harmlessly in the urine.
SPECIAL CONSIDERATIONS
None in prehospital emergencies.
SIDE EFFECTS
- Substantial increase in blood pressure may occur during administration, but it typically resolves quickly after the infusion is completed.
- May change the pigmentation of blood, which can interfere with the RAD-57 oximeter reading and may complicate dialysis in patients with renal disease.
- There are multiple other side effects, but none should prevent the administration of the full dose.
AUTHORIZATION
AEMT: Standing order and Medical Control
Paramedic: Standing order and Medical Control
DOSAGE
- Adult: 5 grams, run IV wide open
- Pediatric: Total volume according to weight, administer as an IV drip over 15 minutes
PEDIATRIC DOSING CHART
| Patient Weight (kg) | Total Volume (ml) over 15 min | Drops per Min (with tubing supplied in Cyanokit) |
|---|---|---|
| 4 | 16 | 16 |
| 5 | 20 | 20 |
| 6 | 24 | 24 |
| 7 | 28 | 28 |
| 8 | 32 | 32 |
| 9 | 36 | 36 |
| 10 | 40 | 40 |
| 11 | 44 | 44 |
| 12 | 48 | 48 |
| 13 | 52 | 52 |
| 14 | 56 | 56 |
| 15 | 60 | 60 |
| 16 | 64 | 64 |
| 17 | 68 | 68 |
| 18 | 72 | 72 |
| 19 | 76 | 76 |
| 20 | 80 | 80 |
| 21 | 84 | 84 |
| 22 | 88 | 88 |
| 23 | 92 | 92 |
| 24 | 96 | 96 |
| 25 | 100 | 100 |
| 26 | 104 | 104 |
| 27 | 108 | 108 |
| 28 | 112 | 112 |
| 29 | 116 | 116 |
| 30 | 120 | 120 |
| 31 | 124 | 124 |
| 32 | 128 | 128 |
| 33 | 132 | 132 |
| 34 | 136 | 136 |
| 35 | 140 | 140 |
| 36 | 144 | 144 |
| 37 | 148 | 148 |
| 38 | 152 | 152 |
| 39 | 156 | 156 |
Ipratropium
GENERIC NAME
Ipratropium
TRADE NAME
Atrovent
DESCRIPTION
Ipratropium is an anticholinergic bronchodilator chemically related to Atropine. It is a parasympatholytic agent used in the treatment of respiratory emergencies. Ipratropium causes bronchodilation and helps to dry respiratory secretions.
HOW SUPPLIED
Vial: 500 mcg in 2.5 mL saline
INDICATIONS
- Dyspnea with wheezing that is unresponsive to Albuterol
CONTRAINDICATIONS
- Allergy or hypersensitivity to Ipratropium
MECHANISM OF ACTION
Ipratropium blocks acetylcholine receptors, inhibiting parasympathetic stimulation, leading to bronchodilation and reduced mucus production.
SIDE EFFECTS
- Palpitations
- Anxiety
- Dizziness
- Headache
- Nervousness
- Nausea
- Vomiting
AUTHORIZATION
EMT: Standing order
AEMT: Standing order
Paramedic: Standing order
DOSAGE
- Adult: 500 mcg Ipratropium combined with 2.5 mg Albuterol, nebulized
- Pediatric: 500 mcg Ipratropium combined with 2.5 mg Albuterol, nebulized
Labetalol
GENERIC NAME
Labetalol
TRADE NAME
Trandate
DESCRIPTION
Labetalol is a selective Alpha and Beta-Blocker used to manage hypertensive emergencies. It lowers blood pressure by decreasing systemic vascular resistance without significantly affecting stroke volume, heart rate, or cardiac output.
HOW SUPPLIED
Vial: 5 mg/ml (100 mg/20 ml)
INDICATIONS
- Hypertensive emergencies with acute neurological symptoms and signs of end-organ damage
CONTRAINDICATIONS
- Hypersensitivity to Labetalol
- Pulmonary edema/crackles or overt cardiac failure
- Cardiogenic shock
- Second or third-degree AV blocks
- Heart rate less than 70 bpm
MECHANISM OF ACTION
Labetalol blocks both Alpha- and Beta-adrenergic receptors. It reduces blood pressure by decreasing systemic vascular resistance, with minimal effect on stroke volume, heart rate, and cardiac output. Onset of action is typically within 5 minutes.
SIDE EFFECTS
- Nausea
- Vomiting
- Dizziness
- Bradycardia
- Hypotension
AUTHORIZATION
Paramedic: Standing order
DOSAGE
- Adult: 10 mg IV/IO over 2 minutes. May repeat dose after 10 minutes with Medical Control approval, up to a maximum of 30 mg. (Do not reduce the initial blood pressure by more than 25% in the first hour.)
- Pediatric: Contact Medical Control
Lidocaine
GENERIC NAME
Lidocaine
TRADE NAME
Xylocaine
DESCRIPTION
Lidocaine is an antiarrhythmic and local anesthetic that also helps reduce intracranial and intraocular pressures. It is commonly used for its effects on the heart's electrical conduction system and for pain management during certain medical procedures.
HOW SUPPLIED
Prefilled syringe: 100 mg/5 ml
INDICATIONS
- Ventricular fibrillation (VF)
- Head injury
- Pain prevention during intraosseous (IO) infusion
- Intubation of patients with penetrating eye injury
CONTRAINDICATIONS
- Allergy or hypersensitivity to Lidocaine
- Usually contraindicated in second-degree Mobitz II and third-degree heart blocks
MECHANISM OF ACTION
- Suppresses ectopic ventricular activity by decreasing the excitability of the heart and its electrical conduction system, preventing premature ventricular contractions from inducing ventricular fibrillation.
- Suppresses ventricular tachycardia (VT) and ventricular fibrillation (VF).
- Decreases intracranial pressure during intubation.
SIDE EFFECTS
- Drowsiness
- Seizures
- Confusion
- Hypotension
- Bradycardia
- Heart blocks
- Nausea
- Vomiting
- Respiratory and cardiac arrest
AUTHORIZATION
Paramedic: Standing order
DOSAGE
IO Insertion (for pain control prior to infusion)
- Adult: 50 mg
- Pediatric: 0.5 mg/kg
Cardiac Arrest (with VF/VT)
- Adult: 1.5 mg/kg IV/IO for the first dose. Subsequent doses: 0.5 mg/kg IV/IO every 3–5 minutes, up to a maximum of 3 mg/kg.
- Pediatric: 1 mg/kg IV/IO every 5 minutes, up to a maximum of 3 mg/kg.
Head/Spinal Cord Injury (head-injured patients requiring intubation)
- All patients: 1 mg/kg IV/IO push prior to intubation, if available
Tachycardia: Wide Complex - No Pulse
- Adult: 1 mg/kg IV/IO push every 5 minutes, up to a maximum of 3 mg/kg.
Tachycardia: Wide Complex with Pulse
- Adult: 1 mg/kg IV/IO push every 5 minutes, up to a maximum of 3 mg/kg.
Magnesium Sulfate
GENERIC NAME
Magnesium Sulfate
TRADE NAME
None
DESCRIPTION
Magnesium Sulfate is used to decrease seizure activity in eclampsia and to terminate certain ventricular arrhythmias, including Torsades de Pointes.
HOW SUPPLIED
Vial: 50% solution in 10 mL (5 grams in 10 mL)
PREPARATION
- For Torsades de Pointes: Draw up in syringe for IV/IO administration.
- For Eclampsia: Mix 4 grams in 100 ml Normal Saline (NS) and drip over 15 minutes.
INDICATIONS
- Pre-Eclampsia / Eclampsia (seizures during pregnancy)
- Torsades de Pointes
- Dyspnea – Respiratory Distress
CONTRAINDICATIONS
- Allergy or hypersensitivity to Magnesium Sulfate
MECHANISM OF ACTION
Magnesium Sulfate acts as a central nervous system depressant, primarily used to manage convulsions associated with pregnancy and to correct severe magnesium deficiency linked to certain cardiac arrhythmias.
SIDE EFFECTS
- Vomiting
- Flushing
- Sweating
- Bradycardia
- Drowsiness
- Respiratory depression
- Arrhythmias
- Hypotension
AUTHORIZATION
Paramedic: Standing order and Medical Control
DOSAGE
Cardiac Arrest – Suspected Torsades de Pointes
- Adult: Standing order: 2 grams IV/IO, push over 4 minutes
- Pediatric: Standing order: 50 mg/kg IV/IO, push over 4 minutes, max dose 2 grams
Eclampsia (Seizures During Pregnancy)
- Adult: Standing order: 4 grams IV/IO, drip over 15 minutes
- Additional Doses: Contact Medical Control for further administration of Magnesium Sulfate
Pre-Eclampsia
- Adult: Contact Medical Control for possible administration of Magnesium Sulfate, max dose 2 grams over 15 minutes in 100 ml NS
Dyspnea – Respiratory Distress
- Adult: Standing order: Magnesium Sulfate 2 grams in 100 ml Normal Saline, infused over 20 minutes IV/IO
Methylprednisolone
GENERIC NAME
Methylprednisolone
TRADE NAME
Solu-Medrol
DESCRIPTION
Methylprednisolone is an anti-inflammatory agent used to manage severe bronchoconstriction and other inflammatory conditions. It suppresses the immune response, particularly in allergic reactions.
HOW SUPPLIED
Unmixed vial: 125 mg
INDICATIONS
- Severe bronchoconstriction and/or impending respiratory failure due to anaphylaxis, asthma, or exacerbation of COPD
CONTRAINDICATIONS
- Allergy or hypersensitivity to Methylprednisolone
MECHANISM OF ACTION
Methylprednisolone acts as an anti-inflammatory agent, suppressing the immune response and reducing inflammation, particularly in allergic and respiratory conditions.
SIDE EFFECTS
- No significant side effects of any frequency
AUTHORIZATION
Paramedic: Standing order
DOSAGE
- Adult: 125 mg IV/IO/IM
- Pediatric: 2 mg/kg IV/IO/IM, max dose 125 mg
Midazolam
GENERIC NAME
Midazolam
TRADE NAME
Versed
DESCRIPTION
Midazolam is a short-acting, water-soluble benzodiazepine that depresses the central nervous system (CNS), producing sedation and decreased responsiveness to commands.
HOW SUPPLIED
1 mg/ml (5 ml vial)
INDICATIONS
- Active seizures
- Sedation prior to cardioversion
- Sedation for administering CPAP
- Violent patients with extreme agitation
- Post resuscitation – sedation for agitation after intubation
CONTRAINDICATIONS
- Allergy or hypersensitivity to Midazolam
PRECAUTIONS
- Respiratory depression
- Hypotension
MECHANISM OF ACTION
Midazolam produces CNS depression, causing drowsiness and decreased responsiveness to commands.
SIDE EFFECTS
- Respiratory depression
- Hypotension
HOW ADMINISTERED
- IV/IO: Administer no faster than 5 mg over 2 minutes. For seizures, give in 2 mg increments, titrating to effect. Allow at least 10 minutes between doses.
- IM: Allow at least 10 minutes between doses. Total dosage may require two injections if volume exceeds the maximum single IM volume.
- IN: Deliver half of each dose per nostril. Allow at least 10 minutes between doses. Use the intranasal route only if IV/IO access is unavailable.
AUTHORIZATION
Paramedic: Standing order and Medical Control
DOSAGE
| Indication | Route | Adult Dosage | Pediatric Dosage |
|---|---|---|---|
| Seizure / Agitation / Violent Patient | IV/IO/IM | 2–5 mg, may repeat every 5 min, max 10 mg total | ≥ 13 years: 2–5 mg, may repeat every 5 min, max 10 mg total < 13 years: 0.1 mg/kg, max 10 mg total |
| Seizure / Agitation / Violent Patient | IN | 5 mg (½ dose per nostril), may repeat every 5 min, max 10 mg total | ≥ 13 years: 5 mg (½ dose per nostril), may repeat every 5 min, max 10 mg total < 13 years: 0.2 mg/kg, max 10 mg total |
| Bradycardia (prior to pacing) / Tachycardia (prior to cardioversion) | IV/IO | 2–5 mg, do not repeat | 0.1 mg/kg, max 5 mg |
| CPAP Sedation (Respiratory Distress) | IV/IO/IM | 0.5 mg, may repeat every 5 min, max 2 mg total | No pediatric protocol |
| Post Resuscitation (Sedation for agitation after intubation) | IV/IO/IM/IN | 2–5 mg, may repeat up to a total of 10 mg | 1 mg IV/IO, may repeat up to a total of 5 mg |
Notes:
- For all IV/IO administrations, administer no faster than 5 mg over 2 minutes.
- For IM administrations, total volume may require two injections if exceeding the maximum single IM volume.
- For IN administrations, deliver half of each dose per nostril. Use this route only if IV/IO access is not established.
Morphine Sulfate
GENERIC NAME
Morphine Sulfate
TRADE NAME
Morphine
DESCRIPTION
Morphine Sulfate is an opioid pain reliever used to manage moderate to severe pain. It acts as a central nervous system depressant, providing both analgesia and sedation.
HOW SUPPLIED
Ampule and multi-dose vial: 10 mg/1 ml
INDICATIONS
- Patients with pain of non-traumatic origin
- Burn patients with pain
- Analgesia prior to cardioversion
CONTRAINDICATIONS
- Allergy or hypersensitivity to Morphine
- Should not be used in trauma patients (other than burn injuries)
- Undiagnosed head injury or sudden onset of altered mental status
MECHANISM OF ACTION
Morphine Sulfate acts as a central nervous system depressant, providing pain relief and sedation by binding to opioid receptors in the brain and spinal cord.
SIDE EFFECTS
- Nausea
- Vomiting
- Abdominal cramps
- Blurred vision
- Constricted pupils
- Altered mental status
- Headache
- Respiratory depression
AUTHORIZATION
Paramedic: Standing order and Medical Control
DOSAGE
| Patient Type | Route | Standard Dosage | Maximum Dosage |
|---|---|---|---|
| Adult (Non-burn pain) | IV/IO/IM | 2–5 mg slow push | 10 mg total |
| Adult (Burn patients) | IV/IO/IM | 2–5 mg slow push | 20 mg total |
| Pediatric (Non-burn pain) | IV/IO/IM | 0.1 mg/kg slow push | 5 mg total |
| Pediatric (Burn patients) | IV/IO/IM | 0.1 mg/kg slow push | 10 mg total |
Administration Notes:
- Administer Morphine slowly over several minutes to avoid rapid onset of side effects, particularly respiratory depression.
- Monitor respiratory status closely, especially in patients with underlying respiratory conditions.
- For burn patients, higher maximum dosages are permitted due to the severity of pain.
Naloxone Hydrochloride
GENERIC NAME
Naloxone Hydrochloride
TRADE NAME
Narcan
DESCRIPTION
Naloxone is used to reverse the effects of narcotic overdose, including respiratory depression caused by both natural and synthetic narcotic analgesics.
HOW SUPPLIED
Prefilled syringe: 2 mg / 2 mL
INDICATIONS
- Complete or partial reversal of central nervous system depression, especially in cases of respiratory depression caused by narcotics and synthetic narcotic analgesics
CONTRAINDICATIONS
- Allergy or hypersensitivity to Naloxone
- Patients who have been intubated
MECHANISM OF ACTION
Naloxone reverses the effects of natural and synthetic narcotic agents, including respiratory depression, by competitively binding to opioid receptors in the central nervous system.
SIDE EFFECTS
- Flushing
- Nausea
- Vomiting
- Can induce rapid withdrawal symptoms in patients dependent on narcotics (use cautiously and only when respiratory depression is present)
- IM administration has a longer onset of action compared to IV administration
AUTHORIZATION
EMT: Standing order (first dose only, IM/IN only)
AEMT: Standing order (first dose only, IM/IN only)
Paramedic: Standing order
DOSAGE
| Patient Type | Route | Dosage |
|---|---|---|
| Adult | IV/IO/IM/IN | 0.5 mg increments, titrate to respiratory sufficiency |
| Pediatric | IV/IO/IM/IN | 0.1 mg/kg, max 2 mg per dose; may repeat every 2 minutes, up to a total of 4 doses |
Administration Notes:
- Titrate doses to achieve adequate respiratory effort, rather than complete reversal of sedation.
- Use cautiously in patients who are opioid-dependent, as it may precipitate acute withdrawal symptoms.
- If given via the IM route, the onset of action may be delayed compared to IV administration.
Nitroglycerin
GENERIC NAME
Nitroglycerin
TRADE NAME
Nitrostat
DESCRIPTION
Nitroglycerin is a potent smooth muscle relaxant used primarily in the treatment of angina pectoris. It causes vasodilation, reducing cardiac workload and increasing coronary blood flow.
HOW SUPPLIED
Tablet or spray: 0.4 mg per tablet or spray
INDICATIONS
- Chest pain indicative of acute coronary syndrome (ACS)
CONTRAINDICATIONS
- Allergy or hypersensitivity to Nitroglycerin
- Systolic blood pressure less than 120 mmHg if no 12-lead ECG has been obtained
- Systolic blood pressure less than 90 mmHg with a 12-lead ECG, and no signs of inferior MI
- Inferior MI indicated on 12-lead ECG (no nitrates should be given)
- Patient has taken erectile dysfunction medication (Sildenafil/Viagra, Tadalafil/Cialis, Vardenafil/Levitra) within the past 48 hours
MECHANISM OF ACTION
Nitroglycerin relaxes smooth muscle, causing vasodilation. This results in decreased preload and reduced cardiac workload, as well as increased coronary blood flow and perfusion of the heart. Pain relief typically occurs within 1–2 minutes, and therapeutic effects last up to 30 minutes.
SIDE EFFECTS
- Headache
- Dizziness
- Weakness
- Tachycardia
- Hypotension
AUTHORIZATION
AEMT: Standing order (1 dose only)
Paramedic: Standing order
DOSAGE
| Patient Type | Route | Dosage | Frequency | Maximum Doses |
|---|---|---|---|---|
| Adult | Sublingual (SL) | 0.4 mg | Every 3–5 minutes | Up to 3 doses, or until pain is relieved or contraindication occurs |
| Pediatric | Not given | N/A | ||
Administration Notes:
- Ensure blood pressure is monitored closely before and after each dose due to the risk of hypotension.
- If patient experiences significant hypotension, dizziness, or syncope, discontinue administration and reassess.
- Use with caution in patients who may have taken erectile dysfunction medications within the past 48 hours due to potential severe hypotension.
Ondansetron
GENERIC NAME
Ondansetron
TRADE NAME
Zofran
DESCRIPTION
Ondansetron (Zofran) is primarily used to treat nausea and vomiting. It is a serotonin receptor antagonist that effectively blocks the vomiting reflex. The duration of action is approximately 8 hours.
HOW SUPPLIED
- Ampule: 4 mg / 2 ml
- Orally Disintegrating Tablet (ODT): 4 mg tablet (scored)
INDICATIONS
- Nausea
- Vomiting
CONTRAINDICATIONS
- Hypersensitivity or allergy to Ondansetron
- Do not administer to children under 1 year of age
- Do not administer to pregnant patients in their first trimester
MECHANISM OF ACTION
Ondansetron blocks serotonin receptors in the central nervous system, preventing the vomiting reflex and reducing nausea.
SIDE EFFECTS
- Headache
AUTHORIZATION
EMT: Adult: IM injection or ODT PO; Pediatric: ODT PO
AEMT: Standing order
Paramedic: Standing order
DOSAGE
| Patient Type | Route | Dosage | Maximum Dosage |
|---|---|---|---|
| Adult | IV/IO/IM/PO (ODT) | 4 mg | 4 mg per dose |
| Pediatric ≥ 1 year | IV/IO/IM | 0.15 mg/kg | Max 4 mg per dose |
| Pediatric (Weight 8–15 kg) | PO (ODT) | 2 mg (split 4 mg tablet on score line) | 2 mg |
| Pediatric (Weight 16–36 kg) | PO (ODT) | 4 mg | 4 mg |
| Pediatric < 1 year | Not authorized | N/A | |
Administration Notes:
- For IV/IO administration, give over 2–5 minutes to prevent rapid onset side effects.
- ODT (Orally Disintegrating Tablet) should be placed on the tongue and allowed to dissolve without chewing or swallowing whole.
- Monitor for signs of headache, which is the most common side effect.
- Use caution in pediatric patients and adjust dosage based on weight.
Sodium Bicarbonate
GENERIC NAME
Sodium Bicarbonate
TRADE NAME
None
DESCRIPTION
Sodium bicarbonate is a salt that provides bicarbonate ions to buffer metabolic acidosis. It is used in several emergency situations, such as cardiac arrest, hyperkalemia, and tricyclic antidepressant overdose, to help restore acid-base balance.
HOW SUPPLIED
Prefilled syringe: 1 mEq/ml
INDICATIONS
- Tricyclic antidepressant overdose
- Suspected hyperkalemia
- Dialysis-related cardiac arrest
- Crush injury (Medical Control required)
- Cardiac arrest lasting longer than 10 minutes
CONTRAINDICATIONS
- Allergy or hypersensitivity to sodium bicarbonate
PRECAUTIONS
- Sodium bicarbonate precipitates with Calcium Chloride. Flush the IV line with 10 ml of Normal Saline between administering these two medications.
MECHANISM OF ACTION
Sodium bicarbonate increases the alkalinity of the urine to enhance the excretion of tricyclic antidepressants. It also acts as a buffer, helping to reduce acidosis in emergency situations.
SIDE EFFECTS
- Few side effects when used appropriately in emergency settings
AUTHORIZATION
Paramedic: Standing order
DOSAGE
| Patient Type | Route | Dosage | Maximum Dosage |
|---|---|---|---|
| All patients (except crush injury) | IV/IO push | 1 mEq/kg | Determined by patient response and clinical condition |
| Crush injury (Adult) | IV infusion | 1,000 ml of ½ Normal Saline with 100 mEq of Sodium Bicarbonate, infused over 1 hour | Medical Control required |
| Crush injury (Pediatric) | IV infusion | Consult Medical Control for dosing | Medical Control required |
Administration Notes:
- To prepare the infusion for crush injury, remove 100 ml from a 1,000 ml bag of Normal Saline, then inject 100 mEq of Sodium Bicarbonate and mix well.
- Monitor the patient’s electrolyte levels and acid-base status closely during administration.
- Adjust the dosage based on the patient’s clinical condition and response.
Terbutaline
GENERIC NAME
Terbutaline
TRADE NAME
Brethine
DESCRIPTION
Terbutaline (Brethine) is a short-acting, selective beta-2 agonist that is used for the treatment and prevention of bronchospasm in both adult and pediatric patients. It is effective for managing bronchospasm due to asthma and is also used in cases of COPD-related bronchospasm in adults. It has a shorter duration of action compared to albuterol.
HOW SUPPLIED
Subcutaneous injection solution: 1 mg/mL
INDICATIONS
- Treatment of bronchospasm associated with COPD
- Treatment of bronchospasm due to asthma exacerbation
CONTRAINDICATIONS
- Known hypersensitivity to terbutaline or its components
MECHANISM OF ACTION
Terbutaline is a selective beta-2 adrenergic agonist with minimal effects on beta-1 receptors and no significant alpha receptor activity. It targets beta-2 receptors located on the bronchiolar smooth muscle, leading to bronchodilation. This action helps relax the bronchial smooth muscle and improves airflow in the lungs.
SIDE EFFECTS
- Injection site reaction
- Nausea
- Insomnia
- Anxiety
- Rash
- Headache
- Vomiting
- Dizziness
- Drowsiness
- Tremor
AUTHORIZATION
Paramedic: Standing order
DOSAGE
| Patient Type | Route | Dosage | Maximum Dosage |
|---|---|---|---|
| Adult | Subcutaneous (SQ) | 0.25 mg; may repeat once after 15 minutes if no significant improvement | 0.5 mg total within a 4-hour period |
| Pediatric | Subcutaneous (SQ) | 0.01 mg/kg (maximum single dose of 0.25 mg); may repeat once after 15 minutes if no significant improvement | 0.25 mg maximum per single dose |
Administration Notes:
- Administer subcutaneously in the upper arm, thigh, or abdomen.
- Monitor the patient for potential side effects, particularly tremors, dizziness, and increased heart rate.
- Do not exceed the maximum dosage limits to avoid increased risk of side effects.
- Reassess the patient after administration and consider additional interventions if symptoms persist.
Tranexamic Acid (TXA)
GENERIC NAME
Tranexamic Acid (TXA)
TRADE NAME
Cyclokapron, Lysteda
DESCRIPTION
Tranexamic Acid (TXA) is an antifibrinolytic agent that helps promote clot formation by preventing the breakdown of fibrin clots. It is used in cases of massive hemorrhage, particularly in trauma and postpartum hemorrhage, to reduce bleeding and improve patient outcomes.
HOW SUPPLIED
1 gram in 10 ml vial
PREPARATION
Mix 1 gram of TXA in 100 ml of Normal Saline (NS).
INDICATIONS
- Hemorrhagic shock or cardiac arrest due to trauma less than three hours old
- Suspected need for massive blood transfusion due to significant internal or external bleeding, indicated by sustained heart rate ≥ 110/min and SBP < 90 mmHg
- Blood loss greater than 500 ml with continued bleeding in a postpartum situation
CONTRAINDICATIONS
- Non-hemorrhagic shock
- Non-traumatic hemorrhagic shock
- Hemorrhagic shock stabilized with other hemostatic agents or measures
- Isolated traumatic brain injury
MECHANISM OF ACTION
Tranexamic Acid inhibits the activation of plasminogen to plasmin, preventing the breakdown of fibrin clots (antifibrinolytic action). This helps stabilize formed clots and reduce ongoing bleeding.
SPECIAL CONSIDERATIONS
- Obtain two blood pressure and heart rate measurements to confirm sustained HR ≥ 110/min and SBP < 90 mmHg before administering TXA to patients likely to respond to fluid bolus(es). Do not delay TXA administration for patients with obvious signs of hemorrhagic shock.
- Prepare the solution just prior to administration. Discard if not used immediately.
- Although there is a theoretical concern, current evidence does not show a significant increase in deep venous thrombosis, pulmonary embolism, myocardial infarction, or stroke with TXA use in published trials.
SIDE EFFECTS
- None known at this time
AUTHORIZATION
Paramedic: Standing order and Medical Control
DOSAGE
| Patient Type | Route | Dosage | Maximum Dosage |
|---|---|---|---|
| Adult (≥ 12 years) | IV infusion | 1 gram IV over 10 minutes; mix 1 gram in 100 ml NS | 1 gram total dose |
| Pediatric | IV/IO infusion | 15 mg/kg IV/IO over 10 minutes; mix 15 mg/kg in 100 ml NS | Consult Medical Control for specific maximum dose |
Administration Notes:
- Infuse TXA over 10 minutes. For adult administration, use a 60 gtts tubing for a straight IV stream or a 10 gtts tubing at 100 drops/minute.
- Monitor the patient’s vital signs and hemodynamic status closely during and after infusion.
- Do not delay administration in patients with clear signs of hemorrhagic shock, as early administration improves outcomes.