0.9% Sodium Chloride (Normal Saline) Classification
Isotonic crystalloid solution
0.9% Sodium Chloride (Normal Saline) Mechanism of Action
Volume replacement, water and electrolytes
0.9% Sodium Chloride (Normal Saline) Pharmacokinetics
Onset of Action= immediate
Peak effects= immediate
Duration of effect= varies by disease process or until renal clearance
Half-Life= N/A
0.9% Sodium Chloride (Normal Saline) Indications/field use
1) dehydration secondary to heat-related emergency
2) shock/hypotension/hypovolemia
3) diabetic ketoacidosis
4) keep open IV
0.9% Sodium Chloride (Normal Saline) Contraindications
1) Pulmonary edema
2) Severe hypertension
0.9% Sodium Chloride (Normal Saline) side effects/adverse reactions
May induce pulmonary edema if given to a pt with history of CHF
0.9% Sodium Chloride (Normal Saline) Dose
Adult: 200-250cc IV, IO, repeat until BP systolic is greater than 100, max dose 2000cc
Pedi: 20cc/kg IV, IO for greater than 1 month old; 10cc/kg IV, IO for less than 1 month old
Cardiogenic shock Pedi: 5-10cc/kg IV, IO
0.9% Sodium Chloride (Normal Saline) Precautions
May cause depletion of other electrolytes in large volumes
May dilute oxygen carrying capacity in pt with severe bleeding
If hypotension persists after 2000cc, consider alpha 1 against infusion (i.e. Dopamine)
0.9% Sodium Chloride (Normal Saline) Drug-Drug Interactions
Few in EMS
5% Dextrose in Water (D5W) Classification
Hypotonic Dextrose Containing Solution
5% Dextrose in Water (D5W) Mechanism of Action
Provides nutrients in the form of dextrose
5% Dextrose in Water (D5W) Pharmacokinetics
Onset of Action= varies depending on goal
Peak Effects= N/A
Duration of Effects= N/A
Half-Life= N/A
5% Dextrose in Water (D5W) Indications/Field use
Dilution of concentrated IV medications
Keep open IV
5% Dextrose in Water (D5W) Contraindications
Hypovolemia requiring volume replacement
Patient with head injury or stroke
5% Dextrose in Water (D5W) Side Effects/Adverse reactions
Rare in therapeutic dosages
5% Dextrose in Water (D5W) Dose
Adult: KVO
Pedi: KVO
5% Dextrose in Water (D5W) Precautions
May cause local venous irritation
Extravasation may cause tissue necrosis
Monitor for signs of circulatory overload
5% Dextrose in Water (D5W) Drug-Drug Interactions
Do not use with Dilantin or Inocor
Lactated Ringer’s Solution (Hartmann’s Solution) Classification
Isotonic crystalloid solution
Lactated Ringer’s Solution (Hartmann’s Solution) Mechanism of Action
Volume replacement, water and electrolytes
Lactated Ringer’s Solution (Hartmann’s Solution) Pharmacokinetics
Onset of Action= Immediate
Peak Effects= Immediate
Duration of Effects= Varies depending on disease process
Half-Life= N/A
Lactated Ringer’s Solution (Hartmann’s Solution) Indications/Field use
Hypovolemia
Severe Burns
Keep open IV
Lactated Ringer’s Solution (Hartmann’s Solution) Contraindications
Patient with congestive heart failure or renal failure
Hypersensitivity to sodium lactate
Lactated Ringer’s Solution (Hartmann’s Solution) Side Effects/Adverse reactions
May induce pulmonary edema if given to a pt with history of CHF
Lactated Ringer’s Solution (Hartmann’s Solution) Dose
Adult: Wide open IV, IO until BP systolic is greater than 100mmhg, then 100ml/hr
Pedi: 20cc/kg IV/IO
Lactated Ringer’s Solution (Hartmann’s Solution) Precautions
Patients should be monitored for circulatory overload
Lactated Ringer’s Solution (Hartmann’s Solution) Drug-Drug Interactions
Additive effects with potassium-sparing drugs; may cause hyperkalemia
Forms PPT in IV tubing Ceftriaxone
Diazepam (Valium) Classification
Anticonvulsant/Sedative/Benzodiazepine/Anxiolytic
Diazepam (Valium) Mechanism of Action
Positive allosteric modulator for GABAa receptors->binds to Benzo receptor site on chloride channels and potentiates binding and effects of GABA (increases intercellular Cl- concentration leading to hyperpolarization of the cell)
Diazepam (Valium) Pharmacokinetics
Onset of Action=1-5 minutes IV, 15-30 minutes IM
Peak Effects=10 minutes IV, 30-45 minutes IM
Duration of Effect=15-60 minutes
Half-Life= 20-50 hours
Diazepam (Valium) Indications/Field use
Major motor seizures
Pre-medication for cardioversion
Acute anxiety
Diazepam (Valium) Contraindications
Hypersensitivity
Diazepam (Valium) Side Effects/Adverse reactions
Hypotension, Tachycardia, Hallucinations, Drowsiness, HA, Amnesia, Respiratory Depression, Blurred Vision, N+V
Diazepam (Valium) Dose
Anxiety (Adult): 2-5mg IV, IO
Seizures (Adult): 5-10mg IV, IO
Amnesia (Adult): 5-15mg IV, IO
Pedi: 0.1-0.2mg/kg IV, IO; 5mg max dose
Diazepam (Valium) Precautions
May cause local venous irritation
Do not give faster than 1ml/min
Have benzo antagonist available
Diazepam (Valium) Drug-Drug Interactions
Additive effects with CNS depressants and alcohol
Lorazepam (Ativan) Classification
Anticonvulsant/Sedative/Hypnotic/Benzodiazepine
Lorazepam (Ativan) Mechanism of Action
Positive allosteric modulator for GABAa receptors->binds to Benzo receptor site on chloride channels and potentiates binding and effects of GABA (increases intercellular Cl- concentration leading to hyperpolarization of the cell)
Lorazepam (Ativan) Pharmacokinetics
Onset of Action=1-5 minutes IV, 15-30 minutes IM
Peak Effects=15-20 minutes IV, 2 hours IM
Duration of Effect=6-8 hours
Half-Life=10-20 hours
Lorazepam (Ativan) Indications/Field use
Major motor seizures
Pre-medication for cardioversion
Acute anxiety
Lorazepam (Ativan) Contraindications
Hypersensitivity
Lorazepam (Ativan) Side Effects/Adverse reactions
Hypotension, Drowsiness, HA, Amnesia, Respiratory Depression, Blurred Vision, N+V
Lorazepam (Ativan) Dose
Adult:0.5-2mg (0.1mg/kg) IV, IO
Adult:1-4mg IM
Pedi:0.05mg/kg IV, IO
Lorazepam (Ativan) Precautions
Have Benzo antagonist available
Lorazepam (Ativan) Drug-Drug Interactions
Additives effects with CNS depressants and alcohol
Midazolam (Versed) Classification
Anticonvulsant/Sedative/Hypnotic/Benzodiazepine
Midazolam (Versed) Mechanism of Action
Positive allosteric modulator for GABAa receptors->binds to Benzo receptor site on chloride channels and potentiates binding and effects of GABA (increases intercellular Cl- concentration leading to hyperpolarization of the cell)
Midazolam (Versed) Pharmacokinetics
Onset of Action=3-5 minutes IV, 15 minutes IM
Peak Effects=20-60 minutes
Duration of Effect=less than 2 hours IV, 1-6 hours IM
Half-Life=1-4 hours
Midazolam (Versed) Indications/Field Use
Pre-medication for cardioversion or TCP
Sedation post intubation
Seizure
Midazolam (Versed) Contraindications
History of narrow-angle glaucoma
Shock, depressed vitals, alcoholic coma
Midazolam (Versed) Side Effects/Adverse reactions
Laryngospasm, bronchospasm, dyspnea, respiratory depression and arrest, amnesia, AMS, tachycardia, bradycardia, PVC’s, retching
Midazolam (Versed) Dose
Adult: 2-5mg (0.5mg/kg) slow IV, IO, IM
Pedi: 0.2mg/kg slow IV; max dose 10mg
Midazolam (Versed) Precautions
Have Emergency resuscitative equipment available; monitor vitals
More potent than other Benzos->increased risk of respiratory depression/arrest
Have benzo antagonist available
Midazolam (Versed) Drug-Drug Interactions
Additive effects with CNS depressants and alcohol