Emergency Med Review
ADENOSINE (Adenocard)
 Slows AV conduction
 Given for supraventricular tachycardia (SVT)
 Contraindications: A-Fib, A-Flutter, VT, 2nd or 3rd degree block
may cause brochospasm in asthma patients.
 DOSE: 6mg rapid IV bolus given in 1-2 seconds, Repeat with
12 mg IV push if PSVT not eliminated.
DILTIAZEM (Cardizem)
 Calcium channel blocker
 For PSVT with or with out WPW, A-Fib, A-Flutter
 Not for AV blocks unless pt has a pacemaker
 May cause decreased BP, caution with renal pts
 DOSE: 20mg IV, cont. infusion 5-15mg/hr
DOUBUTAMINE (Dobutrex)
 Positive inotrope with vasodilatation effect
 For depressed myocardial contractility
 Not for idiopathic hypertrophic sub-aortic stenosis
 DOSE: 2.5-20mcg/kg/min IV
AMIODARONE (Cordarone)
 Increase VF threshold, prolongs repolarization and refractory
period.
 Given for V-Fib, V-Tach, stable wide complex. Tachycardia
 Contraindicated with heart block, severe bradycardia,
DOPAMINE (Intropin)
decreased K
 Action dose related
 Don’t use with heparin, HCO3 and be cautious when using
o Low dose: inotropic support and renal perfusion
Beta blockers, Ca+ channel blockers
increased.
 DOSE: During arrest = 150mg IV push in 3-5 min with stable Vo Med dose: Increase contraction, HR, CO, BP
Tach with pulse = longer infusing same dose
o High dose: Increase BP and CO
 For hemodynamic imbalances in shock syndrome.
AINONE (Incor)
 Monitor BP, I&O, peripleural pulse
 Positive inotropic and potent vasodilator
 DOSE: 2-5mcg/kg/min IV
 For CHF
 Monitor hemodynamics, I?O and electrolytes
DROTRECOGIN ALFA (Xigris)
  inflammation, coagulation
ATROPINE
 For severe Sepsis
 Enhances AV conduction (increase HR)
 Not for internal bleeding, stroke, head injury
 For symptomatic bradycardia
 May cause bleeding
 May extend ischemia into MI
 DOSE: Bradycardia=0.5mg up to 3mg IV, ET
ENOXAPARIN (Lovenox)
 Inhibits thrombos formation
CALC IUM CHLORIDE
 FOR: preventing ischemic complications of unstable Angina
 Electrolyte
and Non-Q wave MI
 For hyperkalemia, calcium channel blocker overdose
 NOT FOR: severe thrombocytopenia, bleeding. Watch for
 Contraindicated for pts with increased Ca+, risk of digitalis
increased bleeding if used with camomile, garlic, gingko,
toxicity
ginsing, or penicllins. Not for IM use.
 IV use only use 5-10mg IV of 10% solution for increased K and
1-4g administered slowly for Ca+ blocker OD
EPINEPHRINE
(Racemic 2.25%)
DEXTROSE
 Bronchodilation, vasoconstriction
 Elevates serum glucose
 For croup, upper airway edema,
 For hypoglycemia (Diabetes)
 DOSE: 0.25ml -1ml
 DOSE: 2.5g IV
(Epi 1-1,000 soln)
 Check blood sugar with Accu check
 Bronchodilation, vasoconstriction
 For Bronchospasm, allergic reaction, anaphalactic shock
DIAZEPAM (Valium)
 Given IM, SC
 Elevates seizure threshold, relaxes skeletal muscle
 DOSE: 0.2-0.5mg
 For seizures
(EPI 1-10,000 soln)
 May cause  BP and resp. drive
 Cardiac stimulation
 DOSE: 2-10mg IV
 For VF, PEA, asystole, anaphylaxis
 DOSE: 1mg IV, ET every 3-5min
DIGOXIN
 Positive inotrope
ESMOLO (Brevibloc)
 For heart failure, A-Fib, A-Flutter, PSVT
 Blocks stimulation of Beta 1 receptor sites leading to
 Not for blocks, VG
decreased HR, BP and contractility
 For SVT, A-Fib, A-Flutter
 Toxicity may produce rhythm disturbances,  HR, blurred
vision, especially with renal pts.
 Not for Pulmonary Edema, cardiogenic shock, bradycardia, 2nd
& 3rd degree block
 DOSE: 10-15mcg/kg IV
 May cause decrease BP, decrease HR, chest pain
CLOMIDTE (Amidate)
 Sedation
 For rapid sequence intubations
 Not for pregnant women or people less then 10 y.o
 DOSE: 0.3 mg/kg IV
FENTANYL (Sublimaze)
 Alters perception of pain
 For pain
 Not for pts on MAO inhibitors, Myasthenia Gravis, acute
asthma or Hx seizures.
 Have Narcan on hand to reverse
FLUMAZENIL (Romazicon)
 Benxodiazepine antagonist
 Reverses the effects of Ativan, Versed, Xanaz, Valium…
 Not for cyclic antidepressant OD
 DOSE: 0.2mg IV
FOSPHENYTOIN (Cerebyx)
 Anticonvulsant
 Status epilepticus
FUROSEMIDE (Lasix)
 Diuretic, vasodilation
 For Pulmonary Edema, 2nd to CHF
 Not for Anuria, decreased K+, Hepatic coma
 May cause hypokalemia, hypocalcemia, hypomagnesemia,
volume depletion, and decreased BP
 DOSE: 20-80 mg IV over 1-2 min
HALOPERIDOL (Haldol)
 Antipsychotic
 For psychotic disorders (schizophrenia)
 Not for Parkinson’s disease, bone marrow depression,
Epilepsy
 Given by deep IM
HEPARIN
 Inhibits coagulation
 For MI, venous thrombosis, pulmonary embolism, Peripheral
arterial embolism.
 Not for hemorrhagic stroke, active bleeding, thrombocytopenia
 DOSE: 60 u/kg IV, cont. infusion 12 u/kg hr
INSULIN (Regular)
 Decreases blood sugar (short acting)
 For diabetes mellitus, keto acidosis
 Overall tx of DKA includes replacing intravascular fluid volume
before administering insulin. Check blood sugar every 30 min
during infusion.
LABETALOL (Normodyne)
 Alpha and Beta blockers
 For severs hypertension, Aortic Aneurysm
 Not for Asthmatics, cardiac failure, decreased HR
LIDOCAINE
 Elevates VF threshold
 For VF, VT, PVC;s
 Not for AV blocks, decrease BP, decreased HR
 DOSE: 1.0 – 1.5 mg/kg IV
 Also used as local Anesthtic, cough suppressant
LORAZEPAM (Adivan)
 Sedation
 For seizures, watch for decreased RR
 DOSE: 2-4 mg IV
MAGNESIUM SULFATE
 May reduce incidence of post infarction ventricular Arrhythmias
 For cardiac arrest due to decreased mg or Torsades de
Pointes
 DOSE: 1-2g IV for arrest
 Torsades 1-2g IV diluted in 50-100ml D5W
MANNITOL (20%)
 Reduces ICP and Cerebral Edema
 Osmotic diuretic
 For severed head injury
 Not for Active bleeding, pulmonary edema
METHYLPREDNISOLONE (Solu-medrol)
 Systemic steroid, decreased inflammation
 For Asthma, Acute spinal cord injury, Anaphylactic shock
 Not for Fungal infections, GI ulcers
 May cause decrease K+, increase sugar
 DOSE: Asthma 10-250 mg/IV q 4-6 hrs
METOPROLOL (Lopressor)
 Beta blocker, decreases BP
 For acute MI, Angina
 Not for Cardiogenic shock, AV blocks, CHF, COPD
 DOSE: 5mg IV
MIDAZOLAM (Versed)
 Produces calming effect
 For sedation (many procedures)
 May cause decreased BP, RR, laryngospasm
 DOSE: 1.5mg 2.5mg IV
MILRINONE (Primacor)
 Vasodilator, inotrope
 For acute heart failure
 Administer in separate IV line from Lasix
 DOSE: 50mcg/kg
NALOZONE (Narcan)
 Narcotic antagonist
 For acute opioid overdose
 DOSE: 0.4 – 2mg IV
NITRODLYCERIN (sublingual, spray, past)
 Vasodilatation, reduces myocardial O2 demand by decreasing
preload, increasing blood flow within coronary vessels.
 For angina, CHF, HTN
 Not for Hypovolemia, severe hypotension
 Side effect: headache
NITROPRUSSIDE (Nitropress)
 Decreases BP
 Dilates peripheral arteries and veins
 For hypertensive crisis
 Wrap container in aluminum foil to protect from light
NOREPINEPHRINE (Levophed)
 Inotrope, vasoconstrictor, dilates coronary arteries
 For acute hypotensive states (MI, sepsis)
 Not for Hypovolemia, profound hypoxia
 May cause ischemic injury, bradycardia, decrease renal
perfusion
PHENYTOIN (Dilantin)
 Stabilizes neuronal membranes
 For seizures
 Not for decreased HR, blocks, hypoglycemia seizures
PROCAINAMIDE (Pronestyl)
 Peripheral vasodilator, decreases PVC’s
 For PVC’s, VT refractory to Lidocain
 Not for AV blocks
PROPOFOL
 Decreases cerebral blood flow, cerebral O2 consumption and
ICP
 Used for sedation
 May cause bradycardia, decreased BP, apnea
SUCCINYLCHOLINE (Anectine)
 Skeletal muscle relaxation & paralysis
 Rapid intubations
 Short acting 4-6min, must be able to ventilated pt
 Not for pts with hyperkalemia (caused arrest), renal failure
 DOSE: 1 – 1.5 mg/ IV
ATRIAL FIBRILLATION (A-Fib)

Erratic/chaotic Atrial contractions with normal or narrowed
QRS complexes.

No P wave present

Rates are very high in atrium > 200, overall HR 180-200

Fix by cardioverting Atrium or medication to slow AV
conduction
atrial fibrillation (top) and sinus rhythm (bottom). The purple arrow
indicates a P wave, which is lost in atrial fibrillation.
ECG of
ATRIAL FLUTTER (A-Flutter)
 P waves fire without conduction in a “saw tooth” pattern
 Unlike A-Fib HR slower and P-waves are present and countable

BLOCKS
 A heart block occurs before a ischemic event such as and MI. The
hearts electrical conduction system is slowed as conduction travels
around dead (necrotic) myocardium to reach its intended site. 1st
degree block – delayed PR interval (not serious)
2nd DEGREE TYPE 1
 Progressively longer PR intervals until and entire QRS complex is
dropped. The HR is generally slower then normal
TENECTEPLASE (TNKase)
 Thrombolytic
 Acute MI
 Not for active bleeding
2nd DEGREE TYPE 2
 More dangerous and may progress to 3rd degree block
 Consistent missing QRS complexes HR slowed
VASOPRESSIN (may be used instead of Epi in code)
 Pressor and antidiurectic hormone activities
 For shock-refractory V-Fib
 DOSE: 40 U IV push, IO or ET 1 time only
3rd DEGREE
 Complete dissociation of Atrias and ventricles. The P waves fire
without any association to QRS which fires independently. Life
threatening will require pacemaker.
VERAPAMIL (Calan)
 Calcium channel blocker
 For PSVT
 Not for AV blocks, people on beta blocker
HYPERKALEMIA
 Dangerous condition leading to cardiac arrest.
 Signs/Symptoms: Bradycardia, aystole, muscle weakness,
confusion, P wave flat.
 To correct: Give calcium chloride, to neutralize give sodium Bicarb,
insulin or Albuterol 10-20 mg over 15 min. To remove from body=
Lasix or dialysis
BETA BLOCKER

Any drug that inhibits the sympathemetic Beta Adrenergic
recepotor sites in the cardiac smooth muscle and bronchial
smooth muscle. Used to slow conduction, and thus slow
excessively high rates. Used for A-Fib, A-Flutter, SVT.
CALCIUM CHANNEL BLOCKER

Blocks the influx of calcium into myocardium thus decreasing
contraction and HR