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Activated Charcoal
-Absorbent- Action: Absorbs toxic substances or irritants by chemical binding and
prevents gastrointestinal absorption
Indications: Poisoning (following emesis or in cases emesis may be contraindicated)
Contraindications & Warnings: None in the presence of severe poisoning
Use caution in patients with intestinal obstruction or GI tract which is not anatomically intact.
Not effective for cyanide, mineral acids, caustic alkalis, organic solvents or ethanol
Possible Side Effects: Nausea & vomit, abdominal cramping and/or bloating, constipation
Dose: Acute poisoning note~10 grams of activated charcoal for each 1 gram of toxin ingested is
considered adequate.
Adult: 1g/kg-typically 50-75 grams
Pediatric: Infant <1YO: 1g/kg
>1YO-12YO:25-50 grams
Administration: Orally or NG tube
Adenosine (Adenocard)
-Antiarrhythmic, Endogenous Nucleoside- Action: Slows conduction through the AV node
of the heart. Proven useful in blocking reentry pathways through the AV node. It is cleared very
quickly, having a half-life of less than 10 seconds.
Indications: Conversion of paroxysmal supraventricular tachycardias (PSVT) to normal sinus
rhythm (NSR)
,Contraindications: Sick Sinus Syndrome, 2nd or 3rd degree heart block, dysrhythmias other
than PSVT
Possible Side Effects: Dyspnea and bronchoconstriction (esp in patients with asthma & COPD),
palpitations and CP, Hypotension, Transient PAC's or PVC's, Facial flushing and headache, At the
time of conversion, a variety of new rhythms may appear on the ECG. Short Lasting 1st,2nd &
3rd degree blocks or transient asystole may result after administration. Due to the drugs short
1/2 life, these effects are generally self limiting. In doses of 6-12mg, there are usually no
hemodynamic side effects.
Important Points: A reduced dose must be used in heart transplant recipients. After
administering adenosine, a rhythm other than PSVT may be evident,resulting in choosing a
different form of treatment. Methyxanthines may decrease the effectiveness of adenosine thus
requiring larger doses.
Route and Dose:
Adult: 1st dose at 6.0mg rapid IV push with NS flush. May repeat 2X at 12.0mg rapid IV push
and NS flush.
Pediatric: Do not give patients <12YO without a physician's order. 1st dose is 0.1mg/kg (max
6.0mg) rapid IV/IO push with NS flush. 2nd dose is 0.2mg/kg (max 12.0mg) rapid IV/IO push
with NS flush
Albuterol (Proventil, Ventolin)
-Sympathomimetic (Beta-2 Selective)- Actions: Albuterol is a sympathomimetic that is
selective for beta-2 adrenergic receptors with minimal amount of side effects. It causes prompt
bronchodilation and has a duration of action of approx. 5 hours.
Indications: Bronchial asthma, reversible bronchospasm associated with chronic bronchitis and
emphysema.
,Contraindications: Hypersensitivity to the drug
Side Effects: Palpitations,CP, arrhythmias, HTN, anxiety, nervousness,tremors,dizziness,
headache, N&V
Precautions: The possibility of developing unpleasant side effects increases when albuterol is
administered with other sympathetic agonists. Beta blockers may blunt the pharmacological
effects of albuterol. Vital signs must be monitored. Caution when administering to elderly
patients with CV disease.
Dose and route:
Adult: 2.5mg (0.5ml of a 5% solution diluted in 2.5ml of NS) by nebulizer
Pediatric: 0.15mg (0.03ml/kg in 2.5ml of NS) by nebulizer
Amiodarone (Cordarone, Pacerone)
-Antidysrhythmic (Class III)- Actions: Prolongs the action potential and refractory period
of the myocardial cells. Relaxes vascular smooth muscle, reduces peripheral vascular resistance,
increases coronary blood flow.
Indications: Recurrent V-Fib/ Pulseless V-Tach. Heymodynamically unstable V-Tach. Can be used
in treatment of refractory, sustained A-Fib, PSVT or symptomatic A-Flutter
Contraindications: Severe sinus node dysfunction, 2nd or 3rd degree heart blocks, cardiogenic
shock, hemodynamically significant bradycardia, pregnancy and lactation. Caution should be
used in CHF patients due to inotropic effects, In patients with liver or renal dysfunction, or
thyroid disease. Patients with pulmonary disease due to serious pulmonary effects such as
fibrosis. Hypersensitivity.
DO NOT ADMINISTER WITH OTHER DRUGS THAT PROLONG QT INTERVALS SUCH AS
PROCAINAMIDE OR PATIENTS WITH AN ALLERGY TO SHELLFISH OR IODINE.
, Side Effects: Hypotension, CHF, AV Block, ventricular ectopic beats, dizziness, fatigue, malaise,
tremors, sinus arrest, cardiogenic shock
Dose:
IVP: cardiac arrest: 1st dose 300mg in 20-30cc D5W IVP. 2nd dose 150mg in 20-30cc D5W IVP 3-
5 minutes after initial dose.
Drip: 150mg IV over 10 min mixed in D5W (15mg/min). May repeat rapid IV infusion every 10
min as needed.
Maintenance Infusion: 540mg IV over 18 hours
Upon conversion of V-Fib/pulseless V-Tach, use remainder from 250cc bag to set infusion.
Aspirin (Acetylsalicylic Acid, ASA)
-Platelet inhibitor and anti-inflammatory- Actions: Blocks formation of thromboxane A2,
blocks platelet aggregation
Indications: Acute Myocardial Infarction and unstable angina
Contraindications: Hypersensitivity, GI ulcers, patients with known bleeding disorders
Side Effects: Prolonged bleeding time, tinnitus and hearing loss, N&V, heartburn, wheezing
Dose:
160-325mg PO chewed
Atropine Sulfate
Activated Charcoal
-Absorbent- Action: Absorbs toxic substances or irritants by chemical binding and
prevents gastrointestinal absorption
Indications: Poisoning (following emesis or in cases emesis may be contraindicated)
Contraindications & Warnings: None in the presence of severe poisoning
Use caution in patients with intestinal obstruction or GI tract which is not anatomically intact.
Not effective for cyanide, mineral acids, caustic alkalis, organic solvents or ethanol
Possible Side Effects: Nausea & vomit, abdominal cramping and/or bloating, constipation
Dose: Acute poisoning note~10 grams of activated charcoal for each 1 gram of toxin ingested is
considered adequate.
Adult: 1g/kg-typically 50-75 grams
Pediatric: Infant <1YO: 1g/kg
>1YO-12YO:25-50 grams
Administration: Orally or NG tube
Adenosine (Adenocard)
-Antiarrhythmic, Endogenous Nucleoside- Action: Slows conduction through the AV node
of the heart. Proven useful in blocking reentry pathways through the AV node. It is cleared very
quickly, having a half-life of less than 10 seconds.
Indications: Conversion of paroxysmal supraventricular tachycardias (PSVT) to normal sinus
rhythm (NSR)
,Contraindications: Sick Sinus Syndrome, 2nd or 3rd degree heart block, dysrhythmias other
than PSVT
Possible Side Effects: Dyspnea and bronchoconstriction (esp in patients with asthma & COPD),
palpitations and CP, Hypotension, Transient PAC's or PVC's, Facial flushing and headache, At the
time of conversion, a variety of new rhythms may appear on the ECG. Short Lasting 1st,2nd &
3rd degree blocks or transient asystole may result after administration. Due to the drugs short
1/2 life, these effects are generally self limiting. In doses of 6-12mg, there are usually no
hemodynamic side effects.
Important Points: A reduced dose must be used in heart transplant recipients. After
administering adenosine, a rhythm other than PSVT may be evident,resulting in choosing a
different form of treatment. Methyxanthines may decrease the effectiveness of adenosine thus
requiring larger doses.
Route and Dose:
Adult: 1st dose at 6.0mg rapid IV push with NS flush. May repeat 2X at 12.0mg rapid IV push
and NS flush.
Pediatric: Do not give patients <12YO without a physician's order. 1st dose is 0.1mg/kg (max
6.0mg) rapid IV/IO push with NS flush. 2nd dose is 0.2mg/kg (max 12.0mg) rapid IV/IO push
with NS flush
Albuterol (Proventil, Ventolin)
-Sympathomimetic (Beta-2 Selective)- Actions: Albuterol is a sympathomimetic that is
selective for beta-2 adrenergic receptors with minimal amount of side effects. It causes prompt
bronchodilation and has a duration of action of approx. 5 hours.
Indications: Bronchial asthma, reversible bronchospasm associated with chronic bronchitis and
emphysema.
,Contraindications: Hypersensitivity to the drug
Side Effects: Palpitations,CP, arrhythmias, HTN, anxiety, nervousness,tremors,dizziness,
headache, N&V
Precautions: The possibility of developing unpleasant side effects increases when albuterol is
administered with other sympathetic agonists. Beta blockers may blunt the pharmacological
effects of albuterol. Vital signs must be monitored. Caution when administering to elderly
patients with CV disease.
Dose and route:
Adult: 2.5mg (0.5ml of a 5% solution diluted in 2.5ml of NS) by nebulizer
Pediatric: 0.15mg (0.03ml/kg in 2.5ml of NS) by nebulizer
Amiodarone (Cordarone, Pacerone)
-Antidysrhythmic (Class III)- Actions: Prolongs the action potential and refractory period
of the myocardial cells. Relaxes vascular smooth muscle, reduces peripheral vascular resistance,
increases coronary blood flow.
Indications: Recurrent V-Fib/ Pulseless V-Tach. Heymodynamically unstable V-Tach. Can be used
in treatment of refractory, sustained A-Fib, PSVT or symptomatic A-Flutter
Contraindications: Severe sinus node dysfunction, 2nd or 3rd degree heart blocks, cardiogenic
shock, hemodynamically significant bradycardia, pregnancy and lactation. Caution should be
used in CHF patients due to inotropic effects, In patients with liver or renal dysfunction, or
thyroid disease. Patients with pulmonary disease due to serious pulmonary effects such as
fibrosis. Hypersensitivity.
DO NOT ADMINISTER WITH OTHER DRUGS THAT PROLONG QT INTERVALS SUCH AS
PROCAINAMIDE OR PATIENTS WITH AN ALLERGY TO SHELLFISH OR IODINE.
, Side Effects: Hypotension, CHF, AV Block, ventricular ectopic beats, dizziness, fatigue, malaise,
tremors, sinus arrest, cardiogenic shock
Dose:
IVP: cardiac arrest: 1st dose 300mg in 20-30cc D5W IVP. 2nd dose 150mg in 20-30cc D5W IVP 3-
5 minutes after initial dose.
Drip: 150mg IV over 10 min mixed in D5W (15mg/min). May repeat rapid IV infusion every 10
min as needed.
Maintenance Infusion: 540mg IV over 18 hours
Upon conversion of V-Fib/pulseless V-Tach, use remainder from 250cc bag to set infusion.
Aspirin (Acetylsalicylic Acid, ASA)
-Platelet inhibitor and anti-inflammatory- Actions: Blocks formation of thromboxane A2,
blocks platelet aggregation
Indications: Acute Myocardial Infarction and unstable angina
Contraindications: Hypersensitivity, GI ulcers, patients with known bleeding disorders
Side Effects: Prolonged bleeding time, tinnitus and hearing loss, N&V, heartburn, wheezing
Dose:
160-325mg PO chewed
Atropine Sulfate
