AEMT

Medication
Administration
KRISTA ALANIS, PARAMEDIC
 •Action: Increases refractory period of cardiac myocytes,
prolongs Phase 3 repolarization by blocking potassium
Amiodarone channels, decreases automaticity of ventricular and
Purkinje fibers, prolongs AV conduction.
•Indications: AEMT’S: Pulseless arrest with shock-
refractory or recurrent VF/VT
•Route: IV/IO bolus

•Contraindications: A-V heart blocks, cardiogenic shock,

irregular wide complex tachycardia
•Side Effects; Hypotension, bradycardia

•Dose: Adult: 300mg – May administer ONE additional

150mg IV bolus 3-5 minutes if shock refractory or
recurrent VT/VF.
•Peds: 5mg/kg IV bolus – Additional doses require
Medical Control approval
 •Action: Antihistamine used to block histamine-mediated
Diphenhydramine symptoms of allergic reaction

(Benadryl) •Indications: Allergic reaction

•Route: IV/IO/IM

•Contraindications: Acute asthma, narrow angle

glaucoma, patients taking MAO inhibitors
•Side Effects: flushing, tachycardia, dilated pupils,
lethargy, dry mouth, urinary retention
•Dose: Adult: 50mg

•Peds: 1mg/kg slowly over 1-2 minutes (MAX of 50mg)

Benadryl is sometimes sued for dystonic effects of other

medications. When combined with other medications
may cause sedative effects. These uses require an order
from medical control.
 •Action: Epi is a catecholamine that agonizes alpha, Beta
Epinephrine 1 and Beta 2 receptors, causing potent vasocontraction,
(Codes) elevated HR, myocardial contractility and
bronchodilation.
•Indications: Pulseless arrest

•Route: IV/IO

•Contraindications: Should never be given IV to a patient

with a pulse
•Side Effects: MI, arrythmias

•Dose: Adult: 1mg (generally 10mL of a 1:10,000

syringe), May repeat every 3-5 minutes to a MAX of 3
doses. Contact Medical Control for additional doses if
patient demonstrates recurrent arrest after ROSC.
•Peds: 0.01mg/kg (0.1mL/kg of 1:10,000 solution)
 •Action: Selective serotonin 5-HT3 receptor antagonist that

Ondansetron results in decreased emesis.

(Zofran) •Indications: nausea/vomiting

•Route: IV/IO

•Contraindications: History of prolonged QT interval

•Side Effects: Prolonged QT interval

•Dose: Adult: 4mg – May repeat x1 (total 8mg if patient is

not on any other antiemetic/antipsychotic medications
•Peds: > 1 year of age: 0.15mg/kg – MAX dose 4mg – One
dose only

Zofran may interact with Haldol and other antipsychotic

meds to prolong QT interval with fewer doses. In first
trimester pregnancy, use with caution and limit to one dose.
Should be limited for severe, intractable vomiting.
 • Action: Targets pain receptor sites in the brain and spinal
Fentanyl chord, resulting in significant analgesia, euphoria an sedation.
Significantly increases frequency and severity of respiratory
Opioids should be avoided in depression and hypotension.
any patient under the influence
of alcohol, benzodiazepines, or • Indications: Moderate to severe pain due to trauma of medical
other CNS depressants, and you conditions.
should avoid use with Benadryl.
• Route: IV/IO, IN
When pain control is started
with one med, do not switch to • Contraindications: Hypotension, shock, respiratory depression
different opioid without
• Side Effects: Chest wall rigidity, respiratory depression/arrest,
discussing with medical control
nausea/vomiting

• Dose: Adult: 1-2mcg/kg, medical emergencies should be

1mcg/kg, Long bone fractures should be closer to 1.5-2mcg/kg
MAX dose 200mcg adult, 100mcg < age 16, 50mcg < age 12 –
May repeat dose every 30 minutes, consider half dose in
elderly (>60yo)

• Peds:1-2mcg/kg IV, 1.5mcg/kg IN

ECG, pulse oximetry, and preferably waveform capnography is

to be placed.
 •Action: Targets pain receptor sites in the brain and spinal
Hydromorphone chord, resulting in significant analgesia, euphoria an
sedation. Significantly increases frequency and severity of
(Dilaudid) respiratory depression and hypotension.
Opioids should be avoided in any patient •Indications: Moderate to severe pain due to trauma of
under the influence of alcohol, medical conditions.
benzodiazepines, or other CNS
depressants, and you should avoid use with •Route: IV
Benadryl. When pain control is started with
one med, do not switch to different opioid •Contraindications: Hypotension, shock, respiratory
without discussing with medical control.
depression
•Side Effects: Respiratory depression/arrest, nausea/vomiting

•Dose: 0.5mg only, may repeat every 15 minutes – MAX

dose 1.5mg (ask for orders for more for transfers, this is 911
specific dosage), also consider half dose for elderly (>60yo)
•Peds: N/A – Fentanyl is preferred

ECG, pulse oximetry, and preferably waveform capnography

is to be placed.
 • Action: Increases GABA activity in the brain, which is an
Midazolam inhibitory neurotransmitter, resulting in significant sedation,

(Versed) relaxant and amnestic effects.

• Indications: ACTIVE tonic-clonic seizures with potential for

airway compromise.

• Route: IV/IO/IN/IM

• Contraindications: hypotension, respiratory depression

• Side Effects: apnea, loss of airway control, bradycardia, acute

delirium

• Dose: Adult: 2-2.5mg IV/IO or 5mg IN/IM – May repeat x1

after 5 minutes if still actively seizing.

• Peds: 0.1mg/kg, MAX 2mg IV, may repeat x1 after 5 minutes

is still actively seizing. IN/IM dosing is 0.2mg/kg, however, IN
is preferred.

Should not be given with an opioid or sedatives, such as

Benadryl or antipsychotics as this has a compounding effect.
Contact medical control as needed. ECG, pulse oximetry, and
waveform capnography is to be placed.
 • Action: Increases GABA activity in the brain, which is an
Lorazepam inhibitory neurotransmitter, resulting in significant sedation,
(Ativan) relaxant and amnestic effects.

• Indications: ACTIVE tonic-clonic seizures with potential for

airway compromise.

• Route: IV/IO/IN/IM

• Contraindications: hypotension, respiratory depression

• Side Effects: apnea, loss of airway control, bradycardia,

acute delirium
• Dose: Adult: 1mg IV/IO or 2mg IN/IM– May repeat x1 after
5 minutes if still actively seizing.

• Peds: 0.05mg/kg, MAX 1mg IV, may repeat x1 after 5

minutes is still actively seizing. IN/IM dosing is 0.1mg/kg,
however, IN is preferred.

ECG, pulse oximetry, and waveform capnography is to be

placed.
Lidocaine 2%
• Action: Local anesthetic for IO infusion.

• Indications: Pain control for IO on a conscious or

disoriented patient.
• Route: IO

• Contraindications: Allergy to anesthetics

• Side Effects: Seizures, tachycardia, arrythmias, hypotension.

• Dose: Adult: 50mg slow push

• Peds: Not available for pediatrics - Medical Control only

Elderly patients with significant CHF or liver disease are

more likely to experience adverse reactions
Methylprednisolone Action: Steroid suppression of acute inflammatory
response, with secondary effect of vascular and respiratory
(Solumedrol) smooth muscle relaxation.

Indications: Severe asthma, anaphylaxis

Route: IV/IO

Contraindications: Active GI bleed

Side Effects: Minimal in the acute single dose

administration, transient hyperglycemia, agitation

Dose: Adult: 125mg bolus over 2 minutes.

Peds: 2mg/kg (MAX 125mg)

This is a “helper drug”. It is NOT first line, as it takes 4-6

hours to take peak effect.
 In the AEMT scope, you are able to
Antibiotics MONITOR these medications.
(Cipro, Rocephin, Ancef,
etc.) You can switch pumps if needed
Dosage, concentration, and rate of these
drips will be given to you by the ER
provider.
Once completed, remove the drop set,
flush the IV site, and discard bag and
drop set into the trash.
 Scenario #1
You and your BLS partner are called to an MVC
on I-70. One patient involved, and has been Patient Is 30 yrs old.
thrown from the vehicle. Dispatch advises he has
Patient has no medical history.
leg injuries.

Your scene is safe Nothing makes it better or worse

As you approach your patient, he appears to be Patient has no allergies
in significant pain, and has an obvious mid-
femur fracture, and some lacerations and
Pain is a 10 on a 10 scale.
bruising on other extremities, no other
immediate life threats are seen.

Vital Signs: BP132/98, HR 114, Respirations 20

Scenario #2 Continued
After narcotic administration, patient states he feels really dizzy and nauseas.

4 lead is normal, and vitals stay the same throughout transport.

Scenario #2 Pain started 10 minutes ago while watching TV,
spouse called 911.
Patient has history of angina, and previous cardiac
You and your BLS partner are called
arrest last year some time.
to residence of a 74 year old male
with a chief complaint of chest pain. Pain does not radiate

Your scene is safe Nothing makes it better or worse

As you approach your patient, he Patient has nitroglycerin for his chest pain and has
appears pale and diaphoretic. taken one about 2 minutes ago, right before your
Vital Signs: BP 90/40, HR 62, arrival on scene.
Respirations 20
Patient has no allergies
Pain is a 7 on a 10 scale, sharp, worse than usual,
and he is very nauseas.
Scenario #2 Continued
12 lead is obtained:
Scenario #2 Continued
Oh no! Your patient is
now unconscious, and the
4 lead shows this:
Scenario #2 Continued
After your treatment, patient
now goes into this rhythm:
Scenario #2 Continued
After your treatment,
Your patient goes into
this rhythm:
Scenario #3
You and your BLS partner Mom states he has never had an
are called to a 4 year old that allergic reaction before.
is having an allergic reaction
Lung sounds reveal wheezes in all
to something he ate. lobes, and stridor is still heard.
Mom states he weighs 38
Vitals are: skin, slight cyanosis in
pounds. the nail beds, pale overall, BP
Your scene is safe 76/42, HR 125, Resp 28 and he is
struggling, SPO2 is 80, and CO2 is
As you approach, patient is reading 22
crying, and has audible
stridor
Scenario #3 Continued
Patients capnography waveform is showing:

4 lead shows:
 Scenario #4
You and your BLS partner
are called to a 23 yr old Patients friends are poor historians,
but they deny any drug use, as she
female having a seizure.
is drug tested at work regularly.
Your scene is safe.

Friends on scene state she

just “felt weird” then fell,
and started “shaking”, about
3 minutes ago.

Your patient is still actively

seizing, with full tonic-clonic
motions, and is not
breathing.
Scenario #4 Continued
Patients stops seizing, and is postictal, and has snoring respirations. Vitals are obtained: BP 115/80, HR
84 & regular, SPO2 92% on room air

While in the ambulance, patient begins seizing again, it has been approximately 8 minutes since the
last benzo was given.
QUESTIONS?