Medications Used...

[SMW83]

I was curious as to how many different medications are used in the ambulance, as well as their side effects and what they are used for...
an example..(don't know if its correct..)
Name used for dosage usage side effects
morphine pain reliever 12mg/kg/min sleepiness

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[Daedalus]

On BLS rigs... not too many. (pretty much just O2 ) As EMT-Bs, we can only administer a very limited range of drugs (especially in CA ), and only if they are prescribed for the patient.
We carry a decent amount of ALS gear and meds as well, but only for use when a paramedic is riding along.

Paramedics (ALS) generally have a rather large assortment of meds that they can administer without a prescription, from Narcan to epi.
Any paramedics here care to start listing?
I'll start:

Name - Oxygen (O2)
Used for - anything and everything lol
Dosage - 12 LPM by NRB or 3-4 LPM by cannula
Side Effects - well, none really when used in the field

 

[12R34Y]

there is no way i have the time or patience to list everything you wanted, but i'll throw out a few drugs i can remember that we carried at my ALS service.

Epi, Lido, Amiodarone, atropine, bicarb, D50, glucagon, thiamine, albuterol, atrovent, activated charcoal, lasix, morphine, fentanyl, versed, narcan, nitro, aspirin, valium, normal saline, adenosine, mag sulfate, benadryl, nitrous oxide.

haven't worked in a a couple of years and can't think of anymore off the top of my head. may be a few more, but that's most of the big one's.

later

 

[hakksar]

I don't feel like looking the rest of this up right now but in Colorado EMT-B's with IV-cert and Physician Advisor approval can administer Epi-Pens, albuterol inhalers, Normal Saline, D-50, oral glucose, nitroglycerin, oxygen, asprin, and activated charcoal. Most BLS ambulances I know of carry at least Normal Saline, D-50, oxygen, asprin, activated charcoal, and oral glucose (I know of a few in rural areas that actually carry all of the above although most need on-line direction to administer some of them). As for ALS ambulances I think that Paramedics in Colorado can administer 42 different medications (I am not exactly sure if this is correct) and most if not all of these are carried on ALS rigs.

 

[dgmedic]

Yeah, will post some drugs....but not all that. Get a pharm book and look them up...they all will be in there.

Epi, Lido, Amiodarone, atropine, bicarb, D50, glucagon, thiamine, albuterol, atrovent, activated charcoal, lasix, morphine, fentanyl, versed, narcan, nitro, aspirin, valium, normal saline, adenosine, mag sulfate, benadryl, cardizem, LR, calcium gluc, labetalol, etomidate, succsinylcholine, zemuron, norcuron, ketamine, captopril, glucagon, terbutaline, haldol, ativan, nitroprusside, dopamine, dobutamine, heparin, retavase, procainamide, vasopressin.....seems that is all I can remember right now from memory....that's pretty much it though.

If you have any questions about a specific drug, post it and it will be answered (I will at least anwer you)....as as far as writing a whole pharm lecture via the board....I really don't think that will happen....sorry

 

[oudoc08]

Just to add a couple from my previous service. Romazicon, TNKase, NO, Lovenox (low mol. wt. heparin), oxytocin.
Gotta go. Long day.

 

[jwk]

Epi, Lido, Amiodarone, atropine, bicarb, D50, glucagon, thiamine, albuterol, atrovent, activated charcoal, lasix, morphine, fentanyl, versed, narcan, nitro, aspirin, valium, normal saline, adenosine, mag sulfate, benadryl, cardizem, LR, calcium gluc, labetalol, etomidate, succsinylcholine, zemuron, norcuron, ketamine, captopril, glucagon, terbutaline, haldol, ativan, nitroprusside, dopamine, dobutamine, heparin, retavase, procainamide, vasopressin

Curious why you would carry:

Versed AND Valium (pretty much do the same thing)
Zemuron AND norcuron (do the same thing, BIG price difference)
Ketamine and Nitrous Oxide(anesthetic drug)
Heparin and Lovenox (urgent administration rarely required)
Nitroprusside (very difficult to titrate without an arterial line)

Been doing anesthesia for 25 years since I was a paramedic - this just seems like overkill on some things, and questionable use in the field on others. I know things change - someone enlighten me.

 

[Wahoo]

Curious why you would carry:

Versed AND Valium (pretty much do the same thing)
Zemuron AND norcuron (do the same thing, BIG price difference)
Ketamine and Nitrous Oxide(anesthetic drug)
Heparin and Lovenox (urgent administration rarely required)
Nitroprusside (very difficult to titrate without an arterial line)

Been doing anesthesia for 25 years since I was a paramedic - this just seems like overkill on some things, and questionable use in the field on others. I know things change - someone enlighten me.

Not sure about all those drugs on an EMS rig either, but for ketamine at least:
The relief of pain is an essential component of prehospital
care and, when required is usually administered on
completion of the primary survey. For simple analgesia
morphine sulphate titrated to the clinical response and
preceded by an antiemetic is usually effective, for example,
in the relief of pain in chest trauma or myocardial
infarction. For patients with multiple injuries and for those
patients requiring manipulation and splintage of fractures
and for entrapments and difficult extrications ketamine is a
safe and effective option, which avoids the potential
decrease in blood pressure and respiratory depression that
is associated with opioid analgesia.
Porter K. Ketamine in Prehospital Care. Emerg Med J 2004;21:351?354.

 

[jwk]

Not sure about all those drugs on an EMS rig either, but for ketamine at least:
The relief of pain is an essential component of prehospital
care and, when required is usually administered on
completion of the primary survey. For simple analgesia
morphine sulphate titrated to the clinical response and
preceded by an antiemetic is usually effective, for example,
in the relief of pain in chest trauma or myocardial
infarction. For patients with multiple injuries and for those
patients requiring manipulation and splintage of fractures
and for entrapments and difficult extrications ketamine is a
safe and effective option, which avoids the potential
decrease in blood pressure and respiratory depression that
is associated with opioid analgesia.
Porter K. Ketamine in Prehospital Care. Emerg Med J 2004;21:351?354.

Interesting. I wouldn't touch Ketamine in a pre-hospital setting. If you're dealing with "entrapments and difficult extrications", that would usually imply at least a risk of a head injury. That would be an absolute contraindication to the use of Ketamine since it raises ICP. I can certainly see the attraction, but would disagree with using it in the field.

 

[dgmedic]

JWK

Versed / Valium : Sorry 'bout that, I copied and pasted from the first list. We have versed, not valium

Ketamine / NO: I took out NO, it's not in my list

Zemuron / Norcuron: if we induct with one we maintain with the other (this is dependant if they have a contraindication to succs. Plus if a facility is maintining on one or the other...so we can maintian what they are using)

Heparin / Lovenox: we only carry Heparin, not lovenox

Nitroprusside: don't necessarily agree with HAVING to have an art line, this has been used in the prehospital setting for quite some time...maybe not 25 years ago....but....well....I'm not trying to imply anything
We do have the capability of monitoring an art-line, balloon pump, etc. plus we carry IV pumps in the field...don't do the good ol gravity drips anymore.

BTW, I work as a flight medic (as well as on the ground), but we do carry all the same drugs on the ground. We have very liberal protocols and they are the same....ground/air....as well as outstanding education....you really can't have one without the other.

Anyway, yeah, I guess prehospital medicine has changed a bit since you were here. Thanks for checking though

 

[jwk]

JWK

Versed / Valium : Sorry 'bout that, I copied and pasted from the first list. We have versed, not valium

Ketamine / NO: I took out NO, it's not in my list

Zemuron / Norcuron: if we induct with one we maintain with the other (this is dependant if they have a contraindication to succs. Plus if a facility is maintining on one or the other...so we can maintian what they are using)

Heparin / Lovenox: we only carry Heparin, not lovenox

Nitroprusside: don't necessarily agree with HAVING to have an art line, this has been used in the prehospital setting for quite some time...maybe not 25 years ago....but....well....I'm not trying to imply anything
We do have the capability of monitoring an art-line, balloon pump, etc. plus we carry IV pumps in the field...don't do the good ol gravity drips anymore.

BTW, I work as a flight medic (as well as on the ground), but we do carry all the same drugs on the ground. We have very liberal protocols and they are the same....ground/air....as well as outstanding education....you really can't have one without the other.

Anyway, yeah, I guess prehospital medicine has changed a bit since you were here. Thanks for checking though

Oh I freely admit I'm an old fart. And I combined a few of the drugs I'd seen in different posts - I'm too lazy to try and cut and paste and quote several different messages into one.

NO is Nitric Oxide - N2O is Nitrous Oxide - two different animals with entirely different actions. Nitrous in the field would be interesting. Is anyone using Nitric Oxide in the field?

 

[12R34Y]

We only give Versed for concious sedation ie. cardioversion, straightening a grossly angulated extremity.

We do NOT give valium for that as it has much much longer half life.
Versed works nice and fast and has more amnestic effects than valium. ideal for quick procedures such as cardioversion on concious patient.

we use nitrous in the field and it works variably in different people. I've had kids with broken arms who would barely let us touch them let alone start a line for morphine. Gave some nitrous....giggling like an idiot and walk to the cot.

others it doesn't touch.

later

 

[dgmedic]

Oh I freely admit I'm an old fart. And I combined a few of the drugs I'd seen in different posts - I'm too lazy to try and cut and paste and quote several different messages into one.

NO is Nitric Oxide - N2O is Nitrous Oxide - two different animals with entirely different actions. Nitrous in the field would be interesting. Is anyone using Nitric Oxide in the field?

yeah, sorry about that....it was just an abbreviation....wasn't trying to show off my knowledge of chemical structure; figured you would know what I was saying (apparently you did). don't believe that succs is a chemical structure either is it.

Anyway, thanks for the critique of my post. Always looking to improve.