EMS Pocket Drug Guide 1st Edition
Visit the link below to download the full version of this book:
https://medipdf.com/product/ems-pocket-drug-guide-1st-edition/
Click Download Now
Contents v
Table VI-11 Burn Management: Rule of “9’s” 359
and Parkland Formula
Table VI-12 Adult Injury Severity Measures 360
(Glasgow Coma Score and Revised Trauma Score)
Table VI-13 Pediatric Injury Severity Measures 362
(Glasgow Coma Score and Pediatric Trauma Score)
Table VI-14 APGAR Scoring for Newborns 364
Table VI-15 Bioterrorism Agents 365
Table VI-16 List of Substances with a General Overview 370
of Prehospital Treatment and Specific Antidotes for Poisoning
and Overdose
Table VI-17 Rapid Sequence Induction (RSI) Intubation 374
Table VI-18 Cardiac Algorithms: ADULT 376
Table VI-19 Cardiac Algorithms: PEDIATRIC 382
INDEX 387
ADULT EMERGENCY CARDIAC CARE MEDICATIONS
INSIDE BACK COVER AND BACK PAGE
This page intentionally left blank
EDITORS
EDITOR
Patrick T. Gomella, MPH, NREMT-P
Class of 2013
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania
Firefighter/Paramedic
Concordville Fire and Protective Association
Concordville, Pennsylvania
ASSOCIATE EDITORS
Rex Mathew, MD, FACEP
Vice President for Emergency Medicine Clinical Operations
Thomas Jefferson University Hospitals
Assistant Professor
Department of Emergency Medicine
Thomas Jefferson University
Philadelphia, Pennsylvania
Matthew McMullan, BS, NREMT-P, CCEMT-P, FP-C
Paramedic/Firefighter
Malvern Fire Company
Malvern, Pennsylvania
David J. Schoenwetter, DO, PhP, FACEP
Medical Director, Geisinger EMS
Medical Director, Geisinger Life Flight
Attending Physician, Emergency Medicine
Geisinger Health System
Danville, Pennsylvania
Jason P. Zielewicz, MS, NREMT-P
Platoon Chief
Susquehanna Health/Regional EMS
Senior Partner
EMERGE Public Safety, LLC.
Williamsport, Pennsylvania
vii
viii Editors
CONSULTING EDITORS
Aimee G. Adams, PharmD
Clinical Pharmacist Specialist, Ambulatory Care
Adjunct Assistant Professor
College of Pharmacy and Department of Internal Medicine
University of Kentucky HealthCare
Lexington, Kentucky
Judith A. Barberio, PhD, APN,C, ANP, FNP, GNP
Assistant Professor
Coordinator, Adult & Family Nurse Practitioner Tracks
Rutgers, The State University of New Jersey
College of Nursing
Newark, New Jersey
Leonard G. Gomella, MD, FACS
The Bernard W. Godwin, Jr, Professor
Chairman, Department of Urology
Jefferson Medical College
Associate Director of Clinical Affairs
Kimmel Cancer Center
Thomas Jefferson University
Philadelphia, Pennsylvania
Tricia L. Gomella, MD
Part-Time Clinical Assistant Professor of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, Maryland
Steven A. Haist, MD, MS, FACP
Clinical Professor
Department of Medicine
Drexel University College of Medicine,
Philadelphia, Pennsylvania
Nick A. Pavona, MD
Professor, Department of Surgery
Benjamin Franklin University Medical Center
Chadds Ford, Pennsylvania
CONTRIBUTORS AND TECHNICAL REVIEWERS
Carol Beck, PhD
Assistant Dean, Jefferson College of Graduate Studies
Assistant Professor, Department of Pharmacology
and Experimental Therapeutics
Thomas Jefferson University
Philadelphia, Pennsylvania
Editors ix
Shawn M. Maguire, BS, NREMT-B
Emergency Medical Technician
University Ambulance Service
Pennsylvania State University
University Park, Pennsylvania
Glenn R. Oettinger, PharmD
Clinical Pharmacist, Emergency Medicine
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
This page intentionally left blank
PREFACE
I am pleased to present the first edition of the EMS Pocket Drug Guide. This guide
is based on the popular Clinician’s Pocket Drug Reference and adapted for use in
the field by front-line EMS providers.
As an EMS provider, I found the many “pocket” drug guides available were
either too large to carry while working or did not provide sufficient drug informa-
tion beyond simply listing a name and classification. While knowing the drug class
is useful for formulating a medically sound treatment plan for your patient, addi-
tional drug-specific information is often necessary to tailor your treatment based
on the specific drugs your patient is currently prescribed. Recent data suggests that
51% of insured Americans take at least one prescription drug for at least one
chronic condition and over 20% of the US population take three or more medica-
tions chronically. Knowing key drug information in the field is becoming more
essential as people begin to use more and more prescription medications.
This book provides several resources that can be accessed quickly to provide
the best care possible. A section is devoted to descriptions of over 70 drugs com-
monly used in the pre-hospital setting, followed by descriptions of about 1000 of
the most commonly used prescription and over-the-counter medications. Knowing
the dosing commonly used for FDA approved and so called off label uses is helpful
in determining if an excessive dose was ingested. A section on commonly used
medicinal herbs and supplements is also included as some of these can be very
clinically significant. A section dedicated to “street drugs” is also included for
quick reference.
A key feature of this guide is the concise “must know” medication information
with drug-specific EMS pearls, which includes signs and symptoms of overdose
and any specific overdose management. This guide is designed with sufficient
detail while maintaining its utility as a truly pocket drug reference. The book also
includes several reference charts and tables relevant to pre-hospital care.
I would like to thank Joe Morita and the entire production staff at McGraw-Hill
for their willingness to bring this book to the emergency service provider. The
opportunity to use the Clinician’s Pocket Drug Reference as a basis for the com-
monly used medications and adapt this information for the EMS provider is appreci-
ated. I would also like to thank my associate editors, consulting editors, contributors,
and technical reviewers who were asked to provide input to the book often on very
short notice. And lastly, my sincerest thanks go to my entire family, several of whom
xi
xii Preface
helped with various aspects of this book, for their support and guidance during the
process.
I encourage providers to take an active role and provide constructive feedback
about this book. Please feel free to e-mail me with any suggestions, drugs or refer-
ence charts you would like to see included in future editions.
Patrick T. Gomella, MPH, NREMT-P
Philadelphia, Pennsylvania
MEDICATION KEY
Medications are generally listed by prescribing class and the individual medica-
tions are then listed in alphabetical order by generic name for both EMS field
mediations (Section I) and the commonly prescribed medications (Section III).
Some of the more frequently recognized trade names are listed for each medication
(in parentheses after the generic name) or if available without prescription, noted
as OTC (over-the-counter).
Generic Drug Name (Selected Common Brand Names)
[Controlled Substance] [Drug Classification] WARNING:
Summarized versions of the “Black Box” precautions deemed necessary
by the FDA. These are significant precautions and contraindications con-
cerning the individual medication. Uses: This includes both FDA-labeled
indications bracketed by ** and other “off-label” uses of the medication.
Because many medications are used to treat various conditions based on
the medical literature and not listed in their package insert, we list com-
mon uses of the medication in addition the official “labeled indications”
(FDA approved) based on input from our editorial board Action: How
the drug works. This information is helpful in comparing classes of drugs
and understanding side effects and contraindications Dose: Adults. Where
no specific pediatric dose is given, the implication is that this drug is not
commonly used or indicated in that age group. Caution: [pregnancy/fetal
risk categories, breast-feeding (as noted below)] precautions concerning
the use of the drug in specific settings Contra: Contraindications Disp:
Drug primary formulation or route (ie, IV, Tabs, and Susp) SE: Common
or significant side effects EMS: Important facts/information relevant to
EMS providers in the field OD: Common symptoms of overdose and
specific treatment suggestions if available and appropriate
CONTROLLED SUBSTANCE CLASSIFICATION
Medications under the control of the US Drug Enforcement Agency (Schedules I–V
controlled substances) are indicated by the symbol [C]. Most medications are
“uncontrolled” and do not require a DEA prescriber number on the prescription. The
following is a general description for the schedules of DEA-controlled substances:
xiii
xiv Medication Key
Schedule (C-I) I: All nonresearch use forbidden (eg, heroin, LSD, mescaline).
Schedule (C-II) II: High addictive potential; medical use accepted. No tele-
phone call-in prescriptions; no refills. Some states require special prescription form
(eg, cocaine, morphine, methadone).
Schedule (C-III) III: Low to moderate risk of physical dependence, high risk of
psychologic dependence; prescription must be rewritten after 6 months or five
refills (eg, acetaminophen plus codeine).
Schedule (C-IV) IV: Limited potential for dependence; prescription rules same
as for schedule III (eg, benzodiazepines, propoxyphene).
Schedule (C-V) V: Very limited abuse potential; prescribing regulations often
same as for uncontrolled medications; some states have additional restrictions.
FDA FETAL RISK CATEGORIES
Category A: Adequate studies in pregnant women have not demonstrated a risk
to the fetus in the first trimester of pregnancy; there is no evidence of risk in the
last two trimesters.
Category B: Animal studies have not demonstrated a risk to the fetus, but no
adequate studies have been done in pregnant women.
or
Animal studies have shown an adverse effect, but adequate studies in pregnant
women have not demonstrated a risk to the fetus during the first trimester of preg-
nancy, and there is no evidence of risk in the last two trimesters.
Category C: Animal studies have shown an adverse effect on the fetus, but no
adequate studies have been done in humans. The benefits from the use of the drug
in pregnant women may be acceptable despite its potential risks.
or
No animal reproduction studies and no adequate studies in humans have been done.
Category D: There is evidence of human fetal risk, but the potential benefits from
the use of the drug in pregnant women may be acceptable despite its potential risks.
Category X: Studies in animals or humans or adverse reaction reports, or both,
have demonstrated fetal abnormalities. The risk of use in pregnant women clearly
outweighs any possible benefit.
Category ?: No data available (not a formal FDA classification; included to
provide complete dataset).
Medication Key xv
BREAST-FEEDING CLASSIFICATION
No formally recognized classification exists for drugs and breast-feeding although
the FDA is considering developing one. This shorthand was developed for the
Clinician’s Pocket Drug Reference.
+ Compatible with breast-feeding
M Monitor patient or use with caution
± Excreted, or likely excreted, with unknown effects or at unknown
concentrations
?/− Unknown excretion, but effects likely to be of concern
− Contraindicated in breast-feeding
? No data available
This page intentionally left blank
ABBREVIATIONS
* *: FDA-labeled indications ACLS: advanced cardiac life support
bracketed by asterisks ACS: acute coronary syndrome,
#: drugs marked with this in Section I American Cancer Society,
have additional information on American College of Surgeons
prescription use included in the ADH: antidiuretic hormone
generic drug section (Section III) ADHD: attention-deficit
÷: divided hyperactivity disorder
: check or monitor ADR: adverse drug reaction
↑ glucose: hyperglycemia AE: adverse events
↑ HR: increased heart rate AF: atrial fibrillation
(tachycardia) AHA: American Heart Association
↑: increase or increased Al: aluminum
↓ BM: bone marrow suppression, ALL: acute lymphocytic leukemia
myelosuppression ALS: amyotrophic lateral sclerosis
↓ BP: hypotension ALT: alanine aminotransferase
↓ plt: decreased platelets (a liver enzyme)
(thrombocytopenia) AMI: acute myocardial infarction
↓: decrease or decreased AML: acute myelogenous leukemia
5-FU: 5-fluorouracil (chemotherapy amp: ampule
drug) AMS: acute myocardial syndrome
5-HT: 5-hydroxytryptamine ANC: absolute neutrophil count
AA: African American ANS: autonomic nervous system
AB: abortion APACHE: Acute Physiologic and
Ab: antibody Chronic Health Evaluation; ICU
abd: abdomen/abdominal illness severity scoring system
ABMT: autologous bone marrow APAP: acetaminophen [N-acetyl-p-
transplantation aminophenol]
Abs: antibodies aPTT: activated partial
ac: before meals (Latin “ante cibum”) thromboplastin time
ACE: angiotensin-converting enzyme ARB: angiotensin II receptor blocker
ACEI: angiotensin-converting ARDS: adult respiratory distress
enzyme inhibitor syndrome
xvii
