Adult II 2015
Emergency Medications
National EMS Education Standard Competencies
Emergency Medications
• Names
• Effects
• Indications
• Routes of administration
• Dosages for the medications administered
National EMS Education Standard Competencies
Emergency Medications (cont’d)
• Actions
• Contraindications
• Complications
• Side Effects
• Interactions
AHA Classification of Recommendations and Level
of Evidence
• Class I
− A treatment should be administered.
• Class IIa
− It is reasonable to administer treatment.
• Class IIb
− Treatment may be considered.
AHA Classification of Recommendations and Level
of Evidence
• Class III
− Treatment should NOT be administered.
− It is harmful, not helpful.
• Class Indeterminate
− Research is either beginning or continuing on
this treatment.
− Cannot be recommended for or against
Medication Listings
• Name of medication
− And other common names
• Class
− How the medication is classified compared to
other medications
Medication Listings
• Mechanism of action
− The way a medication produces the intended
response
• Indications
− Circumstance that shows cause or warning of
disease
• Contraindications
− Any condition that renders some particular line
of treatment improper or undesirable
Medication Listings
• Adverse reaction/side effects
− An abnormal or harmful effect to an organism
caused by exposure to a chemical
• Drug interactions
− Any potential effects a medication may have
when administered with or in the presence of
something else in the patient’s system
Adenosine (Adenocard)
• Classification:
• anti arrhythmatic, diagnostic
agent
• Mechanism of action
− Slows conduction through
the AV node
− Can interrupt reentrant
pathways
− The drug of choice for
reentry SVT
• Indications
− Most forms of stable
narrow-complex SVT
• Contraindications
− Bronchoconstrictive or
bronchospastic lung disease
• Adverse reactions
− Generally short duration and
mild
• Considerations
− Evaluate elderly for signs of
dehydration
− Dose:by rapid IV bolus only
given over 1_2 seconds
administered directly into a vein
or as proximal as possible ;
follow with a rapid saline flush .
Albuterol (Proventil, Ventolin)
• Mechanism of action
− Results in smooth-
muscle relaxation in
the bronchial tree
• Indications
− Treatment of
bronchospasm in
patients with
COPD/asthma)
• Contraindications
− Hypersensitivity
reactions to albuterol
• Adverse reactions
− Often dose-related
and include
headache, fatigue,
lightheadedness,
irritability,
restlessness
• Considerations
− Pregnancy safety:
Category C
− May precipitate
angina pectoris and
dysrhythmias
Alteplase, Recombinant (Tissue Plasminogen Activator
or rTPA, Activase)
• Classification: Thrombolytic agent
• Mechanism of action− Restores perfusion
• Indications− Acute myocardial infarction,
STEMI, massive pulmonary emboli, acute ischemic cerebrovascular accident
• Contraindications− Active internal bleeding
− Recent surgery
Dose: 100mg IV over 2 hr, followed immediately by heparin therapy .
• Adverse reactions
− Intracranial bleeding,
reperfusion
dysrhythmias, chest
pain, hypotension,
GI bleeding, nausea,
abdominal pain
• Considerations
− Monitor vital signs
closely.
− Observe for bleeding.
Amiodarone (Cordarone, Pacerone)
• Classification antiarrhythmatic
• Mechanism of action− Delays repolarization and
increases the duration of action potential
• Indications− Ventricular fibrillation
• Contraindications− Known hypersensitivity to
amiodarone or iodine
− Cardiogenic shock
Dose:1000mg IV over 24hours,150 mg loading dose over 10min,followed
− Over 6 hr at rate 1mg/min
− For maintenance infusion 540mg at 0.5 mg / min over 18 hr .
• Adverse reactions
− Dizziness, fatigue,
malaise
− Congestive heart
failure
• Considerations
− Pregnancy safety:
Category D
− Monitor patient
for hypotension.
Aspirin (ASA)
• Classification:
antiplatelet
• Mechanism of action− Prevents platelets from
clumping together and forming emboli
• Indications− New onset chest pain
suggestive of acute myocardial infarction
• Contraindications− Relatively contraindicated in
patients with active ulcer disease or asthma
• Adverse reactions
− Bronchospasm,
anaphylaxis,
wheezing
in allergic patients,
prolonged bleeding
• Considerations
− Pregnancy safety:
Category D
− Use cautiously with
impaired renal
function .
Atropine Sulfate
• Classification:
• Parasympathetic,Anticholinergic
• Mechanism of action
− Increases heart rate in life-
threatening bradydysrhythmias
• Indications
− Hemodynamically unstable
bradycardia
• Contraindications
− Tachycardia, hypersensitivity
Dose:
for bradycardia 0.4mg to1mg (up to
2 mg )IV every 1-2 hr as needed
.
• Adverse reactions
− Drowsiness, confusion,
headache, tachycardia,
palpitations
• Considerations
− Pregnancy safety: Category
C
− Moderate doses may cause
pupillary dilation.
Calcium Gluconate
• Classification:
• Electrolytes
• Mechanism of action
− Helps maintain cardiac
function
• Indications
− Hyperkalemia,
hypocalcemia
• Contraindications
− Ventricular fibrillation,
digitalis toxicity,
hypercalcemia
− Dose :infusion slowly
,0.5ml-2ml/min, (500mg
/kg/day IV given in divided
Doses.
• Adverse reactions
− Syncope, cardiac
arrest, dysrhythmia,
bradycardia
• Considerations
− Pregnancy safety:
Category C
− Do not administer by
IM or SQ,stop infusion
if patient complains of
discomfort; resume
when symptoms
disappear .
Clopidogrel (Plavix)
• Classification:Antiplatelet
• Mechanism of action
− Inhibits platelet aggregation by blocking Adenosine diphosphate receptors on platelets(ADP), preventing clumping of platelets.
• Indications
− Acute coronary syndrome
− Substitute for aspirin in patients unable to take aspirin
Dose: recent MI,stroke 75mg daily
ACS (Acute Coronary Syndrome )300mg PO loading dose , then 75mg/day with aspirin .
• Contraindications
− Active GI bleeding, intracranial hemorrhage
• Adverse reactions
− Severe neutropenia
− Hemorrhaging
• Considerations
− Pregnancy safety: Category
B
− Often given with
other anticoagulants
Dexamethasone Sodium Phosphate (Decadron)
• Classification: corticosteroid
,Hormone
• Mechanism of action
− Suppresses acute and
chronic inflammation
• Indications
− Anaphylaxis, asthma, spinal
cord injury,cerebral edema
associated with brain tumor
,craniotomy, or head injury .
• Contraindications
− Hypersensitivity, use
caution in suspected
systemic sepsis
• Adverse reactions
− Headache,
restlessness,
euphoria, psychoses
• Considerations
− Pregnancy safety:
Category C
− Protect medication
from heat. Toxicity
and side effects occur
with long-term use.
Diazepam (Valium and Others)
• Classification :
• Benzodiazepine, Anxiolytic, Antiepileptic, Skeletal muscle relaxant (centrally acting ).
• Mechanism of action− Raises the seizure
threshold; induces amnesia and sedation
• Indications− Acute anxiety states and
agitation, acute alcohol withdrawal
• Dose :Status epilepticus5-10mg by slow IV. May repeat q 5-10 min to total dose 30mg .
• Contraindications
− Hypersensitivity, narrow-
angle glaucoma
− Adverse reactions
− Dizziness, drowsiness,
confusion, headache
• Considerations
− Pregnancy safety: Category
D
− Short duration for
anticonvulsant effect
− Reduce dose by 50%
in elderly patients.
Digoxin (Lanoxin)
• Classification :
Cardiac glycoside ,Cardiotonic
• Mechanism of action
− Increases force of myocardial contraction
• Indications
− Congestive heart failure, reentry SVTs, ventricular rate control in atrial flutter and atrial fibrillation
• Dose:evaluate patient carefully
to determine the appropriate dose
loading dose 0.125-0.25mg IV, maintenance dose0.125-0.25mg /day PO .
• Adverse reactions
− Fatigue, headache, blurred
yellow or green vision,
seizures
• Considerations
− Pregnancy safety: Category
C
− Patient receiving IV digoxin
must be on a monitor
− Assessment for renal
function , serum K+, Mg++
level.
• Contraindications
− Ventricular fibrillation, ventricular tachycardia, digitalis toxicity
Diltiazem (Cardizem)
• Classification :
• Calcium channel blocker, antianginal
,antihypertensive .
• Mechanism of action
− Reduces myocardial oxygen
demand
• Indications
− Controls rapid ventricular
rates(Paroxysmal supra
ventriculartachycardia , atrial
fibrillation , atrial flutter.
Dose :direct IV bolus :0.25mg/Kg
(20mg for the average patient )
second bolus of 0.35mg /kg .
Continuous IV infusion 5-10 mg
/hr
• Adverse reactions
− Dizziness, weakness,
headache, dyspnea
• Considerations
− Pregnancy safety: Category
C
− Use with caution in patients
with renal or hepatic
dysfunction.
• Contraindications
− Hypotension
− Sick sinus syndrome
Dobutamine Hydrochloride (Dobutrex)
• Classification:
Sympathomimetic ,Beta1 selective adrenergic agonist.
• Mechanism of action− Increased myocardial
contractility, stroke volume, and increased cardiac output
• Indications− Cardiogenic shock, CHF
• Dose :Administer only by IV infusion using an infusion pump
• 2.5mg -10mg /kg/min IV is ususl rate to increase cardiac output .
• Adverse reactions
− Headache, dyspnea,
tachycardia, hypertension,
chest pain
• Considerations
− Pregnancy safety: Category
B
− Monitor blood pressure
closely.
• Contraindications
− Tachydysrhythmias, severe
hypotension
Dopamine Hydrochloride (Intropin)
• Classification:
• Sympathomimetic
Alpha –adrenergic agonist , Beta1-selective adrenergic agonist, Dopaminergic drug .
• Mechanism of action− Increases myocardial
contractility and stroke volume
• Indications
− Cardiogenic and septic shock, hypotension with low cardiac output states
− Dose :Administer only by IV infusion using an infusion pump
− Initially 2-5mcg/kg/min IV patients who more seriously ill,5mcg/kg/min up to a rate of 20-50mcg/kg/min.
• Adverse reactions− Headache, anxiety,
dyspnea, dysrhythmias
• Considerations− Pregnancy safety: Category
C
− Effects are dose-dependent
− Contraindications
− Hypovolemic shock, pheochromocytoma, tachydysrhythmias
Epinephrine (Adrenalin)
• Classification:Sympathomimetic ,Alpha-adrenergic agonist,Beta1-and beta2- adrenegic agonist ,cardiac stimulant .
• Mechanism of action− Blocks histamine
receptors
• Indications
− Cardiac arrest, symptomatic bradycardia
• Dode:cardiac arrest ;0.5IV during resuscitation q 5 min.
• Adverse reactions
− Nervousness, restlessness,
headache, tremor
• Considerations
− Pregnancy safety: Category
C
− May cause syncope in
asthmatic children
• Contraindications
− Hypertension, hypothermia,
pulmonary edema
Furosemide (Lasix)
• Classification : loop diuretic
• Mechanism of action
− Causes increased urine output
• Indications
− CHF, pulmonary edema, hypertensive crisis
Dose: in pulmonary edema 40 mg IV over 1-2 min.may be increased to 80mg IV given over 1-2 min if response unsatisfactory after 1 hour .
in hypertension 40mg bid. if needed additional anti hypertensive may be needed .
• Adverse reactions
− Dizziness, headache, ECG
changes, weakness
• Considerations
− Pregnancy safety: Category
C
− Ototoxicity, deafness, and
projectile vomiting can
occur with rapid
administration.
• Contraindications
− Hypovolemia, anuria,
hypotension
Haloperidol Lactate (Haldol)
• Classification :
• Dopaminergic –blocking drug
Antipsychotic.
• Mechanism of action
− Inhibits central nervous
system catecholamine
receptors
• Indications
− Acute psychotic episodes
Dose:IV unlabeled use for acute
situations2-25mg IV q hr at
arate of 5mg /min.
• Adverse reactions
− Seizures, sedation,
confusion, restlessness
• Considerations
− Pregnancy safety: Category
C
− Treat hypotension
secondary to haloperidol
with fluids and
norepinephrine,
not epinephrine
• Contraindications
− Parkinson's disease,
depressed mental status
Heparin Sodium
• Classification :Anticogulant
• Mechanism of action− Inhibiting thrombus and clot
formation by blocking the conversion of prothrombin to thrombin and fibronogen to fibrin plasmin; does not lyses existing clots
• Indications− Acute myocardial infarction,
prophylaxis and treatment of thromboembolic disorders
− Dose:Adjust dose according
To cogulation tests. Dosage is adequate when PTT=1.5-3 times control value .
• Adverse reactions
− Pain, anaphylaxis, shock,
hematuria
• Considerations
− Pregnancy safety: Category
C
− Heparin does not lyse
existing clots.
• Contraindications
− Hypersensitivity, active
bleeding
Hydrocortisone Sodium Succinate (Solu-Cortef)
• Classification :
• corticosteroid short acting ,glucocorticoid ,Adrenal cortical steroid, hormone.
• Mechanism of action− Anti-inflammatory;
immunosuppressive with salt-retaining actions
• Indications− Shock due to acute
adrenocortical insufficiency, anaphylaxis, asthma, and COPD.
− Dose: 100mg- 500mg initially and q 2-10h based on condition and response .
• Adverse reactions
− Headache, vertigo,
pulmonary tuberculosis
• Considerations
− Pregnancy safety: Category
C
− May be used in status
asthmaticus as a
second-line drug
• Contraindications
− Systemic fungal infections,
premature infants
Lidocaine Hydrochloride (Xylocaine)
• Classification: Antiarrhythmatic ,local anesthetic .
• Mechanism of action
− Decreases automaticity of ventricular cells , increase ventricular fibrillation threshold .
• Indications
− Alternative to amiodarone in cardiac arrest from ventricular tachycardia
− Dose :Arrhythmias, monitor ECG constantly ,give 50-100mg at rate of 25-50mg /min, 1/3 to 1/2the initial dose may be given after 5min if needed .do not exceed 200-300mgin 1 hr .
• Adverse reactions
− Anxiety, drowsiness,
confusion, seizures
• Considerations
− Apnea induced with
succinylcholine may be
prolonged with high doses
of lidocaine.
− Exceedingly high doses can
result in coma or death.
• Contraindications
− Hypersensitivity, second- or
third-degree AV block in the
absence of an artificial
pacemaker
Magnesium Sulfate
• Classification:
• Electrolyte Antiepileptic .
• Mechanism of action− Reduces striated muscle
contractions
• Indications− Seizures of eclampsia,
torsades de pointes, hypomagnesemia
• Dose:
• 1-4 gm of a 10%-20%solution .Do not exceed 1.5 ml/min of a10% solution. or 4-5 gm in 250ml of 5%dextrose. Do not exceed 3ml / min .
• Adverse reactions
− Drowsiness, CNS
depression, respiratory
depression
• Considerations
− Pregnancy safety: Category
A
− Recommended that
the drug not be
administered in the
2 hours before delivery, if
possible
• Contraindications
− Heart block, myocardial
damage
Mannitol (Osmitrol)
• Classification :
• osmotic diuretic, diagnostic agent,
• Mechanism of action
− Decreases cerebral edema and intracranial pressure
• Indications
− Cerebral edema
• Dose:
• In reduction of intracranial pressure and cerebral edema:1.5-2 gm/kg as a 15%-25% solution over 30-60min.Evidence of reduced pressure should be seen in 15 min.
• Adverse reactions
− Headache, confusion, seizures, pulmonary edema
• Considerations
− Pregnancy safety: Category C
− May crystallize at low temperatures; store at room temperature
− Have ventilatory support available.
• Contraindications
− Hypotension, pulmonary edema, severe dehydration, intracranial bleeding, CHF
Methylprednisolone Sodium Succinate (Solu-Medrol)
• Classification:
• corticosteroid,glucocorticoid , hormone.
• Mechanism of action− Suppresses acute and chronic
inflammation
• Indications− Acute spinal cord trauma,
anaphylaxis, bronchodilator for unresponsive asthma
• Dose:10-40mg IV administered over 1 min to several minutes .give subsequent dosesIVor IM.
• Warning :Rapid IV administration of large doses (more than0.5mg-1gm in less than 10-20min)has caused serious cardiac complications.
• Adverse reactions
− Depression, euphoria,
headache, restlessness,
seizure
• Considerations
− Pregnancy safety:
Category C
− Not effective if time of spinal
cord injury greater than
8 hours
• Contraindications
− Premature infants, systemic
fungal infections
Midazolam Hydrochloride (Versed)
• Classification:
• Benzodiazepine (short acting )
• CNS depressant
• Mechanism of action− Causes sedative, anxiolytic,
amnesic, and hypnotic effects
• Indications− Sedation for medical
procedures.
− Continuous sedation of intubated and mechanically ventilated patients during treatment in critical care setting .
• Adverse reactions
− Headache, somnolence,
respiratory depression
• Considerations
− Pregnancy safety: Category
D
− Administer immediately
prior to intubation
procedure.
• Contraindications
− Acute narrow-angle
glaucoma, shock, coma,
alcohol intoxication
Morphine Sulfate (Roxanol, MS Contin)
• Classification: Opoid agonist
analgesic .
• Mechanism of action
− Alleviates pain
through CNS action
• Indications
− Severe CHF, acute cardiogenic
pulmonary edema
Dose :2.5mg -15mg /70kg of body
weight in 4-5ml water for
injection administered over 4-5
min. Continuous IV infusion 0.1-
1 mg /ml in 5% dextrose in
water by controlled infusion
device .
• Adverse reactions
− Confusion, sedation,
headache, CNS depression
• Considerations
− Pregnancy safety: Category
C
− Morphine rapidly crosses
the placenta.
• Contraindications
− Head injury, exacerbated
COPD, depressed
respiratory drive
Naloxone Hydrochloride (Narcan)
• Classification :
• Opoid antagonist , Diagnostic
agent .
• Mechanism of action
− Reverses respiratory
depression secondary to
opiate drugs
• Indications
− Opiate overdose, complete
or partial reversal of central
nervous system and
respiratory depression
induced by opioids
• Dose:
• Opoid overdose initial dose of 0.4 - 2 mg IV additional doses may be repeated at 2-3 min intervals. If no response after 10mg question the diagnosis .
• Contraindications
− Use with caution in narcotic-dependent patients
• Adverse reactions
− Restlessness, seizures, dyspnea, pulmonary
• Considerations
− Pregnancy safety: Category C
Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
• Classification:
• Antianginal
• Mechanism of action
− Smooth muscle relaxant acting on vasculature, with a resultant decrease in venous return and decrease in arterial BP ,which reduces myocardial oxygen cosumption .
• Indications
− Acute angina pectoris, ischemic chest pain
• Dose: Initial dose , 5mcg/min delivered through an infusion pump .inceased by 5mcg/min .if no response
• 20mcg/min.Once BP response is obtained reduce dose and llengthen dosage intervals. continually monitor response and titrate carefully .
• Adverse reactions− Headache, dizziness,
weakness, reflex tachycardia
• Considerations− Pregnancy safety:
Category C
− Hypotension more common in the elderly
• Contraindications− Hypotension, hypovolemia,
intracranial bleeding or head injury
Norepinephrine Bitartrate (Levophed)
• Classification:
• Sympathomimetic
• Alpha-adrenergic agonist ,Beta1adrenergic agonist , cardiac stimulant ,vasopresser.
• Mechanism of action− Potent alpha-agonist resulting in
intense peripheral vasoconstriction
• Indications− Cardiogenic shock,
unresponsive to fluid resuscitation
Dose :Add 4ml of the solution (1mg/ml)to 1000ml of 5% dextrose solution for a concentration of 4mcg base /ml
Initially give 8-12 mcg /min adjust dose gradually to maintain desired Bp .
• Adverse reactions− Headache, anxiety,
dizziness
• Considerations− Pregnancy safety: Category
C.
− May cause fetal anoxia when used in pregnancy
• Contraindications− Hypotensive patients with
hypovolemia
Ondansetron Hydrochloride (Zofran)
• Classification: Antiemetic
• Mechanism of action− Blocks action of serotonin
• Indications− Prevention and control of
nausea or vomiting
• Dose:
• Prevention of chemotherapy -induced nausea and vomiting three 0.15mg /kg doses IV first dose is given over 15 min, before 30min of starting the chemotherapy .
• Adverse reactions
− Headache, malaise,
wheezing
• Considerations
− Pregnancy safety:
Category B
• Contraindications
− Known allergy to
ondansetron
Oxygen
• Mechanism of action
− Reverses hypoxemia
• Indications
− Confirmed or
expected hypoxemia,
ischemic chest pain
• Contraindications
− Certain patients with
COPD will not tolerate
oxygen concentrations
over 35%.
• Adverse reactions
− Decreased level of
consciousness
(COPD patients),
decreased respiratory
drive in COPD
patients
• Considerations
− Be familiar with liter
flow and each type of
delivery device used.
Phenytoin (Dilantin)
• Classification:
• Antiepileptic , antiarrhythmic group Ib.
• Mechanism of action− Promotes sodium
efflux from neurons
− Effective in treating cardiac arrhythmias, especially those induced by digitalis.
• Indications− Prophylaxis and treatment
of major motor seizures
Dose:status epilepticus 10-15 mg /kg
by slow IV .for maintenance 100mg 6-8 hr .
• Adverse reactions
− Ataxia, agitation, dizziness,
headache, drowsiness
• Considerations
− Pregnancy safety: Category
D
− Carefully monitor vital signs.
− Contraindications
− Hypersensitivity,
bradycardia
Propofol (Diprivan)
• Mechanism of action
− Produces rapid and brief state of general anesthesia
• Indications
− Anesthesia induction/ maintenance, sedation for mechanically ventilated patients
− Dose:Inducción anestésicaIV: 1 – 2,5 mg/kgMantenimiento anestésicoPerfusión IV: 50 – 150 mcg/kg/minSedaciónDosis de carga IV: 0,25 – 1 mg/kgMantenimiento IV:10 – 50 µg/kg/min
• Adverse reactions
− Seizure, apnea, dysrhythmias, asystole, hypotension, hypertension
• Considerations
− Pregnancy safety: Category B
− Avoid rapid administration in elderly patients to avoid hypotension and airway obstruction.
• Contraindications
− Hypovolemia, known sensitivity
Propranolol Hydrochloride (Inderal)
• Classification :• Beta-adrenergic blocker
(nonselective) antianginal,antiarrhythmic.
• Mechanism of action− Reduces chronotropic,
inotropic, and vasodilator response to beta-adrenergic stimulation
• Indications− Hypertension, angina
pectoris
− Dose : life threatening arrhythmias 1-3 mg IV with careful monitoring ,not to exceed 1mg /min .
• Adverse reactions
− Weakness, depression, fatigue, anxiety, dizziness, bronchospasm
• Considerations
− Pregnancy safety: Category C
− Closely monitor patient during administration.
− Use with caution in elderly patients.
− Atropine should be readily available.
• Contraindications
− Sinus bradycardia, second-or third-degree AV block
Sodium Bicarbonate
• Classification :
• Electrolyte , systemic alkalinizer,
• Mechanism of action
− Buffers metabolic acidosis and lactic acid buildup
• Indications
− Metabolic acidosis during cardiac arrest.
Dose:for severe metabolic acidosis ,dose depends on blood CO2 content , PH, and patient clinical condition ,90-180mEq/L.IVduring first hour then adjust PRN.
• Adverse reactions
− Hypernatremia, metabolic
alkalosis, tissue sloughing,
cellulitis
• Considerations
− Pregnancy safety:
Category C
− Repeat as needed in
tricyclic antidepressant
overdose until QRS narrows
• Contraindications
− Metabolic/respiratory
alkalosis, hypokalemia,
electrolyte imbalance
Tirofiban Hydrochloride (Aggrastat)
• Classification:
• Antiplatelet
• Mechanism of action
− Inhibits aggregation of
platelets
• Indications
− Acute coronary syndrome
• Dose:
• 0.4mcg/kg/min infusion over
30min .then continue at rate
of 0.1 mcg/kg/min.
• Adverse reactions
− Dizziness, pain, sweating, intracranial bleeding, CVA
• Considerations
− Pregnancy safety: Category B
− Must be administered only with an infusion pump direct from bottle with a vented IV set
− Severe spontaneous bleeding risk
• Contraindications
− Trauma or major surgery
within the past 30 days
IV Solutions (Colloids and Crystalloids)
• Colloids
− Expand plasma volume
− Most often used in hypovolemic shock states
• Crystalloid solutions are used for:
− Electrolyte replacement
− A route for medication
− Short-term intravascular volume expansion
Dextran
• Mechanism of action
− Sugar-containing
colloid used as an
intravascular volume
expander
• Indications
− Hypovolemic shock
• Contraindications
− Patients with
congestive heart
failure, renal failure, or
known bleeding
disorders
• Adverse reactions
− Rash, itching,
dyspnea, chest
tightness, and mild
hypotension
• Considerations
− In the management of
burn shock, it is
especially important to
follow standard fluid
resuscitation regimens
to prevent possible
circulatory overload.
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