The Drug Box – Exciting Conclusion

Continuing our review of what we carry in our boxes…

Calcium chloride 10%– used for renal patients in arrest. Protects the myocardium from high serum potassium. This is preloaded in 1000 mg syringes and not carried by our ALS 1st responder companies.

Dextrose 50% (D5W) – pre-loaded 25 gram syringe. I usually dilute this in 250 mL of D5W and give it as a drip. This reduces the dramatic wake up effect.

Diphenhydramine – otherwise known as Benadryl, this is the typical antihistamine medication for allergic reactions. Given in combination with epinephrine.

Dopamine – packed in the anti-light packaging. Ours is 400 mg/250 mL, or 1,600 mcg/mL. Check out how to dose it out at Paramedicine 101.

Epinephrine 1:1,000 – comes in glass ampules of 1 mg a piece.

Epinephrine 1:10,000 – comes pre-loaded in 1 mg/10 mL

Furosemide (Lasix) – diruetic medication, comes pre-loaded in 40 mg syringes.

Glucagon – comes packaged in a small box with two vials, one of sterile water and the other with the glucagon in power form. You have to draw up the water with a syringe, inject it into the powder, then redraw the solution for injection. We only really use it for hypoglycemia, but it is useful in antidepressant overdoses as well (don’t ask me for the mechanism of action, many others before me have been unable to figure that out)

Lidocaine 100 mg – pre-loaded syringe. We use it for PVC’s but also to flush an IO line, benefiting from it’s anesthetic properties.

Lidocaine 2 grams – pre-packaged in a solution for drip administration. We very seldomly mix our own drips.

Magnesium sulfate – smooth muscle relaxant, indicated in eclampsia and in Torsades de Pointes. Ours comes in a 1 g/1 mL vial.

Methylprednisolone (Sol-U-Medrol) – anti-inflammtory steroid, used in asthma and related airway emergencies. Comes in an ingenious vial that contains both the sterile water and the the powder drug. I wish they would come up with these for glucagon and diltiazem.

Midazolam (Versed) – short acting benzodiazepine. Used for raising the seizure threshold as well as for chemical restraint and sedation. Comes in a 1 mL/5 mg vial.

Morphine sulfate– narcotic analgesic in a 1 mL/10 mg vial.

Naloxone (Narcan) – narcotic competitive antagonist, it competes with narcotics for narcotic receptors in the nervous system. Comes in a pre-loaded 2 mg syringe.

Nitroglycerine – we carry a pump sprayer and a paste with the paper to administer it to the skin. Not just useful in suspected cardiac chest pain but also in hypertensive crisis, the slower action of the paste makes it ideal so we don’t bottom a BP out too quickly. I think of the spray and paste together like a drip, we have to give a loading dose, then give a smaller amount over time to maintain the effect.

Procainemide – old time anti-dysrhythmic. Comes in a vial 1 gram/10 mL for mixing into a drip.

Promethazine (Phenergan) – comes in a 1 mL glass vial. It is our fist line medication for nausea/vomiting with abdominal pain.

Sodium bicarbonate – used as a buffer agent against acidosis and also used in hyperkalemia. Ours is pre-loaded in a 1 mEq/1 mL syringe.

So that’s what we carry… does anyone carry anything different? What’s it used for? I’d like to hear from you, Leave a comment below!

This article was written by rstine

  • Christopher

    I delved into the potential reason Glucagon works like a sympathomimetic on my blog, basically it also plays with cyclic-AMP (cAMP) but in a way completely independent of beta adrenergic receptors (hence usefulness in B-blocker on Ca-Channel blocker ODs).

  • HybridMedic

    I never could get a straight answer on that, but doesn't it require larger doses? Like 10 mg or more?

  • Christopher

    Empirical evidence shows 2-10mg starting in B-blocker, 5-10mg in Ca-Channel blocker. 3-5mg in refractory anaphylaxis. And once you've done that you've got to do a maintenance drip!Basically more than we have 🙂

  • Christopher

    Back to the drug box, we carry everything you have listed plus:- Ketorolac Tromethamine (Toradol)- Haloperidol (Haldol)- Ranitidine (Zantac): for allergic reactions (50mg slow IVP)- Vasopressin

  • HybridMedic

    Is your vasopressin preloaded?

  • Christopher

    Negatory, 20 units in 1cc, we carry two vials.