Aspirin (ASA)
Aspirin is an antiplatelet medication administered to patients with suspected acute coronary syndrome (ACS). It works by inhibiting cyclooxygenase, preventing thromboxane A2 production and platelet aggregation. The standard dose is 324 mg (four 81 mg chewable tablets) administered orally. Instruct the patient to chew the tablets rather than swallow whole for faster absorption. Indications include chest pain or discomfort suggestive of cardiac origin in patients over 18 years of age. Contraindications include known aspirin allergy, active GI bleeding, recent hemorrhagic stroke, and patients who have already taken a full dose of aspirin. Use caution in patients with asthma, as aspirin can trigger bronchospasm in sensitive individuals. Always consult medical direction as required by local protocol.
Epinephrine Auto-Injector
Epinephrine is a sympathomimetic medication that acts on both alpha and beta adrenergic receptors. It causes bronchodilation, vasoconstriction, and increased heart rate and contractility. It is the primary treatment for anaphylaxis and severe allergic reactions. The adult dose is 0.3 mg (1:1,000 concentration) administered intramuscularly in the lateral thigh via auto-injector (EpiPen). The pediatric dose is 0.15 mg (EpiPen Jr) for patients weighing 15 to 30 kg. The injection site is the mid-outer thigh, and the auto-injector can be administered through clothing. Hold the auto-injector in place for 10 seconds after activation. Indications include signs and symptoms of anaphylaxis such as respiratory distress with wheezing/stridor, urticaria/angioedema, and hypotension. Contraindications are essentially none in a true life-threatening anaphylactic reaction, as the benefit outweighs the risk. Side effects include tachycardia, anxiety, tremors, headache, and pallor. The dose may be repeated every 5 to 15 minutes if symptoms persist.
Nitroglycerin
Nitroglycerin is a vasodilator that relaxes vascular smooth muscle, primarily reducing preload by dilating venous capacitance vessels. It also dilates coronary arteries, improving myocardial oxygen supply. The dose is 0.4 mg sublingual tablet or spray, repeated every 5 minutes for a maximum of 3 doses (per protocol). Indications include chest pain of suspected cardiac origin when the patient has their own prescribed nitroglycerin and medical direction authorizes administration. Confirm that the systolic blood pressure is at least 100 mmHg before each dose. Contraindications include systolic BP below 100 mmHg, recent use (within 24 to 48 hours) of phosphodiesterase inhibitors (sildenafil/Viagra, tadalafil/Cialis, vardenafil/Levitra), head injury with increased intracranial pressure, right ventricular infarction (inferior MI), and maximum doses already administered. Monitor blood pressure closely before and after each dose. Common side effects include headache, hypotension, and dizziness.
Albuterol (Salbutamol)
Albuterol is a beta-2 adrenergic agonist bronchodilator that relaxes smooth muscle in the airways, relieving bronchoconstriction. It is administered via metered-dose inhaler (MDI) with spacer or small-volume nebulizer. The nebulized dose is typically 2.5 mg in 3 mL normal saline, administered over 5 to 15 minutes. The MDI dose varies by protocol but is commonly 2 to 4 puffs with a spacer. Indications include wheezing and respiratory distress associated with asthma, COPD exacerbation, or reactive airway disease. Contraindications include known hypersensitivity to albuterol. Use caution in patients with known cardiac dysrhythmias or tachycardia, as albuterol can increase heart rate. Side effects include tachycardia, tremors, nervousness, and palpitations. The dose may be repeated per protocol for persistent wheezing and respiratory distress. Ensure the patient is sitting upright and coaching them to take slow, deep breaths during nebulizer treatment.
Oral Glucose
Oral glucose is a simple sugar administered to raise blood glucose levels in patients with suspected hypoglycemia. It is available as a gel (typically 15 to 25 grams per tube) or as glucose tablets. Indications include altered mental status with a confirmed blood glucose below 60 mg/dL (or below the threshold defined by local protocol) in a patient who is conscious and able to swallow. The patient must have an intact gag reflex and be able to protect their own airway. Administration technique involves placing the gel between the cheek and gum, or having the patient chew glucose tablets. Contraindications include inability to swallow, unresponsiveness, absent gag reflex, and nausea/vomiting. Recheck blood glucose within 10 to 15 minutes after administration. If the patient does not improve or cannot take oral glucose, advanced providers may administer dextrose IV or glucagon IM. There are no significant side effects at the recommended dose. Always reassess airway patency during and after administration.
Naloxone (Narcan)
Naloxone is an opioid antagonist that competitively binds to opioid receptors, reversing the effects of opioid overdose including respiratory depression, sedation, and hypotension. Routes of administration include intranasal (IN), intramuscular (IM), intravenous (IV), and intraosseous (IO). The intranasal dose is typically 2 to 4 mg delivered via mucosal atomization device. The IM/IV dose is 0.4 to 2 mg, titrated to restore adequate respirations. Indications include suspected opioid overdose with respiratory depression (respiratory rate below 12, pinpoint pupils, and altered level of consciousness). Contraindications include known hypersensitivity to naloxone. Important considerations include the fact that naloxone has a shorter duration of action (30 to 90 minutes) than most opioids, so patients may return to a state of respiratory depression after the naloxone wears off. Titrate the dose to restore adequate breathing rather than full consciousness to reduce the risk of acute opioid withdrawal, which can cause agitation, vomiting, and combativeness. All patients who receive naloxone require transport and monitoring even if they initially refuse, as re-sedation is a significant risk.