Page 162 - 2025 Ranger Medic Handbook

CALCIUM GLUCONATE *
Class: Mineral - Calcium Salt
Action: Essential component and participant in the clotting cascade and ionotropic and vasopressor effects.
Dose: 1g infusion in 100mg or 250mg NaCl or slow push IV/IO over 1–2 minutes after 2nd unit of blood and after every
4 units. 30mg of 10% Calcium Gluconate equals a 1g dose of 10% Calcium Chloride.
Indications: Blood transfusion
Contraindications: Hypersensitivity to drug/class, hypercalcemia, caution with systemic illness or arrhythmias; preg-
nancy category category may use during pregnancy and while breastfeeding
Adverse/Side Effects: Arrhythmias, extravasation necrosis, flushing, dizziness
Interactions: Minimal prehospital interaction
Mission Impacts: 1–3g of Calcium Gluconate dose range is based on mission requirements and logistical constraints.
Medics may only be carrying limited Calcium Gluconate.
SECTION 4 CEFAZOLIN SODIUM (ANCEF)

Class: Antimicrobial – first-generation cephalosporin
Action: Inhibits susceptible bacterial cell wall synthesis rendering cell wall osmotically unstable. Activity against gram-
negative organisms is limited
Dose: 1–2g IM/IV q8hr (max 12g/d)
Indications: Open bone fractures or joint disruptions as presurgical prophylaxis
Contraindications: Hypersensitivity to any cephalosporin and related antibiotics; lactation; pregnancy category may
use during pregnancy and while breastfeeding
Adverse/Side-effects: Anaphylaxis, fever, diarrhea, anorexia, abdominal cramps, maculopapular rash, urticaria
Interactions: Minimal prehospital interactions
Mission Impact: GROUNDING medication for personnel on flight status
K9 Dosage: 0.5–1g (25mg/kg) IV daily; give over 5 minutes

CEFTRIAXONE (ROCEPHIN)
Class: Antimicrobial – antibiotic; third-generation cephalosporin
Action: Preferentially binds to penicillin-binding proteins (PBPs) and inhibits bacterial cell wall synthesis; effective
against most
Enterobacteriaceae, gram-positive aerobic cocci, Neisseria meningitides, and gonorrhoeae; some effect against
Treponema pallidum
Dose: For moderate to severe infections, 1–2g IV/IM q12–24hr (max: 4g/d); for meningitis, 2g IV/IM q12hr; for uncom-
plicated gonorrhea 250mg IM × 1; dilute in 1% lidocaine for IM
Indications: For infections of the middle ear, lower respiratory tract, skin and skin structures, bones and joints, men-
ingitis, intra-abdominal, urogenital tract, pelvis, septicemia; used for surgical prophylaxis
Contraindications: Cephalosporin hypersensitivity; pregnancy category may use during pregnancy and while
breastfeeding
Adverse/Side-effects: Pruritus, fever, chills, pain, induration at IM site, phlebitis at IV site, diarrhea, abdominal
cramps, pseudomembranous colitis, biliary sludge
Interactions: Probenecid decreases renal elimination; alcohol produces disulfiram reaction
Mission Impact: GROUNDING medication for personnel on flight status
K9 Dosage: 1g IV/IM qd

148 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY