Page 167 - 2022 Ranger Medic Handbook

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EPINEPHRINE (INCLUDING EPI-PEN)
Class: Autonomic nervous system agent – natural and synthetic catecholamine; α- and β-adrenergic agonist;
bronchodilator
Action: Sympathomimetic that acts directly on both alpha and beta receptors; the most potent activator of alpha re-
ceptors; strengthens myocardial contraction; increases systolic but may decrease diastolic blood pressure; increases
cardiac rate and output; constricts bronchial arterioles and inhibits histamine release, thus reducing congestion and
edema and increasing tidal volume and vital capacity
Dose: Anaphylaxis: 0.3–0.5mg IM q10–15min (1:1,000 soln = 1mg/1mL) ACLS: 1mg IV/IO q3–5min for cardiac arrest
Onset/Peak/Duration: IV/IM – Onset Rapid/Duration 1–2 minutes
Indications: For hypersensitivity and anaphylactic reactions, acute asthma attack, bronchospasm, mucosal conges-
tion, syncope due to heart block or carotid sinus hypersensitivity, and to restore cardiac rhythm in cardiac arrest;
prolong action and delay absorption of anesthetics; control superficial bleeding
Contraindications: Sympathomimetic amine hypersensitivity; narrow-angle glaucoma; hemorrhagic, traumatic, or
cardiogenic shock; cardiac dilatation, cerebral arteriosclerosis, coronary insufficiency, arrhythmias, organic heart or
brain disease; (use with local anesthesia of fingers, toes, ears, nose, genitalia has been demonstrated safe); pregnancy
category caution advised during pregnancy and consider alternative while breastfeeding
Adverse/Side-effects: Nervousness, restlessness, sleeplessness, fear, anxiety, tremors, headache, CVA, weak- SECTION 4
ness, dizziness, syncope, pallor, sweating, dyspnea; nausea, vomiting; precordial pain, palpitations, hypertension,
MI, tachyarrhythmias; bronchial and pulmonary edema; urinary retention; tissue necrosis; metabolic acidosis; altered
state of perception and thought, psychosis
Interactions: May increase hypotension in circulatory collapse; additive toxicities with other medications
Mission Impact: GROUNDING medication for personnel on flight status

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ERTAPENEM (INVANZ)
Class: Antimicrobial – antibiotic, carbapenem, β-lactam
Action: Broad-spectrum antibiotic that inhibits cell wall synthesis of gram-positive and gram-negative bacteria by its
strong affinity for bacterial cell wall penicillin-binding proteins (PBPs); highly resistant to most bacterial β-lactamases;
effective against most Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter spp.; poorly effective
against enterococci, particularly vancomycin-resistant strains
Dose: 1g IV/IM q24hr (for IV reconstitute with 10mL NS; for IM 3.2mL 1.0% lidocaine without epinephrine)
Indications: For complicated infections of abdomen, pelvis, urinary tract, and skin; also used for community-acquired
pneumonia
Contraindications: Carbapenem, β-lactam, or amide-type local anesthetic (i.e., lidocaine) hypersensitivity; pregnancy
category may use during pregnancy and while breastfeeding
Adverse/Side-effects: Injection site phlebitis or thrombosis; asthenia, fatigue, death, fever, leg pain, anxiety, altered
mental status, dizziness, headache, insomnia; chest pain, hypo- or hypertension, tachycardia, edema; abdominal
pain, diarrhea, acid reflux, constipation, dyspepsia, nausea, vomiting, increased LFTs; cough, dyspnea, pharyngitis,
rales, rhonchi, respiratory distress; erythema, pruritus, rash
Interactions: Probenecid decreases renal excretion
Mission Impact: GROUNDING medication for personnel on flight status

2022 RANGER MEDIC HANDBOOK 153