Page 173 - 2022 Ranger Medic Handbook

KETOROLAC (TORADOL) *
Class: NSAID; anti-inflammatory, analgesic, antipyretic
Action: Inhibits COX-1 and -2 enzymes, resulting in decreased formation of prostaglandin precursors
Dose:
IM – 30mg as a single dose or 15–30mg q6hr
IV – 15mg slow IV push as a single dose or 15mg q6hr (maximum: 120mg/d)
Onset/Peak/Duration:
IV/IM – Onset in 30–60 minutes/Peak in 1–2 hours/Duration 4–6 hours
Indications: For short-term moderate pain management
Contraindications: Ketorolac hypersensitivity; nasal polyps; angioedema or bronchospastic reaction to aspirin or
other NSAIDs; severe renal impairment or renal failure due to volume depletion; patients with risk of bleeding; active
peptic ulcer disease; pre- or intraoperatively; pregnancy category avoid use during pregnancy and may use while
breastfeeding (caution advised in patients trying to conceive)
Adverse/Side-effects: Drowsiness, dizziness, headache; nausea, dyspepsia, GI pain, hemorrhage; edema, sweating
Interactions: May increase methotrexate and lithium levels and toxicity; herbals (fever few, garlic, ginger, ginkgo)
increase bleeding potential SECTION 4

LACTATED RINGER’S (LR)
Class: Plasma volume expander – crystalloid; isotonic salt solution
Action: Each 1L contains 6.0g sodium chloride (Na + 130mEq/L, Cl – 109mEq/L) and other electrolytes (K + 4mEq/L, Ca 2+
3mEq/L, lactate 28mEq/L, and 9kcal/L); pH 6.4; remains in the intravascular space for only a very limited time as it
diffuses rapidly throughout the extracellular space
Dose: 500–1,000mL IV
Indications: For fluid replacement and plasma volume expansion and for adjunctive treatment of shock and hypo-
volemic states caused by hemorrhage, burns, surgery, sepsis, trauma, dehydration, or illness; also used for irrigation
Contraindications: CHF; do not use with blood or blood products
Adverse/Side-effects: Fluid overload, CHF, edema, electrolyte imbalance, hypertension
Interactions: Calcium in LR can bind to other drugs and reduce efficacy, also has potential for creating emboli if given
with blood or blood products
K9 Dosage: Bolus of 1L over 30 minutes, then reassess VS; repeat if no response. Do not exceed 2L in 1 hour

LEVETIRACETAM (KEPPRA)
Class: Antiepileptic
Action: Unknown
Dose: 1,000–4,000mg IV; 1,000mg IV for seizure prevention; 4,000mg for seizure treatment
Indications: For seizure prevention in moderate to severe TBI and treatment of active seizures
Contraindications: Hypersensitivity to drug, pregnancy category caution advised during pregnancy and while
breastfeeding
Adverse/Side-effects: The most common adverse effects of levetiracetam treatment include CNS effects such as
somnolence, decreased energy, headache, dizziness, mood swings and coordination difficulties
Interactions: No significant pharmacokinetic interactions

2022 RANGER MEDIC HANDBOOK 159