MEDS WITH ATTITUDE AT ALTITUDE
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⚠ UNOFFICIAL · PERSONAL USE
Built off-shift, blessed by no one. Tap for fine print.
NO DRUGS MATCH
PCG P27 β€” Push dose pressors: your bridge when the BP is trying to leave the building. Mix it right, label it, and have the drip running concurrently. These are buying time β€” not writing prescriptions.
⚑ WHICH AGENT?
β–ΈTRAUMA / Hemorrhagic Shock β†’ Epinephrine push dose
β–ΈNON-TRAUMA / Vasodilatory Shock β†’ Phenylephrine push dose
β–ΈIf bradycardia is contributing β†’ Epinephrine preferred (has chronotropic effect)
Epinephrine (Push Dose)
Target concentration: 10 mcg/mL β€” for TRAUMA / bradycardia
MIXING β€” USING 1:10,000 (0.1 mg/mL)
1
Draw up 1 mL of Epinephrine 1:10,000 (0.1 mg/mL) into a 10 mL syringe
2
Add 9 mL of 0.9% NS β†’ total 10 mL
3
Final: 0.1 mg / 10 mL = 10 mcg/mL
βœ“ 10 mL syringe at 10 mcg/mL β€” label before use
DOSING
PatientDoseVolumeInterval
Adult10 mcg1 mLq 3–5 min PRN
Pediatric1 mcg/kg (max 10 mcg)0.1 mL/kgq 3–5 min PRN
CLINICAL NOTES
!
Bridge ONLY β€” initiate vasopressor infusion concurrently
!
Onset: 1–2 min. Duration: 5–10 min
!
Do NOT use 1:1,000 concentration for push dose β€” verify vial
Phenylephrine (Push Dose)
Target concentration: 100 mcg/mL β€” for NON-TRAUMA vasodilatory shock
MIXING β€” USING 10 mg/mL VIAL
1
Draw up 1 mL phenylephrine 10 mg/mL
2
Add 99 mL NS β†’ 100 mL total
3
Final: 10 mg / 100 mL = 100 mcg/mL
βœ“ 100 mL at 100 mcg/mL
DOSING
PatientDoseVolumeInterval
Adult100–200 mcg1–2 mLq 2–5 min PRN
Pediatric5–10 mcg/kg0.05–0.1 mL/kgq 3–5 min PRN
CLINICAL NOTES
!
Pure α₁ agonist β€” no chronotropy. Reflex bradycardia possible
!
Avoid if cardiac output already reduced β€” may worsen
!
Bridge ONLY β€” initiate norepinephrine infusion concurrently
Vasopressin Infusion Quick Mix
Per PCG M15 β€” adjunct vasopressor
1
Mix 25 units Vasopressin in 250 mL D5W or NS β†’ 0.1 units/mL
2
Initiate at 0.03 units/min β†’ Rate = 18 mL/hr
3
Obtain consult for dose titration. Typical range 0.01–0.04 units/min
Rate formula: [Dose (units/min) Γ— 60] Γ· 0.1 (units/mL) = mL/hr
0.03 units/min β†’ 18 mL/hr
Y-site compatibility for IV meds + common fluids. Tap any matrix cell to highlight a pair, or use the search/dropdowns. Slamming incompatibles down one line is how you get mystery precipitate and a very bad day.
QUICK PAIRS:
AGENT A
AGENT B
IV COMPATIBILITY MATRIX β€” TAP CELL TO SELECT
C
Compat
?
Conflict
ND
No Data
X
Incompat
Sources: Trissel's Handbook on Injectable Drugs, King's Guide, Stabilis, manufacturer PI. Always verify with pharmacy when in doubt β€” published data β‰  your specific concentrations.
⚑ DRIP RATE CALCULATOR
Drug
Weight
Dose
--
mL / hr
⚠ Always verify calculations independently. Does not replace clinical judgment.
🩺 MEAN ARTERIAL PRESSURE (MAP)
SBP (mmHg)
DBP (mmHg)
--
mmHg MAP
Goal MAP: β‰₯65 mmHg for septic shock Β· β‰₯80 for TBI Β· Stroke: do not lower SBP >15% from baseline
πŸ§ͺ ANION GAP
Na⁺ (mEq/L)
Cl⁻ (mEq/L)
HCO₃⁻ (mEq/L)
Anion Gap
--
Interpretation
--
Formula: AG = Na βˆ’ (Cl + HCO₃) Β· Normal: 8–12 mEq/L
High AG (>12): MUDPILES β€” Methanol, Uremia, DKA, Propylene glycol, Iron/INH, Lactate, Ethylene glycol, Salicylates
❄️ WINTER'S FORMULA (Metabolic Acidosis)
HCO₃⁻ (mEq/L)
Actual PaCOβ‚‚
Expected PaCOβ‚‚
--
Interpretation
--
Formula: Expected PaCOβ‚‚ = (1.5 Γ— HCO₃) + 8 Β± 2
Actual < Expected = additional respiratory alkalosis
Actual > Expected = additional respiratory acidosis
βš–οΈ IDEAL BODY WEIGHT (IBW)
Sex
Height
Actual Wt
kg
IBW
--
Adjusted BW (if obese)
--
BMI Category
--
IBW (M): 50 + 2.3 Γ— (inches > 60) Β· IBW (F): 45.5 + 2.3 Γ— (inches > 60)
Adjusted BW = IBW + 0.4 Γ— (Actual βˆ’ IBW) β€” use for obese pts (BMI > 30) for drug dosing
πŸ’§ PEDIATRIC MAINTENANCE FLUIDS (4-2-1 Rule)
Weight (kg)
Maintenance Rate
--
Daily Volume
--
Calculation
--
4 mL/kg/hr Γ— first 10 kg + 2 mL/kg/hr Γ— next 10 kg + 1 mL/kg/hr Γ— remainder
Standard fluid: D5 0.45%NS + 20 mEq/L KCl (verify with orders)
πŸ“ RATE FORMULAS
Weight-based (mcg/kg/min):
mL/hr = [Dose Γ— Wt (kg) Γ— 60] Γ· Conc (mcg/mL)
Fixed dose (mcg/min):
mL/hr = [Dose (mcg/min) Γ— 60] Γ· Conc (mcg/mL)
Fixed dose (mg/hr):
mL/hr = Dose (mg/hr) Γ· Conc (mg/mL)
Units-based (units/min):
mL/hr = [Dose (units/min) Γ— 60] Γ· Conc (units/mL)
πŸ” DRIP-RATE SANITY CHECK
Pump is running at X mL/hr. What dose is the patient actually getting? Catches transcription / programming errors.
Dose Type
Patient Wt (kg)
Bag amount
mg
Bag volume (mL)
Pump rate (mL/hr)
Target (optional)
mcg/kg/min
Concentration
--
Actual Delivered Dose
--
Sanity
--
Confirms what the pump is actually delivering vs. what was ordered. Difference >10% = recheck programming.
RASS β€” Richmond Agitation-Sedation Scale
βŒ„
+4
Combative
Overtly combative, violent, immediate danger to staff
+3
Very Agitated
Pulls or removes tubes/lines, aggressive
+2
Agitated
Frequent non-purposeful movement, fights ventilator
+1
Restless
Anxious, apprehensive, not aggressive
0
Alert & Calm
Spontaneously alert and calm βœ“ TARGET
–1
Drowsy
Sustained awakening (eye contact) to voice >10 sec βœ“ TARGET
–2
Light Sedation
Brief awakening to voice, eye contact <10 sec
–3
Moderate Sedation
Movement or eye opening to voice, no eye contact
–4
Deep Sedation
No response to voice, movement to physical stimulation
–5
Unarousable
No response to voice or physical stimulation
GCS β€” Glasgow Coma Scale
Total 3–15 Β· Intubate consideration ≀8 Β· Severe TBI ≀8
βŒ„
EYES (E)
4
Spontaneous
3
To voice
2
To pain
1
None
VERBAL (V)
5
Oriented
4
Confused
3
Words
2
Sounds
1
None
MOTOR (M)
6
Obeys
5
Localizes
4
Withdraws
3
Flexion
2
Extension
1
None
E + V + M =
3–15
≀8 = Severe (consider airway) Β· 9–12 = Moderate Β· 13–15 = Mild
CPOT β€” Critical Care Pain Obs. Tool
Non-verbal/intubated Β· Score 0–8 Β· β‰₯3 = treat pain
βŒ„
FACIAL EXPRESSION (0–2)
0
Relaxed, neutral
1
Tense
Brow lowering, orbit tightening
2
Grimacing
All above + eyelid tightly closed
BODY MOVEMENTS (0–2)
0
Absence of movements
1
Protection
Slow cautious movements, touching pain site
2
Restlessness
Pulling tubes, thrashing, attempting to sit up
MUSCLE TENSION (0–2)
0
Relaxed
1
Tense & rigid
2
Very tense or rigid
COMPLIANCE / VOCALIZATION (0–2)
0
Tolerating vent / Normal speech
1
Coughing / Sighing, moaning
2
Fighting vent / Crying out
TOTAL SCORE
0–8
β‰₯3 = Treat pain Β· Goal: <3
CIWA-Ar β€” Alcohol Withdrawal Scale
Max 67 Β· <8 Minimal Β· 8–15 Mild Β· 16–20 Moderate Β· >20 Severe
βŒ„
0
CIWA-Ar Score / 67
Minimal / No withdrawal
<8
Minimal β€” patient officially just unpleasant. Observe.
8–15
Mild β€” hands shaking, mind racing, stories starting.
16–20
Moderate β€” sweat, tremor, seizure risk climbing. Heads up.
>20
Severe β€” pink elephants and real seizures. Call for help.
Treatment per Medical Control / receiving facility β€” GFL formulary varies by base. CIWA scores guide urgency and need for benzo-class therapy; specific agent and dose per provider order.
Shock Index Calculator
HR Γ· SBP Β· β‰₯0.9 = higher mortality / transfusion need (PCG T9)
βŒ„
Γ·
--
Enter HR and SBP above
<0.6
Normal
0.6–0.9
Mildly elevated β€” monitor
0.9–1.2
↑ Mortality risk β€” prepare blood products
>1.2
High mortality β€” activate MTP, aggressive resuscitation
Pediatric Weight Estimator
Broselow-based Β· Enter age (years) OR known weight (kg)
βŒ„
ENTER AGE (1–10 yrs) OR KNOWN WEIGHT (kg)
or
COMMON PEDS DRUG DOSES
Age formula: (Age Γ— 2) + 8 for 1–10 yrs Β· Cuffed ETT: (age/4) + 3 rounded to nearest 0.5 Β· Verify with Broselow tape
APGAR β€” Newborn Assessment
Score at 1 min & 5 min (also 10 min if <7) Β· Each item 0–2 Β· Total 0–10
βŒ„
A β€” APPEARANCE (skin color)
0
Blue / pale all over
1
Body pink, extremities blue (acrocyanosis)
2
Completely pink
P β€” PULSE (heart rate)
0
Absent
1
<100 bpm
2
β‰₯100 bpm
G β€” GRIMACE (reflex irritability)
0
No response to stimulation
1
Grimace / weak cry when stimulated
2
Cry / pull away / cough / sneeze when stimulated
A β€” ACTIVITY (muscle tone)
0
Limp / floppy
1
Some flexion of extremities
2
Active motion / flexed extremities resisting extension
R β€” RESPIRATION
0
Absent
1
Slow / irregular / weak cry
2
Strong cry / regular
TOTAL SCORE
0–10
7–10 = Reassuring Β· 4–6 = Moderately depressed (stimulate, support) Β· 0–3 = Severely depressed (resuscitate per NRP)
⚠ Note: APGAR does NOT determine resuscitation β€” start NRP based on HR, breathing, and tone in the first 30 sec. APGAR is documentation, not a decision tool. If 5-min APGAR <7, repeat q5 min until β‰₯7 or 20 min.
Cincinnati Pre-Hospital Stroke Scale (FAST)
Field stroke screen Β· ANY one positive = high suspicion (~72% sensitivity for anterior stroke)
βŒ„
F β€” FACIAL DROOP
Have patient smile or show teeth.
βœ“
Normal
Both sides of face move equally
βœ—
Abnormal
One side of face does not move as well as the other
A β€” ARM DRIFT
Patient closes eyes, holds both arms straight out for 10 sec.
βœ“
Normal
Both arms move the same OR neither moves
βœ—
Abnormal
One arm drifts down or does not move at all
S β€” SPEECH
Have patient say "You can't teach an old dog new tricks."
βœ“
Normal
Patient uses correct words with no slurring
βœ—
Abnormal
Slurred, wrong words, or unable to speak
T β€” TIME
Establish LAST KNOWN WELL time (not symptom discovery time). This drives the thrombolytic / thrombectomy window.
RESULT
Any 1 of 3 positive
β†’ ~72% probability of stroke Β· Activate stroke alert Β· Glucose, BP, EKG Β· Get NIHSS at receiving facility
⚠ Note: Cincinnati screens anterior-circulation strokes well but misses many posterior-circulation strokes (vertigo, ataxia, diplopia, dysarthria-only). If story sounds neuro and CPSS is negative, do NOT rule out stroke β€” consider FAST-ED or full NIHSS.
NIH Stroke Scale β€” Interactive Scoring
Mild <5 Β· Moderate 5–9 Β· Severe β‰₯10 Β· Max 42
βŒ„
0
NIHSS Total / 42
Enter scores above
BP Goals: Non-thrombolytic <220/110 Β· Thrombolytic candidate <180/105
Do not lower SBP >15% from baseline (M16/M17)
Pregnancy Category Key β€” FDA Legacy
Reference for the PREG badge on each drug card
βŒ„
A
Adequate, well-controlled human studies show no fetal risk
Safest tier β€” examples: thiamine, folic acid, levothyroxine
B
Animal studies show no risk; no adequate human studies β€” OR β€” animal risk not confirmed in human studies
Generally acceptable β€” examples: acetaminophen, ondansetron, ceftriaxone, famotidine, LMWH, metoclopramide
C
Animal studies show adverse effect; no adequate human studies β€” benefit may justify risk
Most resuscitation drugs β€” examples: epinephrine, norepinephrine, fentanyl, ketamine, amiodarone
D
Positive evidence of human fetal risk β€” but benefit may outweigh risk in life-threatening situations
Use only when nothing safer works β€” examples: midazolam, lorazepam, diazepam, phenobarbital, magnesium (chronic), aspirin (3rd trim)
X
Studies show fetal abnormalities β€” risk clearly outweighs any benefit
Contraindicated in pregnancy β€” examples: methotrexate, isotretinoin, warfarin, statins
N/A
Not formally categorized or not applicable
Topical/non-absorbed (activated charcoal), or used during delivery itself (oxytocin)
⚠ Note: The FDA replaced this letter system with narrative labeling (PLLR) in 2015, but the A/B/C/D/X categories are still widely used in clinical reference and crew shorthand. Categories reflect known risk β€” "C" often means "not adequately studied," not "known dangerous." In a coding pregnant patient, the right drug is the one that keeps her alive.