Many drugs produce adverse reactions that may or may not have been anticipated. Some may be readily treated in the field. Please consider anticipated transport time and consult with medical control frequently in these instances.

1. Perform primary assessment and ABC's.
2. Administer Oxygen via a device that will insure adequate oxygenation.
3. Monitor vital signs in accordance with S.O.P. protocol.

INTERMEDIATE LIFE SUPPORT

1. If vital signs are abnormal or unstable, or, medication administration is anticipated, initiate IV access using an isotonic solution and titrate infusion for condition.
2. If signs of local reaction are present, contact Medical Control for administration of 25-50 mg Diphenhydramine.
3. If signs of Anaphylaxis are present, contact Medical Control for administration of Epinephrine 1:1,000 0.3 mg SQ.
4. Request ALS Intercept if patient status not improving and medical control agrees to intercept.

ADVANCED LIFE SUPPORT

1. Perform ECG monitoring.
2. Estabish through history with emphasis on ingestion, time, presence of emesis or mixed ingestion to include alcoholic beverages.
3. Consider rapid transport and contact medical control if necessary.
4. Consider treatment option below.
   1. Anaphylactic or anaphylactoid reaction
      1. Refer to Anaphylaxis protocol.

   2. Beta-Blocker Overdose
      1. Consider Atropine and/or administer 500cc NS fluid bolus for bradycardia or hypotension.
      2. Attach and initiate TCP as soon as possible for symptomatic bradycardia.
      3. Administer Glucagon 1 mg IV q 1-2 min titrating to relief of bradycardia or until TCP captures.
      4. Consider Dopamine infusion for treatment of hypotension once heart rate is acceptable.
      5. Transport Code 3.

   3. Calcium Channel Blocker Overdose (Beware of drug interaction with NaHCO3)
      1. Consult with Medical Control for appropriate dosage of Calcium Gluconate. Standard dosing range should be 100-1000mg slow IVP of a 10% solution. Dopamine may be appropriate for hypotension. Consult with Medical Control for administration.
   4. Dystonic Reaction
      1. Typically to phenothiazine type drugs (Haldol, Compazine, Meclizine, Mellaril, Mepergan, Haloperidol, etc.).
      2. Administer Diphenhydramine 25-50 mg, slow IV push.
   5. Narcotic Overdose
      1. Refer to OVERDOSE protocol.
   6. Tricyclic Antidepressant Overdose
   1. Typically to Amitryptyline, Nortriptyline, Doxepin, Imapramine, Trimipramine, etc.
   2. If ECG changes (especially QRS widening) or dysrhythmias are noted, and patient is symptomatic, administer NAHCO3 1 mEq/kg IV bolus. Contact Medical Control for further orders. Be prepared to initiate NaHCO3 drip.