CuraRN

Drug Cards: Trauma Medications

Student study notes from paramedic coursework (2023 to 2024), not medical advice. Verify clinical values against current references and your local protocols.

Doses are general reference values recorded during paramedic training. They are not protocol: follow your local protocols and current drug references. New Jersey EMS doses and approved medications may differ.

EMS drug cards

Common medications in a trauma context

** trauma meds**	.	.
silver-sulfadiazine	gentamicin	hydromorphone
erythromycin	naproxen

References consulted:

• Tucker, R. (2024). Lippincott Pocket Drug Guide for Nurses (Twelfth, North American Edition). Lippincott.
• Epocrates. (n.d.). Retrieved from https://www.epocrates.com/online/

  silver sulfadiazine

Generic Name:

Silver Sulfadiazine

Trade Names:

Silvadene, Thermazene, SSD Cream

Actions:

Silver sulfadiazine acts as a bactericidal agent, interfering with bacterial cell membrane and cell wall synthesis.

Indications:

• Prevention and treatment of infections in second and third-degree burns.

Contraindications:

• Allergy to sulfonamides or silver.
• Pregnancy (particularly near term).
• Premature infants and newborns (risk of kernicterus).

Dosage Range:

• Apply a thin layer (approximately 1/16 inch or 1.5 mm thick) to the affected area once or twice daily.

Routes of Administration:

• Topical application.

Adverse Reactions:

• Rash.
• Itching or burning sensation.
• Leukopenia.
• Argyria (a rare condition of localized silver toxicity resulting in a blue-gray discoloration of the skin).
• Necrosis of the skin.

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gentamicin

Generic Name:

Gentamicin

Trade Names:

Garamycin, Gentak

Actions:

Gentamicin is an aminoglycoside antibiotic that binds to bacterial ribosomes, inhibiting protein synthesis and leading to bacterial cell death.

Indications:

• Severe bacterial infections caused by susceptible strains of bacteria, including Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus.
• Serious infections such as septicemia, respiratory tract infections, urinary tract infections, and intra-abdominal infections.

Contraindications:

• Hypersensitivity to gentamicin or other aminoglycosides.
• Myasthenia gravis (due to the risk of exacerbating muscle weakness).

Dosage Range:

• Adults: 3-5 mg/kg/day divided into three doses.
• Pediatrics: 6-7.5 mg/kg/day divided into three doses.
• Dosage adjustment is necessary for renal impairment.

Routes of Administration:

• Intravenous (IV).
• Intramuscular (IM).
• Topical (for certain formulations).

Adverse Reactions:

• Nephrotoxicity (kidney damage).
• Ototoxicity (hearing damage).
• Neurotoxicity (nerve damage).
• Allergic reactions.
• Electrolyte imbalances (hypomagnesemia, hypocalcemia).

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hydromorphone

Generic Name:

Hydromorphone

Trade Names:

Dilaudid, Exalgo

Actions:

Hydromorphone is an opioid agonist that binds to mu-opioid receptors in the brain and spinal cord, altering the perception and response to pain.

Indications:

• Moderate to severe pain management.
• Pain in patients who require an opioid analgesic and for whom alternative treatments are inadequate.

Contraindications:

• Hypersensitivity to hydromorphone.
• Severe respiratory depression.
• Acute or severe bronchial asthma.
• Paralytic ileus.
• Use with or within 14 days of MAO inhibitors.

Dosage Range:

• Oral: 2-4 mg every 4-6 hours as needed.
• IV/IM: 0.2-1 mg every 2-3 hours as needed.
• Dosage adjustments may be required for patients with hepatic or renal impairment.

Routes of Administration:

• Oral (tablets, extended-release tablets, liquid).
• Intravenous (IV).
• Intramuscular (IM).
• Subcutaneous (SC).
• Rectal (suppositories).

Adverse Reactions:

• Respiratory depression.
• Sedation.
• Nausea and vomiting.
• Constipation.
• Hypotension.
• Itching.
• Dependence and withdrawal symptoms with prolonged use.

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erythromycin

Generic Name:

Erythromycin

Trade Names:

Ery-Tab, E.E.S., Erythrocin, PCE

Actions:

Erythromycin is a macrolide antibiotic that inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit, thereby preventing peptide chain elongation.

Indications:

• Respiratory tract infections.
• Skin and soft tissue infections.
• Pertussis (whooping cough).
• Diphtheria.
• Prophylaxis of rheumatic fever in penicillin-allergic patients.
• Legionnaires’ disease.
• Certain sexually transmitted infections (chlamydia).

Contraindications:

• Hypersensitivity to erythromycin or any macrolide antibiotics.
• Concurrent use with drugs that are known to prolong the QT interval or cause torsades de pointes.
• Severe hepatic impairment.
• Concomitant use with ergotamine or dihydroergotamine (due to the risk of acute ergot toxicity).

Dosage Range:

• Adults: 250-500 mg every 6 hours (oral).
• Children: 30-50 mg/kg/day divided every 6-8 hours (oral).
• Dosage adjustments may be required for patients with hepatic impairment.

Routes of Administration:

• Oral (tablets, capsules, suspension).
• Intravenous (IV).
• Topical (for certain formulations).

Adverse Reactions:

• Gastrointestinal disturbances (nausea, vomiting, diarrhea, abdominal pain).
• Hepatotoxicity (cholestatic hepatitis).
• QT interval prolongation and cardiac arrhythmias.
• Allergic reactions (rash, pruritus, anaphylaxis).
• Ototoxicity (hearing loss, usually reversible).
• Clostridium difficile-associated diarrhea.

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naproxen

Generic Name:

naproxen

Trade Names:

Aleve, Naprosyn, Anaprox, Midol Extended Relief

Actions:

Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2) enzymes, leading to decreased formation of prostaglandins, which results in reduced inflammation, pain, and fever.

Indications:

• Mild to moderate pain relief.
• Inflammatory diseases such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis.
• Dysmenorrhea (menstrual cramps).
• Acute gout.
• Bursitis and tendonitis.

Contraindications:

• Hypersensitivity to naproxen or other NSAIDs.
• History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
• Active gastrointestinal bleeding or peptic ulcer disease.
• Severe renal or hepatic impairment.
• Use in the setting of coronary artery bypass graft (CABG) surgery.

Dosage Range:

• Adults: 250-500 mg orally twice daily. Maximum daily dose is typically 1000 mg (may be up to 1500 mg in some cases for short durations).
• Pediatrics: Dosing is weight-based; typically, 10-20 mg/kg/day divided into two doses.
• Dosage adjustments may be necessary for patients with renal or hepatic impairment.

Routes of Administration:

• Oral (tablets, extended-release tablets, suspension).
• Topical formulations for localized pain relief.

Adverse Reactions:

• Gastrointestinal disturbances (nausea, vomiting, dyspepsia, constipation, gastric bleeding, ulcers).
• Cardiovascular events (increased risk of heart attack or stroke, especially with long-term use).
• Renal impairment (acute renal failure).
• Hepatotoxicity.
• Allergic reactions (rash, anaphylaxis).
• Central nervous system effects (headache, dizziness, drowsiness).
• Fluid retention and edema.

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