1st of the Month Check-Off

1st of the Month Check-Off

1st of the Month Check-Off

(First Name)
Last Name

Adenosine 12mg/4ml OR 6mg/2ml (6 Required)

Albuterol Sulfate UNIT DOSE 2.5mg/3ml (4 Required)

Amiodarone 150mg/3ml (3 Required)

Anaphylaxis Kit

Asprin 81mg (1 Required)

Atropine Sulfate 1mg/10ml (3 Required)

Benadryl (3 Required)

Dexamethasone 10mg/ml (3 Required)

Dextrose 50% 25g/50ml (3 Required)

Dopamine 400mg 1600 mcg/ml (premix )in D5W (1 Required)

Epinepherine 1:1000 1mg/ml (2 Required)

Epinepherine 1:10,000 1mg/10ml (2 Required)

Magnesium Sulfate 5mg/10ml (2 Required)

Naloxone (Narcan) 2mg/2ml (2 Required)

Nitroglycerin (Nitrostat) 400mcq PER SPRAY OR TABLETS 0.4MG (1 Required)

Ondansetron (Zofran) 4mg/2ml (2 Required)

Oral Glucose 15g PER TUBE (2 Required)

Sodium Bicarbonate 50meq 1meq/ml (2 Required)

Versed 2mg/2ml (2 Required)

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