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Medication Administration

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1 Medication Administration
November 2009 CE Advocate Condell Medical Center Objectives prepared by: Mike Higgins, FF/PM Grayslake Fire Department Power point prepared by Sharon Hopkins, RN, BSN, EMT-P

2 Objectives Upon successful completion of this module, the EMS provider will be able to: 1. Identify the six rights of drug administration correctly 2. Identify medical control’s role in drug administration 3. Identify knowledge of proper use of standard precautions 4. Identify knowledge of proper disposal of contaminated equipment 5. Identify the importance of maintaining a sterile and clean environment

3 Objectives 6. Accurately calculate the drug dosage for a pt with weight stated in pounds, converting weight to kilograms 7. Identify the various routes used to administer medication 8. Identify the proper technique for drawing up meds from an ampule 9. Identify the proper technique for drawing up meds from a vial 10. Identify the proper administration of a medication from a prefilled syringe

4 Objectives 11. Identify the proper administration of sub-lingual medications 12. Verbalize the proper administration of rectal medications 13. Identify the proper administration of IV piggy-back medications 14. Identify the proper administration of in-line nebulizer medications 15. Identify the proper administration of endotracheal medications

5 Objectives 16. Identify proper documentation of medication administration 17. Demonstrate the proper administration of subcutaneous medications 18. Demonstrate the proper administration of intramuscular medications 19. Demonstrate proper administration of intravenous medications / IO meds 20. Demonstrate the insertion of the EZ-IO correctly

6 6 Right of Medication Administration
The RIGHT patient In the field this is the patient lying in front of you When doing clinical in the hospital, it is extremely important to check wrist bands for identifying the right patient The RIGHT drug Check all medications 3 times prior to administration Did you grab the correct medication? Just to reinforce, there are more items to evaluate before administering medication than what is listed in the 6 rights (ie: expiration date, clarity of solution).

7 6 Rights The RIGHT dose The RIGHT time
Most field medications can be easily calculated in your head Double check if you are ever unsure of the dose The RIGHT time In the field the time is now

8 6 Rights The RIGHT route IV/IO Injected IM SQ Inhaled IVPB

9 6 Rights The RIGHT documentation Drug name Dose – verify order in mg
Dose often stated in ‘amps”, “tab” Route of delivery Time administered Person administering the medication Use skill check box Patient response to the medication

10 Allergies Important to screen all patients for their allergy status prior to medication administration If you are in doubt regarding an allergic reaction versus side effect (ie: abdominal distress), contact medical control for clarification

11 Facts and Allergies Lidocaine and Novocain Morphine sulfate
These are different “caine” families so allergy to one does not cross over to the other Morphine sulfate This is NOT a sulfa drug Lasix – furosemide There is a low risk of patients allergic to sulfa drugs having a reaction to Lasix Monitor the patient receiving Lasix if they have a sulfa allergy

12 Medical Control You operate under the license of the Medical Director
You are still individually responsible for having knowledge of the medications you are delivering Inappropriate delivery of medications, even when the patient does not suffer harm, may result in legal ramifications

13 Medical Control Medical control is available as an on-line resource
Clarification regarding indications Clarification regarding dosage Clarification regarding orders received from a physician on the scene In an acute care center, clinic, doctor’s office, you cannot accept orders unless that physician is willing to go with to the hospital

14 Standard Precautions HANDWASHING
Establishing routes for drug administration creates the potential exposure to blood and body fluids Decrease risk of exposure by following standard precautions Gloves Goggles Mask The best standard precaution often forgotten: HANDWASHING

15 Sterile vs Clean Environment
Sterile – free from all forms of life Generally uses extensive heat or chemicals Difficult in the field to maintain sterile environments Most packages are sterile until opened Clean environment Minimize risk of infection Careful handling of equipment to prevent contamination

16 Disposal of Equipment Minimize tasks done in a moving ambulance
Need to decrease risk of EMS exposure Immediately dispose of sharps in a sharps container Rigid, puncture-resistant container Recap needles only as a last resort Use one handed technique

17 Metric System Pharmacology’s principle system of measurement
Widely used in science and medicine 3 fundamental units Grams – weight or mass Liters – volume Meters – distance To avoid use of multiple zero’s , usually change the prefixes (ie: kilo, centi, milli, micro)

18 Drug Administration and Mathematical Skills
To properly prepare and administer medications, need understanding of: Multiplication Division Fractions Decimal fractions Proportions Percentages

19 Converting Pounds to Kilograms
Many medications are dosed based on patient weight Adults – acceptable to be “close enough” Can round off the adult weight Pediatrics – must practice a more precise formula Less room for error in calculation

20 Pounds to Kilograms 1 kilogram = 2.2 pounds
In the field, usually acceptable to take the adult patient’s weight in pounds and divide in half to be close enough to the kilograms In peds, need to take the weight in pounds and divide by 2.2

21 Exercise Convert 150 pounds to kilograms
150/2.2 can be written as 150  2.2 As a fraction, top number (numerator) is divided by the bottom number (denominator) 150 = dividend 2.2 = divisor The divisor must always be a whole number Answer = quotient

22 Exercise 2.2 150 Need to make 2.2 a whole number
Need to make 2.2 a whole number In the metric system, you are multiplying by “10” When multiplying with any derivative of 10, count the zeros and move the decimal that many numbers to the right What you do with the divisor, you must do with the dividend (actions inside and outside the box must match)

23 Example – 150# = ? kilograms 2.2 150 = 22 1500 68.1 22 1500.0 132 180
= 68.1 132 180 176 40 22 18 Decimal moved to the right once in the divisor (ie: 2.2) and therefore had to be moved by the same number of spaces in the dividend (ie: 150). Bring up the new decimal place so it does not get forgotten in the answer. Do regular division making sure to be neat enough to line up your numbers.

24 Medication By Patient Weight
Most typical order is Lidocaine (mg/kg) and pediatric drugs (mg/kg) Calculate the patient’s kilogram Divide pounds by 2.2 Acceptable to divide the adult weight by 2 Multiply the kilogram by the number of mg per kilogram Then you need to calculate the volume (ml) to draw up in the syringe The pediatric patient does not have a lot of room for error so their weight needs to be precise – divide pounds by 2.2.

25 Example Give your 132 pound patient 1.5mg/kg Lidocaine
Lidocaine is packaged as 100 mg/5ml Steps to calculate Convert pounds to kilograms Based on the kilograms, calculate the number of mg required Multiply kilograms by mg/kg required Calculate the ml volume to draw up

26 Answer 132  2.2 = 1320  22 = 60 kg 1.5 mg/kg = 1.5 mg x 60 kg = 90mg
Now, draw up 90 mg (Lidocaine comes 100 mg/5ml) Formula #1: x ml = desired dose x vol on hand dose on hand Formula #2: mg in bottle = mg ordered ml in bottle x ml

27 Formula #1 Formula #1: x ml = desired dose x vol on hand dose on hand
x ml = 90 mg x 5 ml 100 mg x ml = (this fraction means 450  100) (top number divided by bottom number) x ml = 4.5 ml

28 Formula #2 Formula #2: mg in bottle = mg ordered ml in bottle x ml
100 mg = 90 mg 5 ml x ml (cross multiply) x = 450 (divide by 100 to get x = 450 x by itself) (divide top by bottom #) / 100 = 450100 4.5 ml is answer

29 Do Brain Check Give 90 mg Lidocaine Lidocaine packaged 100 mg / 5 ml
Your answer was to give 4.5 ml Brain check 90 mg is slightly smaller than the total amount of 100 mg 4.5 ml is slightly smaller than 5 ml So our math must be correct

30 Routes of Medication Administration
4 basic categories Percutaneous Applied or absorbed thru the skin Pulmonary Absorbed via inhalation or injection Enteral Absorbed thru the gastrointestinal (GI) tract Parenteral Administration outside the GI tract Generally includes the use of needles To remember the “enteral” route – think Entemann’s the dessert people (things you eat).

31 Percutaneous Medication Routes
Meds absorbed through skin or mucous membranes Sublingual route Medication absorbed through the mucous membrane under the tongue Sub = below; lingual = tongue Area extremely vascular Moderate to rapid rate of absorption Avoids the digestive tract

32 Mucous Membranes cont’d
Nasal route Uses a medication atomization device (MAD) Coming soon to Region X Relatively rapid absorption rate in the absence of IV access MAD provides a fine mist that allows even and widespread distribution of medication across the nasal mucosa The Region is preparing to incorporate use of the MAD device in the near future MAD – stands for medication atomization device – a device that produces a fine aerosol mist that permits disbursement of medication across the nasal mucosa for absorption. Some of the medications that can be delivered via this method include fentanyl, versed, and narcan.

33 Pulmonary Medication Route
To administer medications into the pulmonary system via inhalation or injection Generally include gases, fine mists, or liquids Most medications used for bronchodilation for respiratory emergencies Inhalation also used for humidification

34 Nebulizer Uses pressurized oxygen to disperse a liquid into a fine aerosol spray or mist Inhalation carries the aerosol to the lungs

35 Enteral Route - Rectally
Medication absorbed through the GI tract Extreme vascularity promotes rapid drug absorption Absorption more predictable Medications administered rectally do not pass through the liver so are not subject to alteration in the liver Advantageous for the unconscious patient

36 Parenteral Route Any drug administration outside of the GI tract
Typically, this route involves the use of needles Medication is injected into the circulation or into tissues Some parenteral forms (ie: IVP) are the most rapid for drug delivery

37 Syringes Plastic or glass tube for drawing up medications
Range of sizes Medications are given in dosages by weight (ie: mg) Syringes represent volume (ie: ml) Weights (ie: mg) must be mathematically converted to volume (ie: ml)

38 Syringe Markings Plunger Barrel Hash marks
Use most appropriate sized syringe for higher accuracy TB Syringe

39 Medications in Ampules
Breakable vessel with liquid medication Cone-shaped top with thin neck Thin neck is the vulnerable point for intentionally breaking open the ampule Contains a single dose of med

40 Withdrawing From an Ampule
Confirm the medication and dosage Hold the ampule upright Tap the top to dislodge trapped liquid Place gauze (or alcohol wipe package) around thin nick Snap top off away from you Place tip of needle into ampule and withdraw liquid Dispose of ampule into sharps container

41 Medications in Vials Plastic or glass containers with self-sealing rubber top Rubber top prevents leakage from punctures May contain single or multiple doses Liquid is vacuum packaged

42 Withdrawing From a Vial
Confirm the medication and dosage Prepare the syringe and needle based on volume of liquid to draw up Use 1 ml TB syringe for any dose < 1 ml Because of the vacuum, draw up the same amount of air as volume to be removed Cleanse rubber top with an alcohol wipe Insert needle straight into rubber top

43 Vial cont’d Inject the air from the syringe into the vial
Withdraw the desired volume of liquid Watch to keep tip of needle in liquid Helpful to draw a small amount of extra fluid to accommodate removing air bubbles Hold syringe with needle pointing upward Tap side of syringe with finger to displace bubbles to distal end of syringe Expel air bubbles and confirm exact volume required in syringe

44 Medications in Prefilled Syringes
Tamperproof containers packaged with medication already in the syringe Generally contain standard dosages May require assembly

45 Prefilled Syringe Confirm the medication and dosage Assemble syringe
Pop off protective caps Twist glass tube containing liquid into syringe Glass tube becomes the plunger Expel excess air Confirm dosage volume required Lidocaine cap is twisted to unlock and then remove the cap

46 Nonconstituted Medications
Extends viability and storage of time for drugs with short shelf life or instability in liquid form Consists of 2 vials Powdered medication Liquid mixing solution

47 Reconstituting Medications
Confirm medication and dosage Prepare syringe with liquid Cleanse off top of powder vial Inject liquid into powder vial Gently roll vial between palms to dilute powder Check that ALL particles have dissolved Redraw up liquid into syringe, expel excess air

48 Medication Administration

49 Medication Administration
Just because you administer medications now, does not mean your technique is accurate The first rule in medicine: Primum non Nocere Hippocrates First, do no harm!

50 Sublingual Medication Route
Use Standard Precautions Confirm medication and dosage 3 times Have patient lift their tongue Place the tablet between the tongue and the floor of the oral cavity Instruct the patient to allow the pill to dissolve

51 In-line Nebulizer Administration Route
For administration of Albuterol when the patient is no longer able to ventilate effectively to inhale the medication into their lungs Can begin to bag the patient and force the medication into the lungs even prior to intubation Set the equipment up and ventilate via a mask while waiting for intubation

52 Endotracheal Administration Route
Discouraged route but not forbidden Studies have failed to demonstrate adequate absorption of medication via this route If used, double the calculated IVP dosage Hyperventilate to distribute the medication Acceptable for: Lidocaine, Epinephrine, Atropine, and Narcan (ie: LEAN)

53 Rectal Medication Confirm medication and dosage 3 times Via syringe
Use a small diameter syringe based on size of patient Lubricate tip of syringe Turn the patient onto their side Insert tip of syringe into rectum Inject medication Remove syringe and hold cheeks together Permits retention and absorption

54 Rectal Administration
Via IV catheter In place of a syringe tip being placed into the rectum, can place an IV catheter on the needleless syringe and then inject the medication Reduces the diameter of the equipment used Helpful alternative especially in the pediatric population

55 Parenteral Medication Routes
Intradermal injection Subcutaneous injection Intramuscular injection Intravenous injection Intraosseous injection

56 Preparing The Syringe Pull medication into the syringe
Tap the side of the barrel to displace air bubbles to the distal tip Express out the excess air bubbles Confirm accuracy of medication dosage Rubber edge of the plunger lines up with the dosage marking on the barrel Then draw up an additional 0.1 ml of air for SQ or IM injections The air plug pushes the med farther into the site preventing leakage of med Additionally, the air plug assures that all medication has been expelled from the syringe and none remains in the needle.

57 Preparing the Site Wipe the intended site with alcohol
Start wiping from the center moving outward Let the site air dry Introducing alcohol into the site causes irritation Do not blow on the site to hasten drying – causes contamination

58 SQ Route Layer of connective tissue between skin and muscle
Less blood supply than IM so slower absorption rate Slow onset of action but long duration of drug action due to less blood supply Maximum volume of medication is 1 ml Preferred needle size is 25 – 27 G; 3/8 - 5/8 inch Preferred is 450 angle (900 angle acceptable if using ½ inch needle) SQ medications are deposited into loose connective tissue just below the dermis. This area is not rich in blood vessels so the absorption rate is slow. There are pain receptors in this area though. Keep dose volume small. Larger volumes in the subcutaneous layer can cause irritation and possibly an abscess.

59 Subcutaneous Medication Routes
Sites Deltoid Abdominal Thighs Buttocks

60 SQ Technique Prepare the syringe and needle Identify the site
Cleanse the site Pinch a fold of skin up Quickly dart the needle into the fold at a 450 angle 900 angle is an alternative especially with ½” needle Release the fold Aspirate checking for blood return Inject steadily Quickly withdraw the needle and discard Massage the site to enhance absorption If injecting Heparin, do not aspirate and do not massage the area.

61 Aspiration Before Injection
Purpose To check for inadvertent entry into a vessel If you did not check you could be giving an IVP drug instead of a SQ or IM More common for vessel entry during an IM If blood is returned, remove needle and prepare a new syringe and needle If you use the same needle and syringe that blood has been drawn into, you may not be able to detect if you have aspirated blood again at the new injection site and injecting blood into the area can be irritating to surrounding tissue.

62 Pediatric SQ Injections
Most common site is posterior upper arm Next site used is the anterior aspect of the thigh Limited volume up to 1 ml of volume SQ Use 450 angle injected into pinched skin Site has limited use in poor perfusion state

63 IM Route Muscle is extremely vascular and allows for systemic delivery throughout the whole body and a moderate absorption rate Absorption is relatively predictable When using the buttock, important to avoid the sciatic nerve If you strike the sciatic nerve, the patient could develop chronic pain Typical needle size is 21 – 23 G; 1 – 11/2” Use 900 angle Volume limitation dependent on the site used In a child, use 1 inch long needle G.

64 Intramuscular Medication Route
Sites Deltoid Buttock Dorsal gluteal Ventrogluteal Thigh Vastus lateralis Rectus femoris

65 IM Sites Deltoid Easily reached
Smaller sized muscle limits volume used 2 ml maximum Site is finger breadths below the acromial process (AC) and above the armpit crease Area often identified as a triangle Acromial process is the bony bump on the shoulder.

66 IM routes cont’d Buttocks – dorsal gluteal Can inject up to 5 ml
Minimal discomfort felt Must stay away from the sciatic nerve Avoid this site in kids < 2 and in emaciated patients Find the site in the upper, outer quadrant of the buttock Must avoid the sciatic nerve In children, avoid the gluteal muscle until approximately 2 years of age and after they have been walking for a time to sufficiently develop this muscle.

67 IM site cont’d - Ventrogluteal
Volume 1 – 3 ml Good site for children <7months Place the palm over the trochanter of the femur Make a V with the 2nd and 3rd fingers The 3rd finger runs straight up to the iliac crest The 2nd finger angles forward to the anterior superior iliac crest The injection is made inside the V formed between the 2nd and 3rd fingers

68 IM routes cont’d Thigh Vastus lateralis – side of the thigh
Rectus femoris – muscle over the front of the thigh Can inject up to 5 ml volume Practice often is to divide larger volumes into 2 injections of smaller volume

69 Thigh Injection Site To find the site
Place one hand at the top of the thigh at the groin Place one hand on the distal (lower) thigh above the knee The area between the 2 hands can be used Anterior surface of the thigh at the midline is the rectus femoris Lateral to the midline is the vastus lateralis

70 Pediatric IM Injection
Thigh is preferred site in peds Especially used in infants and young toddlers Large muscle mass No proximal nerves or blood vessels Limited subcutaneous fat layer More developed muscle than other sites Can accommodate larger volumes than other pediatric injection sites

71 IM Technique Prepare syringe and needle Identify site
Prepare site – let alcohol air dry Pull the skin taut Dart the needle in at 900 The quicker the dart like insertion, the less painful Slowly and steadily inject the medication Quickly withdraw needle and properly discard Massage site – enhances absorption

72 Intravenous Administration Route
Quickest route to deliver medication directly into the bloodstream Fastest absorption rate Dependent on adequate perfusion Many medications are in prefilled syringes Pop off protective caps Assemble syringe Expel air Confirm dosage Administer medication Watch for response

73 IVP Medication Confirm medication 3 times for accuracy Prepare syringe
Consider need for a flush Secure medication syringe into an IV port as close to the IV site as possible Pinch off the IV tubing Inject the medication at the prescribed speed for the medication A flush of normal saline pushes the drug through the tubing and into circulation. The amount of flush is dependent on the medication (ie: Adenosine is 20 ml flush) and the patient ((ie: pediatrics is 5 ml).

74 Needleless IV Tubing Standard IV tubing to minimize the event of needle stick Port wiped with alcohol Needle twisted onto port Must pinch tubing above injection site Fluid will move in direction of least resistance

75 IVPB Administration Route
To administer a medication over a longer period of time All IV bags hanging need to be labeled The bags can be hung at the same height The IV bags will both drip independently of the other IV bag Secure the IVPB into a port as close to the IV site as possible Label IV bag with date, time, medication amount added, initials of person adding medication.

76 Disposal of Contaminated Equipment
As soon as possible dispose of equipment into sharps container After giving an injection, snap the protective cover over the needle After starting the IV, the needle should be covered as it is retracted after the injection

77 Side Effects and Complications
Remember for all injections Once delivered, cannot get the medication back Be very sure of 5 “rights’ Patient Drug Dose Route Time Once administered, monitor for known side effects and any other changes to the patient

78 Documentation of Medication Administration
Time Drug name Drug dosage in mg Route Patient response

79 EZ-IO Indications Shock, arrest, impending arrest
Unconscious/unresponsive to verbal stimuli 2 unsuccessful IV attempts or 90 seconds duration of a peripheral attempt

80 EZ IO Contraindications Fracture of the tibia or femur
Infection at insertion site Previous orthopedic procedure Knee replacement Previous IO within 48 hours Pre-existing medical condition Tumor near site, peripheral vascular disease Inability to locate landmarks Excessive tissue at insertion site For excessive tissue, hold leg up by heel. Often, the excess fat and skin drop to the backside and you may now be able to feel landmarks.

81 EZ IO Needles Adult patients Pediatric patients
88 pounds or over (40 kg) 15 G; 25 mm blue needle Pediatric patients pounds (3 kg – 39 kg) 15 G; 15 mm pink needle Think “pink” for “peds”

82 EZ IO Equipment 10 ml syringe filled with 0.9 NS
5 ml of NS in syringe for peds patient EZ connect tubing Material to cleanse site EZ IO driver EZ IO needle in it’s case Primed IV tubing 1000 ml bag for adults 250 ml IV bag for geriatric and pediatric patients Pressure bag (B/P cuff is no pressure bag)

83 EZ IO drill with storage case
Should carry 2 of each size needle in case of a failed attempt on the first leg.

84 EZ IO Site Most common site: proximal tibia
Palpate the tibial tuberosity Bump below the patella Identify 2-3 finger widths below the patella Move 1 finger width medially (toward the big toe) In smaller children often will not be able to palpate the tibial tuberosity

85 EZ IO - Technique Prime EZ connect tubing Takes 1 ml to prime tubing
Leave syringe attached Attach needle to driver Insert needle at 900 angle into site Release trigger once decreased resistance is felt Remove driver from needle Remove stylet by rotating counterclockwise

86 EZ IO Technique cont’d Connect EZ primed tubing to needle
May notice backflow of bone marrow Blood will NOT pump out of needle Using syringe, aspirate then flush with remaining NS to confirm placement Needle stands up on own Flushes easily No infiltration felt

87 EZ IO Technique cont’d Remove syringe Attach primed IV tubing
Secure pressure bag to permit flow of fluid Begin infusion Secure tubing to leg Apply wristband Monitor site for infiltration Can administer any IVP medication that would normally be given IV push Apply wristband to same side as IO placement. Wristband is used for all failed and successful attempts. In absence of a pressure bag, may manually squeeze IV fluid bag to begin the flow of IV fluids.

88 EZ IO Documentation Same information for starting an IV Time Solution
Size IV bag Site Person actually performing the puncture

89 Case Study #1 Your patient weighs 150 pounds
They need to receive 1.5 mg / kg Lidocaine Lidocaine packaged as 100 mg/5 ml How much Lidocaine needs to be drawn up and given?

90 Case Study #1 Calculate pounds to kilograms
150  2.2 = 68.1 rounded to 68 kg Calculate total mg of medication To receive 1.5 mg per kg Multiply 1.5 x 68 = 102mg Calculate how much medication to deliver Use formula of your choice

91 Case Study #1 Formula #1 X ml = desired dose x vol on hand
dose on hand X ml = 102 mg x 5 ml 100mg X ml = 510 100 X ml = 510  100 X ml = 5.1 ml (in the adult rounded to 5 ml)

92 Case Study #1 Formula #2 100 mg = 102 mg 5 ml x ml 100 x = 510
x =  100 X = ml (rounded to 5 ml)

93 Case Study #2 Your 45 year-old patient is having an allergic reaction with airway involvement The vital signs are stable What medications are indicated? How do you administer each of the medications?

94 Case Study #2 Epinephrine 1:1000 – 0.3 mg SQ
Bronchodilator, vasoconstrictor Short needle (3/8 - 5/8”) 450 angle Pinch up the skin Benadryl 50 mg IVP slowly or IM Antihistamine Long needle (1” up to 1 1/2”) 900 angle Pull the skin taut before injecting

95 Case Study #2 Always aspirate to check for inadvertent entry into a vein If blood is noted, withdraw needle Prepare a new needle and syringe Injecting the blood can cause irritation With blood in the syringe, may not be able to detect aspiration of new blood at new site

96 Case Study #3 You are on the scene of a full arrest
You cannot find peripheral veins What is you next alternative? How do you confirm needle placement?

97 Case Study #3 EZ IO needle is indicated
Confirmation of needle placement Needle stands up by itself Able to flush the needle easily through the EZ connect tubing Fluid flows with a pressure bag attached No infiltration is noted

98 EZ IO Needle Needle always flushed via the EZ connect tubing
NEVER flush the needle directly – too much pressure

99 Case Study #4 You have an 8 month-old infant with a blood sugar of 45
The patient responds weakly to verbal stimuli What medication is necessary? How do you prepare the medication? How do you administer the medication?

100 Case Study #4 - Hypoglycemia
Ages > 16 – Dextrose 50% Ages 1 – 15 – Dextrose 25% Age < 1 years-old - Dextrose 12.5% Diluted strength due to vein irritation Calculate the dosage Draw up equal amounts normal saline and D25% to make a 1:1 dilution Administer slowly due to vein irritation

101 Case Study #4 Dextrose is given IVP
Wipe off the injection port with alcohol Push on the needleless syringe and twist to connect Pinch off the tubing above the injection port Slowly and steadily administer the medication Evaluate the site for infiltration Evaluate the patient’s response

102 Case Study #5 You are on the scene for a 5 year old having a seizure
Patient weighs 50 pounds History of seizure disorder Glucose level of 80 You are unable to establish a peripheral IV What do you do for the airway? What medication is indicated? How do you administer the medication?

103 Case Study #5 Airway control – bag the patient Medication and route
In active seizure, the respiratory status of the patient is difficult to evaluate and assume the patient is not ventilating well Medication and route Valium 0.5 mg/kg (max 10 mg) rectally

104 Case Study #5 Calculate dose 50 pounds  2.2 = 22.7 = 23 kg
Multiple 0.5 mg x 23 kg = 11.5 mg = 12 mg Max dose is 10 mg Valium comes 10 mg per 2 ml Make sure syringe is needleless Insert syringe into buttocks Inject medication and remove syringe Hold cheeks together

105 Pediatric Resources What resources are available to calculate a pediatric dosage? Back of the SOP’s Medical Control Broselow tape Valium listed as diazepam Narcan listed as Naloxone Normal saline listed as crystalloid

106 Bibliography Bledsoe, B., Clayden, D., Papa, F. Prehospital Emergency Pharmacology 5th Edition. Brady Bledsoe, B., Porter, R., Cherry, R., Paramedic Care: Principles and Practices. Brady. 2009 Edmunds, M. Introduction to clinical Pharmacology. Elsevier Marenson, D. Pediatric Prehospital Care. Brady Region X SOP’s March 2007, Amended January 1, 2008 Sanders, M. Paramedic Textbook. Rev 3rd edition. Mosby. 2007

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